The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.
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.
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.
The NCQA DAV data definition will be included in General Guideline 31 for MY 2022. 11.15.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?
Health IT/Data Collection Certification NCQA Certification programs evaluate systems and processes that support data collection, surveys and quality improvement. NCQA-Certified vendors have gone through a rigorous process to validate accuracy and support your organization.
Accredited-3 years: NCQA awards a status of Accredited – 3 years to organizations that demonstrate strong performance of the functions outlined in the standards for CM-LTSS accreditation.
12 monthsHow 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.
To renew your credential, you must complete required trainings and select continuing education events or activities to earn a total of 30 Continuing Education Unit (CEU) points within the two-year certification period. See the full criteria document for maintaining certification.
NCQA does require that if a practitioner states he is board certified, the managed care organization must verify the accuracy of that information.
The new law designates NCQA as the required and sole accreditor of California's commercial plans. That means three of the four California public sector agencies officially require NCQA Health Plan Accreditation (HPA) for the plans they regulate.
CVO Certification assesses an organization's performance in the following requirement areas: Internal Quality Improvement Process. Protecting Credentialing Information. Verifying credentials.
Credentials Verification Organization CertificationCredentials Verification Organization Certification NCQA Credentials Verification Organization (CVO) Certification helps improve verification operations and protect consumers by ensuring a consistent, effective and diligent verification process.
NCQA accreditation standards help health plans and other organizations align future initiatives with issues that are front and center for employers and states. Through the accreditation process, organizations are able to perform a gap analysis and identify areas for improving their evidence-based practices.
The procedure is commonly referred to as the “8 and 30” file sampling procedure, because the procedure involves reviewing an initial sample of eight files, then reviewing an additional sample of 22 files if any of the original eight fails the review (a total of 30 records).
Over 1,000 health plan products have earned NCQA Health Plan Accreditation.
Requirements cover these key areas:Quality improvement.Population health management.Network management.Utilization management.Credentialing and recredentialing.Members' rights and responsibilities.Member connections.Medicaid benefits and services.
Credentialing is more than a “check-the-box” regulatory duty, it’s an essential safety component of the health care system. Health care organizations must establish the qualifications of their licensed medical professionals by assessing their background and legitimacy to provide care.
Applying industry best practices improves credentialing processes. The standards provide a framework for implementing best practices:
More than 191 million people — over half our country’s population —are enrolled in health plans that report quality results using our Healthcare Effectiveness Data and Information Set. Americans receive better care and can lead healthier lives thanks to the accountability and benchmarking that HEDIS makes possible.
Our 12-person Leadership Team includes our founder, Margaret E. O’Kane. She started NCQA almost 30 years ago, working by herself in a borrowed office.
NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality network for members and contracted clients. Requirements cover these key areas:
The standards are designed for organizations that provide full-scope credentialing services, including:
To retake the examination, register online at www.goAMP.com. Update your information, pay the fee of $395 and schedule the exam. NCQA reserves the right to retire an examination when it releases updates to the recognition program. The eligibility period may be shortened when an examination is retired.
Note: You must bring these approved resources to the exam. Test Centers cannot print a copy on the day of the exam. Materials must be surrendered to the Test Center supervisor after the examination and will not be returned to you.
The underlying principles of PCSP remain the same. Evidence shows that the PCSP model of care can result in reduced costs and healthier and more satisfied patients. The redesigned process focuses more on performance and quality improvement and aligns with many other major national initiatives that impact practices, such as MACRA.
MACRA changes how eligible clinicians get paid under Medicare—transitioning from volume to value—and takes a big step forward for health care quality. CMS rules detail how Medicare will implement MACRA’s Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM).
One goal of the redesign is to reduce required documentation making it easier for practices to show how they meet PCSP recognition requirements. The online reporting platform and virtual reviews are designed to reduce paperwork and reduce the amount of time practices spend showing their progress.
Many recognized practices said that the current process of using two complicated tools (systems) could be improved. In response, NCQA designed a new online system that:
The new online system will launch with the new program on October 28, 2019.
Yes. NCQA released a new PCSP Standards & Guidelines document with updated requirements. In addition, requirements are updated annually. Historically, NCQA updated requirements every three years. NCQA is releasing the updated PCSP at the same time it is launching its new recognition process.
Yes. If you are currently preparing to come through recognition, you may do so under PCSP 2016. Once your three-year recognition concludes, you will transition to the new process. Practices that still want to earn recognition using the 2016 standards must submit their survey by December 31, 2019.
No. Effective November 17, 2020, NTIS is no longer an acceptable source to verify a practitioner's DEA certificate. This FAQ was addressed in the 2021 CVO updates on 11/23/2020. Please see https://dea.ntis.gov for more information.
No. NCQA released a policy change in July 2020 stating that certified QRDA I files are not considered standard supplemental data for HEDIS® reporting in 2022 for HEDIS MY 2021. Because of the dual HEDIS publication, HEDIS MY 2021 Volume 2 did not account for this policy change, but it will be reflected in HEDIS MY 2022 Volume 2. However, this FAQ is a reminder the policy changed in July 2020 and therefore must be followed. Organizations should work with their auditor to have this data validated as nonstandard supplemental data.
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.
NCQA Credentialing Accreditation is designed to ensure that organizations pursuing accreditation can maintain a high-quality network for members and contracted clients.
Credentialing Accreditation assesses an organization’s performance in the following areas:
Credentialing Accreditation is for organizations that provide full scope credentialing services. Eligible organizations:
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.
Pricing is based on multiple factors. Obtain full pricing information by submitting a request through My NCQA.
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.