{"id":11689,"date":"2019-05-13T13:24:40","date_gmt":"2019-05-13T17:24:40","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=11689"},"modified":"2025-11-21T16:24:24","modified_gmt":"2025-11-21T21:24:24","slug":"health-plan-accreditation","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/","title":{"rendered":"Health Plan Accreditation"},"content":{"rendered":"<p>Until 1990 there was no comprehensive way to evaluate a health plan\u2019s quality, no standards of quality to evaluate plans against.<\/p>\n<p>NCQA developed the first set of standards for health plan quality. Its <strong>Health Plan Accreditation program<\/strong> is based on a set of evidenced-based requirements that measure plan performance and provide employers with a way to evaluate current and prospective plans.<\/p>\n<p>Although NCQA now evaluates, certifies, recognizes and accredits a variety of health care organizations and providers, its <strong>Health Plan Accreditation program<\/strong> is the gold standard for evaluation programs across the industry.<\/p>\n<h2>What Is Health Plan Accreditation?<\/h2>\n<p>NCQA\u2019s Health Plan Accreditation program builds on almost three decades of experience measuring the quality of health plans. An organization that earns Accreditation meets standards covering more than 100 measured elements.<\/p>\n<p>The standards focus on:<\/p>\n<ul>\n<li>Quality Management and Improvement<\/li>\n<li>Population Health Management<\/li>\n<li>Network Management<\/li>\n<li>Utilization Management<\/li>\n<li>Credentialing<\/li>\n<li>Member Experience<\/li>\n<\/ul>\n<p>Key features of Health Plan Accreditation include:<\/p>\n<ul>\n<li>Focusing not only on how health plans comply with medical standards but, also behavioral healthcare standards.<\/li>\n<li>Extensively evaluating plans\u2019 population health management efforts, including how they identify member needs and enroll members in appropriate programs.<\/li>\n<li>Mandating that health plans comply with rigorous utilization management standards, so members are receiving treatment decisions that are timely and evidence-based.<\/li>\n<li>Measuring the availability and accessibility of primary care physicians, specialists and behavioral health care practitioners.<\/li>\n<\/ul>\n<h2>What Does Health Plan Accreditation Mean for Employers?<\/h2>\n<p>The rigor of the requirements, combined with onsite review of patient files, means that earning NCQA Accreditation is more than a \u201ccheck the box\u201d process.<\/p>\n<p>For employers\u2014whether they are self-insured or fully insured\u2014NCQA Accreditation means that an independent, nationally recognized organization has validated a plan\u2019s performance.<\/p>\n<p>Without NCQA Accreditation, there is no assurance for employers that a health plan is truly committed to meeting quality standards.<\/p>\n<h2>What Should Employers Do?<\/h2>\n<p>Employers should ask their current or prospective health plans if they are NCQA Accredited.<\/p>\n<p>They can also find information about Accredited plans on NCQA\u2019s <a href=\"https:\/\/www.ncqa.org\/report-cards\/health-plans\/\">Report Cards<\/a>\u2014for example, how a plan scored in categories such as keeping members healthy and helping them get better.<\/p>\n<p>Employers should include requirements in their RFP that health plans are Accredited through NCQA.<\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: center;\"><strong>Have a question? NCQA\u2019s Employer Relations Team can help!<\/strong><\/p>\n<p style=\"text-align: center;\"><a href=\"mailto:employerrelations@ncqa.org\" class=\"btn  btn--red \">Contact the Employer Relations Team<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Until 1990 there was no comprehensive way to evaluate a health plan\u2019s quality, no standards of quality to evaluate plans against. NCQA developed the first set of standards for health plan quality. Its Health Plan Accreditation program is based on a set of evidenced-based requirements that measure plan performance and provide employers with a way [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":11684,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-single-column.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-11689","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Health Plan Accreditation - NCQA<\/title>\n<meta name=\"description\" content=\"NCQA\u2019s Health Plan Accreditation is based on a group of comprehensive requirements that measure plan performance.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Plan Accreditation - NCQA\" \/>\n<meta property=\"og:description\" content=\"NCQA\u2019s Health Plan Accreditation is based on a group of comprehensive requirements that measure plan performance.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/\" \/>\n<meta property=\"og:site_name\" content=\"NCQA\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/NCQA.org\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-21T21:24:24+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/2021\/04\/NCQA_cmyk_tag.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"627\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@NCQA\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/\",\"url\":\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/\",\"name\":\"Health Plan Accreditation - NCQA\",\"isPartOf\":{\"@id\":\"https:\/\/www.ncqa.org\/#website\"},\"datePublished\":\"2019-05-13T17:24:40+00:00\",\"dateModified\":\"2025-11-21T21:24:24+00:00\",\"description\":\"NCQA\u2019s Health Plan Accreditation is based on a group of comprehensive requirements that measure plan performance.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/health-plan-accreditation\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.ncqa.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Employers\",\"item\":\"https:\/\/www.ncqa.org\/employers\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"NCQA Programs of Interest to Employers\",\"item\":\"https:\/\/www.ncqa.org\/employers\/ncqa-programs-of-interest-to-employers\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Health Plan Accreditation\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.ncqa.org\/#website\",\"url\":\"https:\/\/www.ncqa.org\/\",\"name\":\"NCQA\",\"description\":\"Measuring quality. 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