NUR 621 Topic 5 DQ 1

NUR 621 Topic 5 DQ 1


Health plans that participate in the Affordable Care Act are required to be accredited by a national accrediting body. Two primary national accrediting bodies exist, NCQA and URAC. As mentioned above these two organizations provide different levels of accreditation ranging from simple least costly to acquire all the way up to more stringent requirements for more thorough review of a health plan’s quality and utilization management practices. A health plan, based on its strategic goals, can elect to go with the more rigorous set of requirements while another may elect not to do so based on organizational priorities and competencies.

Utilization Review Accreditation Commission (URAC) is the health plan accrediting body in North America created specifically to ensure programs with medical treatment fall within evidence-based practice guidelines set forth by the national medical associations. National Committee for Quality Assurance (NCQA) was created to standardize accreditation of Health plans, and ensure they comply with the Affordable Care Act. Both have stringent standards and both are capable of creating a program that helps health plans provide necessary medical services to patients at a high level of quality and compliance. For more information on either agency please visit their respective website as well as

Accreditation is a non-government process where health plans undergo rigorous independent review by external experts. Health plans choose to become accredited by either NCQA or URAC to acknowledge that they are committed to transparency and playing by the rules. The level of review and the time each one takes are different. Choosing an accrediting body matters because it speaks to your brand’s commitment to quality and transparency. Here is how they compare:

Health plans participate in the Affordable Care Act (ACA), are both accredited by URAC or the National Committee for Quality Assurance (NCQA). When health plans seek accreditation, their sponsoring employer or organization typically has a primary objective in mind, such as: improving the health status of its employees, reducing health plan costs through quality interventions and/or to adhere to a wide-range of government regulations.

NCQA and URAC accredit health plans and survey providers accordingly. Both have been a part of the U.S. healthcare system for many years, with NCQA being incorporated in 1979 and URAC coming together in 1974.

By choosing to be accredited by the National Committee for Quality Assurance (NCQA), your health plan has taken the first step in a long and meaningful journey towards providing the highest quality care available. NCQA’s accreditation program is based on rigorous, objective sets of standards developed over many years. Accreditation is widely recognized as a tangible symbol of a health plan’s commitment to high-quality, patient-centered care.


Health plans participating in the Affordable Care Act must be accredited; what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)? Why would a health plan select one over the other?

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