FAQ Directory

• 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

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

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

Health Plan Ratings is not where you make your public reporting selection because that occurs in NCQA’s Interactive Data Submission System (IDSS). Please contact your NCQA Account Manager if you have questions about IDSS or public reporting.

HPR

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

HPR

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

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

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

• Commercial: MY 2021 HEDIS and CAHPS submitted to NCQA by June 2022
• Medicaid: MY 2021 HEDIS and CAHPS submitted to NCQA by June 2022
• Medicare: MY 2021 HEDIS, MY 2020 CAHPS and HOS

HPR 2022

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

• ".5" = Race/Ethnicity Diversity of Membership 
• "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)

HPR 2023

Yes. The 12-17 years age stratification is reported for the Follow-Up on Positive Screen numerator and should be added to the age stratification on page 240 of MY 2023 HEDIS for QRS Version.

Exchange 2023