Utilization Management Accreditation Benefits & Support

How does my organization benefit from accreditation?

NCQA Utilization Management Accreditation provides a framework for implementing industry best practices to help organizations:

• Conduct fair and timely utilization management decisions using objective, evidence-based criteria: 
  • Collect and use relevant clinical information.
  • Use qualified health professionals to make decisions.
• Align with state requirements.
• Demonstrate their program’s quality to employers, regulatory agencies and health plans.

Where can we find resources?

Find more information about NCQA Utilization Management Accreditation here:

• Standards and Guidelines: The complete descriptions of the standards, including the intent statement and scope of review.
• Interactive Review Tool: Includes the complete standards and guidelines; also lets organizations determine survey readiness. Learn more about the IRT and view online trainings.

Additional support

• The Policy Clarification Support (PCS) system, My NCQA and FAQs can help you interpret NCQA standards.
• Policy Updates: Lists corrections, clarifications and policy changes to NCQA Standards and Guidelines.
• Education and Training: NCQA offers a variety of training options, from on-demand, web-based programs to live, in-person seminars.
• Seals: Print-friendly graphics for use in promoting NCQA status.