Health Insurance Accreditation

[Health insurance accreditation is likely to be of most help where the plan employs the physicians and manages the medical facilities. Health insurance accreditation of PPO networks and HMOs using physicians in private practice does not seem to be a consideration for most people buying individual health insurance. A large employer considering contracting for health care may be more likely to use health insurance accreditation in making choices. - ed.]

Accreditation and Quality

Accreditation Association for Ambulatory Health Care
9933 Lawler Ave.
Skokie, IL 60077-3708
(847) 676-9610
Accredits outpatient health care settings such as ambulatory surgery centers, radiation oncology centers, and student health centers. Call for a list of accredited organizations.

Community Health Accreditation Program
350 Hudson St.
New York, NY 10014
800-669-1656, ext. 242
Accredits community, home health, and hospice programs; public health departments; and nursing centers. Call for a list of accredited organizations.

Consumer Coalition for Quality Health Care
1275 K Street, N.W.
Suite 602
Washington, DC 20005
(202) 789-3606
A national, nonprofit organization of consumer groups advocating for consumer protections and quality assurance programs and policies. Call with general questions about quality issues or for consumer materials on managed care and activities at the State level.

Joint Commission on Accreditation of Healthcare Organizations
One Renaissance Blvd.
Oakbrook Terrace, IL 60181
(630) 792-5000
Evaluates and accredits nearly 20,000 health care organizations and programs including almost 12,000 hospitals and home care organizations, and more than 7,000 other health care organizations that provide long term care, behavioral health care, laboratory and ambulatory care services. The Joint Commission also accredits health plans, integrated delivery networks, and other managed care entities. Visit Quality Check on the Joint Commission's Web site (http://www.jcaho.org) for information on individual accredited organizations or for general information about assessing the quality of health care organizations.

National Committee for Quality Assurance
2000 L St. N.W., Suite 500
Washington, DC 20036
800-839-6487
Web Site: http://www.ncqa.org
Accredits HMOs and other managed care organizations. Call for the NCQA Accreditation Status List, Accreditation Summary Report, publications list, or for general information about quality.

Utilization Review Accreditation Commission
1130 Connecticut Ave. N.W., Suite 450
Washington, DC 20036
(202) 296-0120
Accredits PPOs and other managed care networks. Call for a list of accredited organizations.

This consumer's guide was developed by the Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Rockville, MD, in cooperation with the Health Insurance Association of America, Washington, DC.

[The following organization also has information on health insurance accreditation:

American Accreditation HealthCare Commission/URAC. Information on accredited organizations is available by calling (202) 216-9010 or go to www.urac.org.

Health insurance accreditation is required in some states for managed care operations that serve Medicaid patients.

In addition to health insurance accreditation, independent rating agencies such as A. M. Best - health insurance accreditation, Weiss Ratings - health insurance accreditation, Moody's health insurance accreditation, and Standard and Poor's health insurance accreditation, provide financial ratings of for-profit insurance companies. For non-profit orgaizations and pre-paid operations, financial information from state insurance regulatory agencies and health insurance accreditation organizations may be the best sources of operational evaluation. - ed.]