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Health Plan Accreditation Series: Surveys Through June 2028


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Self-paced
Expires: June 30, 2028
This learning series includes multiple courses that cover the standards required for Health Plan Accreditation.
EARLY BIRD: $1695 until July 31, 2026. Use code PRTQJLTR.

About this Learning Series

Health Plan Accreditation Series: Surveys Through June 2028

EARLY BIRD: $1695 until July 31, 2026. Use code PRTQJLTR.

NCQA Health Plan Accreditation is the only program in the industry that bases results on clinical performance and consumer experience (HEDIS® and CAHPS®). These courses take a deep dive into all the relevant updates for the newly released standards. In addition to providing standards interpretation, these learning activities has been revised to include revised examples that align with the intent of requirements. This learning series is completely self-paced.

Product Alignment

The NCQA publication related to this training may be accessed, can be accessed through the NCQA Store.

What You Will Learn

Topics
  • Artificial Intelligence(AI)
  • Credentialing (CR)
  • Member Experience (ME)
  • Network Management (NET)
  • Population Health Management (PHM)
  • Quality Management & Improvement (QI)
  • Utilization Management (UM)
Learning Objectives
Throughout this course, learners will: 
  • Describe expectations for standard requirements, and their implications.
  • Interpret the intent of requirements for health plan accreditation.
  • Describe relationships and themes across the standards.
  • Recognize requirement implications and considerations for stakeholders.
  • Define performance improvement opportunities.
Learning Outcomes
After completing this course, learners will be able to:
  • Conduct a gap analysis regarding organizational performance against standards.
  • Prioritize initiatives and action items for improving performance.
  • Manage internal and external stakeholder expectations for service delivery.                                                                                                           

Who Should Attend

Clinicians, executives, managers, specialists, consultants, delegates, and vendors who are employed or contracted by health plans with responsibilities related to case management operations, including:

  • Accreditation or Compliance
  • Case Management 
  • Credentialing
  • Network Management
  • Population Health
  • Quality Assurance
  • Social Work
  • Utilization Management

Faculty

Amelia Bedri, MSHA
Amelia Bedri has been with the National Committee for Quality Assurance (NCQA) for over two years and is currently a Senior Program Content Engineer in Product Development. In this position, Ms. Bedri organizes the direction, structure and delivery of NCQA’s 11 Accreditation and Certification Standards and Guidelines, from concept to launch. Ms. Bedri has led the development cycle for NCQA’s Health Equity Accreditation programs and acts as the internal and external subject matter expert for the product. Prior to joining NCQA, Ms. Bedri worked as the lead researcher for MedStar Health Corporation in Washington, DC, in the development of their community health needs assessment. Her experience in the health care industry ranges from a variety of settings including complex care delivery systems, managed care, home and community-based services and consulting for a life sciences start-up and state health department. Ms. Bedri earned an MS in Health Systems Administration from Georgetown University with summa cum laude. 

Vince Pereira, MHA, FAHM, CPHQ, PCMH CCE
Vince Pereira is a Senior Program Manager of Customer Education at NCQA. In this role, Vince leads initiatives that enhance organizational readiness for performance improvement initiative's for health plans, health systems, and their partners. Prior to NCQA, Vince served in performance improvement roles with the Veterans Health Administration and the Department of Health and Human Services. He holds a Master of Health Administration from George Mason University.

Julie Pung, MBA
Julie Pung is an Assistant Director in Accreditation Policy at the National Committee for Quality Assurance (NCQA). She oversees NCQA’s Policy Clarification Support System (PCS) which provides interpretation on NCQA accreditation and certification standards and guidelines. She also oversees development of NCQA accreditation and certification standards and guidelines, Policy updates & clarifications and accreditation policy surveyor education. Prior to joining NCQA, Ms. Pung was Director, Enterprise Quality and Accreditation at Health Care Service Corporation (HCSC) where she oversaw NCQA Health Plan Accreditation for BCBS of Illinois, BCBS of New Mexico and BCBS of Texas and URAC Utilization Management Accreditation for BCBS of Illinois and BCBS of Texas. She holds a Bachelor of Arts degree in Psychology from Kalamazoo College and Master of Business Administration in Healthcare Management from Lake Forest Graduate School of Management.

Gerald Stewart
Gerald Stewart is a health quality improvement practitioner with a Master’s in Health Administration and certification as a Six Sigma Master Black Belt. Gerald has over 25 years of experience in helping improving business processes to deliver value and better experience and outcome for customers.  Gerald has led the production, management and optimization accreditation and certification products for the National Committee for Quality Assurance (NCQA) and has served as a subject matter expert and NCQA surveyor since 2001. Gerald has successfully served in several quality assurance/improvement roles (worn many hats) from NCQA project manager, corporate enterprise quality director, to assistance vice president of operations. For all of them and for whatever comes next, Gerald has been and remains unpretentiously obsessed with Making-It-Better and using the talented people to accomplish better. There is nothing more rewarding in life than knowing that you have help make a positive difference in another human being.

Continuing Education

This course grants 3 Other Continuing Education Unit (CEU) points for PCMH Certified Content Experts.  

This is a non AMA PRA Category 1 Credit TM, 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:
Amelia Bedri: None
Vince Pereira: None
Julie Pung: None
Gerald Stewart: None
 
Additional Planning Committee Members:
Felicia Khaalid: None
Tandeece Tubolino: None
Monifa Yearby: None
Kristen Swift: None

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). 


This program was developed by NCQA staff.
This program received no commercial support.

Here is the course outline:

1. Learning Materials and Resources

2. Health Plan Accreditation 101: Foundations - Through June 2028

3. Health Plan Accreditation 201: Implementation - AI Standards

Learning activity coming September 2026.

4. Health Plan Accreditation 201: Implementation - Credentialing Standards

Learning activity coming September 2026.

5. Health Plan Accreditation 201: Implementation - Member Experience Standards

Learning activity coming September 2026.

6. Health Plan Accreditation 201: Implementation - Network Management Standards

Learning activity coming September 2026.

7. Health Plan Accreditation 201: Implementation - Population Health Management Standards

Learning activity coming September 2026.

8. Health Plan Accreditation 201: Implementation - Quality Improvement Standards

Learning activity coming September 2026.

9. Health Plan Accreditation 201: Implementation - Utilization Management Standards

Learning activity coming September 2026.

10. Attestation

Completion

The following certificates are awarded when the course is completed:

Certificate of Attendance
CCE Other Certificate
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