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
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.
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
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
Find the Standards and Guidelines document in the NCQA eStore.
UM-CR 2019
Utilization Management Accreditation is for organizations that provide full scope utilization management services. Eligible organizations:
Note: “Members” refers to membership of clients and organizations. |
UM-CR 2019
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:
Organizations that meet these criteria are also eligible:
Note: There are other eligibility criteria. Refer to the standards and guidelines document available in the NCQA eStore.
PHQ
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