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.
The variance should not be rounded until the final step in the calculation. The final variance calculation for reporting should be rounded to four decimal places using the .5 rule. For example, the PPD and PUCD values are truncated to 10 decimal places, multiplied together at the member level and summed across members for the total. Round the total sum to four decimal places.
HEDIS 2022
NCQA is aware of updates to the US Preventive Services Task Force (USPSTF) guidelines for colorectal cancer screening. Given these updates, NCQA will evaluate potential changes to the HEDIS Colorectal Cancer Screening (COL) measure through input from our clinical and technical measurement advisory panels, the Committee on Performance Measurement and public comment. Any potential changes to the measure resulting from this evaluation would be included in the HEDIS MY 2022 Technical Update at the earliest.
HEDIS 2021
NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 2.
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 2.
HP 2021
NCQA considers it to be delegation if the organization uses another organization, including a mail service organization, to perform any function not listed in the “Vendor” section of Appendix 3.
NCQA considers it to be a vendor relationship if the organization uses another organization (e.g., a mail service organization) to perform functions evaluated by the elements or element components listed in the "Vendor" section of Appendix 3.
UM-CR-PN 2021
Yes. If an organization adds virtual-only practitioners to its network, the provider directory must indicate that such practitioners are virtual only (i.e., in lieu of a physical office location) to meet NET 5, Element A. Virtual-only practitioners must also be fully credentialed, per requirements in CR 1, Element A.
HP 2021
| Topic | Update Highlights |
| Policies and Procedures | Added a section on Natural Disasters and Cybercrime. |
| Policies and Procedures | Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible. |
| Appendix 2 – Glossary | Added an entry on Behavioral Health Care Clinician. |
| TC 08/BH 01 | Added a note to the guidance language to clarify the required qualifications of a Behavioral Health Care Manager. |
| KM 20/BH 13 | Updated the list of CDS examples in the guidance language. |
| AC 04 | Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice. |
| CM 06 | Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria. |
| QI 01/ QI 02 | Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard. |
| Appendix 5 | Redesigned Appendix 5 to outline measures reporting including a table of standardized measures now supported. |
| Distinction in Behavioral Health Integration | Clarified that already Recognized practices seeking Distinction have one virtual review. |
PCMH 2017
| Topic | Update Highlights |
| Policies and Procedures | Added a section on Natural Disasters and Cybercrime. |
| Policies and Procedures | Updated policy on eligibility to clarify that organizations that operate entirely remotely are eligible. |
| KM 17 | Updated the list of CDS examples in the guidance language. |
| AC 02 | Added language to the guidance to clarify that patient inquiries regarding prescription refills or appointment requests are not considered clinical advice. |
| PM 11 | Updated guidance language to detail how Person-Driven Outcome goals can be used to meet the criteria. |
| QI 01 A, B and C | Measures data must be input from the new ‘Measures Reporting’ tile of the Organization Dashboard. |
PCSP 2019
No. NCQA released a policy change in July 2020 stating that certified QRDA I files are not considered standard supplemental data for HEDIS® reporting in 2022 for HEDIS MY 2021. Because of the dual HEDIS publication, HEDIS MY 2021 Volume 2 did not account for this policy change, but it will be reflected in HEDIS MY 2022 Volume 2. However, this FAQ is a reminder the policy changed in July 2020 and therefore must be followed. Organizations should work with their auditor to have this data validated as nonstandard supplemental data.
HEDIS 2021
