NCQA Health Plan Accreditation is a rigorous evaluation process that assesses the quality of health plans and their ability to meet the needs of their members. As part of the accreditation process, NCQA requires health plans to undergo third-party review. Building internal quality resources set the foundation for a successful accreditation/reaccreditation process, and engaging a third-party advisor plays a key role for the following reasons:NCQA Health Plan Accreditation

  1. Impartial evaluation: Third-party review ensures that the evaluation of a health plan is impartial and objective. Accreditation reviewers are typically employed by the health plan being evaluated or by the organization that owns the health plan. Third-party reviewers, on the other hand, are independent and not affiliated with the health plan being evaluated. This impartiality ensures that the evaluation is fair and unbiased.
  2. Expertise: Third-party reviewers bring a high level of expertise and experience to the evaluation process. They have a deep understanding of the NCQA Health Plan Accreditation standards and the best practices for meeting those standards. They also have experience evaluating multiple health plans, which gives them a broader perspective on the industry.
  3. Accountability: Third-party review holds health plans accountable for meeting the NCQA Health Plan Accreditation standards. If a health plan fails to meet the standards, the third-party reviewer will document the deficiencies and work with the health plan to develop a corrective action plan. This helps ensure that health plans are providing high-quality care and services to their members.
  4. Transparency: Third-party review promotes transparency in the evaluation process. Health plans are required to submit documentation and data to the third-party reviewer, who will then review and validate that information. This transparency ensures that the evaluation is based on objective data and not subjective opinions.
  5. Credibility: Third-party review enhances the credibility of the NCQA Health Plan Accreditation process. Health plans that undergo third-party review are more likely to be viewed as credible and trustworthy by consumers, employers, and other stakeholders.

NCQA provides detailed information about third-party review on their website, including the qualifications for third-party reviewers and the responsibilities of health plans during the review process.

For more information from NCQA, Click HERE.

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