Health Plan Accreditation Process for New Customers

This process helps organizations plan and execute activities to ensure they are ready for NCQA evaluation. The typical evaluation time frame is 12 months from application submission to decision, depending on the organization’s readiness. Some organizations may already be working within NCQA guidelines.

Before Applying

  1. Overview Discussion

    Schedule a consultative call with a program expert at least 12-15 months before your desired survey start date.

    Our program expert will:

    • Discuss eligibility criteria.
    • Review evaluation areas.
    • Identify program benefits.
    • Review the Survey Readiness Package.

    Not currently accredited? Contact us today and a NCQA program expert will be in touch. NCQA-Accredited organizations should submit a request through My NCQA.

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  2. Purchase a Survey Readiness Package

    Purchase the Health Plan Accreditation Survey Readiness Package, 12-15 months prior to your desired survey start date.

     

    This package includes everything an organization needs to initiate a successful survey process:

    What’s included:

    • Health Plan Accreditation Targeted Education for your team, such as self-paced updates to standards and guidelines
    • Standards and Guidelines for relevant Standards Year (access for 2-4 users)
    • Policy Fact Sheets for quick reference on more frequently changing standards such as Quality Improvement, Utilization Management and Credentialing
    • Guidelines for Successful Survey Tip Sheet
    • Town Halls offering live access to Q&A with NCQA experts (up to 4x/year)
    • Interactive Review Tool (IRT) Access (optional for New Customers)
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  3. Review Readiness Resources and Perform a Gap Analysis

    Review of the resources, completion of the comprehensive Education Courses and performing organization readiness using the Interactive Review Tool offered in the Readiness Package is critical to a successful NCQA survey. These activities should be performed 12-15 months prior to your desired survey start date.

    The organization readiness assessment in IRT can help you identify where change is needed, develop a project plan and begin implementing improvements. Many standards require a 6-month look-back period, so you must meet the standards at least 6 months before your survey date.

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  4. Submit the Pre-Application Form

    To initiate the application process, contact your program expert to request a pre-application form. NCQA:

    • Reviews the pre-application form to determine readiness and eligibility.
    • Sends you an online application link (typically within 1–2 business days after receiving the form).
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  5. Submit the Online Application and Access or Purchase the Survey Tool

    Once qualified, submit the online application, select your desired survey start date and purchase/ access the Interactive Review Tool.

    This should happen 9 months prior to your desired survey start date.

    NCQA will contact you to finalize the survey start date and process the application.

    See the Online Application User’s Guide and FAQs for information about the application process.

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After Applying

  1. Align With NCQA Requirements

    Approximately 9 months before the survey start date, work to align your organization with the program standards. You should be fully aligned with the requirements 6 months before your survey start date.

  2. Submit the Survey Tool

    Approximately 3 months before the survey start date, an Accreditation Services Coordinator will contact you to review the survey submission process and answer questions.

    Complete and submit the survey tool on the assigned survey start date—this is the official start of the survey process.

    If required by the Health Plan Accreditation program, an onsite file review is scheduled approximately 7 weeks after the survey submission.

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  3. Earn Health Plan Accreditation

    Your accreditation status is determined within 30 days of the onsite file review or 90 days after survey submission.

    Your organization will receive a preliminary report. You have 2 weeks to review it and provide comments and additional documentation.

    The entire document, including feedback and onsite file review results, is sent to the Review Oversight Committee, which considers all information to determine your final score.

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