Sort By
FAQ 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…
FAQ 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…
FAQ 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.
FAQ 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…
FAQ 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,…
FAQ 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…
FAQ How many files are reviewed in a UM-CR-PN Survey for Accredited MBHOs?
ncqa.org/programs/health-plans/managed-behavioral-healthcare-organizations-mbho/faqs/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…
FAQ 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…
FAQ Have the allowed methods to audit delegate files in UM 12, Element C, factor 5 changed?
ncqa.org/programs/health-plans/managed-behavioral-healthcare-organizations-mbho/faqs/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…
FAQ Have the allowed methods to audit delegate files in UM 13, Element C, factor 5 changed?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000018992No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below: 5 percent or 50…
FAQ 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…
FAQ What is the corrective action process for organizations that do not meet a must-pass element?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000016184A Corrective Action Plan (CAP) is required when an organization does not meet the minimum threshold for one or more must-pass elements. The CAP must…