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Certification in UM/CR

NCQA’s Certification in UM/CR program is available to a variety of organizations that perform Credentialing (CR) and/or Utilization Management (UM).  The standards represent a merger of the POC (Physician Organization Certification) and OC (Organization Certification) products into a single set of standards designed for organizations that provide full scope CR or UM services or both. NCQA Certification provides these organizations the opportunity to demonstrate the quality of their UM and CR programs.

NCQA‘s certification review includes a rigorous on- and off-site evaluation conducted by a team of physicians and managed care experts. A review oversight committee of physicians analyzes the team's findings and assigns a certification status based on the organization’s performance against standards within applicable certification options. 
 


Questions?

For more information, please e-mail pcmh-grip@ncqa.org or call (888) 275-7585, M-F, 8:30 a.m. - 5:00 p.m. ET.

New Online Application Process

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


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NCQA Survey Systems

Prepare for your survey (ISS)
Login to ISS to prepare for and submit your Survey Tool for survey. 

Review a submitted survey (IRT)
Login to ISS to prepare for and submit your Survey Tool for survey. 

More information on IRT
Learn more about NCQA’s Interactive Review Tool, including training information.

NCQA Policy Support

Policy Updates

Corrections, clarifications and policy changes to our stated Standards and Guidelines 

FAQs
New FAQs are posted on the 15th of every month and provide answers to our most commonly asked questions. 

Policy Clarification Support (PCS)
If you cannot find an answer to your question in our FAQs or Policy Updates, submit your inquiry here

UM/CR Report Card

View the Utilization Management/Credentialing Certification Report Card.

 

View Report Card

HEDIS Users Group (HUG)
HUG membership packages offer you access to the most up-to-date information on HEDIS specifications so you can begin planning for the future.

HEDIS and ICD-10
To accommodate the switch from ICD-9-CM to ICD-10, NCQA created a plan to identify a valid and appropriate set of ICD-10 codes for each HEDIS measure.

Interactive Review Tool (IRT)
Learn more about the IRT Web-based Survey Platform.