NCQA Accreditation Levels

If you’re considering NCQA accreditation, it’s important to understand the different levels that can be achieved. These status levels are based on compliance and performance reviews through NCQA and say quite a bit about your organization.

Let’s take a look at the different levels.

NCQA Accreditation Levels

Based on the organization’s performance during the accreditation process, NCQA then rates the organization and awards various levels of accreditation. They are:

Excellent: NCQA awards its top accreditation status of ‘Excellent’ to organizations with programs for service and quality that meet or go beyond the rigorous requirements for patient protection and quality improvement. These results are in the top range of national performance.

Commendable: A status of ‘Commendable’ is awarded to organizations with well-established programs and patient service measures that meet arduous requirements for patient care and protection.

Accredited: NCQA awards a status of ‘Accredited’ to organizations with programs for service and clinical quality that meet general requirements for patient protection & quality improvement. Organizations with this status may not have had their HEDIS/CAHPS results evaluated yet. When their HEDIS/CAHPS results are evaluated, organizations must take on-going action to attain a higher accreditation status.

Provisional: ‘Provisional’ is awarded to organizations with programs for service and clinical quality that meet only some of the basic requirements for protection and quality improvement. Organizations awarded this status should improve their procedures as well as clinical and service quality to achieve a higher accreditation status.

Interim: NCQA awards a status of ‘Interim’ to organizations with a basic level of structure and procedures in place to meet requirements for patient protection and quality improvement. Organizations awarded this status will need to undergo a new review within 18 months to show they have carried out those processes effectively.

Denied: NCQA denies accreditation to organizations whose programs for service and clinical quality did not meet NCQA requirements during the Accreditation survey.

Levels for ACOs

The levels for Accountable Care Organizations are slightly different. They are:

Level 1: Organizations starting the transformation and establishing the basic infrastructure and capabilities to meet the triple aim of better patient experience, better health and lower per capita cost. Length of status is 2 years.

Level 2: Organizations showing well-established capabilities outlined in the standards to meet the triple aim of better patient interaction, better health and lower cost. The length of status is 3 years.

Level 3: Organizations reaching Level 2 criteria and showing strong performance or drastic improvement in performance measures across the triple aim. The length of status is 3 years.

Aim High

Should you decide to move forward with NCQA accreditation, aim high–shoot for the top level of accreditation. Not only will your organization and patients benefit, but your revenue cycle will improve as well.