Provider Network Accreditation FAQs

What is Provider Network Accreditation?

NCQA Provider Network Accreditation is a comprehensive, evidence-based program dedicated to quality improvement that evaluates the accessibility and transparency of organization networks and credentialing of practitioners and providers. NCQA-Accredited organizations demonstrate they have the internal processes and procedures to effectively manage access to care and member experience while ensuring that practitioners and providers are appropriately credentialed.

How does Provider Network Accreditation help my organization?

Use the NCQA Provider Network Accreditation standards to perform a gap analysis and determine improvement areas. The standards provide a framework for implementing industry best practices to:

• Improve operational efficiencies.
  • Consistent monitoring of practitioner availability and accessibility of services.
  • Efficient collection and analysis of member-experience data.
  • Appropriate credentialing of practitioners and providers.
• Elevate your organization’s reputation. Accreditation demonstrates that your organization has the processes and procedures to provide effective network management services.
• Align with state requirements. Use accreditation standards to improve your internal operations and align with state requirements.
• Improve contracting opportunities. Ability to reduce administrative responsibility for NCQA-Accredited organizations that delegate network management and credentialing activities.

What are the Provider Network Accreditation requirements?

Provider Network Accreditation assesses an organization’s performance in the following key areas:

• Credentialing and recredentialing:
  • Protecting information.
  • Verifying credentials.
  • Ongoing monitoring of sanctions and complaints.
  • Providing directory information.
• Network management:
  • Maintaining adequate network.
  • Providing access to appointments.
  • Continuity and coordination of care.

Where can I find the Standards and Guidelines?

Find the Standards and Guidelines document in the NCQA Store.

What organizations are eligible for Provider Network Accreditation?

To be eligible for Provider Network Accreditation, an organization must:

• Not be licensed as an HMO, POS, PPO or EPO.
• Not be eligible for NCQA Accreditation as a health plan or an MBHO. *
• Perform Provider Network functions directly or through contractual agreement.
• Perform Provider Network activities for at least 50% of the provider network.

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 Provider Network 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 Provider Network 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 Provider Network 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 Provider Network 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 Provider Network Accreditation?

Several organizations have earned NCQA Provider Network Accreditation. See the NCQA Report Card for a directory of accredited organizations.