Our Network’s back-office operations are managed by our affiliate, Health System One, Inc. (HS1), a third party administrator (TPA) that is NCQA certified for Credentialing and Utilization Management.
The NCQA’s Utilization Management and Credentialing Certification is a quality assessment program that focuses on consumer protection and customer service improvement. The Certification, which is the result of a voluntary review process, reduces the level of review and information gathering required for current or future health care partners to do business with Health System One.
NCQA standards are extremely demanding, and the Certification puts Health System One on par with the nation’s top health plans in following best practices while encouraging continuous improvement in the areas of Utilization Management and Credentialing.
NCQA’s accreditation process involved a rigorous review of Health System One’s Utilization Management and Credentialing functions to ensure that Health System One follows processes that respect members’ and practitioners’ rights, that only appropriately trained and qualified clinical personnel conduct and oversee utilization review, and that medical decisions are based on evidence-based clinical criteria.
About NCQA: The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers. For complete details on how the review process works, visit www.ncqa.org.