FAQ Directory

AR-KM 1: Problem Lists
NCQA recognizes that the upload requirements for AR-KM 1 (2026) require entering either a numerator, denominator and reporting period OR an uploaded list of top priority conditions and concerns. One of these evidence options will be left blank. This criterion only requires one of the two evidence fields listed to be completed.

AR-AC 2: Appointments Outside Business Hours
AR-AC 2 (2026) requires a Documented Process and Evidence Upload. If extended hours are provided at the practice site, the organization does NOT need to provide a Documented Process. To satisfy the minimum upload requirements in Q-PASS, please create a file (word, PDF, etc.) that indicates that extended hours are provided at the practice site.

AR-CM 3: Person-Centered Care Plans
For AR-2026, all five categories of care management are listed within the Q-PASS upload. You will only upload evidence into 3 of the 5 categories provided, based off of your organization’s care management efforts.  The reason for this reformat is to help evaluators more easily identify what a care plan is managing, as often patients may fall into multiple categories based on diagnoses listed on the care plan. Identifying what CM category the patient is being care managed for helps us eliminate unnecessary back and forth with practices as much as possible. Please note that AR-CM 3 is a site-specific criterion, so each practice-site will need to complete this AR upload. It is acceptable for practice-sites within the same organization to have differing categories that are care managed, as patient populations differ.
 

This applies to the following Programs and Years:

Health Plan Ratings is not where you make your public reporting selection because that occurs in NCQA’s Interactive Data Submission System (IDSS). Please contact your NCQA Account Manager if you have questions about IDSS or public reporting.

This applies to the following Programs and Years:

NCQA inverts rates and percentiles where a “lower value represents better performance” to a “higher value represents better performance” scale in the Health Plan Ratings scoresheets, and then truncates the inverted rate to 3 decimals. For example, a raw rate of 0.0147738807 would display as .985 (1 – 0.0147738807 = 0.9852261193, truncated to 3 decimals).

This applies to the following Programs and Years:

We need you to confirm your plan details (e.g., Accreditation status, State Coverage, Family Association, Organization ID, Submission ID) because this impacts how you will be listed publicly when we release HPR on or around September 15, regardless of your Accreditation status or Public Reporting decision.

This applies to the following Programs and Years:

Information about ECDS can be found on NCQA’s ECDS site.

Additionally, the glossary on NCQA’s Health Plan Report Card site contains some historical ECDS information.

This applies to the following Programs and Years:

The overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points (if the plan is Accredited by NCQA), calculated on a 0–5 scale in half-points (5 is highest), displayed as stars and rounded to the nearest half-point.

This applies to the following Programs and Years:

"1" = Race/Ethnicity Diversity of Membership and Language Diversity of Membership
"1” = Process measures (e.g., screenings, visits)
“1.5” = Patient experience measures (CAHPS)
“3” = Outcome and intermediate outcome measures (e.g., Glycemic Status, Blood Pressure Control)

This applies to the following Programs and Years:

HPR utilizes HEDIS, CAHPS and HOS data sets, and Measurement Years are dependent on HPR year as well as product lines. To find specific data information on each HPR year, please access that year's Measure List by navigating to NCQA’s Health Plan Ratings site.

This applies to the following Programs and Years:

NCQA requires plans to review their projected rating as a final quality assurance step in the Ratings process. Although the projected information is subject to change (from continued quality checks), plans must affirm that they have reviewed their information and have no questions regarding their Accreditation status or projected rating.

This applies to the following Programs and Years:

The plan will receive a “0” on the measure and the measure weight will be included in its Ratings calculation.

This applies to the following Programs and Years:

Measure rates in the IDSS data workbook are multiplied by 100 and rounded to two decimal places, except for certain metrics (e.g., Observed/Expected, Count Variance, Expected Count), which are rounded to four decimal places.

HPR truncates final unrounded raw measure rates and The National All Lines of Business percentiles to 3 decimals.

For example, if the IDSS workbook displays a rate of 78.47, the HPR scoresheet will display .784 (raw rate truncated to 3 decimals).

This applies to the following Programs and Years:

Your overall rating will be “Partial Data Reported” and your measures will display as “NC” (No Credit) on the September 15 release of HPR on the NCQA Health Plan Report Card.

This applies to the following Programs and Years: