NCQA Standards definition

NCQA Standards. “NCQA Standards” means certain National Committee for Quality Assurance (“NCQA”) standards and guidelines applicable to CHPW and/or the Services, published by NCQA and modified from time to time
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Examples of NCQA Standards in a sentence

  • Contractor shall implement the NCQA Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards).

  • The Contractor must adhere to all requirements based on the most current version of NCQA Standards and Guidelines for the Accreditation of MCOs. The standards categories include: Quality Management and Improvement, Standards for Utilization Management, Standards for Credentialing and Recredentialing, Standards for Members’ Rights and Responsibilities, Healthcare Effectiveness Data and Information Set (HEDIS) measures required for credentialing (Medicaid products), and CAHPS survey.

  • Credentialing Policies and Procedures Delegated Full Compliance with NCQA Standards: • Identify scope • Define criteria and verification of criteria • Describe decision making process, including how advice is received from participating practitioners • Describe extent of any delegated credentialing/recredentialing arrangements • Describe right of practitioner to review information.

  • Initial office site visit and medical record keeping practice review of all PCPs, OB/GYNs, and High Volume Behavioral Healthcare practitioners ý Delegated o Not delegated Full compliance with NCQA Standards regarding Initial site visit/medical record keeping review prior to the Committee approval date.

  • Credentialing Policies and Procedures Delegated or Not Delegated Full Compliance with NCQA Standards: • Identify scope • Define criteria and verification of criteria • Describe decision making process, including how advice is received from participating practitioners • Describe extent of any delegated credentialing/recredentialing arrangements • Describe right of practitioner to review information.

  • Organization further agrees to provide only true, accurate and complete information to NCQA and that submission of any Falsified Document or Fraudulent Information (defined below) used to evaluate compliance with NCQA Standards and Guidelines may be grounds for suspension, denial or revocation of accreditation.

  • National Practitioner Data Base (NPDB) Information/Initial Sanction Information ý Delegated o Not delegated Full compliance with NCQA Standards regarding verification of information within 180 days of Committee Approval date • Information from NPDB • Sanction or Limitations information on licensure, as appropriate, must cover the most recent 5 year period available through the data source.

  • Application/ Attestation Delegated Full compliance with NCQA Standards: The PMG/IPA application must include a statement regarding: • Reasons for any inability to perform.

  • CONTRACTOR shall comply with the most current version of the NCQA Standards and shall cooperate with and assist CHPW in demonstrating CHPW’s compliance with NCQA Standards.

  • Credentialing Program description and/or Policies and Procedures (P&Ps) ý Delegated o Not delegated Full Compliance with NCQA Standards: • Define the scope of practitioner network to be cred./recred., i.e. MD, DO, DPM, DDS, IX:, and behavioral health and other licensed independent practitioners.