FAQ Directory

Yes. Replace the reference to “46-49” with “46-50,” and replace the reference to “50-75” with “51-75” in the age stratification and in Table COL-E-A-4: Data Elements for Colorectal Cancer Screening.

This applies to the following Programs and Years:

As noted in the Glossary appendix, NCQA’s long-standing definition of “annual” is 12 months plus a 2-month grace period (12–14 months). “Grace period” refers to allowing organizations to complete an activity after it is due and not before it is due.

This applies to the following Programs and Years:

NCQA considers the following standards to be a delegation relationship if an organization uses a mail service organization to meet the distribution requirements:

• NET 4, Element A: Notification of Termination
• NET 4, Element B: Continued Access to Practitioners
• UM 5, Elements A, B, C: Timeliness of UM Decisions
• UM 7, Elements B, C, E, F, H, I: Denial Notices
• UM 9, Elements B, D: Appropriate Handling of Appeals
• UM 11, Element B: Pharmaceutical Restrictions/Preferences
• UM 11, Element C: Pharmaceutical Patient Safety Issues

This applies to the following Programs and Years:

NCQA considers the following standards to be a delegation relationship if an organization uses a mail service organization to meet the distribution requirements:

• CC 3, Element A: Notification of Termination
• CC 3, Element B: Continued Access to Practitioners
• UM 5, Element A: Timeliness of UM Decisions
• UM 7, Elements B, C: Denial Notices
• UM 9, Elements B, D: Appropriate Handling of Appeals

This applies to the following Programs and Years:

No. There are no Medicare member exclusions. Remove the second bullet from Exclusion 1, which reads:

• Medicare members 66 years of age and older by the end of the measurement period who meet either of the following:
  • Enrolled in an Institutional SNP (I-SNP) any time during the measurement period.
  • Living long-term in an institution any time during the measurement period, as identified by the LTI flag in the Monthly Membership Detail Data File. Use the run date of the file to determine if a member had an LTI flag during the measurement period.

This applies to the following Programs and Years:

• 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

This applies to the following Programs and Years:

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of Plan Confirmation. Please contact this individual at your organization to request access.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

• 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

This applies to the following Programs and Years:

NCQA’s Health Plan Report Card has some information regarding this in the Glossary page and can be found here: https://reportcards.ncqa.org/glossary. Also, we have ECDS page which can be found here: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

This applies to the following Programs and Years: