Which two organizations are named together as accreditation bodies for Managed Care Organizations (MCOs)?

Which two organizations are named together as accreditation bodies for Managed Care Organizations (MCOs)?

• A. NCQA - URAC
• B. TJC - DNV
• C. HFAP - NCQA
• D. URAC - HFAP

Answer: (A)

Accreditation for managed care organizations hinges on independent bodies that set standards for quality, access, and performance. The two organizations most commonly named for accrediting MCOs are the National Committee for Quality Assurance (NCQA) and URAC (Utilization Review Accreditation Commission). NCQA’s MCO standards assess network adequacy, quality improvement, member access, utilization management, medication management, and performance measurement through HEDIS and consumer surveys. URAC’s accreditation emphasizes governance and accountability, patient safety, privacy and information security, member rights and responsibilities, and ongoing quality improvement. Other accreditors like The Joint Commission and DNV focus more on hospitals and provider organizations, while HFAP is more facility-oriented, so NCQA and URAC are the pair most closely associated with accrediting managed care organizations. Some plans pursue both to demonstrate broad commitment to quality and consumer protection.

Accreditation for managed care organizations hinges on independent bodies that set standards for quality, access, and performance. The two organizations most commonly named for accrediting MCOs are the National Committee for Quality Assurance (NCQA) and URAC (Utilization Review Accreditation Commission). NCQA’s MCO standards assess network adequacy, quality improvement, member access, utilization management, medication management, and performance measurement through HEDIS and consumer surveys. URAC’s accreditation emphasizes governance and accountability, patient safety, privacy and information security, member rights and responsibilities, and ongoing quality improvement. Other accreditors like The Joint Commission and DNV focus more on hospitals and provider organizations, while HFAP is more facility-oriented, so NCQA and URAC are the pair most closely associated with accrediting managed care organizations. Some plans pursue both to demonstrate broad commitment to quality and consumer protection.