FAQ Directory: Health Plan Accreditation

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8.15.2020 CR 7: Organizational Providers NCQA added language to CR 7 in the 2020 Health Plan Accreditation standards to clarify that Element A applies to all organizational providers (e.g., telemedicine providers, urgent care centers). What does NCQA mean by “all organizational providers”?

NCQA added the word “all” to CR 7 in the 2020 HPA standards and guidelines because it expects organizations to have policies for assessing all providers with which they contract. However, under the 2020 standards and in previous years, NCQA only scores policies for providers listed in CR 7, Elements B and C.
Because the definition may not be sufficient to clearly identify which organizations NCQA considers “providers,” here is a list of provider types in addition to those listed in Elements B and C:

  • Telemedicine providers.
  • Urgent care centers.
  • Hospice.
  • Clinical labs.
  • Comprehensive outpatient rehabilitation facilities.
  • Outpatient physical therapy.
  • Speech pathology providers.
  • End-stage renal disease services.
  • Outpatient diabetes self-management training.
  • Portable x-ray suppliers.
  • Rural health clinics.
  • Federally qualified health centers.

HP 2020