FAQ Directory

For the Interim Evaluation Option: Interim, to First, to Renewal.

For the First Evaluation Option: First to Renewal.

After a plan progresses to the Renewal Evaluation Option, all subsequent surveys will be for that Evaluation Option, unless the accreditation lapses for more than two years.

Plans with NHP accreditation must apply for the Renewal Evaluation Option with a 12-month look-back period.

Plans new to NCQA can earn accreditation through the Interim Evaluation Option or the First Evaluation Optionplans decide which Evaluation Option fits their needs. The two options give plans flexibility to choose based on their readiness and the comprehensiveness of their services.

No. NCQA conducts onsite surveys for the First and Renewal Evaluation Options, but not for the Interim Evaluation Option.

Plans can look in Appendix 1: Standards Points for 2013, in the 2013 Standards and Guidelines, for a summary table of approximate points for each Evaluation Option. Appendix 2: HEDIS and CAHPS Points contains a summary table for approximate points for HEDIS/CAHPS measures. Appendix 3: Points by Reporting Category contains a summary table of points by reporting category.

An Evaluation Option is defined by a distinct combination of requirements (standards and measures), scoring, statuses and length of accreditation. Health Plan Accreditation (HPA) 2013 has three Evaluation Options: Interim, First and Renewal. Plans are surveyed under one of the three evaluation options based on eligibility.

NCQA administers seven types of surveys to plans seeking accreditation: Full Survey, Follow-Up Survey, Resurvey, Add-On Survey, Expedited Survey, Corporate Survey and State and Federal Agency Survey.

Although NCQA does not anticipate that rates will decrease, plans will need to start early and collect all data by May 15 to ensure that their rates are not affected.

HEDIS 2013

NCQA continually reviews the audit process to ensure that it meets all applicable reporting requirements and is the rigorous process expected by all stakeholders.

Responding to increasing pressure from incentive programs, and with CMS input, over the past year NCQA developed the audit policy described in the June 19 MRRV memo. This change will make a more exacting process that ensures enough time for auditing and reporting valid results.

HEDIS 2013

Yes. For HEDIS 2013, NCQA will enforce a medical record review deadline of May 15 (the previous deadline was May 10). No charts will be accepted past this deadline, when auditors will begin to review records. Holding all plans to the same timeline ensures comparability among submissions.

HEDIS 2013

Communicate timeline changes and processes to staff; to your network of providers; to leadership at your plan; to medical record and copy vendors; and to your software vendor. Develop a plan and prepare with adequate resources for the HEDIS season. Add HEDIS performance guarantees with vendors to ensure clear understanding of goals and timelines.

HEDIS 2013

Yes. We sent communication to plans, auditors, vendors, physician groups, purchaser groups and state and federal agencies.

HEDIS 2013

The new test will reduce the number of errors allowed in the systematic sample collected using the Hybrid Method. Auditors will use the Squeglia Zero-based Sampling Plan, which includes more measures but has a smaller sample of 16 charts.

HEDIS 2013