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Utilization management and credentialing are up for review with National Committee for Quality Assurance (NCQA)’s new certification programs. Already, three organizations — Private Healthcare Systems, Beech Street Corp., and the Detroit Medical Center have agreed to have their programs reviewed.
The certification programs adapt standards included in the credentialing and utilization management sections of NCQA’s PPO (preferred provider organization) Plan Accreditation program, which was introduced last August. The standards have been adapted to allow PPO networks and other organizations performing these functions to participate.
"Giving organizations other than HMOs a chance to prove themselves through NCQA Certification will drive improvement across the industry," says Spencer Falcon, MD, executive vice president of medical management at Private Healthcare Systems, a Waltham, MA, company that covers more than 6 million lives. "We’re pleased to be among the first PPO networks to take part in this program."
NCQA believes that employers and PPOs that contract with organizations for utilization management or provider networks will seek out certified organizations to meet their needs.
According to NCQA officials, while many participants in the program will be PPO networks, certification is open to any organization that performs the specified functions and is not eligible for NCQA’s accreditation programs for managed care organizations and managed behavioral health care organizations. Physician organizations (PO) certified under the 2000 standards for NCQA’s PO Certification program will be deemed to be certified under the new programs.
NCQA currently is accepting survey applications from organizations interested in pursuing certification and is holding two conferences to bring organizations up to speed. The first will be March 19-20 in Houston, and the second will be in Orlando, FL, in early October. For more information on the conferences or the program, visit NCQA's Web site at www.ncqa.org, or contact NCQA at (202) 955-5697.