We refer to a health plan as having been accredited when a private organization deems the health plan nationally recognized for meeting a certain level of quality standards. The national organization has a standard of quality which a health plan must meet. If the health plan meets these standards, it gives an approval. The aforementioned private organization than deems it worthy of accreditation. Furthermore, provider directories are to provide credentialing for the health plans. In addition, the providers of a network must be both licensed and qualified. Employees of the provider and its network must have the relevant licensing, education and so on.
Here is an example of a health plan accreditation organization. This particular organization is NCQA Health Plan Accreditation:
NCQA Health Plan Accreditation is built on two decades of experience. Our commitment to comprehensive research and dedication to quality has helped improve the managed care experience for health plans, patients, care providers and employers. Recognizing hundreds of plans that cover more than 107 million Americans, NCQA is the most widely-recognized accreditation program in the United States. Our experience and prominence have allowed us to build flexible, yet rigorous standards that apply to all types of health plans, including HMOs, PPOs and POS plans.
Health Plan (HP) Accreditation for Plans Participating In Health Insurance Exchange Marketplaces
The Department of Health and Human Services (HHS) nominated NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplaces. NCQA’s Health Plan Accreditation (HPA) contains all the key elements the law requires.