Accreditation Services

Want to be Survey Ready? We’re Ready to Help With Accredation Services!

Competition for Medicaid managed care contracts and consolidation within the market have intensified. In response, states are relying more on independent measures of health plan quality to compare, rate, and score various Medicaid managed care organizations (MCOs).

Accreditation Services from the National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC) and URAC, along with more targeted distinctions, can set plans apart from the crowd.

Accreditation ratings can make a significant difference in determining whether an MCO is awarded or retains a contract. HMA’s accreditation experts work alongside commercial, Medicare and Medicaid health plans to prepare for the accreditation process. Their insights and in-depth knowledge of the accreditation process give MCOs an edge that leads to better accreditation ratings – and more business.

What We Do

Our experts understand the accreditation needs of health plans and other healthcare entities – and we know the requirements inside and out. We use our industry-leading Survey Ready approach to help clients obtain accreditation and implement transformational change to ensure their organization is survey ready every day.

We believe accreditation standards represent how an organization should do business on a daily ongoing basis and should be a part of every employee’s job description. This creates a culture of quality that will substantially lower costs, both in dollars and personnel expenses, while improving care for members.

In addition to these benefits, HMA knows that accreditation is a valuable tool MCOs can leverage for greater strength and success. From determining the right accreditation for your organization to achieving a successful outcome, our experts are with you every step of the way.

Choosing a Path to Accreditation

Our team of accreditation experts will work side by side with your team whether you are seeking NCQA, AAAHC or URAC accreditation, or other certifications or distinctions. By utilizing our Survey Ready Model, we can tailor an approach to meet your specific needs, ensuring that your organization maintains a survey-ready status year-round.

Our experts have extensive experience supporting clients with:

  • Overall NCQA plan accreditation, including Long-Term Services and Supports (LTSS) accreditation and the NCQA Distinction in Multicultural Health Care
  • AAAHC accreditation for health plans, Qualified Health Plans (QHPs), and the Federal Employees Health Benefits (FEHB) program
  • URAC accreditation for dental plans, Medicaid or Medicare health plans, and Pharmacy Benefit Management Plans (PBM)

Accreditation Support Services:

  • Interim or initial accreditation support for first-time applicants
  • Maintenance for re-accreditation, cycle-based accreditation status
  • Review, evaluation and strategy development for provisional accreditation status
  • Annual mock audits and file reviews, including scoring
  • Assistance in designing a Survey Ready Model
  • Healthcare Effectiveness Data and Information Set (HEDIS) strategy development
  • Operational and documentation support to create and update documented processes, materials, and reports for accreditation submission
  • Implementation of multi-state corporate health plan models into a “Single Entity, Multiple Site” model that uses corporate policies for all state health plans to reduce the staff hours and documents needed to update each state location
  • Identification of potential accreditation score improvement for standards, HEDIS, and Consumer Assessment of Healthcare Providers and Systems (CAHPS)
  • HEDIS roadmap review and development for submission

Training Opportunities

  • Annual training for new standards and/or measures
  • Detailed training on how to set up and maintain a Survey Ready Model
  • Semi-annual sessions outlining changes in accrediting body standards to ensure each business area is well versed in new requirements
  • Workshops that develop a population health management strategy and implementation approach
  • Staff training to reduce findings from the mock file audits prior to the required accreditation look-back period

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