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NCQA Accreditation
National Committee for Quality Assurance — Health Plan Accreditation Status
★
ACCREDITED — 3-Year Designation
eKlotho Health Plan · NCQA Health Plan Accreditation · Highest possible designation
Valid Through: December 31, 2025
Renewal Survey: June 2025
Organization ID: NCQA-HPA-00824
Renewal Required Q2 2025
Standards by Domain
26 standards total · 23 met · 3 gaps
QM&I — Quality Management & Improvement
8 standards · 7 met
1 gap ▾
✓
QM1 — Quality Program Organization
Board oversight, committee structure, documented QI program · Last reviewed: Jan 2026
✓
QM2 — Performance Measurement
HEDIS measures collected and reported annually · Last reviewed: Jan 2026
✓
QM3 — Quality Improvement Projects
3 active QI projects documented · Last reviewed: Feb 2026
✓
QM4 — Practitioner Performance
Annual practitioner performance reports · Last reviewed: Jan 2026
✓
QM5 — Delegation Oversight
Delegation agreements and oversight process documented · Last reviewed: Dec 2025
✗
QM6 — Safety Program
GAP: Patient safety event tracking lacks formal trending analysis. Remediation plan assigned to Dr. Rivera, due May 15, 2026.
✓
QM7 — Accreditation Survey
Prior survey documentation maintained · Last reviewed: Jan 2026
✓
QM8 — Population Health Management
Risk stratification program in place · Last reviewed: Feb 2026
UM — Utilization Management
6 standards · 6 met
All Met▾
✓
UM1 — UM Program Oversight
Medical Director oversight documented · Last reviewed: Jan 2026
✓
UM2 — Clinical Criteria
MCG criteria licensed and applied · Last reviewed: Feb 2026
✓
UM3 — Timeliness of Decisions
Decision turnaround monitoring in place · Last reviewed: Jan 2026
✓
UM4 — Denials and Appeals
Denial tracking and appeals process compliant · Last reviewed: Jan 2026
✓
UM5 — Behavioral Health Integration
BH UM program integrated · Last reviewed: Dec 2025
✓
UM6 — Continuity and Coordination
Transition-of-care process documented · Last reviewed: Feb 2026
CR — Credentialing and Recredentialing
5 standards · 4 met
1 gap▾
✓
CR1 — Credentialing Program
Credentialing committee policies documented · Last reviewed: Feb 2026
✓
CR2 — Initial Credentialing
Primary source verification process in place · Last reviewed: Jan 2026
✗
CR3 — Recredentialing
GAP: 12% of providers overdue for 3-year recredential. Owner: Credentialing Team Lead. Due: Apr 30, 2026.
✓
CR4 — Organizational Credentialing
Facility credentialing process compliant · Last reviewed: Dec 2025
✓
CR5 — Credentials Verification Org (CVO)
CVO delegation agreement current · Last reviewed: Jan 2026
MRR — Member Rights & Responsibilities
4 standards · 4 met
All Met▾
✓
MRR1 — Member Rights Statement
EOC and member handbook up to date · Last reviewed: Jan 2026
✓
MRR2 — Language and Accessibility
Multi-language materials, TTY, translation services · Last reviewed: Feb 2026
✓
MRR3 — Grievances and Appeals
G&A process compliant with CMS requirements · Last reviewed: Jan 2026
✓
MRR4 — Confidentiality
HIPAA privacy program documented and audited · Last reviewed: Feb 2026
MC — Member Connections
3 standards · 2 met
1 gap▾
✓
MC1 — Member Experience
CAHPS administered annually · Last reviewed: Feb 2026
✗
MC2 — Complex Case Management Outreach
GAP: Outreach documentation for high-risk members lacks systematic tracking. Owner: Care Management Director. Due: Jun 1, 2026.
✓
MC3 — Health Education
Health education materials available in member portal · Last reviewed: Jan 2026
Gap Analysis — Non-Compliant Items
3 gaps
StandardDomainIssueOwnerDue DateStatus
QM6 Quality Mgmt Patient safety event trending analysis missing Dr. Rivera May 15, 2026 In Progress
CR3 Credentialing 12% of providers overdue for recredential Credentialing Team Lead Apr 30, 2026 Critical
MC2 Member Connections High-risk member outreach tracking not systematic Care Mgmt Director Jun 1, 2026 In Progress
Accreditation Score
88%
Standards compliance
3-Year Accredited
Standards Met23 / 26
Gaps3
Renewal SurveyJune 2025
Key Dates
Current Valid ThroughDec 31, 2025
Survey ScheduledJun 2025
Application SubmittedJan 15, 2025
Gap Remediation DueJun 1, 2026
Quick Actions
AI Assistant
About NCQA Accreditation ▾

NCQA Health Plan Accreditation assesses health plans across 5 domains: Quality Management, Utilization Management, Credentialing, Member Rights, and Member Connections. A 3-year designation is the highest possible.

Domains and Standards ▾
  • Click any domain accordion to expand individual standard compliance status.
  • Green checkmark = Met. Red X = Gap requiring remediation.
  • Click evidence links to view supporting documentation.
Gap Remediation ▾

All gaps must be remediated before the renewal survey. Each gap has an assigned owner and deadline. Track progress in the Gap Analysis table. Evidence must be uploaded before survey date.

Renewal Timeline ▾
  • Submit application 6–12 months before current designation expires.
  • NCQA schedules on-site or virtual survey within 90 days of application.
  • Survey results typically delivered 60–90 days after survey.
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