| An independent group of health professionals
- the National Committee for Quality Assurance (NCQA®)
- developed quality standards and ways to measure the quality
of HMOs.
NCQA accreditation applies to HMOs and is considered to be
one measure of a health plan's performance. The levels of
NCQA accreditations are as follows:
Excellent - NCQA’s highest accreditation status is
granted only to those HMO plans that meet or exceed the requirement
for consumer protection and quality improvement. HMO plans
also must achieve HEDIS results that are in the highest range
of national or regional performance.
Commendable - This next level of accreditation is
granted to those HMO plans that meet or exceed the requirement
for consumer protection and quality improvement.
Accredited - HMO plans that earn this level of accreditation
have met most of the NCQA’s basic requirements.
Provisional - HMO plans that earn this level of accreditation
have met some but not all of the NCQA’s basic requirements.
Denied - Denied is an indication that an HMO did
not meet NCQA's requirements during its review.
Expired - Expired denotes an HMO that has allowed
its provisional, one-year or full accreditation status to
lapse without scheduling another accreditation survey. Plans
receiving a denial do not revert to "expired".
No (Not Accredited) - This category included HMO plans
that (1) have not sought accreditation from NCQA, (2) are
scheduled for or are currently undergoing NCQA review. |
