FAQ Directory

No. NCQA does not require the analysis to be stratified by practitioner type.

HP 2019

The COU measure does include the Medicare product line, and it will be collected in IDSS by NCQA from Medicare plans; however, because it was not included in the CMS Reporting Requirements memo, it is not required to be reported to CMS for HEDIS 2019.

HEDIS 2019

For FQHCs that are part of a larger organization with multiple practices under the same umbrella, UDS reporting would not meet KM 13 because the data is at the organizational/corporate level. The data for KM 13 must be at the practice level because recognition is at the practice level. An exception to this is for standalone practices whose UDS data is specific to the practice site location.

PCMH 2017

NCQA Health Plan Medicaid Module is a complementary program designed to support NCQA-Accredited health plans with a Medicaid product line. The combination of the module standards and NCQA Health Plan Accreditation maximize alignment with the Medicaid Managed Care program requirements. This improves a plan’s opportunity to receive a streamlined state compliance review.

NCQA developed the module by analyzing changes to state and federal requirements for the Medicaid Managed Care programs, as outlined in the Medicaid Managed Care Rule.

HP 2020

• Accreditation Process and Timeline:Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
• Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

HP 2020

An organization is eligible for the NCQA LTSS Distinction for a product/product line if:

• The product/product line has a current NCQA Accreditation status, or
• The product/product line is seeking NCQA Health Plan Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level. Organizations undergoing Interim Survey are not eligible for LTSS distinction.

Health plans that coordinate LTSS and do not provide medical or behavioral services are not eligible for this distinction but can earn Accreditation of Case Management for LTSS.
 

HP 2020

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

HP 2020

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

UM-CR-PN 2019

UM-CR 2019

The first step to earning distinction is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and determines your distinction status within 30 days of the final review.

See a step-by-step process.

HP 2020

• Certification Process and Timeline: identifies key steps, timing and resources to successfully seek Certification.
• Standards and Guidelines: provides the comprehensive descriptions of the standards, including the intent and the scope of review.
• Interactive Survey Tool: includes the complete standards and guidelines and allows your organization to determine its readiness for a survey by responding to each standard. The tool calculates your survey score.

CVO

If you do not currently have Physician and Hospital Quality Certification and are interested in learning more, contact NCQA. If you have a current certification and want to talk to someone about current status or about renewing, submit a question through My NCQA.

PHQ