The NCQA will evaluate PPOs on the following criteria:
- Consumer protection: Do members know about their appeal rights? Are medical review decisions made quickly and fairly? Is members' privacy protected?
- Member service: Are appeals resolved appropriately and in a timely manner? Do members receive complete information about benefits and available providers?
- Access to care: Is the plan's network adequate? Are members satisfied?
- Provider credentialing: Does the plan thoroughly verify practitioner's credentials?
- Plan performance: How does the plan score in such areas as claims processing, customer service and access to needed care.
- Source: NCQA ( http://www.ncqa.org )