NCQA PCSP Recognition: Frequently Asked Questions

What is NCQA PCSP Recognition?

NCQA Patient-Centered Specialty Practice (PCSP) Recognition is a credential for medical specialty practices that demonstrate excellence in coordinated, patient-centered specialty care with strong bidirectional communication with primary care providers. It extends the PCMH model into specialty settings and requires structured referral management, care coordination, team-based care, and quality improvement.

Maureen Plumstead leads IHS's NCQA accreditation work. Thomas G. Goddard, JD, PhD, leads program development to NCQA standards.

Who is eligible for NCQA PCSP Recognition?

Any medical specialty practice — cardiology, oncology, orthopedics, neurology, endocrinology, gastroenterology, and others. Eligible organizations include independent specialty practices, health system specialty practices, academic specialty practices, and multi-specialty groups that receive referrals from primary care and want to formalize care coordination infrastructure.

How does PCSP differ from PCMH?

PCMH is for primary care practices. PCSP is for specialty practices. PCSP specifically addresses how specialty practices coordinate with referring primary care — bidirectional communication, referral tracking, and returning patients to primary care after specialty episodes. Both share patient-centered care principles but apply them to different care delivery contexts.

What is the core requirement that distinguishes PCSP?

Bidirectional care coordination with primary care providers. Specialty practices must demonstrate structured, documented communication with referring clinicians — timely consultation findings, proactive referral tracking, urgent referral protocols, and processes for returning patients to primary care management. Sending a consultation note is not sufficient; the standard requires an ongoing, documented care coordination relationship.

How long does NCQA PCSP Recognition take?

Typically 9 to 12 months from enrollment through recognition decision. Practices should enroll in Q-PASS approximately 6 to 9 months before the target date. The process includes gap analysis, infrastructure development, documentation build, look-back period, mock review, and NCQA review.

What are the referral tracking requirements?

Practices must demonstrate systems for tracking inbound and outbound referrals — ensuring referrals are received, acted upon, and completed, and referring clinicians receive timely communication. The tracking system must be documented and consistently used, addressing referral leakage and communication failures as active care coordination obligations.

Does PCSP require quality measure reporting?

Yes. PCSP practices must maintain a QI program with specialty-appropriate quality measures, track performance, implement interventions, and document QI activities. Practices must also report on at least one driver of health outcome disparity — a requirement implemented for 2025 reporting.

Can a health system pursue both PCMH and PCSP Recognition?

Yes — they are complementary credentials demonstrating end-to-end patient-centered care coordination across the continuum. IHS consults on both programs and can coordinate recognition efforts across primary care and specialty sites within the same system.

Does PCSP Recognition help with value-based care contracts?

Yes. Specialty practices in ACOs, bundled payment programs, or specialty capitation arrangements benefit from PCSP's care coordination infrastructure for improving shared savings performance and demonstrating accountable care partnership compliance.

What does NCQA PCSP Recognition cost?

NCQA publishes fees based on practice size. Contact NCQA directly for current fee information. IHS consulting engagements are scoped per practice — contact IHS for a proposal.

How does IHS approach PCSP consulting?

IHS begins with a gap analysis, then designs referral management and PCP communication infrastructure, builds care plan and team documentation, develops the QI program, conducts a mock review, and supports Q-PASS submission. Maureen Plumstead leads IHS's NCQA recognition work. Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, leads program development to NCQA standards.

Where can I find NCQA's own answers to PCSP questions?

NCQA keeps a PCSP Recognition FAQ page. For other questions, NCQA refers readers to a larger question database and to My NCQA (NCQA, PCSP Recognition FAQs, page opened October 3, 2026). NCQA's FAQ Directory collects answers across its programs and can be filtered by program and year (NCQA, FAQ Directory, page opened October 3, 2026). NCQA also says it charges nothing for the PCSP standards and guidelines document, which it offers through its online store (NCQA, PCSP Recognition FAQs, page opened October 3, 2026).

Does NCQA prevalidate health IT for PCSP practices?

Yes. NCQA runs health IT prevalidation programs, and one is for software used by practices pursuing PCMH or PCSP Recognition. The areas NCQA lists for it include care coordination, access and communication, and performance measurement. Prevalidation is aimed at vendors, who use it to show how their product supports what NCQA evaluates (NCQA, Health Information Technology Prevalidation Programs, page opened October 3, 2026). NCQA's PCSP FAQ page says NCQA reviews the practice itself online during the evaluation (NCQA, PCSP Recognition FAQs, page opened October 3, 2026).