Credentialing Accreditation FAQs

What is Credentialing Accreditation?

NCQA Credentialing Accreditation is a comprehensive program that evaluates the operations of organizations providing full-scope credentialing services, which include verifying practitioner credentials, designated credentialing-committee review of practitioners and monitoring practitioner sanctions.

How does Credentialing Accreditation help my organization?

NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients. The standards provide a framework for adopting industry best practices to accurately and efficiently credential and recredential health care professionals—ensuring that medical organizations employ qualified professionals and align with state requirements.

What are the Credentialing Accreditation requirements?

Credentialing Accreditation assesses an organization’s performance in the following areas:

• Internal Quality Improvement Process.
• Agreement and Collaboration With Clients.
• Protecting Credentialing Information.
• Credentialing Policies.
• Credentialing Committee.
• Credentialing Verification.
• Recredentialing Cycle Length.
• Ongoing Monitoring.
• Notification to Authorities and Practitioner Appeal Rights.
• Assessment of Organizational Providers.
• Delegation of CR.

Where can I find the Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA Store.

What organizations are eligible for Credentialing Accreditation?

Credentialing Accreditation is for organizations that provide full scope credentialing 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 credentialing functions directly or through a contract.
• Must perform credentialing activities for at least 50% of a practitioner network.

Starting July 2024, NCQA Credentialing Accreditation will allow organizations to delegate over 50% of primary source verification to delegates that are NCQA Accredited or NCQA Certified.

Updated Eligibility Policy for CR Accreditation in UM-CR-PN for release in November 2023 – effective for surveys in July 2024

• Credentialing Verification: If more than 50% of credentialing verification is delegated, all delegates must be NCQA Accredited/Certified.
• Decision Making: Organizations are not eligible for CR Accreditation if they delegate more than 50% of credentialing decision making.

Note: A “practitioner network” is the practitioner network of clients and organizations.

*NCQA-Accredited health plans or MBHOs are eligible for Accreditation in UM, CR or PN if they also maintain health plan or MBHO Accreditation. If an organization allows its Accreditation status to lapse, its UM, CR or PN Accreditation status will remain in place but may not be renewed.

What is the process for earning Credentialing 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 CR standards. NCQA conducts the survey and determines your accreditation status within 30 days of the final review.

See a step-by-step process.

What is the price for Credentialing Accreditation?

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

How long does it take to earn Credentialing 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 I get started?

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 to help me get started?

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.

What other organizations have earned Credentialing Accreditation?

Over 150 organizations have earned NCQA Credentialing Accreditation. See the NCQA Report Card for a directory of accredited organizations.