NCQA Health Plan Accreditation
National Committee for Quality Assurance (NCQA) · Washington, D.C., USA
AG Process Grade
Grade A See the Certification rubric →NCQA Health Plan Accreditation is a fee-based, independent third-party accreditation. Because NCQA is an independent standards body whose assessment is not controlled by the payer, the structural cap for commercial self-certifying operators does not apply. The program is supported by substantive published standards, a multi-step evaluation combining survey-tool review, onsite/virtual file review by NCQA surveyors, and audited HEDIS clinical and CAHPS experience measures, with real possibility of denial or provisional status. It is externally recognized (CMS deeming, state Medicaid and OPM use), maintains a verifiable public Report Card registry, and publishes its process and ratings methodology. The single scored gap is the absence of a publicly disclosed aggregate pass/denial rate (4.1 leaf 4.4), which is dashed and removed from both numerator and denominator. Official survey fees are not posted publicly but are available to applicants on request and are corroborated within-norm by independent sources.
Founded 1990 · National Committee for Quality Assurance (NCQA) · HQ Washington, D.C., USA · Healthcare & Life Sciences · Entry Paid
NCQA Health Plan Accreditation is a triennial accreditation for health plans awarded by NCQA, a private, independent 501(c)(3) nonprofit. It evaluates plans against structured standards across areas such as Quality Management and Improvement, Population Health Management, Network Management, Utilization Management, Credentialing, and Members' Rights, and uniquely incorporates audited HEDIS clinical performance and CAHPS consumer-experience measures.
Profile data
| Organizer | National Committee for Quality Assurance (NCQA) |
| Location | Washington, D.C., USA |
| Entry fee | $40,000-$100,000 |
| Cost to receive award | Undisclosed |
| Winner rate | Undisclosed |
| Selection authority | Measured data |
| Data confidence | ● Fully documented |
| Official site | https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/(nofollow) |
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