Provider Network Accreditation
NCQA Provider Network Accreditation creates a framework for organizations to provide efficient, accurate and consistent network management and credentialing services.
A QUALITY IMPROVEMENT FRAMEWORK
Many health insurers rely on tiered and narrow networks to manage costs, and use third-party organizations to validate their networks. In response to these network designs, states and the federal government implemented regulations requiring a minimum level of access to care and services.
The NCQA Provider Network Accreditation helps organizations maintain a high-quality network for members and clients by ensuring organizations:
- Ensure appropriate client agreements.
- Verify credentials.
- Protect credentialing information.
- Ensure credentials peer review process.
- Evaluate contracted provider quality.
- Monitor sanctions and complaints.
- Use objective evidence.
- Maintain adequate network.
- Provide access to appointments.
- Facilitate the continuity and coordination of care.
- Provide physician directories.
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WHY PROVIDER NETWORK MANAGEMENT ACCREDITATION?
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Improve operational efficiencies
Use evidence-based standards to perform a gap analysis and determine improvement areas.
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Elevate your organization’s reputation
Demonstrate to employers, regulatory agencies, health plans and MBHOs that your organization has the processes and procedures to effectively manage access to care and member experience while ensuring that practitioners and providers are appropriately credentialed.
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Align with state requirements
Use accreditation standards to improve your internal operations and align with state requirements.
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Improve contracting opportunities
NCQA-Accredited organizations that delegate network management and credentialing activities to an NCQA-Accredited service provider receive automatic credit for those functions in their Accreditation Survey, reducing administrative responsibility.
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