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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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

9.16.2012 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

9.15.2012 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 Contact Information Who can I contact if I would like to learn if the Exchange Add-on Survey is the correct path for my plan?

Ledia Tabor, Director of Quality Solutions Group (Exchanges) at Tabor@ncqa.org or 202-995-1725.

Jennifer Zutz, Analyst of Quality Solutions Group (Exchanges) at Zutz@ncqa.org or 202-955-1720.

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 How is the Exchange Add-on Survey different from the regular Add-on Survey?

The Exchange Add-on Survey is a streamlined version of the regular Add-on Survey:

Plans do not submit HEDIS/CAHPS

Since HEDIS/CAHPS are not submitted, plans are capped at Accredited status.

NCQA reviews documentation of standards only when the organization manages functions differently from key elements. (The Application defines which standards are required and how many functions are permitted to be performed differently).

No file review for the Exchange product line.

9.15.2012 Basics What is evaluated in the Exchange Add-on Survey?

The Exchange Add-on Survey evaluates plans on a subset of standards and elements listed in Section 7 of the NCQA HPA Exchange Add-on Survey Application. For an organization that will administer its Exchange product line in the same manner as it administers existing NCQA-Accredited product lines, NCQA will award Accreditation to the Exchange product line without conducting a formal survey. An organization qualifies for automatic Accreditation if it attests that it will administer 70% or more of the elements listed in Section 7 in the same manner.

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.

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 Timing What is the duration of the Exchanges Add-on Survey accreditation status?

The Exchanges Add-on Survey accreditation status is valid until your existing accredited products accreditation status expires.

For example:

You have Commercial HMO accreditation, which expires in January 2015.

You bring in your Exchange HMO for accreditation now, through the Exchanges Add-on Survey.

Your accreditation status for the Exchange product line is valid until your Commercial HMO expires in January 2015.

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.