Blue Cross NC Receives NCQA Accreditation

This past spring, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) was surveyed by the National Committee for Quality Assurance (NCQA), the gold standard for health plan accreditation, and received a near-perfect total score of 98.58%.

NCQA accreditation signifies Blue Cross NC’s commitment to ensuring safety of clinical care services and quality health care to its members.

For the survey submission, we scored 139 out of 141, a 98.58% total score, and we achieved 100% on all NCQA must-pass elements and file review.

We also achieved Exclusive Provider Organization (EPO) Accreditation on Commercial and On-Exchange product lines for the first time. This accreditation does not apply to Medicare products.

Every three years, Blue Cross NC is re-accredited by NCQA. NCQA assesses health plans against a rigorous set of standards across six domains. These standards provide a framework for health plans to align and improve operations in areas important to states, employers, and consumers.

We scored the following for each:

• Quality Management & Improvement: 100%
• Population Health Management: 100%
• Network Management: 95%
• Utilization Management: 100%
• Credentialing: 96%
• Member Experience: 97%

During the virtual on-site, NCQA randomly selected files for review from Appeals, Complex Case Management, Credentialing and Recredentialing, Pharmacy, and Utilization Management. We are delighted to report all files passed at 100%.

The NCQA surveyors highlighted Complex Case Management and Population Health as “effective and impactful,” and that Blue Cross NC’s commitment to addressing health care disparities is commendable.

NCQA also shared that the Blue Cross NC team is dedicated, knowledgeable, well-organized, and prepared.

We are proud to show off our new NCQA Accreditation Seal. Customers and potential customers will see it on our website as well as NCQA’s Health Plan Report Card site. This seal of accreditation signifies Blue Cross NC’s commitment to ensuring the safety of clinical care services and quality health care to its members.