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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2.15.2022 COVID-19 Is HEDIS changing data collection strategies for HEDIS MY 2021 due to COVID?

NCQA continues to monitor the impact of COVID on communities and at this time has no plans to modify data collection methods and reporting deadlines.

HEDIS 2021

2.15.2022 Guidelines for Calculations and Sampling: Hybrid Measures When reducing sample sizes for measures with stratifications, which are used: the total rates or the stratified rates?

For measures with stratifications, use the total rate when reducing sample sizes. For measures with multiple indicators and stratifications, use the lowest total rate across indicators when reducing sample sizes.

HEDIS 2021

2.15.2022 Cervical Cancer Screening (CCS) For cervical cancer screening, should we exclude transgender women (male to female, never had a cervix)?

Administrative data, codes in the Absence of Cervix Diagnosis Value Set (e.g., ICD-10-CM Diagnosis code Q51.5 [agenesis and aplasia of cervix]) may be used to exclude transgender members from the measure. If the medical record documents that the member was born male (e.g., transgender male to female), this is evidence that the member does not have a cervix, meets optional exclusion criteria and may be removed from the measure. Medical record documentation of cervical agenesis or clinical synonyms (e.g., evidence a patient was born without a cervix) may also be used to exclude these members. These members should remain in the measure if the organization is unable to find the appropriate documentation.

HEDIS 2021

1.15.2022 UM/CR System Control Delegation Agreement When must the delegation agreement include a description of the delegate’s UM/CR system controls as required in UM 13, Element A and CR 8, Element A?

New delegation agreements implemented on or after January 1, 2022, must include a description of the delegate’s UM/CR system security controls.
 
For delegation agreements in place prior to January 1, 2022, NCQA has extended the time frame for including a description of UM/CR system controls in the delegation agreement. All delegation agreements under the 2024 HPA standards (effective July 1, 2024) must include a description of UM/CR system controls. Prior to July 1, 2024, organizations may alternatively provide a delegation agreement and other mutually agreed upon documentation OR the delegate's system controls policies and procedures in lieu of a delegation agreement with a description of UM/CR System controls.

UM-CR-PN 2022

1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?

No. CCDs are not considered a legal health record and may not be used for hybrid abstraction.

HEDIS 2021

1.14.2022 Continuity of Care Documents Can Continuity of Care Documents (CCDs)/style sheets generated from CCDs be used for hybrid abstraction?

No. CCDs are not considered a legal health record and may not be used for hybrid abstraction. 

HEDIS 2022

12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?

Yes. There were two previously posted FAQs that have been recently updated. One FAQ was posted in September and the second was posted in November. Both FAQs were updated and can be found on the FAQ page with the date of 12.3.2021.

HEDIS 2021

12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?

Yes. There were two previously posted FAQs that have been recently updated. One FAQ was posted in September and the second was posted in November. Both FAQs were updated and can be found on the FAQ page with the date of 12.3.2021.

HEDIS 2022

12.15.2021 Patient-Level Detail (PLD) File Cardiac Rehabilitation (CRE) is new to the CMS PLD file for MY 2021. Only one denominator is included, but the measure has two age bands. What should be reported for the measure?

For MY 2021 PLD submissions, include only data for the Total age band. This must align with the summary Total data reported in IDSS.

HEDIS 2021

12.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Measures In which data element should exclusions be reported when exclusion information is found through a data refresh?

For HEDIS MY 2021 reporting, reporting exclusions in different categories found through a data refresh is flexible; for example, number of original sample records excluded because of valid data errors, number of administrative data records excluded and so on. Record counts must be able to be reconciled between the MRSS, the number of exclusions, records added from the oversample and the denominator.

HEDIS 2021

12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?

Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.

Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:

Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297

Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411

HEDIS 2022

12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?

Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.

Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:

Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297

Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411

HEDIS 2020