For UM Accreditation, 75 files are reviewed per product line. For CR Accreditation, 75 initial credentialing files and 75 recredentialing files are reviewed.
Note: For non-health plan organizations, 30 files are reviewed per product line.
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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9.15.2022 File Review Scope for NCQA-Accredited Health Plans seeking UM-CR-PN Accreditation How many files are reviewed in a UM-CR-PN Survey for Accredited Health Plans?
9.15.2022 Use of NSC to verify education and training Can the National Student Clearinghouse be used to verify education and training?
Although the National Student Clearinghouse (NSC) is not an approved source for primary source verification, NCQA allows verification of credentials through an agent of an approved source. NSC can serve as an agent for some institutions.
Before using NSC, the organization must obtain documentation of a contractual relationship between it and the approved source (institutions that work with NSC). The contractual relationship must entitle the agent to provide verification of credentials on behalf of the approved source.
This applies to the following Programs and Years:
HP 2022|MBHO 2022|UM-CR-PN 2022|CVO 20229.15.2022 Retaining practitioner records How long should practitioner records be retained?
9.15.2022 Quality Compass Data Comparison Across All Product Lines Is there a way to compare the data across product lines?
Currently each license is separated and there is no way to compare Commercial, Medicaid and Medicare in the same license. However, with the Data Exporter function, you will be able to pull reports in Microsoft Excel and that can make data comparison easier.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 Quality Compass Prior Year Data or Trended Data Does Quality Compass allow users to access prior year data or trended results?
Customers interested in accessing prior year data can choose to add up to three years of trended results to their Quality Compass purchase. For example, if you purchase Quality Compass 2022 (MY 2021), you can choose to add the trended data feature to access MY 2020 MY 2019 results.
It is important to note that not all data can be trended due to significant changes in the measure specifications. Quality Compass indicates when measures should be trended with caution or if there has been a break in trending and results should not be trended year-to-year. These trending determinations can be found on the Help tab within the Quality Compass tool or in the Volume 2 HEDIS technical specifications.
Access to the latest data year must be purchased annually.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 Quality Compass Data Usage Update What if my data usage needs change after purchasing Quality Compass?
You can contact the Information Products team for assistance in expanding your permissions to meet your data usage needs. This includes any changes to the amount of data being shared (number of indicators) and how/with who the data is being shared with (internally for quality analysis purposes, external reporting on a brochure, email broadcast, website, blog) or commercial use of the data.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 Quality Compass Appearance Prior to Purchasing How can I see what Quality Compass looks like prior to purchase?
You can experience Quality Compass’ functionality by watching the demo videos available on the Quality Compass webpage (https://www.ncqa.org/programs/data-and-information-technology/data-purchase-and-licensing/quality-compass/). The demo videos walks viewers through some of the key features of Quality Compass as well as how to navigate the tool.
You can also request a walk-through live demo from the Information Products team. Please submit your request through your my.NCQA.org account or contact NCQA’s Customer Support team.
This applies to the following Programs and Years:
HEDIS MY 20229.15.2022 Antibiotic Utilization for Respiratory Conditions (AXR) The Antibiotic Utilization for Respiratory Conditions (AXR) does not include age stratifications and total rate bullets. Was this intentional?
No. A correction will be in the MY 2023 Technical Update. The Ages section in the Eligible Population should read as follows:
Members who were 3 months of age or older as of the Episode Date. Report three age stratifications and a total rate:
- 3 months–17 years.
- 18–64 years.
- 65 years and older.
- Total.
The total is the sum of the age stratifications.
This applies to the following Programs and Years:
HEDIS MY 20239.15.2022 Purchase Order Number Will NCQA accept a purchase order number?
Purchase order numbers may be included for payment and tracking purposes; however, NCQA does not accept additional terms and conditions outside the executed legal agreement. Any and all purchase order terms and conditions have no legal effect and the license is governed solely by the terms of the executed agreement between your entity and NCQA.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 Audit Timeline The HEDIS MY 2022 Audit Timeline posted on NCQA’s website states that organizations must submit all documentation, including Sections 5 and 5a of the Roadmap, by March 1. Does this mean that organizations have until March 1 to submit Sections 5 and 5a?
No. The Roadmap is due January 31. All sections must be submitted by this date. The “March 1” date for Sections 5 and 5a is meant to account for the rare occasion where a supplemental data source is identified after the January 31 deadline and must be considered for audit. These sources must be identified no later than March 1, with a completed Roadmap section. This should be the exception, not the standard process.
This applies to the following Programs and Years:
HEDIS MY 20229.15.2022 Oral Evaluation, Dental Services (OED) The OED measure references the NUCC Provider Taxonomy Value Set to identify dental providers. Is this correct?
9.15.2022 Quality Compass Access When will I receive access to Quality Compass?
Access to the data is granted as soon as payment is received by check or credit card.
The default email address used for access will be the individual’s whose information was included under the “Ship To” section completed at checkout Login and password information will be emailed to the default user after NCQA sets up the account. The default user, also known as the Administrative User, will have access to manage the additional licensed users on the account.