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Healthcare & Insurance Healthcare

Plan Accreditation

A health plan's accreditation status provides an impartial opinion about its quality. An impartial organization accredits a health plan when it determines that the health plan's practices meet national standards.

The following independent, private, not-for-profit organizations dedicated to measuring the quality of health care organizations accredit health plans in the FEHB Program. A health plan's brochure cover will show its accreditation status and the accrediting organization.

Examples of Accrediting Organizations:

Accreditation Association for Ambulatory Health Care (AAAHC)

The Accreditation Association for Ambulatory Health Care (AAAHC) is a private, not-for-profit organization dedicated to improving health care quality and patient safety. AAAHC evaluates how health care is delivered through accreditation programs based on nationally recognized Standards and a unique peer-based review system. AAAHC Standards for health plans are reviewed annually by member organizations, resulting in accreditation criteria that reflect current best practices relevant to the full range of ambulatory health care settings.

The survey process is founded on a collaborative, consultative, educational approach to on-site review of each organization seeking accreditation.

Meets or exceeds AAAHC Standards in eight core chapters: Member Rights, Responsibilities, and Protections; Governance and Administration; Provider Network Credentialing; Case Management and Care Coordination; Quality Improvement and Management; Clinical Records and Health Information; Environment of Care and Safety; Health Education & Wellness Promotion. Relevant special services chapter for specifically focused health plans may also be included: Behavioral Health Services and Dental Services.
Fails to meet or exceed a percentage of AAAHC Standards for Health Plans, or fails to meet any of the Standards identified as "Must fully meet."

National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to assessing and reporting the quality of health plans. Employers, consumer and labor representatives, health plans, quality experts, policy makers, and representatives from organized medicine work together to provide information that enables purchasers and consumers to distinguish among plans based on quality. Their accreditation status helps consumers make more informed health care decision. The levels of accreditation are listed below:

NCQA's highest accreditation status. Levels of service and clinical quality meet or exceed NCQA's requirements for consumer protection and quality improvement AND achieve quality results that are in the highest range of national or regional performance.
Meets or exceeds NCQA's requirements for consumer protection and quality improvement.
Meets most of NCQA's requirements for consumer protection and quality improvement.

Utilization Review Accreditation Commission (URAC)

URAC, is an independent, nonprofit organization that promotes health care quality through its accreditation programs. URAC offers a wide range of quality programs and services that keep pace with the rapid changes in the health care system. URAC's accreditation assures a health plan's commitment to quality and accountability.

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