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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11.15.2022 Lead Screening in Children (LSC) In the MY 2022 specifications for Lead Screening in Children (LSC), there are data elements for ExclusionAdminOptional and ExclusionMedRecsOptional. This measure does not have optional exclusions. Are these data elements in error?

Yes. The data elements for “ExclusionAdminOptional” and “ExclusionMedRecsOptional” are not reported for MY 2022. These data elements and reporting instructions should be removed from Table LSC-1: Data Elements for Lead Screening in Children.

HEDIS 2022

10.15.2022 Mail Service Organization Delegates Are any delegation oversight factors considered not applicable for organizations that use a mail service organization delegate to meet distribution requirements (per a July 15, 2021 FAQ)?

Yes. Using UM 13: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 13, Element A: Delegation Agreement

  • Factor 3 (semiannual reporting): This factor is NA for mail service organization delegates that only perform annual distribution (e.g., UM 11, Element B (annual updates for pharmaceutical restrictions/preferences).
    • Note: Factor 4 (performance monitoring): Annual distribution must be specified as part of the organization’s process for monitoring delegate performance, if applicable.
    • Factor 3 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).
  • Factor 5 (process for providing member experience and clinical performance data to delegates when requested): This factor is NA for mail service organization delegates.

UM 13, Element C: Review of the UM Program

  • Factor 1 (annual review of delegate’s UM program): This factor is NA for mail service organization delegates.
  • Factor 4 (semiannual evaluation of reports): This factor is NA for mail service organization delegates that only perform annual distribution.
    • Factor 4 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).

Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.
 

UM-CR-PN 2023

10.15.2022 MBHO: Mail Service Organization Delegates Are any delegation oversight factors considered not applicable for organizations that use a mail service organization delegate to meet distribution requirements (per a July 15, 2021 FAQ)?

Yes. Using UM 12: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 12, Element A: Delegation Agreement

  • Factor 3 (semiannual reporting): This factor is NA for mail service organization delegates that only perform annual distribution
    • Note: Factor 4 (performance monitoring): Annual distribution must be specified as part of the organization’s process for monitoring delegate performance.
    • Factor 3 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).
  • Factor 5 (process for providing member experience and clinical performance data to delegates when requested): This factor is NA for mail service organization delegates.

UM 12, Element C: Review of the UM Program

  • Factor 1 (annual review of delegate’s UM program): This factor is NA for mail service organization delegates
  • Factor 4 (semiannual evaluation of reports): This factor is NA for mail service organization delegates that only perform annual distribution.
    • Factor 4 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).

Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.

MBHO 2022

10.14.2022 Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) Should we exclude members with a history of allergies or intolerance to statins (including to the PCSK-9 inhibitor) from the SPC and SPD measures?

The Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) measures include an exclusion for members with myalgia, myositis, myopathy or rhabdomyolysis during the measurement year. However, an allergy or history of an intolerance to a statin medication is not considered an exclusion for the measure.  
The general guidance NCQA received from our experts, as well as guidance from the American College of Cardiology , is that patients with atherosclerotic cardiovascular disease should be rechallenged on lower statin doses and alternative statins before being put on non-statin therapies (e.g., PCSK-9 inhibitors) due to statin intolerance. The decision-making process might vary from case to case. Although we incorporated exclusions for muscle-related statin side effects, we acknowledge that the measure may not address all instances of true statin intolerance. We will consider all feedback on this issue, while also ensuring that changes to the measure are valid, scientifically sound and true to the measure's intent (to measure the quality of cardiovascular care provided at the population level).

HEDIS 2023

10.14.2022 General Guideline 16: Deceased Members The deceased member exclusion is now required for MY 2023. The last bullet in the Notes section states, “This is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, remove all member events/episodes from the measure.”
Does this mean that for episode-based measures that if one event meets numerator criteria the member can remain in the measure?

No. Members who die during the measurement year must be removed from all applicable measures. For episode-based measures, a member who died during the measurement year must be removed for all events (even if they meet numerator criteria for an event).

HEDIS 2023

9.15.2022 Quality Compass License Agreement How can we determine if the Quality Compass license agreement meets my needs?

The standard license agreement for Quality Compass allows internal or external reporting for 15 measure indicators, 20 health plan submissions and 2 benchmarks (averages and/or percentiles) outside of the users licensed on the account. If your organization’s expected data usage does not align with the standard agreement, we can review your requested permissions and draft a customized agreement, subject to a different fee structure.
 

HEDIS 2021

9.15.2022 Quality Compass Access When will I receive access to Quality Compass?

Access to the data is granted as soon as payment is received by check or credit card.

The default email address used for access will be the individual’s whose information was included under the “Ship To” section completed at checkout Login and password information will be emailed to the default user after NCQA sets up the account. The default user, also known as the Administrative User, will have access to manage the additional licensed users on the account.

 

HEDIS 2021

9.15.2022 Purchasing Quality Compass How do I purchase Quality Compass?

If you are purchasing Quality Compass directly from the NCQA Store and your organization does not require a custom license agreement, you can simply visit the NCQA Store page to complete your purchase.
If you require a custom data license agreement and have accepted the quote provided by the Information Products (IP) team, the next step is to have a customized agreement forwarded to you for the organization’s review and signature. The customized agreement will include information on the permissions, data usage and fees discussed with the IP department.

Once the agreement is signed by both parties, NCQA will issue an invoice for payment. Once payment is received, you will be granted access to the data and/or the agreed upon permissions take effect.
 

HEDIS 2021

9.15.2022 Quality Compass Data Usage Update What if my data usage needs change after purchasing Quality Compass?

You can contact the Information Products team for assistance in expanding your permissions to meet your data usage needs. This includes any changes to the amount of data being shared (number of indicators) and how/with who the data is being shared with (internally for quality analysis purposes, external reporting on a brochure, email broadcast, website, blog) or commercial use of the data.
 

HEDIS 2021

9.15.2022 Purchase Order Number Will NCQA accept a purchase order number?

Purchase order numbers may be included for payment and tracking purposes; however, NCQA does not accept additional terms and conditions outside the executed legal agreement. Any and all purchase order terms and conditions have no legal effect and the license is governed solely by the terms of the executed agreement between your entity and NCQA.
 

HEDIS 2021

9.15.2022 Quality Compass HEDIS Benchmark Percentiles: Payers and Patient Ages Do the Quality Compass products have the HEDIS benchmark percentiles across all payers and patient ages?

Only the measures whose results were eligible for public reporting are included in Quality Compass. Additionally, certain HEDIS measures are specific to certain product lines and do not have data across all product lines. Specific age and gender stratifications are only applicable to specific measures.
 

HEDIS 2021

9.15.2022 Quality Compass Data Comparison Across All Product Lines Is there a way to compare the data across product lines?

Currently each license is separated and there is no way to compare Commercial, Medicaid and Medicare in the same license. However, with the Data Exporter function, you will be able to pull reports in Microsoft Excel and that can make data comparison easier.
 

HEDIS 2021