Case Management Accreditation FAQs

What is Case Management Accreditation?

NCQA Case Management Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the operations of case management programs in provider, payer or community-based organizations. NCQA-Accredited organizations demonstrate that they have the internal processes and service delivery structure to cost-effectively meet the needs of complex patient and improve health or functional capability.

How does Case Management Accreditation help my organization?

Use the NCQA Case Management Accreditation standards to perform a gap analysis and determine improvement areas. They provide a framework for implementing evidence-based best practices to ensure:

• Efficient and cost-effective case management processes and service delivery:
  • Apply a QI process to improve operations.
  • Maintain security of patients’ personal health information.
  • Ensure access to qualified case management staff.
  • Develop personalized, patient-centered care plans.
  • Manage patients between care settings.
  • Conduct systematic, patient-centered assessments.
  • Monitor patient progress to care goals.

What are the Case Management Accreditation requirements?

NCQA Case Management Accreditation assesses an organization’s performance in the following key areas:

• Identification and assessment.
• Care planning.
• Care monitoring.
• Care transitions.
• Measurement and quality improvement.

Where can I find the Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA Store.

What organizations are eligible for Case Management Accreditation?

NCQA Case Management Accreditation is for organizations that provide a broad range of case management services for complex and high-risk populations:

• Provide case management services for at least 6 months, and
• Deliver a broad range of case management services for complex or high-risk populations, and
• Perform functions covered in the accreditation program or arrange for them to be performed directly or through a service agreement and
• Manage a valid sample size of individuals for NCQA evaluation, where standards require patient file review.

How do we earn Case Management Accreditation?

The first step to earning accreditation 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.

How much does it cost?

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

How long does it take to earn Case 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.

How do we start?

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.

Where can I find information?

• Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
• Standards and Guidelines: The complete standards and guidelines, including the intent statement 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.

What other organizations have earned Case Management Accreditation?

More than 40 organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.