Measure Certification

NCQA has a Measure 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 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 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 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.

Also, you can 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.

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 either 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.
  • Application of measure logic that is by nature idiosyncratic (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 or other programs that load data into a submission tool.
  • Measure versions (alternative measures) not listed on the Certification Report.
  • Software vendors should work with licensed organizations to facilitate review of these additional items. 

What are the benefits of NCQA Measure Certification?

  • 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 a NCQA Certified Measure Seal that enhance your advertising efforts (see the advertising guidelines for details).

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 Measure CertificationSM is a service mark of NCQA.

How do I get started?

The first step to becoming a Certified Vendor is completing an application and signing a one-year certification agreement. Please request an application through the Measure Certification queue in PCS.

Policy Clarification Support (PCS)