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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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11.15.2024 Gold-Standard Example for Member-Reported Services What’s a scenario that reflects the intent of NCQA’s requirements for member-reported services?

Example: During a new-patient office visit, the patient reports receiving a colonoscopy in the previous year to their primary care provider. During the discussion, the provider documents the details (when and where the procedure occurred, findings) in the office visit progress notes in the patient’s EHR.

This example represents the intent behind the HEDIS guidelines because:

  • The provider collecting the information has the appropriate clinical experience to interpret what the patient is sharing and assumes clinical accountability for that aspect of the patient’s clinical care.
  • The provider documents the colonoscopy in the patient’s medical record allowing it to be accessible to other care team providers and to the member for clinical decision making.

ALL MY 2025