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 HEDIS Software Certification are organizations that develop, license, and sell HEDIS reporting software that calculates numerators and denominators using administrative data sources. Such as:
- HEDIS service bureau solutions
- Standalone HEDIS software applications for license or purchase
- Integrated HEDIS reporting modules or applications in a larger, integrated reporting or transaction system.
Benefits of NCQA Software Certification
- Exemption from manual source code review by auditors during the HEDIS Compliance Audit®
- 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)
- Assistance in maximizing your advertising using the NCQA Certified HEDIS Software Vendor Seal (see the advertising guidelines for details)
By achieving Certification, you can demonstrate to prospective customers that your software product has been tested and meets NCQA standards.
In addition, your software will help ensure valid collection and reporting results for health plans - ultimately reducing the time and resources plans will 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 software product. NCQA compares the vendor’s measure results to the expected results and determines if the software computes HEDIS 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.
Software Certification and the Audit
Vendors who achieve Certification are exempt from manual source code review by auditors during the HEDIS Compliance Audit®. HEDIS auditors will 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 will only ask for or review 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 September after the specification freeze date.
New HEDIS Measures in 2007
NCQA has added four new measures to HEDIS 2007, and HEDIS Software Certification will include all of these new measures:
- Potentially Harmful Drug-Disease Interactions in the Elderly
- Relative Resource Use for People With Diabetes
- Relative Resources Use for People With Asthma
- Relative Resource Use for People With Acute Low Back Pain
For further information, questions and application forms for HEDIS Software Certification Program, contact Suzanne Porter, Coordinator, 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.