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What it isn’t: NCQA certification is not equivalent to accreditation for physician organizations. It does not encompass an overall review of processes and quality. It does not evaluate individual physicians.
Who is eligible: Primary care and multispecialty groups and networks, physician hospital organizations, independent practice associations, integrated delivery systems, and organizations providing management services only. Organizations must have been in operation at least 18 months.
What it involves: Certification standards cover six areas: quality improvement, utilization management, credentialing, members’ rights and responsibilities, preventive health services, and medical records. Surveys include on-site review by a two- to four-person team of physicians and managed care experts, as well as an off-site review of documentation. Surveys last one to three days.
How long it lasts: Initial certification will last one year. After a second successful survey, NCQA may extend the certification to three years.
What it costs: $18,000 to $23,000 for two categories; $24,000 to $31,000 for six categories. Costs vary depending on practice size.
For more information: Contact David Arnold at NCQA, 2000 L St. NW, Suite 500, Washington, DC 20036. Telephone: (202) 955-5135. Fax: (202) 955-3599. Web site: http:// www.ncqa.org. To order the 1997 Standards for Certification of Physician Organizations ($75), the Surveyor Guidelines ($195), or the Data Collection Tools ($195 or $365 with the Surveyor Guidelines), contact the NCQA Publications Center, (800) 839-6487. An NCQA seminar, "Achieving Physician Organization Certification: The Fundamentals," will be held Sept. 11-12 in San Francisco. For more information, contact the NCQA Customer Service Center, (202) 955-5697.