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 Quality Compass Medicare Include CAHPS Data Does the Medicare dataset include CAHPS data?

The Medicare product line does not include CAHPS survey results. We recommend contacting Centers for Medicare and Medicaid Services (CMS) if you are interested in obtaining Medicare CAHPS data.

 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 Durable medical equipment in the scope of credentialing Are durable medical equipment entities in the scope of credentialing?

Yes. Durable medical equipment entities are in the scope of CR 7, Element A, to the extent that organizations must have policies and procedures for initial and ongoing assessment of the entities with which it contracts. NCQA’s review of the organization’s assessment of organizational providers is limited to the organizations listed in CR 7, Elements B and C.

This applies to the following Programs and Years:
HP 2022|MBHO 2022|UM-CR-PN 2022

9.15.2022 Quality Compass Release Dates 2022 What are the release dates for the Quality Compass 2022(MY2021) product lines?

The expected release dates for Quality Compass 2022(MY2021) are as follows:

    • Commercial – July 29th, 2022
    • Medicaid – September 30th, 2022
    • Medicare – October 28th, 2022
    • Exchange – November 2022 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 MBHO: File Review Scope for NCQA-Accredited MBHOs seeking UM-CR-PN Accreditation How many files are reviewed in a UM-CR-PN Survey for Accredited MBHOs?

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-MBHO organizations, 30 files are reviewed per product line. 

This applies to the following Programs and Years:
MBHO 2022

9.15.2022 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 2021

9.15.2022 Follow-Up After Emergency Department Visit for Substance Use (FUA) Should the Residential Program Detoxification Value Set be used when reporting the FUA measure? It is not listed in the Value Set Directory.

Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:

  • H0010     Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
  • H0011   Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)

This applies to the following Programs and Years:
HEDIS MY 2023

9.15.2022 Quality Compass How can I obtain plan performance data and/or benchmark results for HEDIS and CAHPS measures?

You can obtain access to performance data and benchmarks via the NCQA Quality Compass tool. Quality Compass is an interactive database containing individual plan performance results for HEDIS® and CAHPS® measures, as well as benchmark data at the national, regional (Census, HHS) and state levels. To learn more about Quality Compass and licensing access to HEDIS performance results, visit our Quality Compass homepage.
 

This applies to the following Programs and Years:
HEDIS MY 2022

9.15.2022 Publicly Reported Plans in Quality Compass How do I know what plans publicly reported data to NCQA? How do I know what measures will be reported in Quality Compass?

To obtain a list of health plan submissions and/or measures publicly reported in Quality Compass for a specific reporting year, contact the Information Products team by submitting your question on my.ncqa.org.
Quality Compass contains HEDIS and CAHPS measures that were eligible for publicly reporting during the measurement year. First year HEDIS measure results are not publicly reported in the tool.
 

This applies to the following Programs and Years:
HEDIS MY 2022

8.19.2022 Long-Term Services and Supports Shared Care Plan With Primary Care Practitioner (LTSS-SCP) For MY2022 reporting, should members without a care plan (or with a partial care plan) be excluded from the LTSS-SCP measure?

No. For MY2022 reporting, members without a care plan (or with a partial care plan) should not be excluded from the LTSS-SCP measure. These members would remain in the measure and would be numerator non-compliant.

This applies to the following Programs and Years:
HEDIS-LTSS MY

8.15.2022 Quality Compass: Data Exporter What is the Data Exporter feature on Quality Compass?

All versions of Quality Compass allow users to build customized reports within the tool. Versions of Quality Compass that include the Data Exporter feature allows users to download and export those custom reports into Microsoft Excel.

The Data Exporter feature also grants access to the “All Measures Download” file. This file contains plan-level performance data for all publicly reported health plan submissions and all HEDIS and CAHPS measure results in a single downloadable file. Versions purchased without Data Exporter will not have the ability to export plan level data but will still have access to Excel versions of the benchmarks.
 

This applies to the following Programs and Years:
HEDIS MY 2022

8.15.2022 Individual Plan Data - Quality Compass What are the “individual plan data” available on Quality Compass?

Individual plan data are the HEDIS and CAHPS performance rates submitted by health plans that chose to publicly report their results to NCQA. Users have access to all publicly reported plans in a specific product line (commercial, Medicaid, Medicare) and can easily select a subset of plans based on coverage in different regions/states.
 

This applies to the following Programs and Years:
HEDIS MY 2022

7.05.2022 KM 09 For which patients does a PCMH need to collect sexual orientation and gender identity data?

Starting in 2023 for Transforming practices and in 2024 for currently recognized practices, direct collection of data on sexual orientation and gender identity of patients is required for KM 09. This requirement applies to all patients aged 18+, though practices are encouraged to also ask adolescent patients if they have a system for doing so.

This applies to the following Programs and Years:
PCMH 2017