Health Plan Accreditation
NCQA's Health Plan Accreditation is built on more than two decades of experience. Our commitment to comprehensive research and dedication to quality has helped improve the managed care experience for health plans, patients, physicians and employers. Recognizing hundreds of plans that cover more than 136 million people (43 percent of the U.S. population), NCQA is the most widely-recognized accreditation program in the United States. Our experience and prominence have allowed us to build flexible, yet rigorous standards that apply to all types of health plans, including HMOs, PPOs, EPOs and POS plans.
NCQA Accreditation is the most comprehensive evaluation in the industry, and the only assessment that bases results of clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures). High-performing health plans choose NCQA Accreditation because it satisfies many stakeholders:
Meets Employer Demands.
Many employers – especially the fortune 500 – do business only with NCQA-Accredited plans. They and other purchasers want to maximize the value of their health care spending. The National Business Group on Health’s widely used eValue8 tool captures NCQA Accreditation status and HEDIS/CAHPs scores as an important indicator of a plan’s ability to improve health, and health care.
Meets Regulator Demands. NCQA Accreditation contains all key elements that federal law and regulations require for State Health Insurance Marketplace plans. Forty-two states recognize NCQA Accreditation as meeting their requirements for Medicaid commercial plans; more than a dozen states mandate it for Medicaid. Also, the Federal Employees Health Benefits Program accepts NCQA Accreditation.
Meets Consumer Demands. Consumers comparison-shop and want to know an insurer’s quality when they select a plan. This trend still grows as consumers become more responsible for managing their health care. Research by NCQA and Consumer Reports shows consumers value accreditation, especially when they know the depth and breadth of NCQA Accreditation.
Health Plan (HP) Accreditation for Plans Participating In Health Insurance Exchange Marketplace
The Department of Health and Human Services (HHS) selected NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplace. NCQA’s Health Plan Accreditation (HPA) contains all the key elements the law requires.
There are three accreditation evaluation options (interim, first, renewal) that create a “glide path”—flexible opportunities for reaching accreditation, regardless of a plan’s longevity or experience with quality reporting. Learn More
Marketplace Accreditation Updates
NCQA understands the importance of aligning the Centers for Medicare & Medicaid (CMS) Marketplace requirements and NCQA Accreditation requirements. For Renewal Surveys and applicable First Surveys, NCQA will continue to score the Marketplace product line on accreditation standards only, and will evaluate whether the organization continues to be a Qualified Health Plan under CMS requirements.