Access & Availability Standards
About the National Committee for Quality Assurance (NCQA)
The National Committee for Quality Assurance (NCQA) is a nonprofit organization that works to improve the quality of health care. NCQA develops evidence-based standards, measures, and accreditation programs that evaluate and certify the performance of health plans, medical groups, and clinicians. By promoting transparency and accountability, NCQA helps consumers make informed health care decisions and encourages providers to deliver higher-quality, patient-centered care. Their work supports improvements in care coordination, patient safety, and health outcomes across the health care system.
Medical and behavioral health providers should be familiar with NCQA because its standards and accreditation programs directly influence the quality measures and care delivery models they are expected to follow. NCQA sets benchmarks for patient care, care coordination, and outcomes that impact provider performance evaluations, reimbursement, and network participation. Understanding NCQA helps providers align their practices with best practices, improve patient outcomes, and meet regulatory and payer requirements. Additionally, for behavioral health providers, NCQA’s growing focus on integrating behavioral and medical care supports collaborative approaches that enhance overall patient well-being.
Access & Availability Standards
We promote access to care by partnering with health care providers to ensure members receive the best possible health care services. It includes evaluation of the availability, accessibility and acceptability of services rendered to members by participating providers. We expect network providers to have procedures in place to see patients within time frames established by NCQA, regulatory bodies (such as the Centers for Medicare & Medicaid Services [CMS]) and plan contracts that are no less (in number or scope) than the hours offered to non-members. Ensuring coverage 24/7 that allows your patients to speak with a practitioner is important for them to receive appropriate care and maintain their health.
We have prepared resources and training to support your understanding of the standards.
- Provider Education Series: Timely Access to Care Training
To take the training:- Log into the Provider Portal.
- Select “Health Plan Resources” from the menu in the navigation bar.
- Select the Provider Education Series: Timely Access to Care Training in the course catalog.
- View the Access Standards and Survey Questions Resource (Coming Soon).
- View our Access to Care and After-Hours Standards Flier (Coming Soon).
News and Announcements
Update to After-Hours Standard Effective July 1, 2026: PCP and Behavioral Health providers must provide 24-hour availability to their CareSource patients by telephone. Whether through an answering machine or a taped message used after hours, patients should be given the means to contact their PCP/BH* provider or a back-up provider to be triaged for care. It is not acceptable to use a phone message that does not provide access to you or your back-up provider and only recommends emergency department use for after hours.
*BH providers may refer their patients to the 988 Suicide & Crisis Hotline if a provider is not available for the call.
NCQA Accreditation
NCQA evaluates the quality of health care that health plans provide to their members and how well a health plan manages all parts of its delivery system — physicians, hospitals, other providers and administrative services — in order to continuously improve the quality of care and services provided to its members. Read about our plan accreditations.