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Blue Cross and Blue Shield of Texas Medicaid Operations Achieve NCQA Accredited Status

AUSTIN (Oct. 17, 2019) _ Blue Cross and Blue Shield of Texas (BCBSTX) has earned an “Accredited” status for its Medicaid operations from the National Committee for Quality Assurance (NCQA). The status is the highest level a program may achieve on a first survey by the NCQA.

NCQA, a nationally acclaimed private organization that uses objective measures in its accreditation process, released the results for BCBSTX’s Medicaid program on its Health Plan Report Card website. The evaluation is based on the quality of care patients receive, patients’ satisfaction with their care and the health plan’s efforts to keep improving its program.

BCBSTX’s Texas Medicaid program operates in two service areas, Travis and Central Texas, serving about 46,000 people, children and adults, in 39 counties.

“This is an outstanding result for a health plan pursuing its first NCQA accreditation. It is a great example of how teamwork, accountability, collaboration and communication can produce excellent results for our Medicaid members,” said Janice Fagen, Vice President of Texas Medicaid Operations. “This confirms that our Medicaid program has the quality infrastructure in place and the commitment to providing and improving our services and programs for the population we serve.”

In addition to achieving the highest level that is awarded to a program on a first survey, BCBSTX scored a total of 48.21 out of 50 points possible and all “must-pass” accreditation standards were met. The accreditation took effect Aug. 13, 2019 and will expire Aug. 13, 2022.

BCBSTX’s Texas Medicaid program voluntarily sought the independent verification prior to the Texas Legislature’s recent passage of a bill which mandates accreditation.

NCQA said on its website that the accreditation matters because “health care quality means patients are getting the right care, in the right amount, at the right time. This means having timely access to care, getting the right treatment and right preventative care. Choosing high-quality health plans and doctors plays a key role in know whether you’ll get high-quality care.”

BCBSTX’s Accreditation Governance team will continue to follow-up with impacted business owners and key stakeholders to close any gaps identified internally and by NCQA.


About Blue Cross and Blue Shield of Texas
Blue Cross and Blue Shield of Texas (BCBSTX) — the only statewide, customer-owned health insurer in Texas — is the largest provider of health benefits in the state, working with nearly 80,000 physicians and health care practitioners, and 500 hospitals to serve 5 million members in all 254 counties. BCBSTX is a Division of Health Care Service Corporation (which operates Blue Cross and Blue Shield plans in Texas, Illinois, Montana, Oklahoma and New Mexico), the country's largest customer-owned health insurer and fourth-largest health insurer overall. Health Care Service Corporation is a Mutual Legal Reserve Company and an Independent Licensee of the Blue Cross and Blue Shield Association.

About NCQA
NCQA is a private, non-profit 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 Web site ( contains information to help consumers, employers and others make more informed health care choices. 

HEDIS® is a registered trademark of NCQA.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

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