NCQA Health Plan Accreditation Consulting
Cost statements revised October 2026.
NCQA Health Plan Accreditation is a program of the National Committee for Quality Assurance (NCQA) that evaluates a health plan against standards for quality, member protection and operations, and Integral Healthcare Solutions (IHS) prepares commercial, Medicaid managed care, Medicare Advantage and Marketplace plans for it with a Standard-by-Standard Review, drafted policies, a mock file review and readiness support.
IHS was founded in February 2002 by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. Maureen Plumstead leads NCQA accreditation engagements. Dr. Goddard leads program development built to NCQA standards. IHS drafts the policies and program documents for your clinical and quality leaders to review and approve, and your organization's named contact submits the application.
What does NCQA Health Plan Accreditation evaluate?
NCQA describes Health Plan Accreditation as a framework that combines clinical performance data with member feedback to evaluate health plans, across eight standard areas: Quality Management and Improvement, Population Health Management, Network Management, Utilization Management, Credentialing and Recredentialing, Members' Rights and Responsibilities, Member Connections, and Medicaid Benefits and Services (NCQA, Health Plan Accreditation, page opened October 4, 2026).
NCQA sells a Survey Readiness Package for each survey year. The 2026 package covers surveys starting July 1, 2026 to June 30, 2027, and the 2027 package covers surveys starting July 1, 2027 to June 30, 2028 (NCQA store, 2026 package and NCQA store, 2027 package, pages opened October 4, 2026). Buy the standards edition that matches your survey start date.
Who needs NCQA Health Plan Accreditation?
Whether a health plan needs NCQA accreditation depends on the contracts and rules that govern it, so read them first. Plans that pursue it include:
- Commercial health plans (HMOs, PPOs, POS and EPO products)
- Medicaid managed care organizations, where the state Medicaid contract names what it accepts
- Medicare Advantage plans
- ACA Marketplace plans, where marketplace and issuer rules apply
- Self-insured employer plans and third-party administrators demonstrating quality to employer clients
- Delegated subcontractors of health plans, where the health plan's delegation agreement sets the requirement
- Provider-sponsored networks and integrated delivery systems entering managed care markets
IHS does not rely on a general statement about which states require NCQA. Your state Medicaid contract and payer contracts are the source, and IHS reads them with you during the Standard-by-Standard Review.
How long does NCQA health plan accreditation take, and what does IHS deliver in each phase?
IHS plans for 12 to 15 months from the start of readiness work to a survey-ready plan, and the NCQA decision follows the survey. That is an IHS planning range, not an NCQA figure. The month ranges below are IHS planning ranges.
| Phase | IHS planning range | What IHS delivers |
|---|---|---|
| 1. Standard-by-Standard Review | Months 1-2 | An educational review of the current standards with your staff, element by element, and a prioritized remediation roadmap |
| 2. Document preparation and committee activation | Months 3-6 | Policy templates across the standard areas, committee charter templates for the QI, UM and credentialing committees, and meeting minute templates so records begin to exist early. The standards you buy state the evidence period that applies to your survey |
| 3. File preparation and mock file reviews | Months 7-9 | Mock file reviews of complex case management, credentialing and clinical appeals files, and a check that staff practice matches the new policies. Your analytics team handles HEDIS data validation and your survey vendor handles CAHPS administration, and IHS coordinates with them |
| 4. Application and evidence preparation | Month 10 | IHS drafts the application text and organizes the highlighted, bookmarked evidence that your organization uploads to NCQA's Interactive Review Tool (IRT). Your named contact submits |
| 5. Survey preparation | Months 11-12 | Mock interview sessions for the directors and executives who may speak with surveyors, built around their own standard areas |
| 6. Decision | After the survey | NCQA scores the survey and its review committee decides. IHS supports any response your organization prepares |
What internal staffing does accreditation need?
Accreditation is not a project for one compliance officer. Plan for executive sponsorship from the CMO and COO, a quality or health equity director accountable for the plan's NCQA work, directors of utilization management, behavioral health and network management who can explain their standard areas to surveyors, and a data and analytics team for HEDIS extraction, CAHPS coordination and QI reporting. These are IHS planning expectations. IHS supplements your team's capacity so your staff builds the competence to maintain accreditation after the engagement.
What does NCQA health plan accreditation cost?
The cost has four parts: NCQA's fees, data reporting vendor costs, consulting fees, and your own staff time. NCQA sells the Health Plan Accreditation Survey Readiness Package through the NCQA store and offers a survey tool as an add-on; NCQA's Health Plan Accreditation page links to the store and offers a way to contact an NCQA representative, and shows no fee amounts. IHS does not restate NCQA prices here because NCQA sets and changes them. Verify current fees with NCQA.
IHS sets a fixed fee for each engagement after a free discovery session, because scope, number of sites and gap severity change the work. Plan for internal time as well: executives, quality, utilization management, data analysts and credentialing staff. For the cost drivers by plan type, see the NCQA health plan accreditation cost guide.
Where does IHS look for gaps before an NCQA health plan survey?
These are the areas an IHS Standard-by-Standard Review checks before submission. They are IHS's review focus, not a list of NCQA findings.
- Documentation continuity: policies that exist on paper but have no consecutive record of operating. IHS starts committee activity early and tracks continuity.
- Delegation oversight: delegated functions at behavioral health organizations, PBMs or CVOs without audit schedules and committee review. IHS builds oversight calendars.
- Committee analysis: reports that pass raw data to a committee without analysis or linked interventions. IHS provides templates that call for analytical narrative.
- Denial notices: letters that do not state the clinical rationale and the member's appeal rights. IHS audits denial letter templates against federal and state requirements.
- Utilization management criteria: unclear documentation of how criteria are developed, updated and shared with practitioners.
- Committee calendars: meetings that miss their review cycles.
- Case management files: files that do not show risk stratification and integrated care plans.
- Network adequacy methodology: geographic access analysis without a documented and validated method.
- HEDIS improvement planning: weak measures without a place in the QI committee's work.
How does IHS help with NCQA health plan accreditation?
The IHS process covers standards acquisition, a Standard-by-Standard Review, document and evidence mapping, mock file reviews against the governing standards, and readiness support. IHS drafts the policies and program documents for your clinicians to review and approve. IHS also prepares organizations for URAC accreditation, and for plans weighing both programs it offers a comparison. See the NCQA and URAC health plan comparison.
Your organization supplies its leaders, records and data, buys the NCQA standards, and submits through its named contact. IHS helps plans select HEDIS audit and CAHPS vendors and build data submission processes, but your organization contracts with them.
What this is not
- IHS is not NCQA, is not an accrediting body, and does not grant or influence an accreditation decision or a rating.
- IHS drafts the text and your organization's named contact submits it to NCQA.
- This page is not legal advice, and no consultant can guarantee an accreditation outcome.
Frequently asked questions
What is NCQA health plan accreditation?
NCQA Health Plan Accreditation is a program of the National Committee for Quality Assurance that evaluates health plans across eight standard areas, including Quality Management and Improvement, Population Health Management, Network Management, Utilization Management, Credentialing and Recredentialing, and Medicaid Benefits and Services (NCQA, Health Plan Accreditation, page opened October 4, 2026).
Which plans must be NCQA accredited?
That depends on the contracts and rules that govern the plan, including the state Medicaid contract, marketplace and issuer rules, and delegation agreements. Read the contract language that applies to you. IHS reviews it with you during the Standard-by-Standard Review.
How long does NCQA health plan accreditation take?
IHS plans for 12 to 15 months from the start of readiness work to a survey-ready plan, and that is an IHS planning range. The timeline includes time for committees to operate under the new policies and produce records before the survey.
How much does NCQA health plan accreditation cost?
NCQA sells the Health Plan Accreditation Survey Readiness Package through the NCQA store and offers a survey tool as an add-on (see NCQA Health Plan Accreditation). IHS does not restate NCQA prices here because NCQA sets and changes them; check the NCQA store. Verify current fees with NCQA. IHS sets a fixed fee for each engagement after a free discovery session.
What is the difference between NCQA and URAC?
NCQA and URAC are separate accrediting bodies with separate standards and surveys, and the accreditor your state rule or payer contract names drives the choice. Some organizations pursue both. See the full comparison.
What does an NCQA accreditation consultant do?
An NCQA accreditation consultant reviews the plan against the current standards, drafts policies, sets up committee structures and minutes, prepares the evidence the plan uploads to the IRT, runs mock file reviews, and prepares staff for survey interviews. Maureen Plumstead leads IHS's NCQA accreditation engagements.
Where can I find NCQA health plan ratings?
On NCQA's Health Plan Ratings page, which links a separate page for each Ratings year it lists. A rating draws on three inputs: clinical quality results (HEDIS), member experience survey results (CAHPS) and whether the plan holds NCQA Accreditation. NCQA rates commercial, Medicare and Medicaid plans this way, and the Report Cards also list Exchange plans (NCQA, Health Plan Ratings, page opened October 3, 2026). Each Ratings year has its own measure list and methodology that state which data years went into it, so check the year before relying on a rating.
What is CAHPS, and how does NCQA use it?
CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, a survey program of the federal Agency for Healthcare Research and Quality (AHRQ). Its Health Plan Survey asks enrollees about their experience with their health plan. AHRQ says NCQA asks every plan seeking accreditation or reporting HEDIS measures publicly to submit results from a modified version of the survey, marked with an H after the version number, such as CAHPS 5.1H (AHRQ, CAHPS Health Plan Survey, page opened October 3, 2026). CMS also runs the survey for Medicare Advantage and Prescription Drug Plans.
How does NCQA address population health management?
In two places. Population Health Management is one of the standard categories NCQA lists for Health Plan Accreditation (NCQA, Health Plan Accreditation, page opened October 3, 2026). NCQA also runs a separate program, Population Health Program Accreditation, which looks at areas such as data integration, population segmentation and targeted interventions. NCQA says a plan seeking Accreditation can receive credit for some of its own population health management requirements through an organization that holds this program's accreditation (NCQA, Population Health Program Accreditation, page opened October 3, 2026).
Who is this not for?
This service is not for a plan that has no accreditation requirement in its contracts and wants no readiness work, or for one that wants software or a law firm's opinion. It is for health plans that need NCQA-ready policies, committee records and files before they submit.
Related pages
See NCQA and URAC health plan comparison, cost guide, NCQA credentialing accreditation and Accreditation Consulting.
Ready to prepare for NCQA Health Plan Accreditation?
Schedule a conversation with IHS. We will assess your current posture against NCQA's standards and outline a roadmap, with Maureen Plumstead leading NCQA accreditation work.