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Healthcare Plan Information

Plan Accreditation

Accreditation is an approval by a private, independent organization. This approval is given after a nationally recognized organization carefully reviews a health plan and decides if it meets the organization's quality 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 it's accreditation status and the accrediting organization.

In addition, plans have their provider directories to note provider credentialing. Provider means a plan's provider network has met standards to ensure that the participating providers are qualified and licensed. Through credentially, an independent accrediting organization checks the policies, procedures, and practices used by a network to verify the education, training, liability record, work history and practice history of providers.


The National Committee for Quality Assurance (NCQA)

The National Committee for Quality Assurance is a private, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans. They are governed by a Board of Directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers, and representatives from organized medicine. NCQAs mission is to provide information that enables purchasers and consumers of managed health care to distinguish among plans based on quality, thereby allowing them to make more informed health care purchasing decisions.

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

Commendable: Meets or exceeds NCQA's requirements for consumer protection and quality improvement.

Accredited: Meets most of NCQA's requirements for consumer protection and quality improvement.

Provisional: Meets some but not all of NCQA's requirements for consumer protection and quality improvement.

Denied: NCQA denies Accreditation to organizations whose programs for service and clinical quality do not meet NCQA requirements during the Accreditation survey.


URAC

URAC, an independent, nonprofit organization, promotes health care quality through its accreditation, education and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.

Full Accreditation: demonstrates full compliance with standards.

Conditional Accreditation: Accredited with 3-6 month follow up to ensure full compliance.

Corrective Action Status: Not accredited with 3-6 month follow up.

Denial: Organization has not received URAC accreditation.

Provisional Accreditation: Awarded to start-up organizations with 6 month follow up.

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