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.

Filter Results
  • Save

    Save your favorite pages and receive notifications whenever they’re updated.

    You will be prompted to log in to your NCQA account.

  • Email

    Share this page with a friend or colleague by Email.

    We do not share your information with third parties.

  • Print

    Print this page.

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 Follow-Up After Emergency Department Visit for Substance Use (FUA) Should the Residential Program Detoxification Value Set be used when reporting the FUA measure? It is not listed in the Value Set Directory.

Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:

  • H0010     Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
  • H0011   Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)

HEDIS 2023

9.15.2022 Quality Compass How can I obtain plan performance data and/or benchmark results for HEDIS and CAHPS measures?

You can obtain access to performance data and benchmarks via the NCQA Quality Compass tool. Quality Compass is an interactive database containing individual plan performance results for HEDIS® and CAHPS® measures, as well as benchmark data at the national, regional (Census, HHS) and state levels. To learn more about Quality Compass and licensing access to HEDIS performance results, visit our Quality Compass homepage.
 

HEDIS 2022

9.15.2022 Publicly Reported Plans in Quality Compass How do I know what plans publicly reported data to NCQA? How do I know what measures will be reported in Quality Compass?

To obtain a list of health plan submissions and/or measures publicly reported in Quality Compass for a specific reporting year, contact the Information Products team by submitting your question on my.ncqa.org.
Quality Compass contains HEDIS and CAHPS measures that were eligible for publicly reporting during the measurement year. First year HEDIS measure results are not publicly reported in the tool.
 

HEDIS 2022

8.19.2022 Long-Term Services and Supports Shared Care Plan With Primary Care Practitioner (LTSS-SCP) For MY2022 reporting, should members without a care plan (or with a partial care plan) be excluded from the LTSS-SCP measure?

No. For MY2022 reporting, members without a care plan (or with a partial care plan) should not be excluded from the LTSS-SCP measure. These members would remain in the measure and would be numerator non-compliant.

HEDIS-LTSS 2022

8.15.2022 Quality Compass: Data Exporter What is the Data Exporter feature on Quality Compass?

All versions of Quality Compass allow users to build customized reports within the tool. Versions of Quality Compass that include the Data Exporter feature allows users to download and export those custom reports into Microsoft Excel.

The Data Exporter feature also grants access to the “All Measures Download” file. This file contains plan-level performance data for all publicly reported health plan submissions and all HEDIS and CAHPS measure results in a single downloadable file. Versions purchased without Data Exporter will not have the ability to export plan level data but will still have access to Excel versions of the benchmarks.
 

HEDIS 2022

8.15.2022 Individual Plan Data - Quality Compass What are the “individual plan data” available on Quality Compass?

Individual plan data are the HEDIS and CAHPS performance rates submitted by health plans that chose to publicly report their results to NCQA. Users have access to all publicly reported plans in a specific product line (commercial, Medicaid, Medicare) and can easily select a subset of plans based on coverage in different regions/states.
 

HEDIS 2022

7.05.2022 KM 09 For which patients does a PCMH need to collect sexual orientation and gender identity data?

Starting in 2023 for Transforming practices and in 2024 for currently recognized practices, direct collection of data on sexual orientation and gender identity of patients is required for KM 09. This requirement applies to all patients aged 18+, though practices are encouraged to also ask adolescent patients if they have a system for doing so.

PCMH 2017

6.30.2022 PCSP July 2022 Summary of Updates What updates were made to the PCSP Standards and Guidelines for Version 5?

TopicUpdate Highlights
Policies and ProceduresSection restructured
Policies and ProceduresAddition of language regarding Corrective Action Plans
KM 06Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection.
KM 06Added requirement that data be direct collection.
PM 19New elective criterion regarding person-driven outcomes.
Appendix 2 – GlossaryAdded “Age as a Vulnerability”

PCSP 2019

6.30.2022 July 2022 Summary of Updates What changes were made to the PCMH Standards and Guidelines for Version 8?

TopicUpdate Highlights
Policies and ProceduresSection restructured
Policies and ProceduresAddition of language regarding Corrective Action Plans
KM 09Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection
KM 10Added requirement that data be direct collection
CM 10New elective criterion regarding person-driven outcomes
Appendix 2 – GlossaryAdded “Age as a Vulnerability”

PCMH 2017

6.15.2022 Clarify scope for CVO 3, Element B What are the differences in scope for system controls at the factor level in CVO 3, Element B?

For CVO 3, Element B:

  • Factor 1 applies to verification source information from credentialing and recredentialing cycles, covered in CVO 4-12.
  • Factor 2 applies to modified credentialing verification information from initial credentialing and recredentialing cycles, covered in CVO 4-12.
  • Factors 3–5 apply to all information associated with credentialing/recredentialing of practitioners, covered in CVO 4-14.
  • Factor 6 requires a monitoring process that covers compliance with all policies and procedures described in factors 1–5.

CVO 2022

6.15.2022 CVO: Delegation Oversight System Controls Monitoring - Audits Are both the organization and delegate required to conduct system controls audits for CVO 15, 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.  

CVO 2022