Health plans that are listed in the Health Plan Report Card have achieved NCQA Accreditation. NCQA uses a team of trained health care experts—including physicians—to conduct a rigorous, on-site and off-site review of the health plan. These expert surveyors evaluate the health plan’s structure and operations against NCQA’s standards that address such things as patient safety, communication with members and other important areas of service. No one affiliated with the health plan is part of the review team or involved in making the accreditation decision.
Health plans seeking NCQA Accreditation must submit information about the quality of the care they provide to members. NCQA uses a measurement system called the Healthcare Effectiveness Data and Information Set (HEDIS), a set of precise clinical performance measures that makes it possible to compare performance across plans.
NCQA evaluates how well an organization performs on required HEDIS measures. To be accredited, NCQA reviews performance on standards and measures for each plan.
View more information about Accreditation and HEDIS.