Accreditation & Oversight
NCQA
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Many states and contracts require NCQA accreditation, effectively making its UM standards semi-regulatory. Accreditation reviews examine actual case files against standards, so operational discipline (documentation of criteria used, reviewer credentials, notice timeliness) is continuously load-bearing.