HEDIS Data Submission

NCQA collects HEDIS survey results directly from health plans and PPOs through the Healthcare Organization Questionnaire (HOQ), and collects HEDIS nonsurvey data through the Interactive Data Submission System (IDSS). All HEDIS data collected by NCQA are maintained in a central database with strict controls to protect confidentiality. Click the links below for more information about the data submission process.

HEDIS data are important to researchers working to improve the health care system, and to NCQA staff seeking to improve HEDIS measures. Commercial data help calculate national performance statistics and benchmarks, and set standards for measures in NCQA's Accreditation programs. With 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 CMS, and collects Medicaid HEDIS data on behalf of state agencies. For its Health Plan Report Cards, NCQA also collects commercial data on behalf of some states and the U.S. Office of Personnel Management.

Data Submission Resources

 

IDSS Resources

IDSS Import Template and Materials 

 

Patient-Level-Detail (PLD) File Instructions and Specifications

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 2017, 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 2017 NCQA Patient Level Detail File Instructions

HEDIS 2017 NCQA Patient Level Detail File Specifications

HOQ

For general inquiries or training information related to the HOQ tool please submit a question to my.ncqa.

 

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