Yes. If validated DAV streams are used, they should be categorized as HIE/clinical registry data sources.
HEDIS 2021
FAQ Directory
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4.15.2022 Data Aggregator Validation (DAV) Data for ECDS Reporting Can validated DAV data streams be used for ECDS reporting? If yes, how should they be categorized (which SSoR)?
4.15.2022 Initiation and Engagement of Substance Use Disorder Treatment (IET) Should denominator episodes be deduplicated to one per day? For example, if a member has two outpatient visits with an SUD diagnosis on the same date of service (with different providers), is it one denominator episode or two?
4.15.2022 Data Aggregator Validation (DAV) Data for ECDS Reporting Can validated DAV data streams be used for ECDS reporting? If yes, how should they be categorized (which SSoR)?
4.01.2022 Why do I need to provide more information for a low denominator or rate if there is no minimum requirement?
It is to ensure patient safety and routine implementation of medical home activities. Depending on the population served and/or the reporting period, a small denominator is unexpected and may indicate issues (e.g., with data, documentation, implementation). Providing additional information allows the practice to explain—beyond the numbers—when performance is outside the expected range.
PCMH 2017
4.01.2022 Is there a minimum threshold requirement when reporting a rate for Annual Reporting?
It depends. If the AR requirement aligns with a PCMH criteria that specifies a threshold, then that value would be the minimum threshold. However, if a threshold is not explicitly stated in the criteria, then a threshold of 80% or more is expected to ensure consistent application of the process. Please note that there may be some cases where it’s acceptable for the rate to fall below 80%.
An explanation is required for practices that report a rate less than 80% for the following criteria: AR-AC 1, AR-AC 2, AR-CC 3 [Tracking Imaging Results], and AR-CC 3 [Tracking Lab Results].
Additionally, this threshold requirement of 80% would also apply if a practice chooses to submit a depression screening measure for AR-QI 1.
PCMH 2017
4.01.2022 Is there a minimum denominator requirement when reporting a rate for Annual Reporting?
No. There is no minimum denominator requirement. A sample of 30 (or more, because this increases the reliability of the sample) is expected to ensure statistical soundness, but there may be cases where it may be appropriate for the denominator to be <30. NCQA requests practices enter an explanation in the Notes from the Organization section in QPASS in this case.
If a practice reports a denominator <30 without a note, the evaluator may contact the practice to confirm data accuracy and to understand the data. The evaluation will be returned to the practice so they can enter an explanation in the Notes from the Organization section for the cited criteria.
PCMH 2017
3.28.2022 RAND Table for LTSS MY 2022 For LTSS MY 2022 reporting, the random number for sampling members for the Long-Term Services and Supports Shared Care Plan With Primary Care Practitioner (LTSS-SCP) is “0.59”; it is “0.58” for Long-Term Services and Supports Comprehensive Assessment and Update (LTSS-CAU) and Long-Term Services and Supports Comprehensive Care Plan and Update (LTSS-CPU). Should all three measures have the same RAND?
3.15.2022 Inaccessibility of practitioners’ licensure information from Maryland Department of Health The Maryland Department of Health (MDH) experienced a network security incident on December 4, 2021, that made its network systems and practitioners’ licensing information inaccessible for primary source verification. The MDH reports that all disrupted licensing board systems were restored as of February 4, 2022. The MDH granted a grace period (with no expiration date) on practitioners’ licenses set to expire between November 2021 and February 2022, and issued temporary licenses to affected practitioners whose licenses will expire June 2022.
How will NCQA evaluate affected practitioners’ files?
For Maryland practitioners credentialed between December 2021 and February 2022, NCQA will not penalize organizations on inability to verify licensure due to the MDH network security incident. NCQA accepts the MDH’s grace period on licensure expirations and accepts temporary licenses issued by the MDH and will consider them current and valid. Organizations should adhere to guidance provided by MDH and document the guidance in the affected practitioners’ credentialing files.
HP 2022
2.15.2022 Updated: MBHO Sampling for UM/CR System Controls Monitoring May organizations that use auditing as a method for monitoring system controls use sampling for UM 11 and CR1, Elements C and D?
Yes. NCQA has decided to allow sampling for organizations that use auditing as the method for monitoring in UM 11, Elements A – D and CR 1, Elements C and D. Organizations must use the “5% or 50 files” audit method: Organizations randomly select 5% or 50 files, whichever is less, from each applicable file type, to review against the requirements:
- Credentialing and recredentialing. (5% or 50 files total)
- At a minimum, the sample includes at least 10 credentialing files and 10 recredentialing files. If fewer than 10 practitioners were credentialed or recredentialed since the last annual audit, the organization audits the universe of files rather than a sample.
- UM denials (5% or 50 files).
- UM appeals (5% or 50 files).
For each applicable file type noted above, the organization must determine the sample size of 5% or 50 files (whichever is less) based on all files in the file universe. The file universe includes all files with or without modifications. The sample that will be audited must include only files with modifications (i.e., modifications that meet and do not meet the organization’s policies and procedures). NCQA does not specify how the organization selects the sample once the sample size is determined using the entire file universe. It may select the sample of modified files from the universe or, if the organization can identify files with modifications, it may randomly select the sample that will be audited from only the modified files.
The organization’s analysis report must include the number or percentage of files that do not meet the organization’s policies and procedures.
Example for UM denials:
- An organization’s UM denial file universe contains 800 files with and without modifications. Therefore, the minimum required sample for review is 40 files (5% of 800) which is less than 50 files. The organization must randomly select the 40 files for review from the total universe of 800 files or from only files with modifications (if the organization’s system has the capability to identify files with modifications). All 40 files must have a modification and are reviewed against the organization’s policies and procedures to identify noncompliant modifications.
Note: The underlined text is an update to the FAQ posted on January 15, 2022.
MBHO 2022
2.15.2022 Updated: Sampling for UM/CR System Controls Monitoring May organizations that use auditing as a method for monitoring system controls use sampling for UM 12 and CR1, Elements C and D?
Yes. NCQA has decided to allow sampling for organizations that use auditing as the method for monitoring in UM 12, Elements A – D and CR 1, Elements C and D. Organizations must use the “5% or 50 files” audit method: Organizations randomly select 5% or 50 files, whichever is less, from each applicable file type, to review against the requirements:
- Credentialing and recredentialing. (5% or 50 files total)
- At a minimum, the sample includes at least 10 credentialing files and 10 recredentialing files. If fewer than 10 practitioners were credentialed or recredentialed since the last annual audit, the organization audits the universe of files rather than a sample.
- UM denials (5% or 50 files).
- UM appeals (5% or 50 files).
For each applicable file type noted above, the organization must determine the sample size of 5% or 50 files (whichever is less) based on all files in the file universe. The file universe includes all files with or without modifications. The sample that will be audited must include only files with modifications (i.e., modifications that meet and do not meet the organization’s policies and procedures). NCQA does not specify how the organization selects the sample once the sample size is determined using the entire file universe. It may select the sample of modified files from the universe or, if the organization can identify files with modifications, it may randomly select the sample that will be audited from only the modified files.
The organization’s analysis report must include the number or percentage of files that do not meet the organization’s policies and procedures.
Example for UM denials:
- An organization’s UM denial file universe contains 800 files with and without modifications. Therefore, the minimum required sample for review is 40 files (5% of 800) which is less than 50 files. The organization must randomly select the 40 files for review from the total universe of 800 files or from only files with modifications (if the organization’s system has the capability to identify files with modifications). All 40 files must have a modification and are reviewed against the organization’s policies and procedures to identify noncompliant modifications.
Note: The underlined text is an update to the FAQ posted on January 15, 2022.
HP 2022
2.15.2022 MBHO: Annual Monitoring of UM System Controls Monitoring for Delegates Have the allowed methods to audit delegate files in UM 12, Element C, factor 5 changed?
No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below:
- 5 percent or 50 of its files, whichever is less, to ensure that information is verified appropriately.
- The NCQA “8/30 methodology” available at https://www.ncqa.org/programs/health-plans/policy-accreditation-and-certification/
Either methodology is allowed, for consistency with other Delegation Oversight requirements for annual file audits.
MBHO 2022
2.15.2022 Annual Monitoring of UM System Controls Monitoring for Delegates Have the allowed methods to audit delegate files in UM 13, Element C, factor 5 changed?
No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below:
- 5 percent or 50 of its files, whichever is less, to ensure that information is verified appropriately.
- The NCQA “8/30 methodology” available at https://www.ncqa.org/programs/health-plans/policy-accreditation-and-certification/
Either methodology is allowed, for consistency with other Delegation Oversight requirements for annual file audits.
HP 2022