NCQA has a Measure Certification program for organizations that develop, license, and sell HEDIS, P4P, or other quality-measure reporting software that calculate measures using administrative data sources. NCQA’s Measure Certification program validates the integrity of the software code that produces measure results. Certifying measures contained in your software demonstrates to existing and prospective customers that the coded measures meet current NCQA standards, improves the accuracy of reporting measures and produces more reliable and comparable results.
How does Measure Certification work?
NCQA creates unique sets of sample data or "test decks," for each measure, developed from randomly generated member-level test data. Test decks test denominator, numerator and exclusion logic. You process this test deck through your HEDIS or P4P measure code. We compare your measure results to the expected results to determine if the code in your software computes the measure correctly. Multiple test decks are available for each measure so you can correct errors.
A measure is NCQA-certified when it passes certification. When you have completed certification, NCQA will issue you a final certification report and seal that can be distributed to health plans, potential clients and Certified Auditors to demonstrate your achievement.
Measure test decks are not packaged together and are tested individually. This allows for you to have the option of testing a subset of HEDIS measures.
Testing also includes the 2017 Quality Rating System (QRS) measure set comprised of clinical measures from HEDIS and a Pharmacy Quality Alliance (PQA) measure – Proportion of Days Covered.
Measure Certification and the Audit
If you achieve Certification, you are exempt from manual source code review for all certified measures by auditors during the HEDIS Compliance Audit® or P4P Audit Compliance Review. Certified Auditors review items that are NOT included in the scope of certification or not listed in a vendor’s certification report, including but not limited to:
Organization-to-vendor field mapping.
Data scrubbing/cleaning routines conducted before measure calculations (by the organization, the vendor or the software that contains certified measures).
Organization-specific data integrity and medical coding issues, especially concerns that could affect the accuracy of the reported rates.
Measure logic application that is idiosyncratic by nature (e.g., organization-specific methods for identifying live births for obstetric-related measures).
Medical record review (MRR) tools and logic, including data entry screens, database layout and the correct combining of medical record and administrative data.
Vendor compliance with IS standards, especially concerns that could affect the accuracy of reported rates.
IDSS import tools, XML files or other programs that load data into a submission tool.
Measure versions (alternative measures) not listed on the Certification Report.
Combination of data types: administrative, medical record, supplemental data.
Queries or other checks deemed by the auditor to be necessary to support the measure results reported by the vendor’s measure code.
A measure rate is not considered a HEDIS rate unless it is audited and approved by an NCQA-certified HEDIS Compliance Auditor.
Vendors should work with licensed organizations to facilitate review of these additional items.
What are the benefits of NCQA Measure Certification?
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA HEDIS Compliance Audit® is a registered trademark of NCQA. NCQA HEDIS Measure CertificationSM is a service mark of NCQA.
- Certified measures are exempt from manual source code review by auditors during the HEDIS Compliance Audit® or P4P Audit Compliance Review.
- Certification incorporates new HEDIS measures into the testing process which reduces time and resources for you and your clients.
- Provides visibility for your company’s commitment to quality (press releases and posting on NCQA’s website).
- Vendors receive an NCQA Certified Measure Seal that enhance your advertising efforts (see the advertising guidelines for details).