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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9.14.2018 Risk of Continued Opioid Use In the HEDIS 2019 Volume 2 Technical Specifications, the Risk of Continued Opioid Use (COU) measure includes the Medicare product line; however, this measure was not included in the CMS Reporting Requirements memo for HEDIS 2019. Given this discrepancy, is the COU measure reported by Medicare plans?

The COU measure does include the Medicare product line, and it will be collected in IDSS by NCQA from Medicare plans; however, because it was not included in the CMS Reporting Requirements memo, it is not required to be reported to CMS for HEDIS 2019.

HEDIS 2019

9.07.2018 KM 13 Would the annual UDS report, by which FQHC’s are required to submit data to HRSA, be acceptable to provide as a report?

For FQHCs that are part of a larger organization with multiple practices under the same umbrella, UDS reporting would not meet KM 13 because the data is at the organizational/corporate level. The data for KM 13 must be at the practice level because recognition is at the practice level. An exception to this is for standalone practices whose UDS data is specific to the practice site location.

PCMH 2017

8.29.2018 What is the Health Plan Medicaid Module?

NCQA Health Plan Medicaid Module is a complementary program designed to support NCQA-Accredited health plans with a Medicaid product line. The combination of the module standards and NCQA Health Plan Accreditation maximize alignment with the Medicaid Managed Care program requirements. This improves a plan’s opportunity to receive a streamlined state compliance review.

NCQA developed the module by analyzing changes to state and federal requirements for the Medicaid Managed Care programs, as outlined in the Medicaid Managed Care Rule.

HP 2020

8.24.2018 Where can I find information to help me get started with MBHO Accreditation?

Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

MBHO 2019

8.24.2018 Where can I find information to help me get started with Health Plan Accreditation?

Accreditation Process and Timeline:Key steps, timing and resources for a successful accreditation.
Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

HP 2020

8.24.2018 How do we earn Physician and Hospital Quality Certification?

Organizations must go through a survey and submit documentation to NCQA. The survey score determines certification. See a step-by-step process.

PHQ

8.24.2018 What is the process for earning LTSS Distinction for Health Plans?

The first step to earning distinction is a discussion with an NCQA program expert. Purchase and review the program resources, conduct a gap analysis and submit your online application.

Align your organization’s processes with the standards. NCQA conducts the survey and determines your distinction status within 30 days of the final review.

See a step-by-step process.

HP 2020

8.24.2018 How do I get started with the Medicaid Module?

If you are not currently accredited and want to learn more, contact NCQA. If you are currently accredited and want to talk to someone about your status or about renewing or adding accreditations, submit a question through My NCQA.

HP 2020

8.24.2018 What does Physician and Hospital Quality Certification cost?

Price varies by organization and is based on number of physicians and number of programs. Contact NCQA for pricing information.

PHQ

8.24.2018 How do I get started with Wellness and Health Promotion Accreditation/Certification?

If you are not currently Accredited or Certified and are interested in learning more, contact NCQA. If you are currently Certified and want to talk to someone about your current status, renewing or adding Certifications, submit a question through My NCQA.

WHP 2016

8.24.2018 Where can I find information to help me get started with Utilization Management Accreditation?

Accreditation Process and Timeline: Key steps, timing and resources for a successful accreditation.
Standards and Guidelines: The complete standards and guidelines, including the intent and scope of review.
Interactive Survey Tool: Contains the complete standards and guidelines; you can also determine your organization’s survey readiness—the tool calculates your potential survey score.

UM-CR 2019

8.24.2018 How do I get started with Utilization Management Accreditation?

UM-CR 2019