FAQ Directory: Health Plan Accreditation

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8.24.2018 How do I get started with Health Plan Accreditation?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

HP 2020

8.24.2018 Where can I find the Health Plan Accreditation Standards and Guidelines?

8.24.2018 Where can I find the LTSS Distinction Standards and Guidelines?

8.24.2018 What organizations are eligible for Health Plan Accreditation?

Any organization that provides managed health care services may apply for the NCQA Health Plan Accreditation if it meets the following criteria:

  • Operates under an insurance license (e.g., HMO, POS, PPO, EPO), and
  • Issues a contract for insurance for a defined population or contracts with an employer to provide managed care services for a self-insured population, and
  • Provides services through an organized delivery system that includes ambulatory and inpatient health care sites, and
  • Performs functions addressed in the standards (quality improvement, care coordination, utilization management, credentialing, member rights and responsibilities), either directly or through a service agreement, and
  • Has a process for monitoring, evaluating and improving the quality and safety of care provided to its members, and
  • Reports audited HEDIS results for designated HEDIS measures and CAHPS ratings and composites, as required for the selected Evaluation Option.

HP 2020

8.24.2018 What is the price for the LTSS Distinction for Health Plans?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

HP 2020

8.24.2018 What is the price for Health Plan Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

HP 2020

8.24.2018 How long does it take to earn LTSS Distinction for Health Plans?

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

HP 2020

8.24.2018 How do I get started with the Medicaid Module?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

HP 2020

8.24.2018 What other health plans have earned LTSS Distinction?

8.24.2018 What is the process for meeting Module requirements?

The first step is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and provides results within 30 days of the final review.

See a step-by-step process.

HP 2020

8.24.2018 What is Health Plan Accreditation?

NCQA Health Plan Accreditation is the most widely recognized, evidence-based program in the industry dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers. It’s the only evaluation program that bases results on actual measurement of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).

HP 2020

8.24.2018 What are Health Plan Accreditation requirements?

NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards help plans in:

  • Quality Management and Improvement.
  • Population Health Management.
  • Network Management.
  • Utilization Management.
  • Credentialing and Recredentialing.
  • Members’ Rights and Responsibilities.
  • Member Connections.
  • Medicaid Benefits and Services.

HP 2020