State, Payer Recognitions for Ambulatory Health Care
30 state agencies recognize and/or rely on Joint Commission ambulatory health care accreditation in lieu of specific state licensure or certification requirements.
National Payer Recognitions
Look for an announcement this fall from Aetna about how Joint Commission Advanced Certification in Spine Surgery will be required to participate in their Institutes of Quality® program for orthopedic (spine) for both hospitals and ambulatory surgery centers.
IngenioRX recognizes Joint Commission as one of three accrediting organizations as a requirement for medical group practices in 14 states: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin.
Blue Cross Blue Shield Association (Blue Distinction)
To participate in Blue Distinction program, the ASC needs to be accredited and have advanced orthopedic certification by an accrediting organization such as The Joint Commission.
Centene recognizes PCMH for incentive payments in 17 states: Arizona, California, Illinois, Indiana, Iowa, Louisiana, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, Ohio, Oregon, South Carolina, Texas, and Washington.
Express Scripts requires accreditation for physician offices that dispense certain specialty pharmaceuticals to be considered in-network. McKesson has selected The Joint Commission as their preferred accreditor to meet Express Scripts’ accreditation requirements.
Highmark recognizes Joint Commission Accreditation for ambulatory surgery centers, urgent care, sleep centers, ambulatory infusion, and renal as an option to meet various contracting and credentialing requirements in the states of Delaware, New York, Pennsylvania, and West Virginia.
Health Resources & Services Administration/Bureau of Primary Health Care (HRSA/BPHC)
For FQHCs, HRSA/BPHC pays the onsite and annual accreditation fees and fees for PCMH certification surveys combined with an ambulatory care accreditation survey.
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