FAQ Directory: Health Plan Accreditation

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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