NCQA, HEDIS, CAHPS and Appeals

NCQA, HEDIS, CAHPS and Appeals

NCQA’s Health Plan Accreditation standards and guidelines are the quality improvement guide for new and established health plans. Coupled with HEDIS®1 /CAHPS®2 scoring, NCQA Health Plan Accreditation (HPA) pioneered the performance-based evaluation of quality of services and care delivered by plans. NCQA also has in pace policies and procedure guidelines for the medical necessity appeals.