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Health Plans/QHPs/Managed Care Organizations

AAAHC has been surveying and accrediting managed care organizations since 1983. In 2012, our Standards for health plans were significantly revised with a stronger focus on managed care principles. 

Standards include:

  • Member Rights, Responsibilities, and Protections
  • Governance and Administration
  • Provider Network Credentialing
  • Case Management and Care Coordination
  • Quality Improvement and Management
  • Clinical Records and Health Information
  • Environment of Care and Safety
  • Health Education and Wellness Promotion

We offer special accreditation programs for health plans that focus on Dental or Behavioral Health.

QHP Accreditation

In 2013, AAAHC was approved as an accreditor for Qualified Health Plans on the federal and state exchanges. For QHPs, we have established a new process for collecting and reporting outcomes data for your members.

Medicare Advantage Deemed Status

AAAHC has held Deemed Status for Medicare Advantage plans from CMS for more than a decade.

Additional information on Medicare Advantage Deemed Status accreditation can be found under the Medicare Advantage section of this page.

Apply for a Health Plan Survey

Use the Application for Survey to submit all application materials to the AAAHC. If you have questions, please contact an Application Coordinator at info@aaahc.org or 847-853-6060

Online Application

NOTE: Organizations downloading the Application for Survey must also download the Business Associate Agreement for HIPAA compliance purposes.

Medicare Advantage

The Centers for Medicare and Medicaid Services (CMS) has established a program that allows private, national accrediting organizations the opportunity to ensure that Medicare Advantage plans are complaint with the requirements of the Medicare Advantage program. CMS identifies those accrediting organizations as “deemed” entities. On June 28, 2002 CMS announced the approval of the Accreditation Association as a deemed entity, thereby allowing the Accreditation Association the privilege to survey Medicare Advantage HMO and PPO plans.

The six areas which are under the Medicare Advantage deeming authority for the Accreditation Association are: quality assurance, antidiscrimination, access to services, confidentiality and accuracy of enrollee records, information on advance directives, and provider participation rules.

A managed care organization that participates in the Medicare Advantage program may choose to have its AAAHC survey include a review of the Medicare Advantage requirements. Managed care organizations that request such a survey, should obtain the AAAHC Medicare Advantage Supplemental Guidebook. This guidebook contains the additional Medicare Advantage requirements that will be reviewed for compliance by the Accreditation Association surveyors.

To obtain a copy of the Medicare Advantage Supplemental Guidebook, as well as further details regarding the Medicare Advantage survey process, please contact Carolyn Kurtz at 847.853.6060.


Advantages of AAAHC Health Plan Accreditation

Meeting AAAHC Standards

Learn more about achieving accreditation for your health plan.

Resources:

Begin with the 2014 edition of the Accreditation Handbook for Health Plans. The Handbook details the Standards and includes information on policies and procedures, as well as worksheets, tools and resources to help your organization prepare for the on-site survey.