Health Plan Accreditation 2024: Credentialing (CR)

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About this Self-paced Training

Explaining Health Plan Accreditation 2024: Credentialing (CR)

NCQA Health Plan Accreditation (HPA) is the only program in the industry that bases results on clinical performance and consumer experience (HEDIS® and CAHPS®).
This live, multi-day course leads learners through a deep dive into the HPA standards for Credentialing (CR). Through this course, presenters will provide you with insight to interpret the requirements, navigate the standards, and avoid misconceptions. In addition to answering live questions, the presenters address scenarios and examples based on performance improvement opportunities from prior NCQA surveys.

Please note: This course presents information based on Health Plan Accreditation 2024 standard requirements that are released in July 2023. The scope of this course applies directly to NCQA Accreditation Surveys conducted between July 1, 2024 and June 30, 2025.

Group Training?

To inquire about group training rates, complete our online form.

Key Topics 

• System Controls for Credentialing.
• Credentialing Committee and Oversight.
• Verification of Credentials.
• Ongoing Monitoring and Interventions.
• Assessment of Organizational Providers Benefits.

Course Resources

• Presentation slides.
• Recording of live session.
• Live Q&A.
• Scenarios for applied learning.
• NCQA surveyor’s perspective of the standards.
• IPCE Credits for physicians, nurses and pharmacists.

What You Will Learn

At the conclusion of this course, learners will be able to:

• Interpret the intent of Health Plan Accreditation requirements for CR Standards.
• Describe relationships and themes across CR Standards.
• Recognize requirement implications and considerations for stakeholders.
• Define performance improvement opportunities.

By achieving these learning objectives, participants may experience the following operational efficacies as three to nine month post-participation outcomes:

• Increased productivity in prioritizing and planning interventions.
• Improved practices in monitoring issues and risks.
• Enhanced coordination in cross-functional efforts.
• Refined tactics in monitoring performance.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates and vendors who are employed or contracted by health plans with responsibilities pertaining to the scope of work listed below:

• Case Management.
• Compliance or Risk Management.
• Population Health Management of Public Health.
• Quality Assurance/Improvement or Performance Management.
• Contracts Management.
• Health Information Systems.
• Health Care Professionals
• Health Care Decision Makers
• Consultants
• Health Plans
• Health Systems
• Population Health Organizations

Faculty

Irv Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Veronica Locke, MHSA

Veronica Locke, MHSA is a process consultant with the Health Care Service Corporation (HCSC) in Dallas, Texas. Prior to joining HCSC, Veronica was a consultant for The Mihalik Group, providing healthcare-related consulting services.  Her areas of expertise include quality assessment and improvement; credentialing; delegation; disease management accreditation/certification; population health management; multicultural health care. 

Veronica is the former Senior Manager of Accreditation Policy for the National Committee for Quality Assurance. She was actively involved in the development and maintenance of the standards and guidelines of NCQA’s Accreditation and Certification programs, specifically Health Plan, Disease Management and Multicultural Health Care Distinction programs. As a member of the Policy team, one of her major responsibilities was to serve as a content champion when providing policy clarifications and trainings internally and externally. 
She received her Bachelor of Science Degree in Public Health from the University of Maryland, College Park and her Master of Health Systems Administration Degree from Georgetown University in Washington, DC.

Continuing Education

In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team. 

This activity was planned by and for the healthcare team, and learners will receive 3.0 Interprofessional Continuing Education (IPCE) credit for learning and change. 

This educational activity is approved for: 3.0 AMA PRA Category 1 Credit^TM, ANA CNE and ACPE.

The assigned universal program number: JA0004597-0000-23-034-H04-P. Upon successful completion of this program (attending the full session and completing a program evaluation), participants will access CPE Monitor on the ACPE website to locate and track their CPE statement of credit.

This live course grants 2.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

NABP Credit Reporting 

If you are a pharmacist completing a course offering CPE credits, please notify NCQA through ncqa.org within 14 calendar days that you have completed a CPE course. You must provide the title of the course, your NABP identification number and your DOB (month/date) within the notification to NCQA. We also recommend you update your education.ncqa.org profile with your NABP identification number.  

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:
Irv Koehler: None
Veronica Locke: None 

Additional Planning Committee Members:
Irv Koehler: None
Veronica Locke: None 
Felicia Khaalid: None 

This program was developed in part by NCQA staff.

Event Type

1. Self Paced