Covering Managed Care
A resource guide for reporters and editors

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Accrediting Organizations

These organizations give seals of approval to managed care plans and other providers of health care, such as hospitals or nursing homes. Each of them writes its own criteria. Their reviews examine the processes and procedures health plans have in place for delivering care, in effect, requiring plans to meet minimum standards to win approval.

Accreditation Association for Ambulatory Health Care
3201 Old Glenview Road, Suite 300, Wilmette, IL 60091
Phone (847) 853-6060/Fax (847) 853-9028
Laura Kroll is our Director of Marketing and we currently accredited over 1600 facilities. If you need further information, you may visit our website at www.aaahc.org or you may contact our marketing department directly. Accredits some 900 health care facilities, including outpatient surgical centers. Mostly a marginal player, it has accredited seventeen HMOs and one independent practice association (IPA).

Joint Commission on Accreditation of Healthcare Organizations

One Renaissance Boulevard, Oakbrook Terrace, Ill. 60181, (630) 792-5000, fax (630) 792-5005, Web site: www.jcaho.org. Communications director Cathy Barry-Ipema (630) 792-5631, president Dr. Dennis O'Leary. It accredits some 18,000 hospitals, nursing homes, home care agencies, clinical laboratories, behavioral health care firms, and ambulatory care centers, plus forty health-care networks, including HMOs and preferred provider organizations, or PPOs. To get accreditation reports, call customer service at (630) 792-5800.

National Committee for Quality Assurance

2000 L St. N.W., Washington, D.C. 20036, (202) 955-3500, fax (202) 955-3599, Web site: www.ncqa.org. Communications director Barry Scholl (202) 955-5197; president Margaret O'Kane. NCQA is the primary accrediting organization for managed care firms; it has examined over 300 HMOs and nineteen managed behavioral health organizations, and certified forty-seven credential verification organizations, firms that contract with HMOs to review the credentials of physicians. Has four classifications for accrediting HMOs: full, one-year, provisional, and denial. Information on which plans are accredited and at what level is available on the Web site. NCQA also collects and disseminates health plan performance data (HEDIS). (See also "Organizations that disseminate data.")

The American Accreditation Healthcare Commission/URAC

1275 K St. N.W. Washington, D.C. 20005, (202) 216-9010, fax (202) 216-9006, Web site: www.urac.org. Press contact Guy D'Andrea, (202) 216-9010 ext. 16; president Garry Carneal, ext. 13. Organization began in 1990 to accredit utilization review firms, which decide whether certain treatments and procedures should be done. It has branched out to accredit other health care organizations such as HMOs and provider-sponsored organizations. It also certifies credential verification organizations.