FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.

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8.24.2018 How long does it take to earn Physician and Hospital Quality Certification?

Once the survey is submitted, an organization receives its certification decision within 60–90 days.

PHQ

8.24.2018 What other organizations have earned Utilization Management Accreditation?

More than 50 organizations have earned NCQA Utilization Management Accreditation. See the NCQA Report Card for a directory of accredited organizations.

UM-CR

8.24.2018 How do we start?

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

8.24.2018 What organizations are eligible for Provider Network Accreditation?

To be eligible for Provider Network Accreditation, an organization must:

Not be licensed as an HMO, POS, PPO or EPO.
Not be eligible for NCQA Accreditation as a health plan or an MBHO.
Perform Provider Network functions directly or through contractual agreement.
Perform Provider Network activities for at least 50% of the provider network.

Note: A “practitioner network” is the practitioner network of clients and organizations.

UM-CR-PN 2019

8.24.2018 What does Physician and Hospital Quality Certification cost?

Price varies by organization and is based on number of physicians and number of programs. Contact NCQA for pricing information.

PHQ

8.24.2018 How long does it take to meet the Medicaid Module requirements?

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.

HP 2020

8.24.2018 Are there any other documents or information that will help me get started with Accreditation/Certification?

Accreditation/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.

WHP 2014

8.24.2018 What other health plans have earned LTSS Distinction?

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

HP 2020

8.24.2018 How do I get started with Wellness and Health Promotion Accreditation/Certification?

If you are not currently Accredited or Certified and are interested in learning more, contact NCQA. If you are currently Certified and want to talk to someone about your current status, renewing or adding Certifications, submit a question through My NCQA.

WHP 2016

8.24.2018 How does the LTSS Distinction for Health Plans help my organization?

Earning NCQA Accreditation of Case Management for LTSS can help organizations:

Become more efficient. A focus on coordinated care, training and measurement can help organizations reduce errors and duplicated services.
Integrate care better. Standards can help organizations improve communication between individuals, caregivers, providers, payers and other organizations that coordinate care.
Provide person-centered care. Standards focus on person-centered services, which can lead to better care planning and monitoring.
Support contracting needs. Standards align with the state needs. NCQA-Accredited organizations demonstrate that they’re ready to be trusted partners in coordinating LTSS services.

HP 2020

8.24.2018 What is the process for earning Accreditation/Certification?

The first step to earning accreditation/certification 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 accreditation status within 30 days of the final review.

See a step-by-step process.

WHP 2014

8.24.2018 What are Managed Behavioral Healthcare Accreditation requirements?

The standards, provide a framework for implementing best practices to improve:

Quality Management and Improvement: Monitor, evaluate and improve the quality and safety of care.
Care Coordination: Coordinate medical care and behavioral healthcare for its members.
Utilization Management: Notifies members and practitioners about coverage decisions within required time frames.
Credentialing and Recredentialing: Verifies the credentials of the practitioners in its network.

Members’ Rights and Responsibilities: Written members’ rights and responsibilities policy exist.

To see the program requirement details, get the Standards & Guidelines document.

MBHO 2019