FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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8.29.2013 Verification of board certification Does NCQA require board certification for practitioners to be included in an organizations network?

No. NCQA does not require board certification for practitioners to be included within its network.

This applies to the following Programs and Years:

8.16.2013 Childhood Immunization Status On May 16, 2013, the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases released a document based on Sanofi Pasteurs Pentacel (DTaP-IPV/Hib) and Daptacel (DTaP) vaccine shortage. Because these vaccines are expected to be in short supply through summer 2013, does NCQA plan any changes to the CIS measure for HEDIS 2014?

No. NCQA will not make any changes to the vaccine requirements for HEDIS 2014. As indicated by the CDC, "Single-component DTaP, IPV, HepB, and Hib vaccines and other age-appropriate licensed combination vaccines are available to complete series begun with Pentacel or Pediarix. Currently, there is a sufficient supply of these products to meet the anticipated demand." You can find additional information in the Guidance for Vaccinating Children during the 2013 Pentacel, Daptacel and Pediarix Shortage article at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/pentacel-guidance.pdf.

This applies to the following Programs and Years:
HEDIS 2014

7.15.2013 Care for Older Adults If there is a list of medications in the progress note, is a prescribing practitioner or clinical pharmacist's signature alone considered evidence that the list was reviewed for the medication review indicator?

The medication review indicator requires both a medication list and evidence that it was reviewed by the appropriate practitioner. The presence of a medication list with the appropriate practitioner's signature is compliant if it is dated during the measurement year. The practitioner's signature is considered evidence that the medications were reviewed.

This applies to the following Programs and Years:
HEDIS 2014

7.15.2013 Prenatal and Postpartum Care For the PPC measure, a Pap test alone is acceptable for the Postpartum Care rate. Is documentation of a Pap test compliant for women under the age of 21?

NCQA is aware that recent guidelines recommend pap tests NOT be performed for women under 21 years of age under general circumstances. However, for the PPC measure, a pap test will remain in the specifications as a way to determine that postpartum care occurred. NCQA allows documentation of only a Pap test because this test indicates that a pelvic exam was performed. This measure includes deliveries in any age group.

NCQA is re-evaluating the PPC measure based on clinical practice guideline updates. Any changes will be included in future HEDIS specifications.

This applies to the following Programs and Years:
HEDIS 2014

7.15.2013 Using physician groups or IPAs to distribute information to practitioners If an organization contracts with a physician group or IPA, may the physician group or IPA distribute information to its practitioners if covered in the contract? Does NCQA consider this contractual arrangement to be delegation?

The physician group or IPA may distribute information to its physicians if this language is in the contractual agreement. NCQA does not consider this to be delegation. The organization must provide the required information to the physician group or IPA.

This applies to the following Programs and Years:
UM-CR 2013

7.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for HEDIS 2014?

6.15.2013 Scoring for factors for Interim Surveys Factors 2, 4 and 5 require activities to have been in place for a period of time that is longer than is likely to be the case for organizations seeking Interim Accreditation, especially new health plans, like CO-OPs. How will these factors be scored?

Factors 2, 4 and 5 are scored NA for Interim Surveys.

This applies to the following Programs and Years:

6.15.2013 Documentation needed for Interim Surveys What documentation is expected for Interim Surveys in QI 7, Element B?

The organization must provide a documented process describing the system, and how it meets the requirements in the element.

This applies to the following Programs and Years:

6.15.2013 Medical record review requirement for Exchanges in Florida and Pennsylvania Is a medical record review required for Exchanges coming through Interim Survey in Florida or Pennsylvania?

No. Because Exchanges come under federal statutes, and medical record review is not required at this time under the federal statutes, medical record review is not included in Interim Surveys in Florida and Pennsylvania.

This applies to the following Programs and Years:

6.15.2013 Documentation for Interim Surveys for interpreter services What is the required documentation for interpreter or bilingual services since there may be no membership? What is required as evidence?

The organization must provide a documented process describing how it plans to meet the requirements when it does have a membership with a need for such services.

This applies to the following Programs and Years:

6.15.2013 Practitioner involvement in the QI Committee for Interim Surveys Other than review and approveal of policies and procedures, what is expected to meet the requirement of practitioner involvement?

The organization must provide evidence that practitioners were involved in review and approval of policies and procedures.

This applies to the following Programs and Years:

6.15.2013 Distribution of materials for Interim Surveys Where elements require materials as a data source for all survey types, must the materials be distribute for Interim Surveys?

Organizations going through Interim Survey must present materials to meet the requirements of the element. Materials are not required to have been distributed, and do not have to be in final layout form, but must be approved by the organization. Draft materials are appropriate if approved by the organization.

This applies to the following Programs and Years: