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.
Because W30 and WCV are administrative only, the services and documentation in the supplemental data (e.g., medical record) must be clinically synonymous with the codes in the measure’s administrative specification. The organization determines this and it is reviewed by the auditor. Supplemental data must adhere to requirements in General Guideline 31 of the HEDIS Volume 2 MY 2020 & MY 2021 specifications.
HEDIS 2021
Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
Yes. This is true if the organization loads its supplemental data before approval. If the organization does not load its supplemental data until after approval is complete then “Number of numerator events by administrative data in eligible population (before exclusions)” will be equal to “Numerator events by administrative data.”
Appendix 4—Data Element Definitions of the MY 2020 & 2021 Volume 2 Technical Specifications includes an explanation of the data elements and how they are reported.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2020
Yes. Use the beginning of the first segment as the start of the last enrollment segment. For HEDIS Volume 2 MY 2020 & 2021, multiple enrollment segments with no gaps are treated the same as one enrollment segment with no gaps.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
Yes. Services provided during a telephone, e-visit or virtual check-in are eligible for use in reporting for both rates (Timeliness of Prenatal Care and Postpartum Care) and for both data collection methods (administrative and hybrid).
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
Yes. Member-reported biometric values (height, weight, BMI percentile) collected during a telephone visit, e-visit or virtual check-in that meet the requirements of General Guidelines 39: Member-Reported Services and Biometric Values are eligible for use in reporting.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
Yes. Although the required palliative care exclusion is intended to be identified using administrative data, medical record and supplemental data may also be used. If a member is identified as being in palliative care during hybrid medical record review, the member must be removed from the sample and replaced with a member from the oversample. Count the member in the “Number of medical records excluded because of valid data errors” data element.
If organizations use supplemental data to remove members in palliative care from administrative-only measures or hybrid measures, they must follow the supplemental data guidelines (General Guideline 31). Count these members in the “Number of required exclusions” data element.
**This FAQ applies to HEDIS Volume 2 MY 2020 & MY 2021.
HEDIS 2021
NCQA added the word “all” to CR 7 in the 2020 HPA standards and guidelines because it expects organizations to have policies for assessing all providers with which they contract. However, under the 2020 standards and in previous years, NCQA only scores policies for providers listed in CR 7, Elements B and C.
Because the definition may not be sufficient to clearly identify which organizations NCQA considers “providers,” here is a list of provider types in addition to those listed in Elements B and C:
HP 2020
If an organization contracts with external entities to store its own UM data or contracts with UM delegates that store data, NCQA also reviews contracts from up to four randomly selected external entities, or reviews all external entities if the organization has fewer than four. If factor 6 is not addressed in a contract, the organization may also present the external entity’s policies and procedures for review. NCQA reviews documentation from the organization and from each external entity against the factor. To be scored “yes,” the organization's and each external entity’s documentation must meet the factor.
Note: The underlined text is an update to the FAQ posted on June 15, 2020. Refer also to the FAQ on the same date regarding cloud storage entities.
UM-CR-PN 2020
It depends. For initial measurement, the organization conducts quantitative and qualitative analysis of data.
For remeasurement, the organization conducts quantitative analysis and also conducts qualitative analysis if quantitative analysis demonstrates that stated goals were not met.
HP 2020
