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Health Plan Accreditation

NCQA's Health Plan Accreditation is built on more than two decades of experience. Our commitment to comprehensive research and dedication to quality has helped improve the managed care experience for health plans, patients, physicians and employers. Recognizing hundreds of plans that cover more than 136 million people (43 percent of the U.S. population), NCQA is the most widely-recognized accreditation program in the United States. Our experience and prominence have allowed us to build flexible, yet rigorous standards that apply to all types of health plans, including HMOs, PPOs, EPOs and POS plans.

NCQA Accreditation is the most comprehensive evaluation in the industry, and the only assessment that bases results of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures). High-performing health plans choose NCQA Accreditation because it satisfies many stakeholders:

Meets Employer Demands. Many employers – especially the fortune 500 – do business only with NCQA-Accredited plans. They and other purchasers want to maximize the value of their health care spending. The National Business Group on Health’s widely used eValue8 tool captures NCQA Accreditation status and HEDIS/CAHPs scores as an important indicator of a plan’s ability to improve health, and health care.  

Meets Regulator Demands. NCQA Accreditation contains all key elements that federal law and regulations require for State Health Insurance Marketplace plans. Forty-two states recognize NCQA Accreditation as meeting their requirements for Medicaid commercial plans; more than a dozen states mandate it for Medicaid. Also, the Federal Employees Health Benefits Program accepts NCQA Accreditation. 

Meets Consumer Demands. Consumers comparison-shop and want to know an insurer’s quality when they select a plan. This trend still grows as consumers become more responsible for managing their health care. Research by NCQA and Consumer Reports shows consumers value accreditation, especially when they know the depth and breadth of NCQA Accreditation.

Health Plan (HP) Accreditation for Plans Participating In Health Insurance Exchange Marketplace

HPA 2013 streamlines the accreditation process by reducing administrative burdens for new and currently accredited health plans. Revised standards and point allocations create three accreditation evaluation options and comprise a “glide path”—flexible opportunities for reaching accreditation, regardless of a plan’s longevity or experience with quality reporting.

  • Interim Survey is for plans that need accreditation before or right after they open for business. It focuses on policies and procedures, does not include HEDIS/CAHPS reporting and is valid for 18 months – half as long as the other options.
  • First Survey is for plans new to NCQA, and leads to accreditation that is valid for 3 years. HEDIS/CAHPS reporting is required only in year 3 of accreditation. This helps prepare health plans for Renewal requirements.
  • Renewal Survey is available to NCQA-Accredited plans seeking to extend their accreditation another 3 years. HEDIS/CAHPS reporting is mandatory and plans are scored based on their performance results

Marketplace Accreditation Updates

NCQA understands the importance of aligning the Centers of Medicare and Medicaid (CMS) Marketplace requirements and NCQA Accreditation requirements. With regard both to requirements for reporting enrollee survey results and HEDIS measure results, NCQA plans to accept results that follow CMS reporting requirements. 

 

Frequently Asked Questions

Frequently Asked Questions (FAQ)
NCQA is currently in the process of enhancing our FAQ site. To make the transition seamless for our customers, we are keeping the old FAQ site active while we continue to work on our new page.

Program Support

Policy Clarification Support
Submit Questions related to NCQA standards (policies and procedures).

New Online Application Process

A new application and scheduling process begins May 15 for Accreditation programs.


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HPA Brochure

Click here to download the brochure.