Yes. NCQA posted an example HAI SIR table to the HEDIS 2017 Web site at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017. The final HAI SIR table (Table HSIR) will be posted to the NCQA Web site by January 2, 2017.
HEDIS 2017
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. NCQA posted an example HAI SIR table to the HEDIS 2017 Web site at http://www.ncqa.org/hedis-quality-measurement/hedis-measures/hedis-2017. The final HAI SIR table (Table HSIR) will be posted to the NCQA Web site by January 2, 2017.
HEDIS 2017
No. If an organization inadvertently includes a medical necessity denial in the UM 4H benefit denial file review, NCQA verifies that the file is appropriately classified as a medical necessity denial. If so, NCQA scores the file NA. If not, NCQA reviews the files under the benefit denial requirements of UM 4H.
UM-CR 2016
Yes. If an organization inadvertently includes a benefit denial in the UM 4–UM 7 medical necessity denial file reviews, NCQA verifies that the file is appropriately classified as a benefit denial. If so, NCQA scores the file NA. If not, NCQA reviews the files under the medical necessity denial requirements of UM 4–UM 7.
UM-CR 2016
NCQA collects clinical data for the Quality Rating System (QRS) under contract for CMS, but does not collect or report Exchange data for any other purpose.
Published CMS guidance (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/2019-QRS-and-QHP-Enrollee-Survey-Technical-Guidance_FINAL_20181016_508.pdf) states (page 19, Section 8, Quality Rating Information Preview Process), “The proof sheets will include benchmark information for measure results and an associated definition/rationale for any invalid/non-numeric results (e.g., NR).”
You can e-mail the Exchange Operations Support Center Help Desk at CMS_FEPS@cms.hhs.gov or phone 855-267-1515 if you have questions about benchmarks for Exchange QRS data. Reference “Exhange Quality Initiatives (MQI)-QRS” in the subject line.
Exchange 2016
For factor 1, organizations present a report of complaints and appeals by product line.
For factor 2, organizations present a report showing member experience results by product line. Organizations are not required to conduct a separate survey for each product line brought forward. If organizations conduct one behavioral healthcare survey across all product lines, results must be presented by product line, even if response rates are low.
No, Humana will not be participating in P4P Medicare Advantage measurement and reporting, and should not be included in PO data reporting. Self-reporting POs and health plan clinical data file layouts did not include Humana and Humana members should not be included in self-reporting PO or health plan rates.
IHA 2015