Healthcare Accreditations
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²»Á¼Ñо¿Ëù 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.
²»Á¼Ñо¿Ëù’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.
²»Á¼Ñо¿Ëù Corporation's health plans have several NCQA accreditations and distinctions:
- Health Plan Accreditation (HPA)Ìýmeasures health plan performance related to quality improvement, population health, network management, utilization management, credentialing, and member experience.
- Health Outcomes Accreditation (HOA)Ìýprovides a data-driven understanding of the health plan’s population and their unique needs and experiences, identifying and addressing gaps and disparities in care.
- Community-Focused Care Accreditation (CFCA)Ìýassists health plans to cultivate community-based partnerships to connect members to non-medical or social needs resources.
- Long-Term Services & Supports (LTSS)ÌýDistinction provides a framework for organizations to deliver person-centered care that meets individual’s needs and state requirements.
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The following subsidiaries currently hold one or more than one NCQA accreditation:
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Alabama
- Ambetter of Alabama
Arkansas
- Ambetter from Arkansas Health & Wellness
- QualChoice Health Insurance
Arizona
- Arizona Complete Health
- Ambetter from Arizona Complete Health
California
- Health NetÌý
- Ambetter from Health Net
Delaware
- Delaware First HealthÌý
- Ambetter Health of Delaware
Florida
- Sunshine Health
- Ambetter Health
Georgia
- Peach State Health Plan
- Ambetter from Peach State Health Plan
- Ambetter Health SolutionsÌý
Hawaii
- 'Ohana Health Plan
Iowa
- Iowa Total Care
- Ambetter Health
Illinois
- Meridian Health Plan of Illinois
- Ambetter of Illinois
Indiana
- Managed Health Services (MHS)
- Ambetter Health
- Ambetter Health SolutionsÌý
Kansas
- Sunflower Health Plan
- Ambetter from Sunflower Health Plan
Kentucky
- WellCare of Kentucky
- Ambetter from WellCare of Kentucky
Louisiana
- Louisiana Healthcare Connections
- Ambetter fromÌýLouisiana Healthcare ConnectionsÌý
Michigan
- Meridian Health Plan of Michigan
- Ambetter From Meridian (Michigan)
Missouri
- Home State Health
- Ambetter from Home State Health
- Ambetter Health SolutionsÌý
MississippiÌý
- Magnolia Health
- Ambetter from Magnolia Health
- Ambetter Health SolutionsÌý
North Carolina
- Carolina Complete Health
- Ambetter of North Carolina
Nebraska
- Nebraska Total Care
- Ambetter Health
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 CareÌý
Ohio
- Buckeye Health Plan
- Ambetter from Buckeye Health Plan
- Ambetter Health SolutionsÌý
Oklahoma
- Oklahoma Complete Health
- Ambetter of Oklahoma
Oregon
- Trillium Community Health Plan
PennsylvaniaÌý
- PA Health & Wellness
- Ambetter Health
South CarolinaÌý
- Absolute Total Care
- Ambetter from Absolute Total Care
- Ambetter Health SolutionsÌý
Tennessee
- Ambetter of Tennessee
Texas
- Superior HealthPlan
- Superior HealthPlan Network
- Ambetter from Superior HealthPlan
Washington
- Coordinated Care
- Ambetter from Coordinated Care
Wisconsin
- MHS Health Wisconsin
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²»Á¼Ñо¿Ëù’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:
- ²»Á¼Ñо¿Ëù Corporation – Credentialing
- Diamond Designation Program – Physician Quality (Certified)
- ²»Á¼Ñо¿Ëù Pharmacy Services – Utilization Management
- ²»Á¼Ñо¿Ëù Management Company –ÌýUtilization Management
- Envolve Dental dba ²»Á¼Ñо¿Ëù Dental Services – Utilization Management
- Envolve Vision Benefits dba ²»Á¼Ñо¿Ëù Vision Services – Utilization Management
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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:
- ²»Á¼Ñо¿Ëù Pharmacy Services – Drug Therapy Management
- AcariaHealth – Specialty Pharmacy
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AcariaHealth
Expires 12/01/2028
²»Á¼Ñо¿Ëù Pharmacy Services, Inc.
Expires 03/01/2027
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Core Certification
²»Á¼Ñо¿Ëù 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, ²»Á¼Ñо¿Ëù 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. ²»Á¼Ñо¿Ëù 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 .
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