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NCQA Update - 2014. National Credentialing Forum February 6, 2014. Exchanges. Federally-Facilitated Exchanges: Requirements Phase in. HPA 2013 - 2014 Evaluation Options. What is an Evaluation Option?. An Evaluation Option is defined by its distinct combination of:

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Ncqa update 2014

NCQA Update - 2014

National Credentialing Forum

February 6, 2014




Hpa 2013 2014 evaluation options
HPA 2013 - 2014Evaluation Options


What is an evaluation option
What is an Evaluation Option?

  • An Evaluation Option is defined by its distinct combination of:

    • Requirements (standards and measures)

    • Scoring

    • Statuses

    • Length of accreditation




So what s happened
So what’s happened

  • NCQA has accredited XXX Exchanges

  • Were accredited under the Interim standards or as an “Add-on” to currently accredited plans

  • Those with Interim status will be coming through First Evaluation Option at the end of December 2014 and 2015.



Cr 3 credentialing verification
CR 3: Credentialing Verification

  • Added

    • Factor 4: Verification of board certification status, if applicable.

  • Documentation

    • No new requirements

  • Rationale

    • Allows separate verification of boards that cannot be used to meet E & T requirement.

    • Allows for verification of certification for recertification.


Possible change in 2016
Possible Change in 2016

  • Adding the following for Exchanges

    • Essential Community Providers (ECP)

      • Providers with experience caring for medically underserved populations.

      • Include community health clinics, Ryan White HIV/AIDS providers, Family Planning Providers (Title X Family Planning Clinics), Indian Providers and safety-net hospitals (hospitals that receive disproportionate Share Hospital funding), STD Clinics, TB Clinics, Hemophilia Treatment Centers, Black Lung Clinics.

      • Go to https://data.cms.gov/dataset/Non-Exhaustive-List-of-Essential-Community-Provide/ibqy-mswq for a full list.


Possible change in 20161
Possible Change in 2016

  • Adding the following for Exchanges

    • Children’s Dental Services

      • Currently only oral surgeons are included in NCQA credentialing requirements.

      • May need to add dentists who treat children in future.


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