FAQ Directory

NCQA will give organizations credit (an individual measure rating of “5”) if both reported Direct Race and Direct Ethnicity is ≥20%. Organizations that do not report Direct Race and Direct Ethnicity ≥20% will receive an individual measure rating of “0”. The measure has a weight of 1.0. 

This applies to the following Programs and Years:

To calculate individual measure scores, NCQA truncates final raw rates and percentiles to 3 decimals and compares the rates submitted by plans to The National All Lines of Business 10th, 33.33rd, 66.67th and 90th measure benchmarks and percentiles, and then assigns the individual measure rating (calculated as whole numbers on a 1–5 scale) that the plans receive for each measure as follows:

5 = plans with a rate ≥ 90^th percentile (top 10% of plans)

4 = plans in the top third but not in the top decile (66.67^th percentile ≤ rate < 90^th percentile)

3 = the middle one-third of plans or (33.33^rd percentile ≤ rate < 66.67^th percentile)

2 = plans above the bottom 10% of plans but in the bottom one-third of plans (10^th percentile ≤ rate < 33.33^rd percentile)

1 = plans with a rate < 10^th percentile (in the bottom 10% of plans)

This applies to the following Programs and Years:

Yes. Plans that are non-numerically rated (Partial Data Reported, No Data Reported, Low Enrollment) still need to review all other plan-related information (e.g., Legal Name, State Coverage, NCQA Accreditation status) to ensure its accuracy.

This applies to the following Programs and Years:

NCQA will give organizations credit (an individual measure rating of “5”) if the reported “Total Known” Preferred Written Language and “Total Known” Preferred Spoken Language is ≥20%. Organizations that do not report “Total Known” Preferred Written Language and “Total Known” Preferred Spoken Language ≥20% will receive an individual measure rating of “0”. The measure has a weight of 1.0.

This applies to the following Programs and Years:

We use your Accreditation status as of the last business day in June of the release year  for display purposes and to calculate bonus points. If a plan has an NCQA status modifier (e.g., Under Review by NCQA, Under Corrective Action, Merger Review in Process, Appealed by Organization) as of the last business day in June of the release year, it will be appended to the Accreditation status.

Display options during the Plan Confirmation, Projected Ratings and Final Ratings releases are: Yes; Yes (Interim); Yes (Provisional); Yes – CAP; Yes – APEAL; Yes (Interim) – CAP; Yes (Provisional) – CAP; Yes (Provisional) – APEAL; Yes – Merger Review in Process; Yes – Under Review by NCQA; Yes (Interim) – Under Review by NCQA; Yes (Provisional) – Under Review by NCQA; No; No (In Process); No (Scheduled); No (Suspended); No (Revoked).

Accreditation status display options for the public release of the Ratings on NCQA's Health Plan Report Card website on September 15 are: Accredited; Not Accredited; Accredited – Interim; Accredited – Provisional; Accredited – Under Review by NCQA; Under Corrective Action; Scheduled; In Process; Expired; Denied; Suspended; Revoked; Accredited – Appealed by Organization; Accredited – Merger Review in Process.

This applies to the following Programs and Years:

AR-KM 1: Problem Lists
NCQA recognizes that the upload requirements for AR-KM 1 (2026) require entering either a numerator, denominator and reporting period OR an uploaded list of top priority conditions and concerns. One of these evidence options will be left blank. This criterion only requires one of the two evidence fields listed to be completed.

AR-AC 2: Appointments Outside Business Hours
AR-AC 2 (2026) requires a Documented Process and Evidence Upload. If extended hours are provided at the practice site, the organization does NOT need to provide a Documented Process. To satisfy the minimum upload requirements in Q-PASS, please create a file (word, PDF, etc.) that indicates that extended hours are provided at the practice site.

AR-CM 3: Person-Centered Care Plans
For AR-2026, all five categories of care management are listed within the Q-PASS upload. You will only upload evidence into 3 of the 5 categories provided, based off of your organization’s care management efforts.  The reason for this reformat is to help evaluators more easily identify what a care plan is managing, as often patients may fall into multiple categories based on diagnoses listed on the care plan. Identifying what CM category the patient is being care managed for helps us eliminate unnecessary back and forth with practices as much as possible. Please note that AR-CM 3 is a site-specific criterion, so each practice-site will need to complete this AR upload. It is acceptable for practice-sites within the same organization to have differing categories that are care managed, as patient populations differ.
 

This applies to the following Programs and Years:

Health Plan Ratings is not where you make your public reporting selection because that occurs in NCQA’s Interactive Data Submission System (IDSS). Please contact your NCQA Account Manager if you have questions about IDSS or public reporting.

This applies to the following Programs and Years:

NCQA inverts rates and percentiles where a “lower value represents better performance” to a “higher value represents better performance” scale in the Health Plan Ratings scoresheets, and then truncates the inverted rate to 3 decimals. For example, a raw rate of 0.0147738807 would display as .985 (1 – 0.0147738807 = 0.9852261193, truncated to 3 decimals).

This applies to the following Programs and Years:

We need you to confirm your plan details (e.g., Accreditation status, State Coverage, Family Association, Organization ID, Submission ID) because this impacts how you will be listed publicly when we release HPR on or around September 15, regardless of your Accreditation status or Public Reporting decision.

This applies to the following Programs and Years:

Information about ECDS can be found on NCQA’s ECDS site.

Additionally, the glossary on NCQA’s Health Plan Report Card site contains some historical ECDS information.

This applies to the following Programs and Years:

The overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points (if the plan is Accredited by NCQA), calculated on a 0–5 scale in half-points (5 is highest), displayed as stars and rounded to the nearest half-point.

This applies to the following Programs and Years:

"1" = Race/Ethnicity Diversity of Membership and Language Diversity of Membership
"1” = Process measures (e.g., screenings, visits)
“1.5” = Patient experience measures (CAHPS)
“3” = Outcome and intermediate outcome measures (e.g., Glycemic Status, Blood Pressure Control)

This applies to the following Programs and Years: