Case Management Accreditation Requirements

NCQA Case Management Accreditation evaluates organizations performing case management services that typically focus on patients who are at high risk of experiencing costly hospitalizations or poor health outcomes because of complex social, behavioral or medical needs. Organizations must meet program criteria to pursue the accreditation.

FOCUS AREAS TO ENSURE HIGH QUALITY

NCQA Case Management Accreditation requirements ensure that organizations can consistently use efficient and cost-effective case management processes and delivery of services. Requirements cover these key areas:

• Identification and assessment.
• Care planning.
• Care monitoring.
• Care coordination.

To see all program requirements, get the Standards & Guidelines document.

REQUIRED ORGANIZATION SERVICES

The standards are designed for organizations providing case management services that include patient identification and assessment, care planning, care monitoring and care transitions to meet the needs of patients and their families.; for example:

• Case management organizations.
• Population health management organizations.
• Health plans.
• Managed behavioral healthcare organizations.
• Provider-based organizations (e.g., medical groups, hospitals, integrated delivery systems).
• Community care teams.

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