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The National Committee for Quality Assurance (NCQA) maintains and regularly updates quality standards utilized by the health insurance industry to gauge levels of ongoing quality and improvement. The standards include over 1,500 requirements that impact Blue Cross NC business areas across the enterprise. These requirements are central to our Quality Improvement Program designed to improve quality, safety, and member experience.
In addition to the audit of quality standards compliance, NCQA also annually evaluates health plan performance based on 25 clinical HEDIS (The Healthcare Effectiveness Data and Information Set) measures and 8 member CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey questions. NCQA annually evaluates how well Plans perform on these audited measures against regional and national benchmarks/ thresholds, which can then, in turn, be used as a comparative quality performance tool for consumers and other health plans.
Quality accreditation level is earned based on a 100 point scale between two domains:
- Quality Standards
- HEDIS & CAHPS
NCQA audits Plans against the standards through a rigorous on and off site survey process every three years.
Blue Cross NC was reaccredited by NCQA in April 2014 and earned a "Commendable" accreditation status, which applies to the commercial and Exchange PPO and POS products.