Best Practices for NCQA Survey Readiness

Today, NCQA accreditation is one of the leading indicators of high-quality healthcare, and keeping up with NCQA’s latest standards is critical to a health plan’s success. That means undergoing rigorous, regular surveys to ensure ongoing compliance.

Preparing for an NCQA survey can be stressful for your team, and it can divert substantial time and resources away from your core business as you work to meet strict deadlines and requirements. But that doesn’t mean you can or should cut corners. In fact, you stand to face even more costly fines or to lose your accreditation altogether if you fail to satisfy minimum requirements.

Below, we share the ins and outs of an NCQA survey, along with our top strategies to streamline your planning and preparation. By following some simple best practices, you can not only achieve your accreditation goals, but keep the leadup process as quick and painless as possible.

The Anatomy of an NCQA Survey

From initial planning to final certification, the entire survey process should take around 14 months to complete. Depending on your accreditation status, surveys can occur every 12 to 36 months. That means you can expect to be in a near-constant state of preparation and upkeep—because quality is a journey, not a destination.

NCQA survey timelines can be grouped into three distinct categories:

• Pre-submission: The pre-submission stages span the 12 or so months before your survey start date, running from your eligibility review and gap analysis through your organizational readiness evaluation. It involves preparing and finalizing key documents—including your survey application, file-review universe lists, and delegation worksheets—and bookmarking all NCQA elements and factors in each document or data source.
• Submission: The day you submit your survey documents and element answers to NCQA is scheduled in advance—typically on a Tuesday—and is considered your survey start date.
• Post-submission: The post-submission stages last approximately 12 weeks, from your survey start date to your final report and certification. This includes offsite processes to review and respond to any issues uncovered during the survey, an onsite/virtual file review, and post-survey procedures to receive your preliminary report, final report, certification, and seal.

As you may have noticed, the actual survey process doesn’t even begin until you can prove your organization is eligible and you’ve performed a full gap analysis and self-evaluation with remediation—about a year’s worth of work. Let’s take a closer look at what that entails.

Prep like a Pro

NCQA recommends kicking off preparations at least 12 months prior to your expected survey start date. On their website, you can find overviews of the evaluation process as it pertains to each program type (CR, CVO, HP, MBHO, etc.), which can help you pinpoint the precise standards you’ll need to follow and the exact requirements you’ll need to meet.

To help you on your way, we consulted with our director of quality and compliance, Shannon Kern, who served as the senior operations engineer and a certified scrum product owner (CSPO) at NCQA. She led the organization’s Interactive Review Tool (IRT) project team for over seven years, overseeing the platform’s evolution from its initial deployment.

Kern offered some inside perspectives and helpful tips to simplify and expedite your preparations. Above all, she says, make sure you give each part of the process the careful attention it deserves.

“Many organizations underestimate the number of issues surveyors will find and don’t allow enough time for review. Waiting until the last minute can cause a range of problems, so building in sufficient time for each step of the process is very important.”

–Shannon Kern, Director of Quality and Compliance, Certify

To ensure your NCQA survey preparations are carried out efficiently and effectively:

• Align internally with a designated team (i.e., an accreditation task force)
  
  The first step you should take is to convene a competent accreditation survey committee of subject matter experts (SMEs). Appoint an administrative lead to take the helm as the main point of contact.
  
  At your first meeting, read through the survey application together to ensure there are no unexpected requirements or procedural surprises. Make sure to flag and track any concerns or doubts you may have regarding your organization’s status.
  
  Pro tip: Every healthcare organization is different—from its internal structure to its product delivery system. Before you do anything else, check NCQA’s eligibility standards for your specific program to ensure you meet the listed criteria.
  
  Your team will be assigned an NCQA accreditation survey coordinator (ASC) about six months prior to your submission date. In the meantime, if you have questions regarding your eligibility or the application process, NCQA offers various ways to get in touch with a program expert. 
  
  You can also contact your assigned applications and scheduling account representative (ASAR) with any application questions—or view your application status on my.ncqa.org.
  
• Purchase the correct NCQA Standards & Guidelines and Survey Tool.
  
  If your organization intends to submit your survey tool, you can just purchase the web-based tool. The applicable Standards and Guidelines (S&G) and File Review System (or File Review Workbook) are both included in this option. The Interactive Review Tool (IRT) helps you perform a self-evaluation, conduct a mock file review, and calculate your potential survey score. You should plan to access the tool with updated S&Gs at least nine months prior to your desired start date.If your organization does not plan to submit your survey for a particular standard year, then you do not have to purchase a tool.In other words, if you just need the updated S&Gs, you can opt for either the related e-publication (PDF) or the web-based version, depending on your personal preference. The e-pub is easy to share with functional leads across your organization and does not require upgrades for user licenses. The web-based S&Gs, on the other hand, are a great option if you want to use features like the Navigation Tree or Guidelines tab to help you through each element.
  
  Pro tip: Double-check that you’re purchasing the survey tool for the correct standard year and lookback period. Not all NCQA programs publish new S&Gs each year, but those that do make their updated standards effective starting July 1st of the given standard year. Plan accordingly, and purchase S&Gs as early as possible—so you can incorporate requirement changes into your documented processes, reports, materials, and files and ensure your lookback period is covered for the next NCQA survey.If this is your first survey, pay special attention to the front matter of your applicable S&Gs—particularly the Policies and Procedures—as well as the Guidelines for a Successful Survey and Document Preparation Guidelines.
  
  If this is a renewal or interim survey, review the Summary of Changes closely, which can be found in the S&Gs or in the “actions” button of your IRT. We recommend reading through the front matter, too—even if this isn’t your first rodeo.
  
• Perform a gap analysis.
  
  You should perform a thorough gap analysis 9 to 11 months prior to your planned survey start date, weighing your organization’s current processes against those listed in your program’s S&Gs. Ensure your organizational structure is up to date and that you have your approval tracking history on hand for each documented process. 
  
  Pro tip: As you begin checking and compiling documentation, pay close attention to the data source behind each element. We don’t recommend inundating surveyors with secondary or supplemental data, as they’re only looking for the required data sources for each element in the S&Gs. It’s helpful to ensure the required reports and materials for each element cover your intended lookback period entirely. Once you’ve identified any gaps, sit down with your team to prioritize improvements and develop a reasonable project plan. Make sure you assign gaps and other plan elements to a functional lead and that you set precise internal due dates. Try to build in some extra time around deadlines, as you’re sure to need it when planning for your final submission.
  
• Determine your eligibility for automatic credit (AC).
  
  You can receive automatic credit toward certain must-pass file review and non-file review elements for functions delegated to a NCQA-Accredited, -Certified, or -Recognized delegate, which takes quite a bit of busywork off your team’s plate.To determine whether you qualify, review the eligibility criteria in the Delegation and Automatic Credit appendix of your IRT Product Resources for the product and standard year. For example, the latest health plan standards state that, for non-file review elements, an authorized delegate must perform a specified function for at least 70% of your providers for credentialing (CR) or provider network (PN) delegation.
  
  Pro tip: When claiming auto credit, don’t forget to include a copy of your delegation agreement—which must be signed and dated by both parties—along with a full list of delegated activities. You should also confirm that your agreement dates cover your lookback period. It’s also good practice to have an assigned lead review delegation agreements and ensure all delegation oversight is being carried out as planned.
  
• Schedule your survey, and conduct a meticulous final review.
  
  When you’re ready to schedule your survey—which you should do at least nine months prior to your desired submission date—you can contact an NCQA representative for a pre-application form. After you complete this form, NCQA will send you a link to complete your online application, where you can select a survey start date.
  
  Once your submission date is set and confirmed, you can work to implement the plan you laid out in your gap analysis and get your materials in order. Keep in mind, once you submit your survey, you will not be able to upload any documents updated after the submission date.
  
  Pro tip: NCQA recommends uploading no more than three documents per element, so surveyors can efficiently check compliance for each requirement. When possible, we suggest merging related documents into a single file and using clear and consistent highlighting and bookmarking to enable smooth navigation.

As with any deadline, plan to submit your survey a few days or weeks in advance to leave room for any important, last-minute considerations—like updated policies and procedures. Having this cushion will also allow you to work in a final quality check, using the IRT’s Submission Overview Report and Navigation Tree to assist you.

Finally, as you await your offsite and onsite processes, we recommend conducting a mock file review or two to run through the expected program and address any potential issues upfront. Do not wait until your offsite/onsite review to do this—you can practice as early and as often as you need. Catching gaps ahead of time helps prevent lower NCQA scores, especially when it comes to file review surveys. The fewer compliance gaps in the final file review list, the better.

“My go-to strategy is creating crosswalks to track and cross-check all accreditation and regulatory requirements across our policies and procedures, reports, meeting minutes, and other materials from year to year— baking quality, compliance, and security into our processes right out of the gate.”

– Shannon Kern, Director of Quality and Compliance, Certify

Want to track your progress? We’ve collected these steps and strategies into a handy checklist you can distribute to your team and use to guide your survey preparations.

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)
• Have operationalized a certain process, but it is not recorded within your P&Ps, SOPs, or other documented process
• 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
• 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 Certify. 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 Certify Can Help

As an industry-leading provider intelligence platform, Certify 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 Certify.

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 Certify at your back can really come in handy.”

– Shannon Kern, Director of Quality and Compliance, Certify

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.

If you have questions about our NCQA survey support—or want to learn more about our one-click credentialing solution—reach out to our expert team or request a product demo today.

Looking for More NCQA Survey Support?

Download our essential survey checklist to ensure you’re on track for every survey deadline and requirement.