Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can ask a question through My NCQA.
No. The use of another entity’s evidence-based content within the organization’s case management system is not considered delegation if the organization maintains control over how the content is used and can customize it as needed. The evidence used to support the content must be cited.
HP 2023
No. The use of another entity’s software to collect credentialing information is not considered delegation unless the other entity also reviews the information on the organization's behalf. NCQA standards allow organizations to use software to collect credentialing information from approved sources, as long as organization staff document that the information was reviewed and verified.
CM 2023
| Topic | Update Highlights |
| Front Matter | Added definitions of “electronic health record (EHR)” and “certified electronic health record technology (CEHRT).” |
| TC 05 | Added a note that beginning in 2024, practices will be required to have an EHR. |
| KM 09 | Added a note that gender identify and sexual orientation requirements apply to all patients 18 years of age and older. |
| CM 10 | Replaced “person-driven outcomes approach” with “person-centered outcomes approach.” |
| QI 08 & QI 09 | PCMH QI 08 and QI 09: Added notes stating that if the measures reported in QI 01 or QI 02 do not leave room for improvement, practices may choose different measures within the categories to focus improvement efforts on. |
PCMH 2017
| Topic | Update Highlights |
| Front Matter | Added definitions of “electronic health record (EHR)” and “certified electronic health record technology (CEHRT).” |
| TC 05 | Added a note that beginning in 2024, practices will be required to have an EHR. |
| KM 09 | Added a note that gender identify and sexual orientation requirements apply to all patients 18 years of age and older. |
| CM 10 | Replaced “person-driven outcomes approach” with “person-centered outcomes approach.” |
PCSP 2019
Evaluators may ask practices to provide an explanation, or context and reasoning, for the data submitted. If a reported performance rate seems too low (or too high), the evaluator may ask the practice to enter an explanation of the performance in the Notes section of QPASS.
Practices are expected to provide a clear and succinct response as to why their performance rate is low, or unusually high. Because practices are expected to have fully implemented PMCH workflows and processes, the Review Oversight Committee (ROC) members would like to understand the reasoning behind the reported performance rates.
PCMH 2017
No. The measure requires evidence of an advance care plan during the measurement year, dated during the measurement year. If the advance care plan is scanned into the EMR and dated in the measurement year, it meets criteria. If the plan is found in the EMR or member record from a prior year, it does not meet criteria unless there is dated evidence that it was reviewed or discussed during the measurement year.
HEDIS 2023
No. Medication reconciliations performed during a post-op/surgery follow-up visit alone do not meet criteria even if the visit was performed by the provider who admitted the member or who performed the surgery, or if the procedure is typically performed inpatient. The intent is that medical record documentation must support awareness of the hospitalization (denominator event) at the time of the medication reconciliation, even if the provider admitted the member or saw the member during the hospitalization, or if the procedure is typically performed inpatient.
HEDIS 2023
Yes. If multiple measures use the same sample, a deceased member is removed from all related samples. For example, deceased members who are removed from the Childhood Immunization (CIS) sample would also be removed from the Lead Screening (LSC) sample. Similarly, deceased members who are removed from the Hemoglobin A1c Control for Patients With Diabetes (HBD) sample would also be removed from Blood Pressure Control for Patients With Diabetes (BPD) and Eye Exam for Patients With Diabetes (EED) samples. This FAQ was previously posted in November 2022 and was updated to remove the reference to the KED measure.
HEDIS 2023
Yes. Although LOINC codes were removed from the INR Test Value Set, organizations should use laboratory claims and data for this value set, in addition to medical claims. This value set should be listed in General Guideline 28 with other value sets that do not contain LOINC codes.
Exchange 2023
Yes. Although LOINC codes were removed from the Drug Test Value Set, organizations should use laboratory claims and data for this value set. This value set should be listed in General Guideline 28 with the other value sets that do not contain LOINC codes but should use laboratory claims and data.
**This FAQ applies to QRS MY 2022.
Exchange 2022
Yes. The reporting instructions for the initial population and exclusions data elements for ASF-E and DSF-E for MY 2022 and MY 2023 are incorrect. The reporting instructions should state, “For each stratification, repeat per metric” for the initial population and exclusions data elements. Refer to the PDF for the corrected data elements tables.
Note: The information is correct in IDSS (the validations check "For each stratification, repeat per metric” for the initial population and exclusions data elements).
**This FAQ applies to both HEDIS Volume 2 MY 2022 and HEDIS Volume 2 MY 2023
HEDIS 2023
