NCQA
Blue Cross and Blue Shield of New Mexico's BlueChoice PPO plans and HMO New Mexico, Inc., are accredited by the National Committee for Quality Assurance (NCQA). The NCQA accreditation process is the most widely recognized national evaluation that consumers, purchasers, and regulators use to assess and compare the caliber of managed care plans.
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PPO Accreditation Effective August 12, 2005, Blue Cross and Blue Shield of New Mexico (BCBSNM)received "Full Accreditation" status for its BlueChoice PPO plans. |
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HMO Accreditation Effective August 28, 2006, HMONM was awarded "Commendable Accreditation" by NCQA. |
NCQA is an independent, not-for-profit organization that evaluates managed care organizations and maintains the Health Plan Employer Data and Information Set (HEDIS®), a set of standardized performance measures designed to ensure consumers have the information they need to compare the performance of managed health care plans. More than 60 standards and selected HEDIS® performance measures were evaluated by a team of physicians in such areas as member rights and responsibilities, quality management and improvement, clinical services, preventive health, utilization management, and the credentialing process for network physicians and other providers.
The Consumer Assessment of Health Plans (CAHPS®) 2.0H Commercial Adult Member Satisfaction Survey is a set of survey tools used to assess patients' satisfaction with their health plans. The CAHPS® survey is applied to a random sample of BCBSNM/HMONM health plan members, and provides findings by plan service area and by each individual question. Developed jointly by the Agency for Healthcare Research and Quality (AHRQ) and NCQA, the CAHPS® 2.0H survey is the most comprehensive tool available for assessing consumers' experiences with their health plans.
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), a U.S. Government agency.
URAC
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BCBSNM has administered the Federal Employees Program (FEP) since 1961, providing health care benefits and services to FEP participants.
BCBSNM was re-surveyed in June 2004 and received 100 percent URAC compliance for the Federal Employee Program in October 2004.
URAC is an independent, nonprofit organization committed to promoting health care quality through accreditation and certification programs. URAC standards are developed by a committee of experts, including providers, health care organizations, insurers, and the public interest. URAC reviews a company's operations to ensure that national standards are met and that the company is operating according to its policies.
Originally, URAC was incorporated under the name "Utilization Review Accreditation Commission." That name was shortened to the acronym "URAC" when they began accrediting health plans and other organizations in 1996. URAC sometimes uses a second corporate name, "American Accreditation HealthCare Commission, Inc."
