MHR Newsletter

Driving healthcare quality one NCQA accreditation at a time

2024 #6
June 21, 2024
By: Nancy Ross Bell

From Susan 

MHR has been abuzz with activity during the first half of 2024!

To hold true to our Mission, Vision, and Values, we regularly embark on our own process improvement so that you, our trusted and valued clients, receive the highest outcomes while engaging with us in our products and consultative services.  Among our many accomplishments, we:

  • Updated our tools, templates, and training to the most current standards and are making them available for easy purchase online.
  • Added new tools and training, such as how to assess your staffing to sustain NCQA Accreditation, which we often see as an issue.
  • Developed a plan to refresh our website to better serve our customers. Changes are coming soon!
  • Presented a client-only webinar on updates from NCQA and an additional webinar on NCQA’s Proposed Changes to the 2025 Standards.

MHR consultants are known for their deep knowledge and experience with NCQA’s programs. This month, we feature MHR’s Consultant, Dena Reeves, whose clinical background in case management and utilization management are highly valued in guiding clients through their surveys.

In May, we wished Kelsi Baird the very best as she pursued her next career journey. At the same time, we are welcoming new consultants to MHR in June—learn more in an upcoming newsletter as they onboard with MHR.

Remember to save November 1, 2024, for our client dinner at NCQA’s Health Innovation Summit in Nashville.  Let us know if you plan to attend.

Susan K. Moore, President & CEO


MHR’s President & CEO Susan K. Moore welcomed over 100 attendees, clients, and non-clients, to a complimentary webinar on May 17, 2024, when she reviewed some of NCQA’s proposed changes to the 2025 standards and graded the general areas based on her opinion of the value that it will bring to organizations and its members. Grades were high!

If you attended the webinar and did not receive our detailed slides, please let us know. Here are a few highlights.

QI 3 & 4                                                                     B

Among the proposed changes is merging QI 3 and 4 and placing a heavier reliance on HEDIS measures from Health Plan Ratings. The issue of continuity and coordination is long-standing and difficult to address. Changes will reduce the burden of these standards while maintaining rigor on an important issue. However, the bar is set low: not having to improve quality until July 2026, with perceived “double-dipping” for crediting HEDIS and standards, thus a grade of B.

Information Integrity                                               A-

Kudos to NCQA for refocusing system control standards on inappropriate modifications, providing clear definitions, and moving must-pass requirements to audit and analysis instead of a documented process. Organizations previously accredited with system control requirements in the 2022 or 2023 standards will eventually need to transition to the new, more stringent requirements for information integrity.  

Credentialing for HPA and MBHO                          A

Among multiple changes to the credentialing standards, we call out the following:

  • The timeframe for notification of committee decisions is reduced from 60 days to 30 days, and the timeframe for reviewing ongoing reports is reduced from 30 days to 10 days.
  • Composition of the credentialing committee should align with the needs and diversity of the membership.
  • A field for race, ethnicity, and language must be added to practitioner applications
  • Documentation in files and committee minutes is enhanced throughout

Credentialing                                                           A

Credentialing Verification Organizations (CVO) Certification will become Credentialing Certification (CRC) if the proposed standards are adopted. Requirements align between CRC and Credentialing Accreditation (CRA).

  • The need for governing body approval is maintained.
  • SMART goals and annual analysis are required for Quality Improvement
  • Information integrity standards replace system controls
  • The timing for primary source verification changes from 120 days to 60 days

Standardization and alignment of scores support a grade of A.

Susan’s Key Takeaways

MHR is on high alert for the final adopted changes and will be ready to guide you through as needed. What you can do now:

  • Prioritize your delegation agreements and system integrity changes
  • Determine changes needed in your quality improvement plan based on QI 3 metrics
  • Begin drafting changes to credentialing policies and minutes
  • Begin moving up timeframes for credentialing
  • Determine if IT system changes will be needed for practitioner data on applications


You can now purchase MHR’s proprietary tools, templates, and training sessions. From a list of all available items, clients and non-clients alike can select what they need. Let us know, and we will help you decide what you may need.

If you are not using our tools and training now, stop the struggle with trying to maintain your own and risk not being compliant! 

All items are updated with the most recently available standards.  If you purchase an item now that is compliant with the 2024 standards, you will receive a 2025-compliant version at no additional charge.  

 Ask your MHR Consultants for assistance selecting items most applicable to your organization.  Non-clients may contact our Virtual Assistant at [email protected]


If you are not a current client, please reach out to Susan to schedule a Discovery Call and learn how we guide organizations on their path to NCQA Accreditation.  




Dena Reeves, BSN, RN

MHR’s clinical consultants come to MHR on unique paths, from working in clinically related roles in organizations to managing NCQA surveys, where they gain detailed knowledge of NCQA standards. While working as a leader within the managed care arena and diving deep into the NCQA standards, Dena developed a strong interest in consulting, which eventually led her down the path to consulting with MHR.

Dena joined MHR in 2022, bringing her clinical expertise in high-risk maternity, case management (CM), and utilization management (UM) and various experiences leading NCQA activities.  Dena consults on NCQA Accreditation for Case Management, Utilization Management, and Health Plans. Working with the MHR team, she enjoys the camaraderie and the ability to share and learn from each other.  We laugh together, celebrate successes, and support each other when challenges arise.

Dena’s commitment to her clients is rooted in trust and nonjudgmental feedback. She is always there to listen and respond to their needs. What truly drives her is the satisfaction of guiding her clients through their NCQA journey, witnessing increased employee engagement in their organizations, and ultimately, enhancing the quality of care and services they provide to their members.  

To help ensure the success of her clients, Dena focuses on three things. She ensures optimal time in her schedule to give attention to clients and meet their needs. She leans on her own years of direct experience in managed care and consulting and experiences shared by her MHR colleagues to help inform her feedback and recommendations for client success. If clients’ unique situations need policy clarification, Dena reaches out to NCQA’s Policy department for answers.

Dena's transition from managed care to consulting was not the only change she embraced. Born and raised in New York City, she now resides in rural Pennsylvania, helping to manage a homestead farm with her family and honing her gardening skills at the same time! Being adaptable and flexible allows Dena the ability to balance her professional commitments to her MHR clients with her roles as a wife, mother of two adult children, and proud grandmother of three.

Read more about Dena and MHR’s other consultants, where we profess that Experience Matters when it comes to your NCQA Survey preparation!


We asked NCQA for you!

Artificial Intelligence (AI) is widely used, but can you use it for Utilization Management (UM) Decisions?

MHR Asked NCQA:  May organizations use AI to make medical necessity denial decisions or appeal decisions?

NCQA Responded: No. NCQA UM standards do not allow the use of AI to make medical necessity denial decisions or any appeal decisions. 

If an organization uses AI in the UM process, medical necessity review requires that denial decisions be made only by an appropriate clinical professional, and appeal decisions require same-or-similar specialist review, as specified in the NCQA standards.  

News from NCQA:

Follow the links.  

Keep updated with the latest MHR’s latest blogs

Sustain Quality Management During Your NCQA Accreditation Cycle

How to Make Meaningful Updates to Your NCQA Population Health Management Strategy



August 9, 2024
MHR’s Client-Only TrainingSave the Date

  • Live Webinar -Policy Changes & Surveyor Training Insights

August 13-14, 2024
Rise: Bedrock of Healthcare Virtual Training Series (Quality)

August 20-21, 2024
Rise: Bedrock of Healthcare Virtual Training Series (SDoH)

September 9-11, 2024
NAHQ Next 2024

  • Virtual

September 24-26, 2024
AHIP: 2024 Consumer Experience and Digital Health Reform

  • Nashville, TN

October 1-3, 2024
Rise: The 14th Annual HEDIS® & Quality Improvement Summit

  • Las Vegas, NV

October 31-November 2, 2024 -Save the Date- MHR Client Dinner on 11/1
NCQA Health Innovation Summit

  • Nashville, TN

December 13, 2024
MHR’s Client-Only TrainingSave the Date

  • Live Webinar -Policy Changes & Surveyor Training Insights

MHR was incorporated in 1991 and specializes in preparing organizations for all NCQA accreditation and certification products.

All MHR consultants were responsible for NCQA accreditation in their previous roles before joining MHR as an independent consultant. Most consultants are also NCQA surveyors and the majority are clinicians. Read more about How We Work!

We welcome hearing from you! Please get in touch with us. 

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