Accreditation by the National Committee for Quality Assurance (NCQA) has moved beyond a checkbox — it is a foundational element and a strategic differentiator of a health plan’s strategy that signals quality, equity and accountability. At Healthmine, we understand the critical role that NCQA accreditation plays in driving plan performance, ensuring compliance, and advancing health equity. That’s why we’ve expanded our consulting services to offer comprehensive, end-to-end advisory support for both NCQA Health Plan Accreditation (HPA) and Health Equity Accreditation (HEA) across all lines of business.
Whether you’re preparing for first-time accreditation, gearing up for reaccreditation, or pursuing a Health Equity designation, Healthmine brings expert guidance, proprietary tools and a 100% success rate in achieving accreditation for our plan partners.
NCQA 2026 standards: Big changes are coming
NCQA recently announced that the 2026 HPA standards will be available for purchase starting August 29, 2025. The updates introduce meaningful shifts — particularly within the Utilization Management (UM) domain — that will reshape how plans demonstrate performance and compliance.
These changes go beyond simple requirement fulfillments — they will require updates to policies, workflows and cross-functional collaboration across departments. UM data collection and evaluation can assist plans to identify process improvements and improve member experience. NCQA is also requiring plans to put an action plan in place to improve upon any opportunities that are identified through this process. There are also important timeliness updates that will require close examination of internal systems and procedures.
At Healthmine, we’re preparing clients for what’s next. Our team is closely tracking the updates, interpreting the implications, and developing the resources and guidance needed to help health plans navigate the new 2026 standards with confidence. Whether you're proactively preparing or reassessing your readiness, we're here to help you navigate every step with clarity and confidence.
What makes us stand out
There is no shortage of consultancy agencies. So, what makes us different? Our consultants include current NCQA surveyors and subject matter experts with first-hand knowledge of how standards are evaluated — and what sets top-performing submissions apart.
We view ourselves as an extension of our plan partners’ teams, rather than a siloed consultant for a single project. We work alongside your teams to interpret standards, identify gaps and build and implement strategies tailored to your organization’s structure, goals and timeline, setting you up for long-term success with critical NCQA knowledge while also working toward accreditation now.
Here's how we can help you:
- Gap assessments and readiness reviews: Evaluate current operations and documentation against NCQA standards
- Custom roadmaps and workplans: Build a tailored action plan aligned with submission timelines and resource capacity
- Training and SME workshops: Empower your teams with training sessions led by NCQA experts
- Proprietary audit tools: Access our templates, and mock audit tools that streamline preparation
- Health Equity Accreditation support: Address the structural, data, and community engagement elements unique to the Health Equity designation
- Standards support: Get expert guidance on interpreting and operationalizing the forthcoming updates, with a focus on Utilization Management and emerging priority areas
- Evidence development support: We identify and mitigate gaps, helping your team compile and annotate the documentation needed for a successful submission
- Survey liaison support: Act as your liaison with NCQA, including direct submission of evidence into the Interactive Review Tool (IRT) to streamline the process and ensure alignment with reviewer expectations
Whether your organization is preparing for full accreditation or targeting a specific domain, we adapt our support to fit your needs — from project management to strategic consulting.
Approach accreditation with confidence
No matter your line of business, our team understands the operational, clinical and regulatory context surrounding your accreditation goals — and delivers the guidance you need to navigate them with clarity, efficiency and confidence.
We don’t see accreditation as an endpoint. We see it as a catalyst to strengthen operations, improve outcomes and better serve your members. If your organization is planning for NCQA Health Plan Accreditation or Health Equity Accreditation — or preparing for the significant changes coming in 2026 — we’re here to help you succeed efficiently, effectively and with full confidence.
Let’s talk about how we can help you move forward with purpose and precision towards your accreditation goals. Contact us for a free 30-minute introductory call to learn more about how we help plans just like yours.
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