October 22, 2018

Utilization Management/Credentialing Certification

February 2015

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The National Committee for Quality Assurance's (NCQA) Certification in Utilization Management/Credentialing is available to a variety of organizations that perform Credentialing and/or Utilization Management Services.

Integrated Health Partners received its first NCQA Certification in Utilization Management/Credentialing in 1999 and has remained certified ever since. In November, Integrated Health Partners had a scheduled audit with NCQA for recertification purposes. 

The recertification process requires IHP to pull 40 credentialing charts and 40 utilization management charts for review. A minimum of eight from each category must be reviewed for accuracy. If an element is missing, then all of the charts from that category will be reviewed for accuracy.  

This year, like many previous years, only the minimum number of charts from each category were reviewed. We are pleased to announce that IHP passed and is now Certified by NCQA in Utilization Management/Credentialing through December 10, 2016. Below is more information regarding the certification from NCQA.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferrred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.

NCQA’s Certification in Utilization Management/Credentialing is available to a variety of organizations that perform Credentialing (CR) and/or Utilization Management (UM) Services.  The standards represent a merger of the POC (Physician Organization Certification) and OC (Organization Certification) products into a single set of standards designed for organizations that provide full scope CR or UM services or both. NCQA Certification provides these organizations the opportunity to demonstrate the quality of their UM and CR programs.

NCQA‘s Certification review includes a rigorous on- and off-site evaluation conducted by a team of physicians and managed care experts. A review oversight committee of physicians analyzes the team's findings and assigns a certification status based on the organization’s performance against standards within applicable certification options. 
 

In-Depth Program Information

Certification Statuses an Organization Can Achieve 

UM/CR Program Evaluation Options

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