What does it mean if my health plan has been accredited by NCQA? Why is accreditation or certification important?
Accreditation organizations evaluate one or more areas of a health care entitys operational processes, organizational structure, medical management procedures, member service practices, quality improvement activities, etc. Accreditation or certification means that the entity has passed a rigorous review and has the necessary processes, structure, and administration in place to promote/provide quality care and protect patient rights. Accreditation or certification can be focused on one or more specific areas (e.g. provider credentialing or utilization management) or it can cover all of the organizations major operations. Many types of health care organizations can be accredited or certified. These can include: managed care plans (HMO, PPO, POS), physician organizations (IPAs or medical groups), physician/hospital organizations (PHO), and others. In addition to NCQA there are other organizations (JCAHO and American Accreditation HealthCare Commission/URAC are examples of two others) that
