U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce
Insurance Services Programs
Federal Employees Health Benefits Program
FEHB Plan Accreditation
Accreditation is an approval by a private, independent organization. This approval is given after a nationally recognized organization carefully reviews a health plan and decides if it meets the organization's quality standards.
In our health plan listings we show the accreditations given to these plans by the following independent, private, not-for-profit organizations dedicated to measuring the quality of health care organizations.
In addition, plans have annoted their provider directories to note provider credentialing. Provider credentialing means a plan's provider network has met standards to ensure that the participating providers are qualified and licensed. Through credentially, an independent accrediting organization checks the policies, procedures, and practices used by a network to verify the education, training, liability record, work history and practice history of providers.
The Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)
The Joint Commission evaluates and accredits more than 17,000 health care organizations and programs in the United States. Since 1951, JCAHO has developed state-of-the-art, professionally based standards and evaluated the compliance of health care organizations against these benchmarks. Link to JCAHO Home Page.
Accreditation with Commendation — JCAHO's highest accreditation level, awarded to a plan that has demonstrated exemplary performance. This category will be discontinued in 2003. Valid for 3 years.
Accreditation without Recommendations - Demonstrates satisfactory compliance with JCAHO standards in all performance areas. Valid 3 years.
Accreditation with Recommendations — JCAHO accreditation status - Demonstrates satisfactory compliance with JCAHO standards in most performance areas. Valid for 3 years.
Provisional - Demonstrates satisfactory compliance with a subset of standards. Valid for 6 months until the plan is re-surveyed.
Conditional - Demonstrates the capability of achieving satisfactory compliance but has not done so.
The National Committee for Quality Assurance
(NCQA)
The National Committee for Quality Assurance is a private, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans. They are governed by a Board of Directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers, and representatives from organized medicine. NCQAs mission is to provide information that enables purchasers and consumers of managed health care to distinguish among plans based on quality, thereby allowing them to make more informed health care purchasing decisions.
Excellent — NCQA's highest accreditation status. Levels of service and clinical quality that meet or exceed NCQA's requirements for consumer protection and quality improvement AND achieve HEDIS results that are in the highest range of national or regional performance. Valid for 3 years.
Commendable — Meets or exceeds NCQA's requirements for consumer protection and quality improvement. Valid for 3 years.
Accredited — Meets most of NCQA's requirements for consumer protection and quality improvement. Valid for 3 years.
Provisional — Meets some but not all of NCQA's requirements for consumer protection and quality improvement. Valid for 3 years.
New health plan Accreditation — NCQA accreditation status - New health plans that have the structures and processes to monitor and improve patient care. Designed for plans less than 2 years old.
URAC
URAC is a nonprofit, charitable organization founded in 1990 by various stakeholders in the health care community. URAC's first mission was to improve the quality and accountability of health care organizations using utilization review services programs. In later years, URAC's mission expanded to cover a larger range of service functions found in various health care settings including the accreditation of integrated systems such as health plans to smaller organizations offering specialty services.
Accredited — Demonstrates full compliance with standards. Valid for 2 years.
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