Healthcare Accreditations
 


Centene Corporation strives to meet rigorous standards that reflect our commitment to providing quality care to all members. These efforts are recognized through various certifications and accreditations from top healthcare quality organizations, covering both health plans and specialty healthcare organizations.

Centene’s NCQA Health Plan Accreditations

The National Committee for Quality Assurance (NCQA) helps improve health care quality. NCQA evaluates health plans in meeting standards and guidelines through an accreditation process which evaluates operational policies, data used to monitor operations, care and services outcomes, implementation of quality improvement process, and verification of processes related to health care management.

Centene Corporation's health plans have several NCQA accreditations:

  • Health Plan Accreditation (HPA): measures health plan performance related to quality improvement, population health, network management, utilization management, credentialing, and member experience.
  • Health Equity Accreditation (HEA) supports health plans services that consider cultural and language needs, aiming to reduce health inequities.
  • Long-Term Services & Supports (LTSS) provides a framework for organizations to deliver person-centered care that meets individual’s needs and state requirements.


 

NCQA Accredited - Health Plan
NCQA Accredited - Health Equity Accreditation
NCQA Accredited - LTSS

The following subsidiaries currently hold one or more than one NCQA accreditation:

 

Alabama

  • Ambetter of Alabama

Arkansas

  • Ambetter from Arkansas Health & Wellness
  • QualChoice Health Insurance

Arizona

  • Arizona Complete Health
  • Ambetter from Arizona Complete Health

California

  • Health Net 

Delaware

  • Ambetter Health of Delaware
  • Delaware First Health 

Florida

  • Sunshine Health
  • Ambetter from Sunshine Health

Georgia

  • Peach State Health Plan
  • Ambetter from Peach State Health Plan

Hawaii

  • 'Ohana Health Plan

Iowa

  • Iowa Total Care

Illinois

  • MeridianHealth of Illinois
  • Ambetter of Illinois

Indiana

  • Managed Health Services (MHS)
  • Ambetter from MHS

Kansas

  • Sunflower Health Plan
  • Ambetter from Sunflower Health Plan

Kentucky

  • WellCare of Kentucky
  • Ambetter from WellCare of Kentucky

Louisiana

  • Louisiana Healthcare Connections
  • Ambetter from Louisiana Healthcare Connections 

Michigan

  • Meridian Health Plan of Michigan
  • Ambetter From Meridian (Michigan)

Missouri

  • Home State Health
  • Ambetter from Home State Health

Mississippi 

  • Magnolia Health
  • Ambetter from Magnolia Health

North Carolina

  • Ambetter of North Carolina
  • WellCare of North Carolina

Nebraska

  • Nebraska Total Care
  • Ambetter from Nebraska Total Care

New Hampshire

  • NH Healthy Families
  • Ambetter from NH Healthy Families

New Jersey

  • Fidelis Care
  • Ambetter from WellCare of New Jersey

Nevada

  • SilverSummit Healthplan
  • Ambetter from SilverSummit Healthplan

New York

  • Fidelis Care
  • Ambetter from Fidelis Care 

Ohio

  • Buckeye Health Plan
  • Ambetter from Buckeye Health Plan

Oklahoma

  • Ambetter of Oklahoma

Oregon

  • Trillium Community Health Plan

Pennsylvania 

  • PA Health & Wellness
  • Ambetter from PA Health & Wellness

South Carolina 

  • Absolute Total Care
  • Ambetter from Absolute Total Care

Tennessee

  • Ambetter of Tennessee

Texas

  • Superior HealthPlan
  • Ambetter from Superior HealthPlan

Washington

  • Coordinated Care
  • Ambetter from Coordinated Care

Wisconsin

  • MHS Health Wisconsin

 


 

 

 


 

Centene’s Specialty Healthcare Organization NCQA and URAC Accreditations

NCQA

National Committee for Quality Assurance evaluates specialty programs for patient-centered care, aiming to improve patient outcomes, and demonstrating a commitment to quality. Specialty NCQA accreditations focus on areas of patient programs, operations, and quality improvement, aligning organizations with contracting partners, and highlighting best practices.

Specialty Company NCQA Accreditations:

  • Cenpatico Behavioral Health – Utilization Management
  • Centene Corporation – Credentials Verification Organization
  • Diamond Designation Program – Physician Quality
  • Centene Pharmacy Services – Utilization Management
  • Envolve Dental dba Centene Dental Services – Utilization Management
  • Envolve Vision Benefits dba Centene Vision Services – Utilization Management
  • Ohana - Managed Behavioral Healthcare Organization

 

NCQA Accredited - Utilization Management 3 years
NCQA Accredited - Managed Behavioral Health Organization
NCQA Accredited - Credentialing Verifications Organization
NCQA Accredited - Health Equity Accreditation


 

 

URAC

Utilization Review Accreditation Commission provides accreditation standards to validate high quality healthcare to improve outcomes with continuous quality improvement and regulatory requirements. Specialty URAC accreditations focus on areas of pharmacy services, digital/telehealth, patient care management, and administrative management.

Specialty Company URAC Accreditations:

  • Centene Pharmacy Services – Drug Therapy Management
  • Envolve Pharmacy Solutions (AcariaHealth) – Specialty Pharmacy


 

URAC Specialty Pharmacy Accredited Seal
AcariaHealth
Specialty Pharmacy
Expires 12/01/2025
URAC Pharmacy Services Accredited Seal
Centene Pharmacy Services, Inc.
Pharmacy Services - Drug Therapy Management, Opioid Stewardship
Expires 03/01/2027


 

 

 


 

Core Certification

Centene standardizes the information given to healthcare providers. The Committee on Operating Rules for Information Exchange (CORE) is an initiative by a nonprofit alliance of health plans, networks and trade associations to simplify healthcare administration. With CORE certification, Centene joins others in standardizing the information sent to providers, so they receive consistent, uniform information from each insurer. CORE certification helps providers offer the best possible care consistently to each member, which in turn helps members maintain better health. It also improves interactions between health insurers and providers, reduces costs and administrative hassles, meets HIPAA requirements, and increases accuracy and speed in paying claims. Centene has received the CAQH CORE® health plan certification seal and is exchanging electronic administrative data in compliance with the CORE rules. For more information about CORE, please visit CAQH.

 

CAQH Certified logo