FAQ Directory

HPR uses the prior year Medicare CAHPS data so NCQA will use the corresponding sub ID, therefore, could differ from the Medicare plan's CAHPS sub ID of the HPR release year. 
 

HPR

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of the sites. Please contact this individual at your organization to request access.

HPR

NCQA currently maintains prior year HPR scores here: https://reviewratingsfinal.ncqa.org. You can also purchase the HPR detailed results file which lists plan’s overall rating, composite, subcomposite and measure level scores: https://store.ncqa.org/other-products/health-plan-rankings.html

HPR

• "1” = Process measures (e.g., screenings, visits)
• “1.5” = Patient experience measures (CAHPS)
• “3” = Outcome and intermediate outcome measures (e.g., HbA1c Control, Blood pressure control)

HPR 2022

NCQA currently does not rate Exchange plans for Health Plan Ratings/Health Plan Accreditation (HPR/HPA). This is primarily because CMS has their own Quality Rating System (QRS), and NCQA has to receive special permission from CMS to use the data for our Accreditation program. NCQA is actively participating in these discussions, and any changes to this policy will be communicated to all organizations in a timely manner.

HPR

Your overall rating will be “Partial Data Reported” and your measure rates will be displayed as “NC” (No Credit) on the September 15 release of HPR on the NCQA Health Plan Report Card.

HPR

HPR truncates final raw rates and percentiles to 3 decimals, so if your IDSS workbook shows 78.47, HPR will show the raw rate of .784 (truncated at 3 decimals).

HPR

NCQA defines “state coverage” as the states where a plan is licensed to operate. Plans that submit HEDIS/CAHPS data provide this information each year during the HOQ process. If plans do not submit these data, NCQA uses state licensing and membership data provided for Accreditation or gathered from external sources.

HPR

The plan will receive a “0” on the measure and the measure weight is included in the Ratings calculation.

HPR

NCQA requires plans to review their projected rating as a final quality assurance step in the ratings process. Although the projected information is subject to change (from continued quality checks), plans must affirm that they reviewed their information and have no questions regarding their Accreditation status or projected rating.

HPR

HPR utilizes HEDIS, CAHPS, and HOS data sets and Measurement Years are dependent on HPR year as well as product lines. To find specific data information on each HPR year, please access that year's Measure List by navigating to this page https://www.ncqa.org/hedis/health-plan-ratings/
 

HPR

HPR 2024