HEDIS Data Submission
NCQA collects HEDIS data directly from Health Plan Organizations and Preferred Provider Organizations for multiple purposes via the Healthcare Organization Questionnaire (HOQ) and HEDIS non-survey data through the Interactive Data Submission System (IDSS). The links below provide important information concerning the data submission process. All HEDIS data collected by NCQA are maintained in a central database with strict controls to protect confidentiality.
HEDIS data collected by NCQA are important for researchers working to improve the health care system, as well as for NCQA staff seeking to improve the HEDIS measures themselves. Commercial HEDIS data are used to calculate national performance statistics and benchmarks, as well as to set standards for measures included in NCQA's Accreditation program. Given plan permission, commercial data are also included in Quality Compass®. Health plans, purchasers, consultants and the media use Quality Compass data for comparative health plan performance analyses.
NCQA collects Medicare HEDIS data on behalf of the Centers for Medicare & Medicaid Services (CMS), and Medicaid HEDIS data on behalf of state agencies. In addition, NCQA collects commercial data on behalf of some states and the U.S. Office of Personnel Management for health plan report cards.
For more information about Medicare Special Needs Plans' reporting requirements, please click here.
IDSS Import Template and Materials
This Interactive Data Submission System ("IDSS") is protected by U.S. and international copyright laws.
Patient-Level-Detail (PLD) File Instructions and Specifications
Starting in 2016, NCQA requires a PLD file validation for all submissions (Medicare, Medicaid, commercial and Marketplace). It is a final method of validating that the counts of individual members match the measure totals in the Interactive Data Submission System (IDSS). The PLD files will not be submitted to NCQA in 2016, but must be submitted to the Certified HEDIS Compliance Auditor as part of rate validation. Submitting Medicare PLD files to CMS is still required, and organizations must follow CMS instructions.
HEDIS 2016 NCQA Patient Level Detail File Instructions
HEDIS 2016 NCQA Patient Level Detail File Specifications