About this Learning Activity

Health Plan Accreditation Updates: Credentialing Self-paced

This course leads learners through a deep dive into the most recent updates to Credentialing (CR) standards for Health Plan Accreditation. In addition to answering questions, the presenters address scenarios and examples based on performance improvement opportunities from prior NCQA surveys.

This learning activity presents information on Health Plan Accreditation standard requirements that are released each July on a rolling basis. 

What You Will Learn

Learning Objectives

By participating within this learning activity, learners will:

• Describe updates and changes to the standards and guidelines.
• Interpret the intent of Credentialing requirements.
• Describe relationships and themes across requirements.
• Recognize requirement implications and considerations for stakeholders.
• Define performance improvement opportunities.

Learning Outcomes

After completing this course, learners will be able to:

• Develop and maintain evidence-based program policies and procedures.
• Prioritize performance improvement initiatives.
• Implement reliable and valid practices for managing NCQA Accreditation.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates and vendors who are employed or contracted by health plans with responsibilities pertaining to the scope of work listed below:

• Health care professional.
• Health decision makers
• Consultant.
• Health plan.
• Health Systems
• Population health organizations

Faculty

Albert "Irv" Koehler, RN, MBA, CPHQ, CPC

Irv Koehler is a health care quality consultant for the Koehler Quality Group, LLC. In this position, he is an NCQA administrative surveyor and provides consulting services to organizations evaluating and preparing for NCQA Accreditation/ Certification projects, risk adjustment validation for managed care organizations, education on quality improvement practices and outcome measure development and tracking.  

Mr. Koehler is also a registered nurse with active licensure in Florida and Tennessee, and certification in quality and medical coding. Previously, he was a quality improvement professional at AmeriHealth Caritas and BlueCross BlueShield of Tennessee.

Mr. Koehler has an MBA from the Florida Institute of Technology, a BS in Nursing from Florida Southern College, a BA in Psychology and an ADN from Purdue University.

Continuing Education

This course grants 1.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.

This is a non AMA PRA Category 1 CreditTM, ANA CNE, ACPE activity.

* Please note – You must attend the entire program to be eligible for total number of contact hours.

Disclosure of Relevant Financial Relationships

The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.

For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution.  For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.

Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Relevant financial relationships exist with the following companies/organizations:

Faculty:
Albert "Irv" Koehler: None

Additional Planning Committee Members:
Vince Pereira: None 

This program was developed in part by NCQA staff.