Software Certification

NCQA has a Software Certification program for organizations that develop, license, and sell HEDIS, P4P, or other quality-measure reporting software that calculate numerators and denominators using administrative data sources.

NCQA’s Software Certification program validates the integrity of your commercial software products that produce measure results. Certifying your software product demonstrates to existing and prospective customers that the product meets current NCQA standards, improves the accuracy of reporting measures and produces more reliable and comparable results.

How does Software 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 software product. We compare your measure results to the expected results to determine if your software computes the measure correctly. Multiple test decks are available for each measure so you can correct errors.

Your product is NCQA-certified when all tested measures pass certification. Once you have completed certification you will receive a final certification report and seal that can be distributed to health plans, potential clients and Certified Auditors to demonstrate your achievement.

You can also choose to test a subset of HEDIS measures. The measure test decks are not packaged together and are tested individually. Each vendor that completes partial certification receives a final certification report and seal which indicates each measure certified.

Software Certification and the Audit

If you achieve Certification you are exempt from manual source code review by auditors during the HEDIS Compliance Audit® or P4P Audit Compliance Review. Certified Auditors need to review items that are not included in the scope of Software Certification or not passed in a vendor’s certification report.

What is not included in the scope of certification?

• Medical Record Review tools and logic, including data entry screens, database layout and the combination of medical record and administrative data (confirm that the software applied the 14-day rule)
• Interactive Data Submission System (IDSS) import tools
• Organization-to-vendor field mapping
• Data scrubbing/cleaning routines conducted before HEDIS measure calculations (by either the organization or the vendor)
• Organization-specific data integrity and medical coding issues, especially concerns that could affect the accuracy of the reported rates such as aggregating inpatient stays that include interim bills
• Application of measure logic that is by nature idiosyncratic (e.g., organization-specific methods for identifying live births for OB-related measures)
• Vendor compliance with IS standards, especially concerns that could affect the accuracy of reported rates

What are the benefits of NCQA Software Certification?

• Your product is 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).
• Certified Vendors receive a NCQA Certified Software Vendor Seal that enhance your advertising efforts (see the advertising guidelines for details).

Contact SoftCert@ncqa.org for further information, questions and application forms.

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 Certification^SM is a service mark of NCQA.