The 2017 CM standards are effective on or after January 30, 2017. For organizations that have already scheduled a survey through June 30, the 2014 CM standards year will end on June 30, 2017.
CM 2014
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.
Yes. Documentation of Tanner stage meets criteria for the physical exam and physical developmental components, but should not be double-counted toward both (if used as evidence of physical exam, it may not be used as evidence of physical developmental, and vice versa). Documentation of Tanner stage does not meet criteria for the Well-Child Visits in the First 15 Months of Life (W15) or Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) measures as sexual maturity rating is not recommended until 7 years of age.
HEDIS 2017
Hospitals for which plans have discharges from but are not identifiable in Table HSIR should not be included in the hospitals reported in the category "Number of Contracted Hospitals With Reportable SIR." However, discharges from these hospitals should be included in “Total Inpatient Discharges” and in “Percentage of Total Discharges From Hospitals With Unavailable SIR.” Use Table HSIR posted on the NCQA Web site to make the determination; organizations do not need to refer to the Hospital Compare web site.
HEDIS 2017
The Value Based P4P program intends to measure all commercial HMO/POS members, but we understand that not all POs can limit their numerators and denominators to specific product lines. For this reason, and because VBP4P is not currently scoring the PO-level aggregated performance, POs may include all payer types. If the PO has the ability to limit the patient population to just commercial HMO/POS, that is also accepted.
IHA 2016
Based on the potential burden of reporting PO-specific membership and because VBP4P is not currently scoring the PO-level aggregated performance rate, POs may include all patients for the provider. If the provider has the ability to only include the PO’s members, that is also accepted.
IHA 2016
Yes. Organizations may map NDC codes so that the same set of codes for high-intensity and moderate-intensity statins are used for both the SPC-B and SPD-A measures. An NDC code that is not on the HEDIS list may be used if its generic name, strength/dose and route match an NDC code on the HEDIS list. Organizations should document the method used to map codes: Mapping is subject to review during a HEDIS Compliance Audit. Requirements for mapping are described in General Guideline 50 in HEDIS 2017 Volume 2.
HEDIS 2017
The criterion referenced must be identifiable by name and must be specific to an organization or source (e.g., ABC PBM’s Criteria for Treatment of Hypothyroidism with Synthroid or CriteriaCompany Inc.’s Guidelines for Wound Treatment). If it is clear that the criterion is attributable to the organization, it is acceptable to state “our Criteria for XXX” (e.g., our Criteria for Treating High Cholesterol with Lipitor).
Note: This also applies to Element E and Element H in HPA and Element E in UM-CR.
UM-CR 2016