Summer Changes to Accred, Cert Programs Will Spread
June 27, 2023 · Andy Reynolds
Two process improvements this summer to NCQA Accreditation and Certification programs affecting more than 1,700 customers are a preview of changes coming to other NCQA programs and almost 600 more customers in the next few years.
The upgrades debuting this summer are to:
- File Review System: How NCQA manages accreditation and eCertification file review.
- Delegation: How organizations document the work they assign to their partners or contractors.
| Changes to the File Review System (FRS) | ||||
| Health Plan Accreditation | Utilization Management Credentialing Provider Network Accreditation | Case Management – Long-Term Services and Support Accreditation | ||
| WHAT we’re launching | Online system to manage the file review process for NCQA Accreditation and Certification surveys. | |||
| Effective July 1, 2022 | Effective July 1, 2023 | |||
| WHY we’re doing this | To automate how we collect file data, file selections, record file findings and conduct self-assessments for file monitoring and mock audits. | |||
| HOW this helps customers | More efficient than the previous, manual method using Excel workbooks | |||
| WHEN file info is due | The file universe is still due on date of survey submission, but can now be uploaded to the new File Review System. Final file selections are still released via the system 10 business days before onsite review. On the date of the scheduled onsite, the NCQA surveyor uses the system to record file scores. | |||
| WHERE to get tools to help you | See the resources in your purchased IRT license. | |||
| WHERE to read background | In our blog: “One-Stop Shop” Eases Accreditation’s Logistical Load | |||
| WHO this affects | 1,167 customers/customer products | 280 customers/customer products | 103 customers/customer products | |
We plan to apply these changes in the next 1-2 years to other NCQA programs that use file review:
- Case Management Accreditation (73 customers or their products, as of June 2023)
- Credentials Verification Organization Certification (113).
- Managed Behavioral Health Organization Accreditation (34).
- Population Health Program Accreditation (35).
- Wellness and Health Promotion Accreditation/Certification (42).
| Changes to Delegation Process | ||||
| Health Plan Accreditation | Health Equity Accreditation | Utilization Management Credentialing Provider Network Accreditation | Case Management – Long-Term Services and Support Accreditation | |
| WHAT we’re launching | New or enhanced delegation system for surveys whose delegation information is due… | |||
| Enhancements effective July 31, 2023 | Under Standards Year 2023+ (July 1, 2023) | Effective July 31, 2023 *Subject to change | Effective July 31, 2023 | |
| WHY we’re doing this | To enhance the system launched 2022. | To automate the process for reporting and processing delegation data. | ||
| HOW this helps customers | Simplifies submission and selection of delegate information. | |||
| WHEN delegation info is due | 6 weeks before survey submission. | |||
| WHERE to get tools to help you | See resources in your purchased IRT license. | |||
| WHERE to read background | December 2022 email to customer | NA | ||
| WHO this affects | 1,167 customers/customer products | 194 customers/customer products | 280 customers/customer products | 103 customers/customer products |
- Delegate selections (if required) are provided to organizations 4 weeks before submission. Selected delegates will be indicated in the delegation module and will also be populated into applicable delegation oversight elements in the core IRT survey tool.
- Delegation information may be entered directly into the module or submitted in an updated worksheet, available in the Organization Background section of the IRT.
- The new delegation module was designed to be user-friendly. We welcome your feedback to make sure we are meeting that goal. If you have recommendations for other improvements, please contact us through your MyNCQA account.
