To evaluate the health plan's activities for ensuring that doctors and other providers are qualified, NCQA reviews credential files, interviews health plan staff and grades the results from consumer surveys conducted by independent survey organizations. NCQA looks for:

• policies to effectively assess the qualifications of doctors and other providers who care for plan members.

• a committee of doctors who select and evaluate the plan’s doctors and other providers.

• evidence that the health plan verifies doctors’ training, licensure and certification.

• evidence that doctors disclose any information that affects their ability to practice medicine.

• evidence that the health plan looked for information on any malpractice suits or sanctions.

• on-site review of doctors’ offices by the health plan to ensure offices are accessible and adequate.

• evidence of periodically reexamining doctors’ training, licensure and certification.

• evidence of periodically looking for information on any malpractice suits or sanctions.

• evidence of evaluating experience with doctors and other practitioners, including information from plan members.

• a process for periodically conducting an onsite review of doctors’ offices by the health plan.continuous review of doctors’ sanctions, licensure and patient complaints

• a process for suspending or removing doctors when necessary.

• evaluations of the quality of hospitals, nursing homes and home health agencies affiliated with the health plan.

• a well-defined program for continuously improving the quality of clinical care and service provided to plan members.

• commitments from doctors that they will cooperate with health plan efforts to improve quality.

• policies that require doctors to keep medical records in a way that maintains patient confidentiality and promotes effective patient care.

• complete and proper documentation of information in medical records.

• health plan members’ ratings of doctors’communication; specifically, how often did their doctor listen carefully, explain things, show respect and spend enough time with them.

• health plan members’ ratings of all health care received from their doctors and other health providers in the plan.

• health plan members’ ratings of their personal doctor or nurse.

• health plan members’ ratings of the specialist they saw most often.

• a well-defined program for improving the quality of clinical care and service provided to plan members.

• individuals in the health plan responsible for overseeing quality improvement programs.

• actual improvements that the plan has made in care and service.

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