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.
The Exchange Add-on Survey is a streamlined version of the regular Add-on Survey:
Plans do not submit HEDIS/CAHPS
Since HEDIS/CAHPS are not submitted, plans are capped at Accredited status.
NCQA reviews documentation of standards only when the organization manages functions differently from key elements. (The Application defines which standards are required and how many functions are permitted to be performed differently).
No file review for the Exchange product line.
If an organization does not qualify for automatic Accreditation for its Exchange product line, NCQA will survey those elements that it will administer differently using NCQAs existing add-on survey process. The survey will only consist of the off-site portion of the survey process and will not include a file review.
Although the event/diagnosis criteria do not specifically state "and/or," it is implied. As long as there are two outpatient visits or two nonacute inpatient discharges, or one outpatient visit and one nonacute inpatient discharge, with a diagnosis of RA, the member meets the criteria for eligible population.
HEDIS 2013
No. GFR testing is not currently acceptable for the Medical Attention for Nephropathy indicator. Clinical experts determined that certain characteristics, such as age, sex and race, may impact the effectiveness of such tests for monitoring nephropathy. If a member was determined to have impaired kidney function based on a GFR test, it is expected that there would be other documentation in the medical record that would make the member compliant for the nephropathy indicator (e.g., documentation of a visit to a nephrologist or documentation of medical attention for any appropriate conditions listed in the specifications).
HEDIS 2013
