FAQ Directory

Yes. As long as the organization will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines.

Base fee is $15,000 if an organization qualifies for automatic accreditation and $22,500 if an organization must go through a review. However, this includes the already submitted application submission fee. Actual additional amount required prior to NCQA awarding automatic accreditation is $5,000 or prior to the survey date if a review is required is $12,500. NCQA will bill organizations for the remainder of the fees due prior to awarding automatic accreditation or conducting the survey.

Application submission fee is $10,000. Organizations should use the Invoice and Payment Information Form included in the application packet to generate their own invoice for the application fee.

The Exchange Add-on Survey is a streamlined accreditation approach available for organizations that currently have NCQA Health Plan Accreditation for any product line (commercial, Medicaid or Medicare) and wants to add its Exchange product line to its existing Accreditation.

Plans coming through the Exchange Add-on Survey are capped at Accredited status because HEDIS/CAHPS is not included.

No. By "in print," NCQA means a printed copy of a document that is made available (e.g., by mail) to eligible individuals who may not have access to the Internet.

The Exchange Add-on accreditation status is valid until your existing NCQA accredited product expires. Once this occurs, you must bring your Exchange product through the Renewal Evaluation Option which would include submission of HEDIS and CAHPS results starting in 2015.

1. Allows you to market your Exchange product as NCQA Accredited to Exchanges and potential members.

2. Allows you to meets Exchange accreditation requirements, for those Exchanges that require Exchange _specific Accreditation.

3. Its a streamlined and efficient process, where plans need to attest that they will operate their Exchange the same as their accredited product. Unless there are many differences, NCQA will not review further documentation.

The application will be available by the end of September 2012 and can be submitted anytime; however, NCQA will not begin Exchange Add-on surveys until after January 1, 2013. Note that applications will only be accepted through December 31, 2013, as the Exchange Add-on Survey is a temporary strategy to help plans receive accreditation to qualify for Exchanges.

The Exchange Add-on Survey evaluates plans on a subset of standards and elements listed in Section 7 of the NCQA HPA Exchange Add-on Survey Application. For an organization that will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines, NCQA will award Accreditation to the Exchange product line without conducting a formal survey. An organization qualifies for automatic Accreditation if it attests that it will administer 70% or more of the elements listed in Section 7 in the same manner.

Once you submit your application, NCQA will determine if your organization is eligible for automatic accreditation. If you apply before February 1, 2013 and NCQA determines your organization is eligible for automatic accreditation then NCQA will award the accreditation status in the first quarter of 2013. If you apply after February 1, 2013 and NCQA determines your organization is not eligible for automatic accreditation then NCQA will award the accreditation status about two months after you apply.

If upon review of your application, NCQA determines that your organization is eligible for automatic accreditation, NCQA staff will contact you to schedule a date to start your Exchange Add-on survey and issue an ISS tool to you to complete and submit on the start date. If your organization achieves accreditation then the status will be awarded about three months after the start of the survey.

Note that NCQA posts accreditation status updates on its Web site once a month on the 15th of each month for statuses effective as of the end of the previous month.

The Exchanges Add-on Survey accreditation status is valid until your existing accredited products accreditation status expires.

For example:

You have Commercial HMO accreditation, which expires in January 2015.

You bring in your Exchange HMO for accreditation now, through the Exchanges Add-on Survey.

Your accreditation status for the Exchange product line is valid until your Commercial HMO expires in January 2015.