Healthcare Accreditations
 

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.

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 Health Plan (Community Care Services [CCS] program) - Managed Behavioral Healthcare Organization

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