FAQ Directory

NCQA Utilization Management Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope utilization management services, which include using evidence-based criteria, relevant clinical information and qualified health professionals to make utilization management decisions.

UM-CR 2013

Over 1,000 health plan products have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

HP 2020

NCQA Provider Network Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the accessibility and transparency of organization networks and credentialing of practitioners and providers. NCQA-Accredited organizations demonstrate they have the internal processes and procedures to effectively manage access to care and member experience while ensuring that practitioners and providers are appropriately credentialed.

UM-CR-PN 2019

Any organization that provides wellness and health promotion services can apply for accreditation/certification if it:

• Provides wellness services, either directly or through a service agreement, and
• Provides wellness services for at least three months before survey submission, and 
• Has a process for monitoring, evaluating and improving the quality and safety of services provided to eligible participants.

WHP 2013

More than 30 organizations have earned NCQA Health Plan Accreditation. See the NCQA Report Card for a directory of accredited organizations.

MBHO 2019

Find the Standards and Guidelines document in the NCQA eStore.

HP 2020

The typical evaluation time frame is 12 months from application submission to decision, depending on an organization’s readiness. Some organizations may already be working within NCQA guidelines.

MBHO 2019

Organizations that have earned NCQA LTSS Distinction can be found in the NCQA Report Card.

CM 2017

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

MBHO 2019

CVO Certification assesses an organization’s performance in the following requirement areas:

• Internal Quality Improvement Process
• Protecting Credentialing Information
• Verifying credentials.

NCQA’s CVO Certification program offers the following 11 certification options:

CVO 2016

Pricing is based on multiple factors. Full pricing information can be obtained by submitting a request through My NCQA.

WHP 2013

Find the Standards and Guidelines document in the NCQA eStore.

HP 2020