Accreditation

Formal recognition by an authorized body, such as NCQA or URAC, that a healthcare organization meets established quality standards and best practices for credentialing, care delivery, or administration.

Accreditation is a formal recognition that an organization meets a defined set of quality and operational standards. In healthcare, accreditation applies to both health plans and healthcare facilities. For health plans, the main accrediting bodies are NCQA and URAC. When a health plan achieves NCQA accreditation, it means their credentialing process, utilization management, member services, and quality improvement programs meet national standards. This affects you as a provider because NCQA-accredited plans have standardized credentialing processes that are more predictable and transparent. For healthcare facilities, accreditation comes from organizations like The Joint Commission (TJC), AAAHC (Accreditation Association for Ambulatory Health Care), and CARF (Commission on Accreditation of Rehabilitation Facilities). Hospital accreditation by The Joint Commission is considered the gold standard and is recognized by CMS as meeting Medicare certification requirements. During credentialing, payers check whether your facility (if applicable) is accredited. An accredited facility has already been through a rigorous review of its safety, quality, and operational standards. This gives the payer confidence that patients will receive care in a safe environment. If you are in an ambulatory surgery center, urgent care center, or other facility-based practice, accreditation can also speed up payer credentialing. Some payers have expedited credentialing processes for providers affiliated with accredited facilities because the facility's accreditation has already verified many of the same standards the payer would check. Accreditation is voluntary for most healthcare organizations, but it is increasingly expected by payers, patients, and employers. The investment in achieving and maintaining accreditation pays off through easier credentialing, improved patient trust, and better operational performance.