January 31, 2005

Seven Software Vendors Receive NCQA’s HEDIS Software Certification

Health plans using certified vendors’ software are exempt from source code review during HEDIS 2005 Compliance Audit™ 

WASHINGTON— The National Committee for Quality Assurance (NCQA) announced today that seven leading commercial software vendors received NCQA Certification for their Health Plan Employer Data and Information Set (HEDIS®)-related software. Health plans that use NCQA-Certified software for HEDIS data collection are not required to undergo manual source code review during the HEDIS Compliance Audit™, a required component of NCQA Accreditation and other oversight programs. Two additional vendors expect to complete testing later this spring.

“Plans that use NCQA-Certified software can spend more time improving quality in ways that matter to their members and less time getting ready for a HEDIS audit," said Mary Braman, NCQA’s Director of Licensure & Certification. “Certified software vendors create good products that streamline the audit process and provide accurate results. They are to be commended for the quality of their software.”

The following vendors have received NCQA HEDIS® Software Certification:

• AdvanceMed, Corporation 
• Catalyst Technologies, Inc. 
• Ingenix, Inc.
• McKesson, LLC 
• Q Mark, Inc. 
• TierMed Systems, LLC
• ViPS, Inc.

Two vendors, Austin Provider Solutions and Nauset Software, Inc., are scheduled for testing and will have results by the end of the spring.

HEDIS® software is designed to sift through health plan databases, collect relevant data and calculate HEDIS results. NCQA validates software by generating unique sets of sample data, or "test cases," for vendors to process using their software. NCQA compares the vendor’s output to the expected results to determine if the software computes HEDIS results correctly. The automated process provides for a precise, comprehensive source code review.

In addition to full certification, NCQA offers limited certification to vendors whose software tests a subset of the HEDIS measurement set. Three vendors are completing testing of a limited set of measures to support the health plans and provider organizations that produce data for California’s much-publicized Pay for Performance (P4P) initiative, a statewide effort that uses standardized measures to evaluate the performance of physician organizations and reward those that perform at a high level.  P4P and other such efforts sometimes require plans and provider organizations to report subsets of the full HEDIS measurement set. In response, many vendors produce software addressing only a portion of HEDIS measures to support these managed care organizations and provider groups. Three vendors are currently testing specialized products for the P4P measure set under the Limited Software Certification program:

• Austin Provider Solutions
• Catalyst Technologies, Inc.
• Q Mark, Inc. 

NCQA maintains an up-to-date list of Certified vendors on its Software Certification Web page. Vendors that receive full or limited certification are added to the list on an ongoing basis. For more information about either HEDIS Software CertificationSM program, contact Anne Smith, Software Certification Manager, at (303) 651-6995, or e-mail smith@ncqa.org.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. NCQA is committed to providing health care quality information through the Web and the media in order to help consumers, employers and others make more informed health care choices.