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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Organizations do not report an IP-ECDS coverage rate; they report a count of members in the initial population covered by ECDS. NCQA does not publicly report these data, which are for internal NCQA use and for benchmarking analysis to help determine the timeline for public reporting.
NCQA is evaluating existing HEDIS measures, eCQMs and other de novo measure concepts for inclusion in the ECDS domain. Selected measures will be reengineered and retested, as necessary, and must be approved by the CPM before their release in ECDS, consistent with other HEDIS measures.
To qualify for HEDIS ECDS reporting, practitioners and practitioner groups that are accountable for clinical services provided to members must have access to data used by plans for quality measure reporting, regardless of the SSoR.
NCQA does not currently specify a method of data access, but a core principle of ECDS reporting is that the information needed to deliver the highest-quality care must be available to the entire health care team responsible for managing a member’s health.
Qualifying modes of access may be as simple as a provider’s phone request for member information, or as sophisticated as an integrated decision support system. The care team’s ability to access data must be documented, to provide evidence that information is available whether or not it is accessed.
Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.
Electronic Clinical Data Systems (ECDS) are a network of databases containing plan members’ personal health information and records of their experiences with the health care system. ECDS may also support other care-related activities, directly or indirectly, through various interfaces that include evidence-based decision support, quality management and outcome reporting.
If a member’s data cannot be classified as ECDS, the member is not included in the ECDS coverage or the measure denominator.
There are several tools for tracking patient progress (for example, https://aims.uw.edu/resource-library/excel%C2%AE-patient-tracking-template). that “convert” data into a format that is considered an ECDS for reporting quality measures.
Yes. Data collected by care/case managers employed by a health plan are appropriate, and are reported in the Case Management category in the measure report.
Care/case managers are considered part of the member’s care team because they help members manage a condition and/or their use of health care services.
Yes. The intent is to exclude members who were dispensed opioids on only one date of service during the measurement year. If the member had multiple prescriptions (for the same or different medication) on one date of service and had no opioid prescriptions on another date of service during the measurement year, the member is excluded.
The ECDS reporting method uses much of the same data classified as supplemental for other HEDIS measures, but ECDS measures adhere to different reporting rules from those in other HEDIS domains. Unlike supplemental data used for HEDIS, data for ECDS reporting are classified by source and are used to report all measure elements (e.g., denominator, exclusions, numerator).
Yes. If the notification indicates that members may be represented by anyone, this is acceptable because the reference to “anyone” implies “including an attorney.” If the notification lists specific types of individuals, it must also specify “an attorney.”
