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.
Massachusetts practices may apply for PCMH PRIME Certification at any time; there is no application submission deadline. Practices may apply for PCMH PRIME Certification at the same time as they are renewing or sustaining their NCQA PCMH Recognition, or they may apply for PCMH PRIME as a separate program at any time.
As practices obtain PCMH PRIME Certification, or make a commitment to doing so (thereby receiving “Pathway to PCMH PRIME” status), their names are posted on this website.
The HPC is committed to engaging payers to support PCMH PRIME practices and their efforts toward behavioral health integration. The HPC is involved in ongoing discussions with payers about PCMH PRIME, and we encourage practices to speak with their payer contacts about certification incentives or other payments that may be available
There are a variety of validated screening tools that practices may use to meet PP 07-PP 11.These include, but are not limited to, PHQ-9, AUDIT, GAD-7, CRAFFT, and SWYC. The PCMH PRIME Standards and Guidelines document gives additional examples of screening tools that may be used to fulfill each factor. Practices may select from among those examples, or use any other validated screening tools that work for them.
Practices seeking PCMH PRIME Certification must submit documentation to NCQA for review or participate in an NCQA virtual review. NCQA reviewers evaluate the evidence to determine whether the practice has met the PCMH PRIME criteria. NCQA provides its assessment to the HPC. Based on this assessment, the HPC then scores the practice and determines whether it has met PCMH PRIME Certification requirements.
The PCMH PRIME review process varies depending on whether a practice applies to PCMH PRIME concurrently with a PCMH 2017 survey or applies to PCMH PRIME only (to supplement previously earned PCMH Recognition).
· Practices applying to PCMH PRIME concurrently with a PCMH 2017 survey will submit PCMH PRIME evidence as part of the PCMH 2017 virtual review process. The PCMH 2017 review process may take up to 12 months but varies by individual practice timelines and capabilities. This process includes up to three virtual check-ins lasting up to two hours each. Practices applying only to PCMH PRIME or to PCMH PRIME concurrently with Annual Reporting will upload all evidence to Q-PASS without participating in a virtual check-in. NCQA evaluates a practice’s documentation for PCMH PRIME within 60 days of receipt.
Once the PCMH PRIME documentation review is complete, NCQA provides its assessment results to the HPC. The HPC issues a final scoring decision to the practice within 15 business days of receiving results from NCQA.
Yes, if the pediatric practice conducts postpartum depression screening during an infant care visit, the practice may receive credit for this diagnostic. The practice does not necessarily have to create a new patient record, nor store the results of the screening in the infant’s record, so long as it can provide the required documentation to NCQA.
PCMH PRIME is a site-specific certification program. Unless otherwise noted in the PCMH PRIME Standards and Guidelines, practices must submit site-specific evidence. For some of the PCMH PRIME criteria, practices that are part of a multi-site organization can share the same evidence. Please see the PCMH PRIME Standards and Guidelines for specific details regarding which evidence can be shared across practice sites.
First, go to the HPC’s website to complete a short application indicating your practice’s intent to pursue PCMH PRIME.
Once your practice has submitted the HPC application and is ready for next steps with NCQA, you should apply through the new NCQA Q-PASS system. The PCMH PRIME application is separate from the PCMH application in Q-PASS. Practices may apply for PCMH PRIME Certification separately or concurrently with the PCMH Recognition process and Annual Reporting.
§ For PCMH 2014 Level 3 or PCMH 2017 Recognized practices:
