FAQ Directory

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

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

• 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

Find the Standards and Guidelines document in the NCQA eStore.

HP 2020

If you are not currently 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.

CVO 2016

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

The first step in earning Certification begins with an overview discussion with an NCQA program expert. Next, you will purchase the program resources, review, conduct a gap analysis and then submit your online application. Next you will align your processes with the standards. Finally, NCQA conducts the survey, creates a report and your Certification status is determined within 30 days of the final review. See a step-by-step process.

CVO

WHP 2014

• 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 if:

• It has a current NCQA Accreditation status, or
• Is seeking NCQA Case Management Accreditation.

Note:  NCQA conducts LTSS Distinction Surveys at the legal-entity level.
 

CM 2017

Organizations must go through a survey and submit documentation to NCQA. The survey score determines certification. See a step-by-step process.

PHQ

The standards and guidelines document is the publication that contains the requirements for certification. You can download this document for free through the NCQA eStore.

These standards include:

For Physician Quality:

• Measures and Methods: Evaluates how an organization measures the quality and affordability of care provided by physicians, including:
  • Use of standard sources.
  • How cost is measured.
  • Defined methodologies.
  • Adherence to key principles.
  • Frequency of measurement.
• Working with Physicians: Evaluates the transparency of the physician measurement program and how organizations work with physicians to respond to requests for corrections or changes.
• Working with Customers: Looks at the organization’s level of transparency with customers (consumers and purchasers) regarding the details of its physician measurement program, and whether the organization works with consumers to address complaints.
• Program Input and Improvement: Ensures that the organization seeks input and feedback on the design of its physician measurement program and on its reporting process, to improve the program’s value to physicians and customers.

For Hospital Quality:

• Hospital Performance: The organization provides consumers and purchasers with information about how hospitals perform, to help them make decisions based on quality and cost. Organizations are evaluated on:
  • Hospital performance data: How they report payer quality and cost information to customers.
  • Decision support tools: Whether hospital reports support informed decision making.
  • Availability of information to customers: Whether they make hospital performance information available to consumers, purchasers and others.
  • Scope of hospitals: How they report performance information on hospitals in the network.
  • Working with hospitals on reporting: Whether they work with network hospitals on reporting.
  • Information about measurement: Whether they make information available about performance-based payments.
  • Feedback on Customer Reports: Whether they seeks customer feedback, with the goal of improving the usefulness of hospital performance reports.

PHQ