FAQ Directory

• "1” = Process measures (e.g., screenings, visits)
• “1.5” = Patient experience measures (CAHPS)
• “3” = Outcome and intermediate outcome measures (e.g., HbA1c Control, Blood pressure control)

This applies to the following Programs and Years:

NCQA currently does not rate Exchange plans for Health Plan Ratings/Health Plan Accreditation (HPR/HPA). This is primarily because CMS has their own Quality Rating System (QRS), and NCQA has to receive special permission from CMS to use the data for our Accreditation program. NCQA is actively participating in these discussions, and any changes to this policy will be communicated to all organizations in a timely manner.

This applies to the following Programs and Years:

Your overall rating will be “Partial Data Reported” and your measure rates will be displayed as “NC” (No Credit) on the September 15 release of HPR on the NCQA Health Plan Report Card.

This applies to the following Programs and Years:

HPR truncates final raw rates and percentiles to 3 decimals, so if your IDSS workbook shows 78.47, HPR will show the raw rate of .784 (truncated at 3 decimals).

This applies to the following Programs and Years:

NCQA defines “state coverage” as the states where a plan is licensed to operate. Plans that submit HEDIS/CAHPS data provide this information each year during the HOQ process. If plans do not submit these data, NCQA uses state licensing and membership data provided for Accreditation or gathered from external sources.

This applies to the following Programs and Years:

The plan will receive a “0” on the measure and the measure weight is included in the Ratings calculation.

This applies to the following Programs and Years:

NCQA requires plans to review their projected rating as a final quality assurance step in the ratings process. Although the projected information is subject to change (from continued quality checks), plans must affirm that they reviewed their information and have no questions regarding their Accreditation status or projected rating.

This applies to the following Programs and Years:

This applies to the following Programs and Years:

HPR utilizes HEDIS, CAHPS, and HOS data sets and Measurement Years are dependent on HPR year as well as product lines. To find specific data information on each HPR year, please access that year's Measure List by navigating to this page https://www.ncqa.org/hedis/health-plan-ratings/
 

This applies to the following Programs and Years:

We anticipate that PCV20 will be added to the CIS value sets in the HEDIS MY 2024 Technical Update, scheduled for release on April 1, 2024.
Although the PCV20 vaccine is not included in the measure for MY 2023, NCQA does not anticipate this will impact performance. The measure denominator only includes children who were at least 18 months old and expected to have already completed the pneumococcal series by June 2023 (the month when ACIP recommended PCV20).
 

This applies to the following Programs and Years:

Typically, no as health plan staff are not practicing practitioners within the health plan's network. The intent of collaboration requirements are for organizations to demonstrate collaboration between their behavioral healthcare delivery system (network practitioners) and medical care delivery system (network practitioners). 

Note: Demonstrating collaboration with an MBHO is acceptable for the collaboration with “behavioral healthcare practitioners” component of the requirement.

This applies to the following Programs and Years:

If an organization delegates more than 50% of primary source verifications and one or more of its delegates loses Accreditation/Certification status, NCQA considers this a Reportable Event. The organization must notify NCQA (through My.NCQA.org) within 30 calendar days.

This applies to the following Programs and Years: