Utilization Management/Credentialing/Provider Network (UM/CR/PN)

NCQA Utilization Management Accreditation provides a framework for implementing industry best practices to ensure fair and timely utilization evaluations using objective, evidence-based criteria, collection and use of relevant clinical information to make utilization management decisions, as well as ensuring qualified health professionals assess requests and make utilization management decisions and alignment with state requirements.

NCQA Credentialing Accreditation focuses on consumer protection and customer service improvement. It provides a framework for organizations to implement industry best practices that help them accurately and efficiently credential and recredential health care professionals.

NCQA Provider Network Accreditation helps organizations maintain a high-quality network for members and clients by ensuring organizations ensure appropriate client agreements, verify credentials, protect credentialing information, ensure credentials peer review process, evaluate contracted provider quality, monitor sanctions and complaints, use objective evidence, maintain adequate network, provide access to appointments, facilitate the continuity and coordination of care, and provide physician directories.

     


Looking for the Application Packet for This Product?

The application process for Accreditation, Certification and Distinction is now managed through My.NCQA. Please see the Online Application User’s Guide for more information on the new application and scheduling process.


 

9 Item(s)

Set Descending Direction
  1. 2019 UM/CR/Provider Network Survey Tool (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  2. 2018 UM/CR/Provider Network Survey Tool (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  3. 2017 UM/CR Survey Tool (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  4. 2019 UM/CR/Provider Network Standards and Guidelines (epub)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  5. 2018 UM/CR/Provider Network Standards and Guidelines (epub)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  6. 2017 UM/CR Standards and Guidelines (epub)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  7. 2019 UM/CR/Provider Network Standards and Guidelines (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  8. 2018 UM/CR/Provider Network Standards and Guidelines (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.
  9. 2017 UM/CR Standards and Guidelines (web-based)

    Please click the link below for pricing information for this product.
    Click here for pricing by user level.

9 Item(s)

Set Descending Direction