FAQ Directory

We use your Accreditation status as of June 30 for display purposes and to calculate bonus points. If a plan has an NCQA status modifier (e.g., Under Review by NCQA, Under Corrective Action, Merger Review in Process, Appealed by Plan) as of June 30, it will be appended to the Accreditation status. Display options during the Plan Confirmation, Projected Ratings and Final Ratings releases are: Yes; Yes (Interim); Yes (Provisional); Yes – CAP; Yes (Interim) – CAP; Yes (Provisional) – CAP; Yes – Under Review by NCQA; Yes (Interim) – Under Review by NCQA; Yes (Provisional) – Under Review by NCQA; No; No (Scheduled); No (In Process).

Accreditation status display options for the public release of the Ratings on NCQA's Health Plan Report Card website on September 15 are: Accredited; Not Accredited; Accredited – Interim; Accredited – Provisional; Accredited – Under Review by NCQA; Under Corrective Action; Scheduled; In Process; Expired; Denied.

This applies to the following Programs and Years:

NCQA’s Health Plan Report Card has some information regarding this in the Glossary page and can be found here: https://reportcards.ncqa.org/glossary. Also, we have ECDS page which can be found here: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

This applies to the following Programs and Years:

We need you to confirm your plan details (e.g., Accreditation status, State Coverage, Family Association, Organization ID, Submission ID) because this impacts how you will be listed publicly when we release HPR on or around September 15, regardless of your Accreditation status or Public Reporting decision.

This applies to the following Programs and Years:

Plans can have multiple ratings for one product within the same state because they might have certain state or contractual submission requirements that fall outside of the combined submission requisite that they send to NCQA for Accreditation purposes. Therefore, this results in plans submitting one combined submission (required) for Accreditation and then they still elect to select other submissions for state or other contractual obligations, which NCQA includes as part of its Ratings program.

This applies to the following Programs and Years:

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of Plan Confirmation. Please contact this individual at your organization to request access.

This applies to the following Programs and Years:

Please go to the 2023 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2023/), where you’ll find our Marketing Guidelines (once they're posted) for how you can market your plans’ scores.

This applies to the following Programs and Years:

• Commercial: MY 2022 HEDIS and CAHPS submitted to NCQA by June 2023
• Medicaid: MY 2022 HEDIS and CAHPS submitted to NCQA by June 2023
• Medicare: MY 2022 HEDIS, MY 2021 CAHPS and HOS

This applies to the following Programs and Years:

• Commercial: MY 2021 HEDIS and CAHPS submitted to NCQA by June 2022
• Medicaid: MY 2021 HEDIS and CAHPS submitted to NCQA by June 2022
• Medicare: MY 2021 HEDIS, MY 2020 CAHPS and HOS

This applies to the following Programs and Years:

• ".5" = Race/Ethnicity Diversity of Membership 
• "1” = Process measures (e.g., screenings, visits)
• “1.5” = Patient experience measures (CAHPS)
• “3” = Outcome and intermediate outcome measures (e.g., HbA1c Control, Blood pressure control)

This applies to the following Programs and Years:

Yes. The 12-17 years age stratification is reported for the Follow-Up on Positive Screen numerator and should be added to the age stratification on page 240 of MY 2023 HEDIS for QRS Version.

This applies to the following Programs and Years:

For measures with hybrid reporting methodology (HBD, BPD, EED), members who have not had a diagnosis of diabetes but receive diabetes medications for conditions other than diabetes (e.g., weight loss, heart failure) may be identified as valid data errors and replaced with a member from the oversample.
To meet criteria for a valid data error for these measures, the medical record must contain no evidence of diabetes and must contain evidence to substantiate the data error (how the member wound up in the measure, why it is incorrect). It is expected that the medical record will not contain evidence of diabetes, and will contain documentation that the patient is on the medication, and why. This documentation, in combination with no other documentation of diabetes in the medical record, meets criteria for a valid data error. Valid data errors are subject to review by the auditor.
Valid data errors work for the Hybrid Method only because medical record data are used to ensure that the member does not have diabetes. For the administrative method, these members remain in the measure as medical records are considered supplemental data that may not be used for identifying valid data errors, or when reporting the HBD, BPD and EED measures using the administrative method, or the KED, SMD, EDH and SPD measures, which are administrative-only measures.
We are working to refine the diabetes denominator related to off-label medication use. The next annual HEDIS public comment period is planned for February–March 2023, but organizations may submit comments on any measure, at any time, through PCS (you do not need to wait until February).

*This FAQ applies to the following measures: Hemoglobin A1c Control for Patients With Diabetes (HBD), Blood Pressure Control for Patients With Diabetes (BPD), Eye Exam for Patients With Diabetes (EED), Kidney Health Evaluation for Patients With Diabetes (KED), Statin Therapy for Patients With Diabetes (SPD), Diabetes Monitoring for People With Diabetes and Schizophrenia (SMD), and Emergency Department Visits for Hypoglycemia in Older Adults With Diabetes (EDH)

This applies to the following Programs and Years:

No. The use of another entity’s software to collect credentialing information is not considered delegation unless the other entity also reviews the information on the organization's behalf. NCQA standards allow organizations to use software to collect credentialing information from approved sources, as long as organization staff document that the information was reviewed and verified.

This applies to the following Programs and Years: