FAQ Directory

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.

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5.15.2023 MBHO: Applicable Standards for Mail Service Organizations Considered Delegates What standards are considered a delegation relationship if an organization uses a mail service organization to meet the distribution requirements?

NCQA considers the following standards to be a delegation relationship if an organization uses a mail service organization to meet the distribution requirements:

CC 3, Element A: Notification of Termination
CC 3, Element B: Continued Access to Practitioners
UM 5, Element A: Timeliness of UM Decisions
UM 7, Elements B, C: Denial Notices
UM 9, Elements B, D: Appropriate Handling of Appeals

MBHO 2023

5.15.2023 Social Need Screening and Intervention (SNS-E) Should the SNS-E measure include exclusion criteria for Medicare members?

No. There are no Medicare member exclusions. Remove the second bullet from Exclusion 1, which reads:

Medicare members 66 years of age and older by the end of the measurement period who meet either of the following:
- Enrolled in an Institutional SNP (I-SNP) any time during the measurement period.
- Living long-term in an institution any time during the measurement period, as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the measurement period.

Exchange 2023

5.15.2023 Definition of Annual Does NCQA’s definition of “annual” allow for a 2-month grace period?

As noted in the Glossary appendix, NCQA’s long-standing definition of “annual” is 12 months plus a 2-month grace period (12–14 months). “Grace period” refers to allowing organizations to complete an activity after it is due and not before it is due.

CVO 2023

4.24.2023 Health Plan Ratings Overview How do the Ratings work, in brief?

NCQA’s HPR overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS (Medicare only) measure ratings, plus Accreditation bonus points (if the plan is Accredited by NCQA), rounded to the nearest half point displayed as Stars. Dozens of measures are calculated on a 0–5 scale in half-points (5 is highest) by comparing the plan submitted rate to The National All Lines of Business 10th, 33.33rd, 66.67th and 90th measure benchmarks.

HPR

4.24.2023 Health Plan Ratings Lower is Better Rates Why don’t my “lower is better” rates match between IDSS and the projected ratings scoresheet?

For HPR, NCQA inverts all final rates and percentiles where a lower value represents better performance to a higher value represents better performance scale in the HPR scoresheets and then truncates to 3 decimals. For example, a raw rates of .2325 would display as .767 (1-.2325 = .7675, truncated at 3 decimals).

HPR

4.24.2023 Plan Confirmation CAHPS Survey As a Medicaid plan, I can choose to be scored on Adult CAHPS, on Child CAHPS or on the General Population of Child CCC CAHPS. Why can’t I change my selection in plan confirmation?

Your CAHPS Component selection was made in the HOQ. It is final and cannot be modified.

HPR

4.24.2023 Plan Confirmation Login for Health Plan Ratings Why can’t I log on to Plan Confirmation? Or I can log on, but I don’t see any plans?

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of Plan Confirmation. Please contact this individual at your organization to request access.

HPR 2023

4.24.2023 Health Plan Ratings Data for Scoring What data is 2023 HPR using to score plans?

Commercial: MY 2022 HEDIS and CAHPS submitted to NCQA by June 2023
Medicaid: MY 2022 HEDIS and CAHPS submitted to NCQA by June 2023
Medicare: MY 2022 HEDIS, MY 2021 CAHPS and HOS

HPR 2023

4.24.2023 Advertise/Market Health Plan Ratings Scores How can I market or advertise my plans’ 2023 Health Plan Ratings scores?

Please go to the 2023 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2023/), where you’ll find our Marketing Guidelines (once they're posted) for how you can market your plans’ scores.

HPR 2023

4.24.2023 Accreditation Status in Health Plan Ratings How is my Accreditation status used in HPR and how will it be displayed?

We use your Accreditation status as of June 30 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 Plan) as of June 30, 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 (Interim) – CAP; Yes (Provisional) – CAP; Yes – Under Review by NCQA; Yes (Interim) – Under Review by NCQA; Yes (Provisional) – Under Review by NCQA; No; No (Scheduled); No (In Process).

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.

HPR

4.24.2023 Health Plan Ratings Information Confirmation Why do I have to confirm this information if our plan is not Accredited, or we will say “No” to Public Reporting?

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.

HPR

4.24.2023 Multiple Health Plan Ratings for One Product in a State How is it possible for plans to have multiple ratings for one product within a given state?

Plans can have multiple ratings for one product within the same state because they might have certain state or contractual submission requirements that fall outside of the combined submission requisite that they send to NCQA for Accreditation purposes. Therefore, this results in plans submitting one combined submission (required) for Accreditation and then they still elect to select other submissions for state or other contractual obligations, which NCQA includes as part of its Ratings program.

HPR