A healthcare organization, facing provisional NCQA status after a failed accreditation and zero scores in QI 3 and QI 4, turned to our team—its third consulting firm—amid a complex CAP submission deadline.

Through expert guidance, detailed gap analysis, and strategic support led by Kim and Sheila, the client achieved full CAP acceptance, lifted their provisional status, passed the resurvey without citations, and regained confidence on their path to full accreditation.

Challenge

Potential Client entered NCQA’s Provisional Status after a prior failed accreditation attempt, scoring zero points in QI 3 and QI 4—a significant blow to their quality improvement credibility. The initial consulting team, sourced through legal channels, failed to meet expectations, and the organization sought new expertise to salvage their compliance trajectory.

Additionally, they faced a complex Corrective Action Plan (CAP) submission deadline and were under pressure to pass critical elements in:

• QI 1, 3A, 3B, 4
• UM 12A, 12C

A failed QI component posed a risk to their overall accreditation, requiring a strategic and technically accurate response within a 3–6 month look-back window for the CAP survey.

Solution

We were the third consulting firm approached but ultimately secured the engagement thanks to the rapid, high-quality support provided by Kim and Sheila.

Our approach involved:

• Serving as auditor and strategic advisor during the CAP preparation.
• Conducting a deep gap analysis and developing a detailed work plan aligned with NCQA’s 2023 standards.
• Supporting the creation of an integrated, streamlined QI 3 submission document, even as QI 3C was still pending resolution.
• Coordinating weekly check-ins and ensuring readiness ahead of the September 30th submission review.
• Working closely with primary NCQA liaisons 

Key Milestones

• March 26, 2024: Original CAP submission.
• June (3rd week): Final NCQA report received.
• September 30, 2024: Target date for new submission progress on key QI and UM elements.
• A follow-up status report was delivered per the client's timeline.
• Resurvey conducted with a significantly improved evidence package.

Results

• The NCQA Sr. Manager, Surveyor Management confirmed no issues were identified during the resurvey.
• The survey end date was moved up to expedite finalization.
• Client’s leadership expressed strong satisfaction, stating:

“Hooray! Thank you again for your help and support – we couldn’t have done this without you!”

Impact

• Provisional Status lifted
• CAP fully accepted
• Successful resurvey with no citations
• Client is now back on track toward full accreditation with a more confident internal compliance posture.

Conclusion

Our firm’s ability to translate NCQA standards into actionable, organization-specific strategies, coupled with our agile support model, turned around a challenging situation.

We provided not just consulting but credibility restoration at a critical moment in the client's accreditation journey.