No. The requirement is that organizations verify Medicare sanctions from any of those sources, but there is no requirement to verify sanctions from all of them.
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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1.15.2025
Sources for Medicare Sanctions (MBHO) Are organizations required to verify Medicare sanctions from all of the following sources?
• AMA Physician Master File.
• FSMB.
• NPDB.
• SAM.gov.
1.15.2025 Reviewer Names on Denial and Appeal Notifications (MBHO & UM) Does NCQA require names or signatures of the reviewers on UM denial and appeal notifications?
1.15.2025 Verification of Licensure Does a clinician who is licensed to practice in multiple states need to be verified in each state?
1.15.2025 Use of documents produced using the Consolidated Clinical Document Architecture (C-CDA) standard Can documentation produced using the C-CDA standard, such as Continuity of Care Documents (CCD), discharge summaries or progress notes, be used as proof-of-service documentation or medical record review?
No. Documents produced using the C-CDA standard are structured summaries or snapshots of information used to facilitate data exchange. They are not eligible as proof of service for HEDIS MY 2024, and should not be used for medical record review abstraction.
This applies to the following Programs and Years:
HEDIS MY 20241.15.2025 Medication Lists deleted from the Asthma Medication Ration (AMR) measure A new version of the MY 2024 Medication List Directory (MLD) was released on 1/15/2025 with changes to asthma medications. What was the reason for the changes and how does this impact the Asthma Medication Ratio measure specification?
An error was identified in the HEDIS MY 2024 Medication List Directory (released on April 1, 2024). For the Asthma Medication Ratio (AMR) measure, “package size” and “unit” are required to perform calculations. If we cannot find package size and unit for NDC codes, we cannot include the codes in the AMR medication lists. For the MY 2024 Update release of the MLD, an alternative method was used to identify package size and unit so more codes could be included in the medication lists. Because this method resulted in incorrect information, we removed these codes from 11 medication lists.
- Albuterol Medications
- Asthma Controller and Reliever Medications
- Beclomethasone Medications
- Budesonide Formoterol Medications
- Budesonide Medications
- Ciclesonide Medications
- Fluticasone Medications
- Fluticasone Salmeterol Medications
- Formoterol Mometasone Medications
- Levalbuterol Medications
- Mometasone Medications
Three medication lists were removed from the AMR measure.
- Fluticasone Furoate Umeclidinium Vilanterol Medications
- Salmeterol Medications
- Tiotropium Medications
Customers who purchased the HEDIS MY 2024 Medication List Directory should re-download the file from the My Downloads section of their My NCQA account. Customers who purchased a product that contains the AMR measure specification should delete the three medication lists, consistent with how changes from the technical update are applied.
This applies to the following Programs and Years:
HEDIS MY 202412.16.2024 MMP Plans CMS intends to dissolve Medicare-Medicaid Plan (MMP) contracts in 2026. Will that change product line rules for Accreditation?
12.16.2024 Reviewer Names on Denial and Appeal Notifications Does NCQA require names or signatures of the reviewers on UM denial and appeal notifications?
12.16.2024
Sources for Medicare Sanctions Are organizations required to verify Medicare sanctions from all of the following sources?
• AMA Physician Master File.
• FSMB.
• NPDB.
• SAM.gov.
12.16.2024 NPDB Acceptable Source for Medicare and Medicaid Exclusions Is the NPDB an acceptable source for Medicare and Medicaid exclusions?
For Medicare, organizations may obtain exclusion information from any of the NCQA acceptable sources. |
This applies to the following Programs and Years:
HP 2025|CRPN 202512.13.2024 Advance Notice of RAND Table Changes for HEDIS MY 2025 How is NCQA changing the release of RAND numbers for HEDIS reporting beginning in MY 2025?
NCQA will remove the RAND table from the Guidelines for Calculations and Sampling with the release of the HEDIS MY 2025 Technical Update on March 31, 2025. Future releases of the HEDIS Volume 2: Technical Specifications for Health Plans publication will not contain a RAND table.
Beginning MY 2025, NCQA will use an alternative timeline and approach to distribute RAND numbers for HEDIS reporting. This information will be released in the NCQA store for purchasers of HEDIS Volume 2 in the November before production of systematic samples for hybrid reporting (e.g., November 2025, for MY 2025).
Organizations participating in NCQA’s Measure Certification program will receive separate guidance on how NCQA will accommodate this change for certification of systematic sampling logic.
This applies to the following Programs and Years:
HEDIS MY 202511.15.2024 Implementation Plans for Health Equity Will the implementation plan deadlines be extended for the 2024 Health Equity Accreditation and Health Equity Accreditation Plus products?
Yes. For Initial Surveys scheduled on or between July 1, 2024, and June 30, 2026, the organization may submit a detailed implementation plan that includes a timeline as evidence for applicable factors.
Implementation plans may be submitted for Initial Surveys for the following requirements until June 30, 2026:
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HE 2, Element A.
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HE 2, Element D.
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HE 2, Element E.
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HE 2, Element G.
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HE Plus 3, Element C.
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HE Plus 5, Element B.
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HE Plus 5, Element E.
This applies to the following Programs and Years:
11.15.2024 Verification of Medicare and Medicaid Sanctions and Exclusions Are organizations only required to verify Medicare and Medicaid sanctions and exclusions for practitioners who only provide services for members in the organization’s Medicare and Medicaid product lines?
No. Verification of sanctions and exclusions are not product line–specific requirements. For each practitioner in the scope of credentialing, the organization must verify Medicare and Medicaid sanctions regardless of the product line for which practitioners are contracted.
