MVP Consulting GroupLong Beach, California, USA
- What they do
- Compliance consulting
- Who they help
- Its website offers consulting for NCQA, HIPAA, AAAASF, AAAHC, CARF and more.
- Standards
- Pricing
- Not published
NCQA
The National Committee for Quality Assurance is a private nonprofit that accredits and certifies health plans and other managed care organizations and runs the HEDIS measure set.
Its flagship Health Plan Accreditation evaluates a plan against standards in quality improvement, population health management, network management, utilization management, credentialing and recredentialing, and member experience, with additional Medicaid modules, and combines that review with HEDIS and CAHPS results.
Many state Medicaid programs, employers, and the Marketplace require or reward NCQA accreditation, and NCQA's Health Equity, Utilization Management, Credentialing, and Patient-Centered Medical Home programs use the same evidence model.
NCQA is a documentation-heavy accreditor. For most standards a plan must show a written policy or procedure that addresses each required element, then reports or materials that show the process operated, and then a file review sample.
Plans submit all of this through NCQA's survey tool before the review; surveyors validate on site or virtually and a review oversight committee makes the decision.
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Who has to comply
Voluntary, but effectively required for commercial, Medicaid, and Marketplace plans in many states and for Medicare Advantage plans seeking deemed status for certain CMS requirements. Also used by managed behavioral health organizations, credentialing verification organizations, utilization management firms, and provider practices under other NCQA programs.
What the assessor asks to see
For each standard, surveyors ask for the written policy or procedure, then the documented process and reports showing the activity occurred during the look-back period, then files for review (for example credentialing files, utilization management denial files, appeal files, and complaint files).
They also review the quality improvement program description and annual evaluation, the population health management strategy, network adequacy analyses, delegation agreements and oversight audits, member rights materials, and HEDIS audit results.
Where the requirement sits: NCQA evidence types: documented process, reports, materials, records/files (health plan, PCMH, CVO programs)
Every internal policy in one place
AllyMatter is a full system for every internal policy your company keeps, including the ones NCQA turns on. Build the whole library in one place, across every department, and prove who has read what.
Start here
Health Care Compliance Program Policies and Code of Conduct: who needs it, what goes in it, how often it is reviewed and who signs it off. Run exactly that in AllyMatter, alongside every other policy your company keeps.
How it works
Every document is approved by someone other than its author, versioned, distributed to the people it covers and acknowledged by name. Sign it where a signature is what the standard wants, send a set out together as a package, and export a dated record of who read which version when an assessor asks.
The written policies this standard turns on live here, with every version and every acknowledgment on the record.
Who helps with NCQA
A specialized consultant market of former NCQA surveyors and managed care compliance firms that provide readiness assessments, policy writing, mock file reviews, and survey tool submission support. Engagements often span a full three-year cycle with a heavy push in the twelve months before survey.
Firms that name this framework in their own material. A listing is not a recommendation. Each firm can confirm its own.
Listed in random order, reshuffled each time the page loads. Firms that pay for a listing are shown at the top, labeled Sponsored.
Who assesses NCQA
NCQA surveyors (physician and administrative reviewers) conduct the review; NCQA's Review Oversight Committee determines the accreditation status. HEDIS data must be audited by an NCQA-licensed HEDIS compliance auditor. NCQA licenses HEDIS compliance audit organizations and trains its own surveyors.
Recognition comes from states, CMS, and purchasers.
Assessors
Be the first NCQA assessor listed here
This page is read by the organizations looking for someone to certify them.
Tools for NCQA
Tools that name this framework in their own material.
Grouped by type. Inside each group the order is random, reshuffled each time the page loads. AllyMatter, the publisher of this site, is always first.
AllyMatterPolicy management tool, the policy and acknowledgment layerPublisher of this siteRelated reading
- NCQA's 2025 Credentialing Standard ChangesDetails the biggest credentialing standard change in 20 years: shorter verification windows, monthly monitoring, and the policy edits each one forces.National Association Medical Staff Services
- Impact of NCQA Health Equity Accreditation on Medicaid Managed CareShows how states turn an NCQA accreditation into a Medicaid contract condition, and what plans have to evidence to hold it.ProspHire
Independent third-party explainers, chosen by hand. Not affiliated with this site and not paid placements. All links are nofollow.
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From the publisher
Run the Policy Side of NCQA in AllyMatter
Approve the policies NCQA asks for, keep every version, and record a named acknowledgment from each person who has to read them.
See how AllyMatter works ↗From $29/mo, 20 editors, unlimited staff