Standards Matter: National Committee for Quality Assurance — Guidelines Update for 2023

Standards Matter: National Committee for Quality Assurance — Guidelines Update for 2023

Provider credentialing is an invaluable and necessary process for the healthcare sector. Modio, along with our parent company, CHG Healthcare, works hard to ensure that the credentialing process is as seamless, effective, and safe as possible and prides itself on delivering those high standards. One of the ways we ensure this is through our work with the National Committee for Quality Assurance (NCQA) — a nonprofit organization in the U.S. that aims to improve healthcare quality through accreditation, certification, and measurement programs. 

The goal of the NCQA is to evaluate and certify healthcare organizations based on rigorous quality standards and also develop tools to measure and improve healthcare quality. Certification indicates that an independent organization, such as NCQA, has validated a Credentials Verification Organization’s (CVO) performance. This certification provides assurance to healthcare organizations that the CVO is meeting quality standards and delivering efficient, accurate credentialing information. This process is never easy, but it’s invaluable — for the organization, its clients, and ultimately, the patients served. 

CHG’s CVO uses Modio’s OneView credentialing platform to ensure the highest standards are being met for its clients. “NCQA has an extensive and detailed accreditation/certification process that evaluates healthcare organizations based on their performance in several key areas, including patient care and clinical quality,” says John Bou, co-founder and COO of Modio. “By achieving NCQA certification, the CVO is able to adopt those standards, document its work product in Modio’s system, and improve the quality of its own credentialing services. It allows us to be as transparent as possible with our clients and ensure our clients know the level of work we are delivering.”

The NCQA periodically reviews and updates these standards to meet the needs and changes within the healthcare sector. The most recent changes aimed to ensure the integrity of provider credentialing data by preventing unauthorized access, modifications, and the unapproved release of data. The new standards also required updated processes for receiving, dating, and storing provider information; tracking modifications to credentialing data; identifying staff authorized to review, modify, and delete information; and auditing system controls.

The process of implementing changes in NCQA standards involves gathering feedback from stakeholders (such as CVOs, hospitals, and health plans), drafting standards, seeking public comments, making revisions based on feedback, and finalizing the standards. In some cases, if there is significant concern or lack of response, the standards may be paused or further evaluated.

The important work of the NCQA helps foster a culture of quality and safety in healthcare for everyone. The CVO can continue to maintain NCQA standards using Modio’s OneView platform to credential thousands of providers by leveraging technology that enables streamlining processes and sharing verification data. At the end of the day, we all have a common goal to improve the delivery of healthcare, ultimately leading to better patient care.

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