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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10.11.2012 Submission of NCQA WHP Performance Measures When must organizations submit NCQA WHP Performance Measures in order to obtain Accredited With Performance Reporting (AWPR) status?

Organizations coming through the WHP accreditation process for the first time and that wants to earn AWPR status must submit audited measures with the ISS Survey Tool submission. Organizations with current AWPR status must submit measures on April 15 to maintain the AWPR status. Organizations that do not submit performance measures with their Survey Tool can apply for an upgrade to AWPR status at the next annual submission date (the April 15 following receipt of accreditation status).

WHP 2013

9.16.2012 General Guidelines Can an organization continue to collect medical records for members in the hybrid sample after the May 15 medical record review deadline and record them in supplemental database for use in the current reporting year?

No, organizations may not continue to collect medical record data past May 15 and enter it into a supplemental database for use in the current HEDIS year.

HEDIS 2013

9.16.2012 Cervical Cancer Screening The USPSTF released new recommendations for cervical cancer screening in March 2012. It recommends cytology (Pap test) screening every three years for women 21_65 years of age or, for women 30_65 years of age who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every five years. In light of the new recommendations, will NCQA update the CCS measure to account for the lengthened screening for women 30_65 years?

In response to USPSTF recommendations, NCQA has scheduled the CCS measure for reevaluation in 2012. The appropriate staff and panels will review updates and other relevant guidelines and will evaluate potential changes to the measure. Proposed changes, if any, will be posted for Public Comment in February 2013 and, pending final approval by the NCQA Committee on Performance Measurement, will be included in HEDIS 2014.

HEDIS 2013

9.16.2012 Medication Reconciliation Post-Discharge The Medication Therapy Management (MTM) program is required for CMS Parts C and D data validation audits. May we use data from the MTM program to satisfy the "medication reconciliation" requirements in the MRP measure?

Data from the MTM program may be used only if the organization can distinguish a member's discharge medications from the member's current medications. The reconciliation must have occurred on or within 30 days of discharge by a prescribing practitioner, clinical pharmacist or registered nurse to meet the intent of the measure.

HEDIS 2013

9.15.2012 Basics What are the benefits for completing the Exchange Add-on Survey?

1. Allows you to market your Exchange product as NCQA Accredited to Exchanges and potential members.

2. Allows you to meets Exchange accreditation requirements, for those Exchanges that require Exchange _specific Accreditation.

3. Its a streamlined and efficient process, where plans need to attest that they will operate their Exchange the same as their accredited product. Unless there are many differences, NCQA will not review further documentation.

9.15.2012 Basics What happens after the Exchanges Add-on Survey accreditation status expires?

The Exchange Add-on accreditation status is valid until your existing NCQA accredited product expires. Once this occurs, you must bring your Exchange product through the Renewal Evaluation Option which would include submission of HEDIS and CAHPS results starting in 2015.

9.15.2012 Basics What if I do not qualify for automatic accreditation because less than 70% of elements listed will be administered differently?

If an organization does not qualify for automatic Accreditation for its Exchange product line, NCQA will survey those elements that it will administer differently using NCQAs existing add-on survey process. The survey will only consist of the off-site portion of the survey process and will not include a file review.

9.15.2012 Timing When is the first date that I can submit my application for the Exchanges Add-on Survey?

The application will be available by the end of September 2012 and can be submitted anytime; however, NCQA will not begin Exchange Add-on surveys until after January 1, 2013. Note that applications will only be accepted through December 31, 2013, as the Exchange Add-on Survey is a temporary strategy to help plans receive accreditation to qualify for Exchanges.

9.15.2012 Basics I only have my Commercial HMO accredited. Can I bring my Exchange PPO through the Exchange Add-on Survey?

Yes. As long as the organization will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines.

9.15.2012 Basics What is highest accreditation status I can receive through the Exchanges Add-on Survey?

Plans coming through the Exchange Add-on Survey are capped at Accredited status because HEDIS/CAHPS is not included.

9.15.2012 Pricing What is due at the time of the actual survey date?

Base fee is $15,000 if an organization qualifies for automatic accreditation and $22,500 if an organization must go through a review. However, this includes the already submitted application submission fee. Actual additional amount required prior to NCQA awarding automatic accreditation is $5,000 or prior to the survey date if a review is required is $12,500. NCQA will bill organizations for the remainder of the fees due prior to awarding automatic accreditation or conducting the survey.

9.15.2012 Basics What is the Exchange Add-on Survey?

The Exchange Add-on Survey is a streamlined accreditation approach available for organizations that currently have NCQA Health Plan Accreditation for any product line (commercial, Medicaid or Medicare) and wants to add its Exchange product line to its existing Accreditation.