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 What is CVO Certification?

NCQA CVO Certification evaluates the operations of organizations that verify practitioner credentials. Verification is accomplished through the primary source, through a recognized source or through a contracted agent of the primary source.

CVO 2016

8.24.2018 What is Wellness and Health Promotion Accreditation/Certification?

NCQA Wellness and Health Promotion Accreditation/Certification evaluates full and limited scope wellness program performance against the standards. Programs should appropriately address implementing a workplace program, protecting private health information and empowering participants to improve their health.

WHP 2014

8.24.2018 What is Managed Behavioral Healthcare Organization Accreditation?

NCQA Managed Behavioral Healthcare Organization Accreditation is a comprehensive, evidence-based evaluation that reviews organizations to assure they use processes to deliver high-quality care and access. It provides a framework for organizations to align and improve operations in areas of quality improvement, care coordination, utilization management and credentialing and recredentialing and members’ rights.

MBHO 2019

8.24.2018 What are the Accreditation/Certification requirements?

The Accreditation/Certification assesses an organization’s performance in the following requirement areas:

  • Workplace program implementation.
  • Protection of private health information.
  • Ability of services to empower participants to improve their health.

WHP 2014

8.24.2018 Where can I find the Utilization Management Standards and Guidelines?

8.24.2018 How long will it take to earn Accreditation/Certification?

The typical evaluation timeframe, from application submission to decision, is 12 months. This depends on the organization’s readiness, as some organizations may already be working within NCQA guidelines.

WHP 2014

8.24.2018 What organizations are eligible for Utilization Management Accreditation?

Utilization Management Accreditation is for organizations that provide full scope utilization management services. Eligible organizations:

  • Must not be licensed as an HMO, POS, PPO or EPO.
  • Must not be eligible for NCQA Accreditation as a health plan or an MBHO.
  • Must perform utilization management functions directly or through a contract.
  • Must perform utilization management activities for at least 50% of the members.
​Note: “Members” refers to membership of clients and organizations.

UM-CR 2019

8.24.2018 What is the price for the LTSS Distinction for Case Management Organizations?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

CM 2017

8.24.2018 How long does it take to earn Utilization Management Accreditation?

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.

UM-CR 2019

8.24.2018 What organizations are eligible for Physician and Hospital Quality Certification?

In general, any organization that operates a physician measurement program or hospital transparency program is eligible for certification. This includes, but is not limited to:

  • Health plans.
  • Provider networks.
  • Collaborative measurement organizations.
  • Information providers.

Organizations that meet these criteria are also eligible:

  • Operate a physician measurement program or hospital transparency program, as defined in the standards.
  • Are responsible for responding to complaints from consumers and to requests for change from physicians or hospitals based on the organization’s actions.
  • Comply with applicable federal, state and local laws and regulations, including requirements for licensure.
  • Operate without discrimination based on sex, race, creed or national origin.

Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.

PHQ

8.24.2018 What is the price for Utilization Management Accreditation?

Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.

UM-CR 2019

8.24.2018 How does Physician and Hospital Quality Certification help our organization?

Health plans increasingly use physician quality information for value-based contracting, pay-for-performance programs, provider networks, physician tiering and more. Because payers make decisions based on these data, how data are measured is important.

The NCQA Certification process helps ensure that health plans and provider networks make decisions based on sound methodology, and assures patients and physicians that those decisions are transparent and that quality is not sacrificed to cost.

PHQ