Jul 23 2019 | Press Release | By

Lumeris Awarded NCQA Accreditation for Case Management and Utilization Management

Lumeris also fully Certified by NCQA for 11 out of 11 verification services


ST. LOUIS, MO — JULY 23, 2019 – Lumeris, an industry leader in value-based care, today announced that the National Committee for Quality Assurance (NCQA) Review Oversight Committee has awarded the company Accreditation status for Case Management and Utilization Management. In addition, Lumeris also earned Certification as an NCQA Credentials Verification Organization (CVO) for verification services. NCQA’s mission is to improve the quality of health care and is governed by a Board of Directors that includes employers, consumers, health plans, quality experts, policy makers and representatives from organized medicine.

Lumeris earned 3-year NCQA Case Management Accreditation for its Complex Case Management program, based on the company’s demonstrated strong performance of specific functions. For Case Management, NCQA Accreditation standards are developed with input from researchers in the field, the Case Management Expert Panel and standing committees, employers, both purchasers and operators of Case Management programs, state and federal regulators and other experts. These standards are purposely set high to encourage organizations to continuously enhance their quality.

Lumeris also received 3-year Accreditation by NCQA in Utilization Management. Utilization Management Accreditation is a quality assessment program that focuses on consumer protection and customer service improvement. (NCQA has reviewed and accredited Lumeris’ Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.)

With the CVO Certification, Lumeris meets NCQA’s credentialing standards for health plans. CVO Certification includes rigorous on-site evaluations conducted by a team of health care professionals and

certified credentialing specialists. A national oversight committee of physicians analyzes the team’s finding and determines certification based on the CVO’s compliance with NCQA standards.“The NCQA accreditation and certification process requires rigorous evaluation to demonstrate quality performance,” said Greg Alexander, Senior Vice President of Delivery and Operations at Lumeris. “We’re proud to be recognized by NCQA for our dedication to quality and our ongoing efforts to drive improvements in health care for our partners and their patients.”

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.


Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians. For the past eight years, Lumeris with Essence Healthcare, its inaugural client with more than 63,000 Medicare members in Missouri and Illinois, has received 4.5- to 5-Star Ratings from the CMS and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.


NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa.



Marcus Gordon




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