If the medical board does not provide the expiration date for a practitioner's board certification, the organization must verify and document that the board certification is current within 180 calendar days of the credentialing decision date.
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8.29.2013 Lack of expiration date for board certification What is NCQA's documentation requirement if a medical board does not provide an expiration date?
8.29.2013 Documentation requirement for CVOs using the NPBD-PDS What documentation expectations are there for CVOs that use the NPDB-PDS for collections and reporting of sanction information?
The CVO must provide NCQA with evidence of current or continuous enrollment of the practitioner in the NPDB-PDS, and of review and reporting of NPDB-PDS activity within 120 calendar days to the organizations client. If no sanction information is reported by the NPDB-PDS, the CVO must provide documentation of this in the file and must report to clients that no sanctions were reported. The organization determines its method of documentation.
This applies to the following Programs and Years:
8.29.2013 Verification of certification for an unrecognized board Does NCQA only accept ABMS and AOA sponsored boards as verification sources? What does NCQA require for verification of boards from non-ABMS or non-AOA boards if the practitioner claims to be board certified?
No. With the exception of ABMS or AOA sponsored boards, NCQA requires organizations to determine and list specialty boards they accept within their credentialing policies and procedures. At a minimum, at least annually, organizations must obtain confirmation from specialty boards that they perform primary-source verification of education and training. A specialty board that provides annual written confirmation that it conducts primary source verification of education and training can be used as an acceptable source for verification of education and training if the organization names the specialty board in its policies and procedures.
The organization must verify board certification status for any practitioner claiming to be certified by an ABMS or AOA sponsored boards, or by a specialty board recognized by the organization.
This applies to the following Programs and Years:
8.29.2013 Documentation requirements using NPDB-PDS Databank What are the documentation expectations for CVOs that use the NPDB-PDS Databank's Continuous Query for collecting and reporting malpractice history?
The CVO must provide NCQA with evidence of a practitioners current or continuous enrollment in the NPDB-PDS Databank, and of review and reporting of databank activity to the organizations client within 120 calendar days.
If no malpractice history is reported by the databank, the CVO must document this in the file and must report to clients that no malpractice settlements were reported. NCQA does not prescribe how the organization documents this information.
This applies to the following Programs and Years:
8.16.2013 Childhood Immunization Status On May 16, 2013, the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases released a document based on Sanofi Pasteurs Pentacel (DTaP-IPV/Hib) and Daptacel (DTaP) vaccine shortage. Because these vaccines are expected to be in short supply through summer 2013, does NCQA plan any changes to the CIS measure for HEDIS 2014?
No. NCQA will not make any changes to the vaccine requirements for HEDIS 2014. As indicated by the CDC, "Single-component DTaP, IPV, HepB, and Hib vaccines and other age-appropriate licensed combination vaccines are available to complete series begun with Pentacel or Pediarix. Currently, there is a sufficient supply of these products to meet the anticipated demand." You can find additional information in the Guidance for Vaccinating Children during the 2013 Pentacel, Daptacel and Pediarix Shortage article at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/pentacel-guidance.pdf.
This applies to the following Programs and Years:
HEDIS 20147.15.2013 Prenatal and Postpartum Care For the PPC measure, a Pap test alone is acceptable for the Postpartum Care rate. Is documentation of a Pap test compliant for women under the age of 21?
NCQA is aware that recent guidelines recommend pap tests NOT be performed for women under 21 years of age under general circumstances. However, for the PPC measure, a pap test will remain in the specifications as a way to determine that postpartum care occurred. NCQA allows documentation of only a Pap test because this test indicates that a pelvic exam was performed. This measure includes deliveries in any age group.
NCQA is re-evaluating the PPC measure based on clinical practice guideline updates. Any changes will be included in future HEDIS specifications.
This applies to the following Programs and Years:
HEDIS 20147.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for HEDIS 2014?
All supplemental data requirements are included in General Guideline 39 in the HEDIS 2014 Volume 2 Technical Specification. Customers can find additional information about the supplemental data policy (including FAQs specific to supplemental data) at the following link, http://www.ncqa.org/Newsroom/MediaEvents/HEDIS2014CodeTransitionSupplementalDataUse.aspx.
This applies to the following Programs and Years:
HEDIS 20147.15.2013 Using physician groups or IPAs to distribute information to practitioners If an organization contracts with a physician group or IPA, may the physician group or IPA distribute information to its practitioners if covered in the contract? Does NCQA consider this contractual arrangement to be delegation?
The physician group or IPA may distribute information to its physicians if this language is in the contractual agreement. NCQA does not consider this to be delegation. The organization must provide the required information to the physician group or IPA.
This applies to the following Programs and Years:
UM-CR 20137.15.2013 Care for Older Adults If there is a list of medications in the progress note, is a prescribing practitioner or clinical pharmacist's signature alone considered evidence that the list was reviewed for the medication review indicator?
The medication review indicator requires both a medication list and evidence that it was reviewed by the appropriate practitioner. The presence of a medication list with the appropriate practitioner's signature is compliant if it is dated during the measurement year. The practitioner's signature is considered evidence that the medications were reviewed.
This applies to the following Programs and Years:
HEDIS 20146.15.2013 Medical record review requirement for Exchanges in Florida and Pennsylvania Is a medical record review required for Exchanges coming through Interim Survey in Florida or Pennsylvania?
6.15.2013 Documentation to meet structural standards if delegated to an NCQA Accredited or Certified organization According to the Automatic Credit for Delegating to an Accredited HP appendix, there are some structural requirements that do not receive automatic credit when delegating to an NCQA Accredited or Certified Health Plan. What documentation is required if the organization accepts the delegates structural requirement as its own?
For all standards/elements that have been identified as structural requirements, the organization must provide its own materials, processes and other data sources as evidence that it meets each structural component of the standard. Organizations may adopt other organizations' procedures as its own. If an organization adopts existing procedures from another organization, it must provide evidence of formal adoption by its governing body or other group or individuals with appropriate authority.
This applies to the following Programs and Years:
6.15.2013 Distribution of materials for Interim Surveys Where elements require materials as a data source for all survey types, must the materials be distribute for Interim Surveys?
Organizations going through Interim Survey must present materials to meet the requirements of the element. Materials are not required to have been distributed, and do not have to be in final layout form, but must be approved by the organization. Draft materials are appropriate if approved by the organization.