Every three years, Community First undergoes the National Committee for Quality Assurance (NCQA) survey process for health plan accreditation and distinction. 

We are proud to announce that in November, Community First earned the renewal accreditation status for:

Product Line/ProductAccreditation Status
Medicaid – HMO Accredited
Commercial – HMO/POS CombinedAccredited
Long Term Services and SupportsDistinction

Community First earned accreditation for the Standards for Medicaid Health Plan Accreditation, Commercial Health Plan Accreditation, and the LTSS Distinction Renewal Surveys.

NCQA accredits health plans based on the health plan’s performance in three domains: 

1.         Compliance with quality standards

2.         Quality metrics (HEDIS)

3.         Member (CAHPS) and Provider satisfaction surveys

Health plans seeking accreditation are required to submit over 150 documents including reports, policies, newsletters, Member/Provider correspondence, and educational pieces as evidence for compliance. Community First is also required to complete file reviews for utilization management medical denials, behavioral health denials, pharmacy denials, appeals, case management, LTSS service coordination, and credentialing/recredentialing for the Medicaid and Commercial products. 

The results of the satisfaction surveys are also due to three years of continual staff education, mock file reviews, training, updating documents to include revised standards, and constant program oversight. The amount of growth in each of the areas is incredible. 

For more information about NCQA accreditation, please visit https://www.ncqa.org/.

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