NCQA PCMH Recognition Evidence Binder Checklist

Inspection template to organize and verify documentation for NCQA Patient-Centered Medical Home (PCMH) recognition across the six PCMH concepts, including core criteria and elective credits.

Practice Profile and Submission Readiness

• Practice name, site, and recognition cycle are documented
• Evidence binder version and last updated date are recorded
• Submission owner and backup owner are identified
• NCQA recognition scope is clearly defined
  Document whether the binder covers a single site, multiple sites, or a specific recognition cycle.

Concept 1: Patient-Centered Access and Continuity

• Appointment access standards are documented and current
• Same-day or timely access evidence is included
• After-hours coverage process is documented
• Continuity of care assignment method is documented
• Evidence of patient empanelment or attributed patient list is included

Concept 2: Care Management and Support

• High-risk patient identification process is documented
• Care plans or care management examples are included
• Transitions of care workflow is documented
• Medication reconciliation evidence is included where applicable
• Referral tracking or closed-loop referral process is documented

Concept 3: Care Coordination and Care Transitions

• Specialist referral criteria and workflow are documented
• Hospital or ED transition follow-up process is included
• Communication templates for external care partners are included
• Closed-loop communication evidence is present
• Care coordination responsibilities are assigned to specific roles

Concept 4: Quality Improvement

• Quality improvement plan is current and approved
• Performance measures and dashboards are included
• At least one documented improvement cycle is included
• Data collection method and reporting frequency are documented
• Staff participation in QI activities is evidenced

Concept 5: Care Planning and Self-Management Support

• Self-management support materials are included
• Shared decision-making process is documented
• Care plan review cadence is documented
• Patient engagement evidence is included

Concept 6: Performance Measurement and Reporting

• Required measures are identified and mapped to the submission
• Measurement source data or extracts are included
• Reporting period is clearly documented
• Data validation or reconciliation method is documented
• Submission package includes final evidence index and crosswalk