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Where can I find information to help me get started with the LTSS Distinction?
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000012333Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.Standards and Guidelines: The complete standards and guidelines, including the intent and scope…
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When will the 2017 CM standards be effective and when will the 2014 CM standards year end?
ncqa.org/programs/health-plans/case-management-cm/faqs/all/?faq=000008324The 2017 CM standards are effective on or after January 30, 2017. For organizations that have already scheduled a survey through June 30, the 2014…
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Is automatic credit available for Interim Surveys for organizations that delegate UM 13 (UM 12 in HP 2017), Triage and Referral for Behavioral Healthcare, Elements A and B to an NCQA-Accredited/Certif
ncqa.org/programs/health-plans/long-term-services-and-supports/ltss-distinction-for-health-plans/all/?faq=000008271Yes. Automatic credit is available for an Interim Survey if the organization delegates to an NCQA-Accredited/Certified health plan, MBHO or UM-CR. The delegate’s Accreditation/Certification Survey…
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May health plans receive automatic credit for the new UM pharmacy elements if they delegate to organizations accredited or certified under standards years prior to 2016?
ncqa.org/programs/health-plans/utilization-management/faqs/um-cr-pn/?faq=000006274Organizations seeking accreditation or certification in UM under the 2016 standards may receive automatic credit for updating delegation agreements prior to survey tool submission, to…
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What documentation must an NCQA-Certified CVO provide to an organization for an accreditation survey file review?
ncqa.org/programs/health-plans/credentials-verification-organization-cvo/faqs/all/?faq=000005323The organization and the CVO determine the documentation methods for reporting information. Acceptable methods include a checklist, the actual documents and access to electronic credentialing…
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How and when must the organization notify NCQA of Reportable Events?
ncqa.org/programs/health-plans/case-management-cm/faqs/all/?faq=000004820The organization must notify NCQA, in writing, within thirty (30) calendar days of the issuance of the notice of sanctions, issuance of a fine or…
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Are health plans required to report regulatory actions taken against the organization?
ncqa.org/programs/health-plans/case-management-cm/faqs/all/?faq=000004818Yes. The Agreement for Health Plan Accreditation Survey (the “Agreement”), specified in the “Organization’s obligations” section of the standards and guidelines, requires the organization to…
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When are ER denial files included in the universe of files for file review during an Accreditation or Certification Survey?
ncqa.org/programs/health-plans/utilization-management/faqs/um-cr-pn/?faq=000002700Generally, ER denials are not included in the universe of files for initial UM decisions unless a denial is appealed. In that case, the ER…
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What organizations are eligible to pursue Case Management Accreditation?
ncqa.org/programs/health-plans/case-management-cm/faqs/all/?faq=000002819NCQA considers entities that perform relevant functions to be eligible for NCQA CM Accreditation, including, but not limited to: CM organizations, population health management organizations,…
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What is the process for reporting performance measure results for Accredited With Performance Reporting (AWPR) status?
ncqa.org/programs/health-plans/wellness-and-health-promotion-whp/faqs/faq-directory-wellness-and-health-promotion/?faq=000002849Organizations are responsible for reporting NCQA WHP performance measure results exactly as specified if they are seeking AWPR status. Organizations must submit performance measure results…
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When must organizations submit NCQA WHP Performance Measures in order to obtain Accredited With Performance Reporting (AWPR) status?
ncqa.org/programs/health-plans/wellness-and-health-promotion-whp/faqs/faq-directory-wellness-and-health-promotion/?faq=000002767Organizations coming through the WHP accreditation process for the first time and that wants to earn AWPR status must submit audited measures with the ISS…
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2026 WHP Standards and Guidelines (epub)
store.ncqa.org/index.php/catalog/product/view/id/58682026 STANDARDS AND GUIDELINES FOR ACCREDITATION AND CERTIFICATION IN WELLNESS & HEALTH PROMOTION
This publication outlines the standards and features explanations and examples of how to meet the stan...