National Committee for Quality Assurance Standards

The National Committee for Quality Assurance (NCQA) regularly updates and maintains quality standards utilized by the health insurance industry to gauge levels of ongoing quality and improvement. Health Plans are surveyed on a three-year cycle that includes an audit of on-going NCQA activities conducted throughout each year. NCQA Health Plan Accreditation survey include rigorous on-site and off-site evaluations. Below is a summary of the six quality standard categories 蓝十字数控 follows per NCQA's Guidelines and Standards for the Accreditation of Health Plans.1 These categories are central to 蓝十字数控's Quality Improvement Program designed to improve quality, 安全, 和成员的经验.

质量管理与改进(QI)

Implementing corrective actions based on assessment results, aimed at addressing identified deficiencies and improving outcome.1

利用管理(嗯)

Evaluating and determining coverage for and appropriateness of medical care services, as well as providing needed assistance to clinician or patient, 与其他各方合作, 确保资源的合理使用.1

认证和再认证(CR)

A process by which an infoanization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members.1

成员的经验(我)

A process by which the infoanization provides members with access to health care information and tools to better manage their health. Communicating information to member's that specifies their rights and responsibilities related to a mutually respectful relationship with the infoanization, 处理投诉及上诉, 福利和获得医疗服务的机会, 选择医生和医院, 他们的隐私和保密, 和准确的覆盖材料.1

人口365体育彩票app管理(PHM)

Addressing the care needs of the infoanization's membership population across the continuum of care.1

网络管理(净)

The process by which an infoanization works to maintain an adequate network of health care practitioners and providers to meet the needs and preferences of its membership.1

Consumers can easily access infoanizations' NCQA statuses and other information on health care quality on NCQA's website at www.ncqa.info, or by calling NCQA Customer Support at (888) 275-7585.2 If you have any questions related to 蓝十字数控's NCQA Quality Improvement Program, please contact your regional Strategic Provider Relations Consultant.


1 National Committee for Quality Assurance, (2020). 2021 Standards and Guidelines for the Accreditation of Health Plans. 华盛顿特区.C.:  © 2020 by the National Committee for Quality Assurance.
2 National Committee for Quality Assurance, (2020, Sept 9). Advertising and Marketing Guidelines Health Plan Accreditation. 从检索 NCQA HPR Advertising and Marketing Guidelines.