The Utilization Management 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.
Not currently accredited? Contact us today and an NCQA program expert will be in touch. NCQA-Accredited organizations should submit a request through My NCQA.
Purchase the Standards & Survey Tool
Purchase to develop a better understanding of the evaluation areas and requirements.Expand
Purchase 9–11 months from your desired survey start date.
- Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
- Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.
Perform Gap Analysis
Approximately 9–11 months from your desired survey start date, perform a gap analysis.Expand
The analysis compares the standards to your organization’s current processes.
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 Pre-Application Form
To initiate the application process, contact your program expert to request a pre-application form.Expand
- Reviews the pre-application 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.
See the Online Application User’s Guide and FAQs for information about the application process.
Align With NCQA Requirements
Approximately 9 months before the start date, align your organization with the 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 start date, an Accreditation Services Coordinator will contact you to review the 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 Utilization Management Accreditation program, an onsite file review is scheduled approximately 7 weeks after the survey submission.
Your 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.
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