Accreditations

NCQA

HEALTH PLAN ACCREDITEDNCQA Accredited Health Plan Seal

Georgia Marketplace | Georgia Medicaid

Indiana Marketplace | Indiana Medicaid

Kentucky Marketplace

Michigan Medicaid | Michigan Medicare

North Carolina Marketplace

Ohio Marketplace | Ohio Medicaid

West Virginia Marketplace

Wisconsin Marketplace | Wisconsin Commercial

NCQA Health Plan Accreditation status is awarded for service and clinical quality that meet the basic requirements of NCQA’s rigorous standards for consumer protection and quality improvement while Interim is awarded for those organizations with basic structure in place that will need to undergo a new review within 18 months to demonstrate they have executed those processes effectively.

NCQA evaluates the quality of health care that health plans provide to their members and how well a health plan manages all parts of its delivery system — physicians, hospitals, other providers and administrative services — in order to continuously improve the quality of care and services provided to its members.

NCQA Health Plan Accreditation includes rigorous on-site and off-site evaluations of over 60 standards and selected HEDIS® measures. A team of physicians and health plan experts conduct accreditation surveys. A national oversight committee of physicians analyzes the team’s findings and assigns an accreditation level based on the performance of each plan being evaluated to NCQA’s standards. A trained team of health care experts, including physicians, conduct a rigorous on-site survey of the health plan. NCQA uses information from health plan records, consumer surveys, interviews with plan staff and performance on selected HEDIS® measures.

NCQA HEALTH EQUITY ACCREDITATION94 Health Equity Accreditation rgb

Georgia Medicaid

Indiana Medicaid

Ohio Medicaid

Ohio Medicaid

Health Equity Accreditation is awarded to CareSource because we focus on the foundation of health equity work: building an internal culture that supports the organization’s external health equity work; collecting data that help the us create and offer language services and provider networks mindful of individuals’ cultural and linguistic needs; identifying opportunities to reduce health inequities and improve care.

Improving health equity requires engagement and partnerships across the entire health care industry, as well as with industry stakeholders such as employers, regulators and community-based organizations. NCQA’s Health Equity Accreditation provides an actionable framework for helping health systems continuously improve—and prioritize—health equity for the members and communities we serve.  

NCQA LONG-TERM SERVICES AND SUPPORTS (LTSS) DESTINCTIONNCQA Distinction Seal

Michigan Medicaid | Michigan Medicare

Ohio Medicaid

NCQA’s LTSS Distinction is awarded to CareSource because we have the capability to coordinate LTSS services. LTSS Program standards help us meet state needs, close quality gaps and support the best care, regardless of setting. We earned accreditation

  • We are more efficient. A focus on coordinated care, training and measurement helps us reduce errors and duplicated services.
  • We integrate care better. Standards help us improve communication between individuals, caregivers, providers, payers and other organizations that coordinate care.
  • We provide person-centered care. Standards focus on person-centered services, which can lead to better care planning and monitoring.
  • We support contracting needs. Standards align with federal requirements for states. CareSource is an NCQA-Accredited organization that demonstrates that we are a trusted partner in coordinating LTSS services.

NCQA Utilization Management Accreditation54 Accred UM CMYK

Utilization Management Accreditation is awarded to CareSource because of our framework for implementing industry best practices to ensure:

  • Fair and timely utilization evaluations using objective, evidence-based criteria:
    • Collection and use of relevant clinical information to make utilization management decisions.
    • Qualified health professionals assess requests and make utilization management decisions.
  • Alignment with state requirements.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.