NCQA, the leader in quality and performance measurement, has developed a HEDIS Software Certification program that ensures the integrity of commercial software products that produce HEDIS results. By becoming NCQA-Certified, you can help improve the accuracy of reporting measures and produce more reliable and comparable HEDIS results while gaining an advantage over your competitors.
Who is eligible?
Vendors eligible for Software Certification are organizations that develop, license, and sell HEDIS or P4P reporting software that calculates numerators and denominators using administrative data sources. Such as:
-
Service bureau solutions
-
Standalone software applications for license or purchase
-
Integrated reporting modules or applications in a larger, integrated reporting or transaction system.
Benefits of NCQA Software Certification
-
Exempts you from manual source code review by auditors during the HEDIS Compliance Audit® or P4P Audit Compliance Review
-
Incorporates new HEDIS measures into testing process - reducing time and resources for you and health plans interested in purchasing your product
-
Provides visibility for your company’s commitment to quality (press releases and posting on NCQA’s website)
-
Enhances your advertising using the NCQA Certified Software Vendor Seal (see the advertising guidelines for details)
By achieving Certification, you can demonstrate to prospective customers that your software product is tested and meets NCQA standards.
In addition, certified software helps ensure valid collection and reporting results for health plans –ultimately reducing the time and resources plans need to update and integrate these new measures into their system – giving you the competitive advantage.
The software certification process
NCQA creates unique sets of sample data or "test decks," developed from randomly generated member-level test data for each measure, that vendors process through their HEDIS or P4P software product. NCQA compares the vendor’s measure results to the expected results and determines if the software computes HEDIS or P4P rates correctly. Multiple test decks are provided for each measure to allow for correction of errors.
NCQA awards HEDIS Software Certification when a minimum of 90 percent of the measures pass certification. Each vendor that completes the certification requirements receives a Final Certification Report and Seal that can be distributed to health plans and HEDIS Compliance Auditors to demonstrate their achievement.
Vendors can also test any subset of HEDIS measures; the measures are not packaged together, but tested individually. Each vendor that completes partial certification receives a Final Certification Report and Seal indicating which measures were tested.
Software Certification and the Audit
Vendors who achieve Certification are exempt from manual source code review by auditors during the HEDIS Compliance Audit® or P4P Audit Compliance Review. Auditors continue to evaluate MCO-to-vendor field mappings; data scrubbing and cleaning routines; MCO-specific data integrity and medical coding issues; application of idiosyncratic measure logic, e.g., MCO-specific methods for identifying live births for OB-related measures; and medical record abstraction tool logic. Auditors review only source code used to produce measures that do not receive a "pass" status.
Beginning certification
Vendors interested in becoming a Certified Software Vendor must complete an application and sign a one year certification agreement. Vendors who return complete applications and signed agreements to NCQA are participants in the program, are included in an NCQA press release and receive access to sample test decks that can be used for practice testing. Actual testing starts in October after the specification freeze date.
New HEDIS Measures in 2009
NCQA has added four new measures to HEDIS 2009, and HEDIS Software Certification will include all of these new measures:
P4P Measure Set
Measures for Payment or Public Reporting
-
Encounter Rate by Service Type
-
Childhood Immunization Status – 24 Month Continuous Enrollment
-
Appropriate Treatment for Children With Upper Respiratory Infection
-
Breast Cancer Screening
-
Cervical Cancer Screening
-
Chlamydia Screening in Women
-
Cholesterol Management for Patients with Cardiovascular Conditions – LDL Screening and Control
-
Use of Appropriate Medications for People With Asthma
-
Colorectal Cancer Screening
-
Appropriate Testing for Children With Pharyngitis
-
Avoidance of Antibiotic Treatment for Adults With Acute Bronchitis
-
Use of Imaging Studies for Low Back Pain
-
Annual Monitoring for Patients on Persistent Medications
Coordinated Diabetes Care Domain
-
Diabetes Care—HbA1c Testing, HbA1c Poor Control, HbA1c Good Control, LDL Screening and Control, Nephropathy Monitoring
For further information, questions and application forms for HEDIS Software Certification Program, contact Suzanne Porter, Analyst, Licensure & Certification at porter@ncqa.org / (202) 955- 5127.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
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 Software CertificationSM is a service mark of NCQA.