Health Plan Accreditation Process
This process helps organizations plan and execute activities to ensure they are ready for NCQA evaluation. The typical evaluation time frame is 12 months from application submission to decision, depending on the organization’s readiness. Some organizations may already be working within NCQA guidelines.
Schedule a consultative call with a program expert at least 12 months before your desired survey start date.Expand
Our program expert will:
- Discuss eligibility criteria.
- Review evaluation areas.
- Identify program benefits.
- Review the application process.
Purchase the Standards & Survey Tool
Develop a better understanding of the evaluation areas and requirements. Purchase 9–11 months from your desired survey start date.Expand
Perform a Gap Analysis
Approximately 9–11 months from your desired survey start date, perform a gap analysis by comparing the standards to your organization’s current processes.Expand
The survey tool has a readiness assessment that can help you do this.
Identify where you need to make changes, develop a project plan and begin implementing improvements. Many standards require a 6-month look-back period, so you must meet the standards at least 6 months before your survey date.
Submit the Prequalification Form
To initiate the application process, contact your program expert to request a prequalification form. NCQA:Expand
- Reviews the prequalification form to determine readiness and eligibility.
- Sends you an online application link (typically within 1–2 business days after receiving the form).
Submit the Online Application
Once qualified, submit the online application and select the desired survey start date.Expand
You should submit the application approximately 9 months before your desired survey start date.
NCQA will contact you to finalize the survey start date and process the application.
Align With NCQA Requirements
Approximately 9 months before the survey start date, work to align your organization with the program standards. You should be fully aligned with the requirements 6 months before your survey start date.
Submit the Survey Tool
Approximately 3 months before the survey start date, an Accreditation Services Coordinator will contact you to review the survey submission process and answer questions.Expand
Complete and submit the survey tool on the assigned survey start date—this is the official start of the survey process.
If required by the Health Plan Accreditation program, an onsite file review is scheduled approximately 7 weeks after the survey submission.
Earn Health Plan Accreditation
Your accreditation status is determined within 30 days of the onsite file review or 90 days after survey submission.Expand
Your organization will receive a preliminary report. You have 2 weeks to review it and provide comments and additional documentation.
The entire document, including feedback and onsite file review results, is sent to the Review Oversight Committee, which considers all information to determine your final score.