Achieving NCQA Health Plan Accreditation


Our consultants have worked in a variety of management, operational, and technical positions within commercial and government payer organizations, and average more than 15 years of experience in the healthcare industry. We have first-hand knowledge of your challenges, and understand how to overcome competitive pressures, organizational obstacles, and limited resources. Our experience includes assisting 100+ health plans in nearly all 50 states on diverse projects that range from complex, multi-year enterprise implementations to concise, efficient assessments or market inquiries.

The administrative burden of auditing health plans is shifting from CMS to the National Committee for Quality Assurance (NCQA), as more and more states are requiring Medicaid plans to obtain NCQA accreditation. This process is complex and time-consuming, particularly for health plans with limited resources.

In this case study, learn how one health plan engaged third-party healthcare consultants to help it attain reaccreditation during the pandemic. After assessing the plan’s current documentation against NCQA regulations, the team identified additional projects which met NCQA standards, helping the health plan achieve NCQA Health Plan Accreditation for all three of its lines of business.

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