Provider Network Accreditation
The PN Accreditation program is effective on July 1, 2018.
NCQA created PN Accreditation in response to the emergence of contracts requiring management of practitioner and provider networks.
PN Accreditation is available to organizations that perform credentialing and network management activities. The standards, designed for organizations that provide full scope credentialing and network management services, provide a framework for implementation of industry best practices to ensure:
- Accessibility and transparency of organization networks
- Consistent monitoring of practitioner availability and accessibility of services
- Efficient collection and analysis of member experience data
- Appropriate credentialing of practitioners and providers
- Alignment with state requirements
NCQA Accreditation demonstrates the quality of organizations that provide credentialing and network management services to employers, regulatory agencies, health plans and MBHOs.
The Accreditation Survey includes a rigorous evaluation conducted by a team of physicians and managed care experts. An independent review oversight committee of physicians analyzes the team’s findings and assigns an accreditation status based on the organization’s performance against standards.
Note: Organizations that meet the PN Accreditation requirements automatically earn CR Accreditation.
To be eligible for PN Accreditation, organizations:
- Must not be licensed as an HMO, POS, PPO or EPO
- Must not be eligible for NCQA Accreditation as a health plan or an MBHO
- Must perform PN functions directly or through contractual agreement
- Must perform PN activities for at least 50% of the provider network
Note: “Provider network” refers to the network of institutions and practitioners of clients and organizations
Accreditation Statuses an Organization Can Achieve
Organizations can earn the following NCQA Accreditation status levels based on their performance against NCQA’s Standards and Guidelines.
- Accredited - 3 years: NCQA awards a status of Accredited – 3 years to organizations that demonstrate strong performance of the functions outlined in the PN standards.
- Accredited - 2 years: NCQA awards a status of Accredited – 2 years to organizations that demonstrate performance of the functions outlined in the PN standards.
- Denied: NCQA awards a status of Denied Accreditation to organizations that do not meet NCQA requirements.
In-Depth Program Information