National Committee for Quality Assurance

Home » Resources » Dictionary » Terms

Definition - What does National Committee for Quality Assurance mean?

The National Committee for Quality Assurance (NCQA) is a private non-profit organization focused on health care quality assurance. Over many years, NCQA has developed comprehensive standards for a number of different types of health care organizations. Health care providers may be accredited or certified by the NCQA if they meet these standards. In addition to these reviews, NCQA also provides research, training, consumer education and other services related to the performance and provision of health care services. There is no law requiring healthcare providers to be NCQA certified and no Federal oversight of the accreditation rules but it has still become a benchmark of quality used by a number of organizations.

SureHire explains National Committee for Quality Assurance

The NCQA plays a key role in evaluating the quality of health care plans. NCQA accredited providers are scored using a report card that employers and other interested parties can use to compare available health care plan providers. When evaluating health related organizations, the National Committee for Quality Assurance examines an organization's ability to provide efficient and appropriate care. Currently, NCQA has over 1,500 that health insurance providers must meet in order to qualify for accreditation. During the review process, NCQA conducts on-site audits and off-site surveys. The five primary areas of review for health care plan providers under NCQA standards are quality management and improvement, utilization management, credentialing and re-credentialing, members' rights and responsibilities, and member connections.

In addition to health care plans, NCQA also offers reviews of individual clinicians, accountable care organizations, disease management organizations, and other healthcare services related entities.

Subscribe to SureNews!

Get your Reasonable Suspicion Checklist! Join our community and get access to more resources like this! Emails are sent monthly, so no need to worry, we will not fill up your inbox.