Payer Best Practices for Success: The healthcare industry is one of the most critical and rapidly evolving industries in the world. Healthcare payers, such as insurance companies, play an essential role in this industry by providing financial protection to individuals and families in the event of illness or injury.
NCQA Health Plan Accreditation program provides a framework for assessing the quality of health plans and ensuring that they meet certain standards.
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.
URAC accreditation consulting valuation begins with seeing the importance of earning a credential. The multifaceted world of accreditation can be daunting, from choosing the right accreditation body to getting correct documentation in place to ensure accreditation success.
Are you a health plan looking into NCQA accreditation? We know that the process can be daunting and often stressful, so we’ve compiled a list of NCQA basics to help those who are pondering an NCQA accreditation. If you are a health plan who has already chosen to pursue NCQA accreditation, take a look at our blog post "NCQA Health Plan Accreditation : The Difference Between Failure and Success." For those of you just getting started let's dive into the NCQA basics, from who the NCQA is to an overview of their Health Plan accreditation levels. Hopefully this list helps jump-start your journey towards successful healthcare accreditation.
The NCQA announced on September 29, 2015 that the 2nd volume of HEDIS 2016 (The Healthcare Effectiveness Data and Information Set) would be completely ICD-10 compliant and ready for the implementation day of OCT 1. The NCQA has phased out the ICD-9 codes as per NCQA regulations and added over 73,000 ICD-10 codes, across 56 HEDIS measures. "Health plans, health data clearinghouses and health care providers will now be able to code records to comply with CMS requirements for HEDIS reporting."
On September 17, 2015 the NCQA announced the release of the 2015-16 Health Insurance Plan Ratings, debuting the new ratings methodology as well. These ratings, which are shift from the "ranking" system previously used by the accrediting body, compare the services and quality of over 1,000 health plans. These ratings "provide consumers with a more accurate picture of how health insurance plans perform in key quality areas." The easy to use system lets consumers search for health plans by state, and plan name or plan type (Private, Medicaid, Medicare). Consumers can also sort the listings by Accredited Status, Consumer Satisfaction, Prevention, and Treatment (in addition to rating). Top performers nationwide, with an overall 5.0 rating and 4.5 Consumer Satisfaction include: Capital District Physicians' Health Plan, Harvard Pilgrim Health Care, Kaiser Foundation Health Plan of Northern California.
Through research, expert interviews, and hands on work with some of the top national organizations we have discovered the keys to accreditation success....and they might not be what you think! This is a must attend event for anyone undergoing accreditation or re-accreditation. Discover essential components on how to maximize your accreditation success rate, save your organization money, and get the most out of your accredited status.
If your accreditation has cost your organization more time, money, and internal resources than you had thought and you still feel like you are not prepared for your survey/audit, then this is one informational session you won't want to miss! During Wednesday's live webinar we will be answering these questions and many more! Based on years of consulting experience we have identified the hallmarks of organizations that are successful in the accreditation process, and are excited to share them with you. As an added bonus we will share tips on how to maximize your Accreditation ROI with a post accreditation checklist that every organization should utilize to get the maximum mileage and ROI from their accreditation.