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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 their provider directories to note provider credentialing. Provider 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 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.

Commendable — Meets or exceeds NCQA's requirements for consumer protection and quality improvement.

Accredited — Meets most of NCQA's requirements for consumer protection and quality improvement.

Provisional — Meets some but not all of NCQA's requirements for consumer protection and quality improvement.

Denied — NCQA denies Accreditation to organizations whose programs for service and clinical quality do not meet NCQA requirements during the Accreditation survey.

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.