Meeting AAAHC Standards

Meeting the AAAHC Standards for Health Plans.

Organizations that apply for the AAAHC survey are reviewed against a set of Standards that describes the characteristics that AAAHC believes defines the high quality care required of an accreditable organization. Applicable Standards include:

  • Rights and Responsibilities and Protection of Members
    Does your organization treat members with respect, consideration and dignity?
    Are members informed of their right to change providers?
    Does your organization have protection and security in place?
  • Governance and Administration
    Does your governing body meet regularly and properly document its decisions and activities?
    Does the governing body fully accept legal responsibility for all aspects of the operation and performance of the organization?
    Does your organization have policies, procedures and controls to ensure orderly and efficient management that results in quality health services and fulfills the directives of the governing body?
    Do you employ qualified management personnel and contract with a sufficient number of providers to ensure access to and availability of services?
  • Provider Networks Credentialing
    Does your organization have a comprehensive program in place that requires the credentialing of all providers, including ancillary providers?
    Do you maintain credentialing files confidentially or utilize a CVO?
  • Case Management and Care Coordination
    Does your organization have policies that ensure member care coordination, comprehensiveness of care, and continuity of care?
    Is there an accountable process of utilization management in place?
    Have guidelines and clinical protocols been adopted, and are network physicians involved in their development?
    Are there programs in place  for the care of members with chronic conditions?
  • Quality Improvement and Management
    Is management accountable for the quality of services delivered?
    Do you conduct ongoing quality improvement activities?
    Do you have a risk management program?
  • Clinical Records and Health Information
     Does your organization establish policies and contract requirements related to the maintenance  of appropriate accounts and complete clinical records that meet the requirements of applicable regulations, including patient privacy by your provider network?
  • Environment Care and Safety
    Does your organization have a system in place to provide a network of primary and specialty care producers whose facilities and environment meet high standards of safety and patient care?
  • Health Education and Wellness Promotion
    Does your organization have policies, procedures and programs in place to provide health education and promote healthy practices to its members?

While the conditions above are only a representative sample of the requirements needed to earn accreditation, if you were able to answer yes to these questions, your organization may be on the right path toward achieving AAAHC accreditation. Specific information and additional detail regarding AAAHC Standards can be found in the Accreditation Handbook for Health Plans. The Handbook explains the Standards of AAAHC as they apply to health plans, including information on policies and procedures, along with worksheets, to help you prepare for your survey. The Handbook can be ordered at www.aaahc.org or by calling 847-853-6060.