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Are NCQA-Accredited/Certified delegates required to provide semiannual reporting to organizations, and are organizations required to evaluate semiannual reports from NCQA-Accredited/Certified delegate
ncqa.org/programs/health-plans/long-term-services-and-supports/case-management-accreditation-for-ltss-only-health-plans/faqs/all/?faq=000025497No. Effective immediately for delegation oversight standards, organizations receive automatic credit for the delegation agreement semiannual reporting requirement in Element A, and for the delegation…
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How does NCQA define “threshold languages” for CM-LTSS Accreditation and LTSS Distinction in Health Plan Accreditation?
ncqa.org/programs/health-plans/long-term-services-and-supports/case-management-accreditation-for-ltss-only-health-plans/faqs/all/?faq=000025159NCQA defines threshold languages as “all languages other than English spoken by 5% of the population or by 1,000 eligible individuals, whichever is less.” Applicable…
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Has NCQA been in communication with CAQH about including the new NCQA requirements for race, ethnicity and language on its application?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000025073Yes. NCQA has worked with CAQH to add a notice to its practitioner- and customer-facing provider credentialing applications, recognizing that discriminatory uses of race, ethnicity…
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Under the verification time limits, NCQA added a note that states the new verification time limits apply to files processed by the organization or its delegate(s) on or after July 1, 2025. Files proce
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000024608For Health Plan, MBHO and Credentialing Accreditation, “processed” refers to the credentialing decision date. For Credentialing Certification, “processed” refers to the date when credentialing verifications…
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CMS intends to dissolve Medicare-Medicaid Plan (MMP) contracts in 2026. Will that change product line rules for Accreditation?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000024609No. Plans that are responsible for both the Medicare and Medicaid components for dual-eligible members may select Medicare, Medicaid, or both, for Accreditation purposes.
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How many measures must an organization include in an improvement plan for QI 3, Elements C and D?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000024379For Health Plan Accreditation 2025, the organization is only required to take action on one measure for Health Plan Ratings for which it received a…
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NCQA posted a memo with changes to the NCQA Accreditation Standards for the 2024 and 2025 Standards Years indicating that organizations are no longer required to describe their process for system cont
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000024222No. Organizations are still required to monitor for system controls. The NA for the system controls policies and procedures requirement (e.g., UM 12, Element A,…
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How many files are reviewed in a UM-CR-PN Survey for Accredited Health Plans?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000020681For UM Accreditation, 75 files are reviewed per product line. For CR Accreditation, 75 initial credentialing files and 75 recredentialing files are reviewed. Note: For…
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How many files are reviewed in a UM-CR-PN Survey for Accredited MBHOs?
ncqa.org/programs/health-plans/behavioral-health-accreditation/faq/all/?faq=000020683For UM Accreditation, 75 files are reviewed per product line. For CR Accreditation, 75 initial credentialing files and 75 recredentialing files are reviewed. Note: For…
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Have the allowed methods to audit delegate files in CVO 15, Element C, factor 5 changed?
ncqa.org/programs/health-plans/credentials-verification-organization-cvo/faqs/all/?faq=000019909No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
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Have the allowed methods to audit delegate files in CR 8, Element C, factor 5 changed?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000018994No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
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Have the allowed methods to audit delegate files in UM 12, Element C, factor 5 changed?
ncqa.org/programs/health-plans/behavioral-health-accreditation/faq/all/?faq=000018993No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…