Ncqa health plan accreditation requirements
[DOC File]Volume 18, Issue 17
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_0b67a5.html
Preferred provider organization A preferred provider organization (PPO) is an accreditable entity whose performance NCQA assesses using the NCQA PPO Plan Accreditation standards. PPO plans take responsibility for providing health benefits-related services to covered individuals and for managing a practitioner network.
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https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_148e0a.html
NCQA does not require primary source verification of work history. The health plan must obtain a minimum of five years of relevant work history through the practitioner’s application or curriculum vitae including the beginning and ending month and year for each work experience.
[DOCX File]CR 1: Credentialing Policies
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_a621fe.html
[DOCX File]APPENDIX 5 - NCQA
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_a324ca.html
A health plan that is NCQA WHP Accredited or Certified is eligible for automatic credit during its HP Accreditation survey for the elements listed in the table below that were in the scope of its WHP survey. In this case, criteria for automatic credit is waived.
[DOCX File]Overview of Delegation in Managed Care
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_1985de.html
[DOCX File]National Council on Aging | Improving the Lives of Older ...
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_5426fe.html
Today, 38 states, the Centers for Medicare & Medicaid Services (CMS) and the Office of Personnel Management (OPM) recognize NCQA Accreditation as meeting some or all of their requirements for health plans. NCQA is happy to work with state agencies that oversee health plans to identify opportunities to streamline oversight while ensuring quality.
[DOC File]Established Child Health Care Quality Measures
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_044e37.html
[DOCX File]Escalation and Corrective Action
https://info.5y1.org/ncqa-health-plan-accreditation-requirements_1_197faa.html
HEDIS®
Automatic credit is not available for an NCQA Accredited or NCQA Certified parent or wholly owned or controlled subsidiary or affiliated entity in the corporate family if the function being performed was excluded from or varies significantly from its NCQA Accreditation or NCQA Certification requirements.
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