What is the difference between URAC and NCQA?
NCQA accredits organizations ranging from health plans including HMOs and PPOs to physician networks and medical groups. URAC accredits health plan programs including dental plans, healthcare management programs, pharmacy quality management programs, and provider integration and coordination programs.
What is the NCQA 8/30 rule?
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).
Does NCQA require board certification?
NCQA does not require board certification; however, the organization verifies current certification status of practitioners who state that they are board certified.
Is NCQA accreditation mandatory?
Thirty-three states in the commercial market—including Departments of Insurance and Public Employee Benefit Programs—require or recognize NCQA Health Plan Accreditation to promote high quality care for consumers.
What are the NCQA categories?
NCQA assesses the organization for performance against each standard….Standards for evaluation include:
- Quality Management and Improvement (QI).
- Population Health Management (PHM).
- Network Management (NET).
- Utilization Management (UM).
- Credentialing and Recredentialing (CR).
- Member Experience (ME).
What is NCQA look back period?
The look-back period should be specified as 12 months for all product lines, for Renewal Surveys, which is consistent with the other file review standards and elements. NCQA initially changed the scope of review to account for a change made to verbal notification and how it no longer affords organizations an extension.
How does NCQA evaluate delegation?
Reports from delegates NCQA reviews the organization’s evaluation of regular reports, and each report must show evidence of substantive evaluation, thorough review and analysis. The organization must receive at least semiannual reports from all delegates, including NCQA-Accredited and NCQA-Certified delegates.
How long is NCQA accreditation good for?
3 years
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.