The National Committee for Quality Assurance (NCQA) is the leading accrediting body for health plans, including health maintenance organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS)
plans in the United States. In addition, the NCQA also accredits the following programs:
• Disease management
• Case management
• Wellness and health promotion
• Accountable care organizations
• Wellness and health promotion
• Managed behavioral health care organizations (NCQA, n.d.a)
The full list of NCQA accreditation requirements are published on its website at www.ncqa.org. The 2015 Health Plan Accreditation Program requirements include specific criteria divided into the following sections:
• Quality management and improvement (QI)
• Utilization management (UM)
• Credentialing and recredentialing (CR)
• Members’ rights and responsibilities (RR)
• Member connections (MEM)
• Medicaid benefi ts and services (MED)
• Health Effectiveness Data and Information Set (HEDIS) performance measures (see the “Measuring the Quality of Care” section for more information about HEDIS).