Run NCQA PCMH Recognition Evidence Binder Checklist — Free

Practice Profile and Submission Readiness

Practice name, site, and recognition cycle are documented critical (required)

Yes No N/A

Evidence binder version and last updated date are recorded critical (required)

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.

Note (optional)

Concept 1: Patient-Centered Access and Continuity

Appointment access standards are documented and current critical (required)

Yes No N/A

Same-day or timely access evidence is included

Yes No N/A

Note (optional)

After-hours coverage process is documented critical (required)

Yes No N/A

Continuity of care assignment method is documented

Yes No N/A

Note (optional)

Evidence of patient empanelment or attributed patient list is included critical (required)

Yes No N/A

Concept 2: Care Management and Support

High-risk patient identification process is documented critical (required)

Yes No N/A

Care plans or care management examples are included

Yes No N/A

Note (optional)

Transitions of care workflow is documented critical (required)

Yes No N/A

Medication reconciliation evidence is included where applicable

Yes No N/A

Note (optional)

Referral tracking or closed-loop referral process is documented critical (required)

Yes No N/A

Concept 3: Care Coordination and Care Transitions

Specialist referral criteria and workflow are documented critical (required)

Yes No N/A

Hospital or ED transition follow-up process is included critical (required)

Yes No N/A

Communication templates for external care partners are included

Yes No N/A

Note (optional)

Closed-loop communication evidence is present critical (required)

Yes No N/A

Care coordination responsibilities are assigned to specific roles

Concept 4: Quality Improvement

Quality improvement plan is current and approved critical (required)

Yes No N/A

Performance measures and dashboards are included

Yes No N/A

Note (optional)

At least one documented improvement cycle is included critical (required)

Yes No N/A

Data collection method and reporting frequency are documented

Yes No N/A

Note (optional)

Staff participation in QI activities is evidenced

Yes No N/A

Note (optional)

Concept 5: Care Planning and Self-Management Support

Self-management support materials are included

Yes No N/A

Note (optional)

Shared decision-making process is documented critical (required)

Yes No N/A

Care plan review cadence is documented

Yes No N/A

Note (optional)

Patient engagement evidence is included

Yes No N/A

Note (optional)

Concept 6: Performance Measurement and Reporting

Required measures are identified and mapped to the submission critical (required)

Yes No N/A

Measurement source data or extracts are included

Yes No N/A

Note (optional)

Reporting period is clearly documented critical (required)

Data validation or reconciliation method is documented

Yes No N/A

Note (optional)

Submission package includes final evidence index and crosswalk critical (required)

Yes No N/A

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Run: NCQA PCMH Recognition Evidence Binder Checklist

Practice Profile and Submission Readiness

Concept 1: Patient-Centered Access and Continuity

Concept 2: Care Management and Support

Concept 3: Care Coordination and Care Transitions

Concept 4: Quality Improvement

Concept 5: Care Planning and Self-Management Support

Concept 6: Performance Measurement and Reporting

Get your results