Health Plan Medicaid Module

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 months before your desired survey start date. Our program expert will:

    • Discuss eligibility criteria.
    • Review evaluation areas.
    • Identify program benefits.
    • Review the application process.

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

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  2. Purchase the Standards & Survey Tool

    Purchase the Standards and Guidelines and the Survey Tool program resources to develop a better understanding of the evaluation areas and requirements 9–11 months from your desired survey start date.

    • 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.
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  3. Perform a Gap Analysis

    Approximately 9–11 months from your desired survey start date, perform a gap analysis by comparing the standards to your organization’s current processes.

    The Survey Tool has a readiness assessment that can help you do this.

    Identify where you need to make changes, 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 Prequalification Form

    To initiate the application process, contact your program expert to request a prequalification form.

    NCQA:

    • Reviews the prequalification 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

    Once qualified, submit the online application and select the desired survey start date. You should submit the application approximately 9 months before 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 Application Training Video 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 Survey 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 Medicaid Module program, an onsite file review is scheduled approximately 7 weeks after the survey submission.

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  3. Meet the Health Plan Medicaid Module Standards

    Your results are 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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