No. Sampling is not required by product line if the product lines are managed the same (a single system is used to manage all product lines).
UM-CR-PN 2022
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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5.15.2022 System Control Requirements Review by Product Line If auditing is used to monitor an organization’s system controls or a delegate’s system controls, is sampling by product line required?
5.15.2022 Clarify scope for new Credentialing System Controls Oversight requirement (CR 1, Element D) How is the new oversight requirement, CR 1, Element D, different from the monitoring requirement in factor 5 in CR 1, Element C?
CR 1, Element C, factor 5 requires organizations to have a process for monitoring that policies and procedures are followed for all other factors (factors 1–4) in this element at least annually. Policies and procedures must describe the monitoring process for factor 5.
For CR 1, Element D, the organization submits evidence that it identified, analyzed and acted only on modifications to credentialing/recredentialing information (CR 2 – CR 5) that did not meet the organization’s policies and procedures.
UM-CR-PN 2022
5.15.2022 Clarify scope for new UM System Controls Oversight requirement (UM 12, Elements B and D) How are the new oversight requirements, UM 12 Elements B and D, different from the monitoring requirements in factor 7 in UM 12, Element A and C?
UM 12, Elements A and C, factor 7 require organizations to have a process for monitoring that policies and procedures are followed for all other factors (factors 1–6) in this element at least annually. Policies and procedures must describe the monitoring process for factor 7.
For UM 12, Elements B and D, the organization submits evidence that it identified, analyzed and acted only on modifications to receipt and notification dates (UM 5) that did not meet the organization’s policies and procedures.
UM-CR-PN 2022
5.15.2022 MBHO: System Controls Goal for Analysis Is a goal required for system controls monitoring analysis for UM 11, Elements B and D, factor 2 and CR 1, Element D, factor 2?
5.15.2022 Delegation Oversight System Controls Monitoring - Audits Are both the organization and delegate required to conduct system controls audits for factor 5 in UM 13, Element C and CR 8, Element C?
Both the organization and delegate must monitor the delegate’s system security controls as part of the delegation oversight requirements and may choose audit as the monitoring method. If auditing is the chosen method, the delegate provides an audit report of modifications that did not comply with its policies and procedures or with the delegation agreement.
The organization is not required to conduct an audit if it determines that the delegate adequately monitored and reported noncompliant modifications, but must provide documentation (a report, meeting minutes or other evidence) that it reviewed and agreed with the delegate’s findings. If the organization determines that the delegate did not adequately monitor noncompliant modifications, it must conduct its own audit of the delegate’s system controls.
The organization must submit its documentation and the delegate’s documentation as part of the survey.
UM-CR-PN 2022
5.15.2022 MBHO: UM and CR Advanced System Controls—Policies and Procedures Are organizations that provide evidence of “advanced system controls” eligible to receive Met for UM 11, Elements A and C, and for CR 1, Element C?
No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for UM 11, Elements A and C and for CR 1, Element C. Policies and procedures must address all factors regarding advanced system control capabilities.
Organizations are only eligible to receive a score of Met for UM 11, Elements B and D, and for CR 1, Element D if they provide evidence of advanced system control capabilities that both automatically record dates and prevent changes that do not meet the organization’s policies and procedures.
MBHO 2022
5.15.2022 System Controls Goal for Analysis Is a goal required for system controls monitoring analysis for UM 12, Elements B and D, factor 2 and CR 1, Element D, factor 2?
5.15.2022 UM and CR Advanced System Controls—Policies and Procedures Are organizations that provide evidence of “advanced system controls” eligible to receive Met for UM 12, Elements A and C, and for CR 1, Element C?
No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for UM 12, Elements A and C and for CR 1, Element C. Policies and procedures must address all factors regarding advanced system control capabilities.
Organizations are only eligible to receive a score of Met for UM 12, Elements B and D, and for CR 1, Element D if they provide evidence of advanced system control capabilities that both automatically record dates and prevent changes that do not meet the organization’s policies and procedures.
UM-CR-PN 2022
5.05.2022 2022 Health Plan Ratings Release Date When will the 2022 Health Plan Ratings be publicly displayed?
NCQA’s 2022 Health Plan Ratings will publicly be displayed on or around September 15 at NCQA’s Health Plan Report Card, which can be found here: https://reportcards.ncqa.org/health-plans.
HPR 2022