What surveyors are looking for
There are certain red flags NCQA surveyors are watching for—and clearing them in advance will help you avoid costly delays and corrections down the line.
Among other things, your organization can expect to lose points if:
- You fail one or more must-pass elements or don’t meet minimum category thresholds, triggering a corrective action plan (CAP)
- You have operationalized a certain process, but it is not recorded within your P&Ps, SOPs, or other documented process
- You have not kept up with new standards—like CVO 3, Element B, “Credentialing System Controls,” which was introduced in the 2022 standard year around the handling of system maintenance
- You don’t have a viable process for handling and safely disposing of confidential data like personal identifiable information (PII) and protected health information (PHI)
Remember, NCQA surveyors are fact-finders. Make sure you review the “explanation” section for each element in your scope of review and that you understand all expectations for your evaluation program—and, if applicable, your units of assessment—before submitting your application.
Pro tip: Check the list of exceptions for all possible NA options—and don’t assume all elements or factors are allowed NA scores.
How to streamline survey preparations
When it comes to NCQA compliance and survey readiness, automation is a true game-changer. Without it, the sheer amount of people power, work hours, and resources that go into manually checking spreadsheets and verifying individual files can quickly make preparations unmanageable.
Many health organizations choose to delegate their data management to an NCQA-certified CVO like CertifyOS. The right CVO partner will not only automate essential tasks like credentialing, network monitoring, and compliance tracking and condense months of work into minutes, they’ll provide a single source of truth where you can manage your documents, run customized reports, and organize your NCQA survey materials with just a few clicks.
Among other benefits, working with an automated data solution can help you:
- Reduce your risk of a denial or corrective action plan
- Ensure data accuracy and save months of preparation time and back-and-forth corrections
- Receive automatic credit and operational relief for delegated CR elements, including must-pass
Your team will be at ease knowing your NCQA survey and accreditation needs are being met—and your providers are being credentialed—according to the highest quality standards in healthcare.
How CertifyOS can help
As an industry-leading provider intelligence platform, CertifyOS is NCQA-Certified for 11 out of 11 CVO evaluation products. We diligently track and incorporate all changes to NCQA standards with regular gap analyses and oversight, ensuring health plans (HP), managed behavioral health organizations (MBHOs), and credentialing accreditation (CR) organizations are never caught off-guard. Organizations like these can receive substantial automatic credit for their NCQA surveys when delegating credentialing and monitoring activities to CertifyOS.
What’s more, since our director of quality and compliance is a former NCQA accreditation manager, surveyor, and head engineer, we know what it takes to make the grade.
“Having worked for NCQA for eight years, I’ve seen it all. Survey consultants don’t always cover the valuable, granular details that health plans need to succeed [with credentialing]. That’s where having an expert partner like CertifyOS at your back can really come in handy.”
–Shannon Kern, Director of Quality and Compliance, CertifyOS
Our customers can count on us to consult on and optimize survey preparations upon request, so they can level up their credentialing without having to worry about compliance issues, improving the overall quality of patient care.
Looking for more NCQA survey support?
Download our essential survey checklist to ensure you’re on track for every survey deadline and requirement.