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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| Topic | Update Highlights |
| Policies and Procedures | Section restructured |
| Policies and Procedures | Addition of language regarding Corrective Action Plans |
| KM 06 | Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection. |
| KM 06 | Added requirement that data be direct collection. |
| PM 19 | New elective criterion regarding person-driven outcomes. |
| Appendix 2 – Glossary | Added “Age as a Vulnerability” |
| Topic | Update Highlights |
| Policies and Procedures | Section restructured |
| Policies and Procedures | Addition of language regarding Corrective Action Plans |
| KM 09 | Addition of Sexual Orientation and Gender Identity as required topics of data collection. Added requirement that data be direct collection |
| KM 10 | Added requirement that data be direct collection |
| CM 10 | New elective criterion regarding person-driven outcomes |
| Appendix 2 – Glossary | Added “Age as a Vulnerability” |
No. Delegate files may be audited using one of the following methods as described in the factor explanation and noted below:
Either methodology is allowed, for consistency with other Delegation Oversight requirements for annual file audits.
For CVO 3, Element B:
Both the organization and delegate must monitor the delegate’s system security controls as part of the delegation oversight requirements and may choose audit as the monitoring method. If auditing is the chosen method, the delegate provides an audit report of modifications that did not comply with its policies and procedures or with the delegation agreement.
The organization is not required to conduct an audit if it determines that the delegate adequately monitored and reported noncompliant modifications, but must provide documentation (a report, meeting minutes or other evidence) that it reviewed and agreed with the delegate’s findings. If the organization determines that the delegate did not adequately monitor noncompliant modifications, it must conduct its own audit of the delegate’s system controls.
The organization must submit its documentation and the delegate’s documentation as part of the survey.
No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for CVO 3, Element B. Policies and procedures must address all factors regarding advanced system control capabilities.
New delegation agreements implemented on or after July 1, 2022, must include a description of the delegate’s CR system security controls.
For delegation agreements in place prior to July 1, 2022, NCQA has extended the time frame for including a description of CR system controls in the delegation agreement. All delegation agreements under the 2024 CVO standards (effective July 1, 2024) must include a description of CR system controls. Prior to July 1, 2024, organizations may alternatively provide a delegation agreement and other mutually agreed upon documentation OR the delegate's system controls policies and procedures in lieu of a delegation agreement with a description of CR System controls.
Yes, if the language specifies that the delegate must meet NCQA requirements (CVO 3, Element B, factor 4; CVO 15, Element C, factor 5), template language may be used in the delegation agreement. Language specific to each delegate is not required.
Practices should submit an explanation when their performance falls below 80% for the following AR criteria:
• AR-AC 1: Timely Clinical Advice by Telephone
• AR-CC 4 (Option): Diagnostic Test Tracking (2 rates)
Practices should submit an explanation when their performance falls below 30% for the following AR criteria:
• AR-CC 5: Secondary Referral Tracking
If the practice does not submit an explanation, NCQA will contact the practice and request context for their performance rates.
No. There is no percentage threshold for referral tracking measures. The expectation is that practices track important referrals routinely; if performance is lower than expected, the practice should enter the rationale for their low percentage in the Notes from the Organization section in QPASS.
For example, if data show a 30% return rate, that means 70% of the practice’s referred patients never had a report returned to their PCP.
No. There is no minimum denominator requirement. A sample of 30 (or more, because this increases the reliability of the sample) is expected to ensure statistical soundness, but there may be cases where it may be appropriate for the denominator to be <30. NCQA requests practices enter an explanation in the Notes from the Organization section in QPASS in this case.
If a practice reports a denominator <30 without a note, the evaluator may contact the practice to confirm data accuracy and to understand the data. The evaluation will be returned to the practice so they can enter an explanation in the Notes from the Organization section for the cited criteria.
It depends. If the AR requirement aligns with a PCSP criteria that explicitly specifies a threshold, then that value would be the minimum threshold. However, if a threshold is not explicitly stated in the criteria, then 80% or more is expected to ensure consistent application of the process. Please note that there may be some cases where it’s acceptable for the rate to fall below 80%.
An explanation in the Note section of Q-PASS is required for practices that report a rate less than 80% for the following criteria: AR-AC 01 [Timely Clinical Advice by Telephone], AR-CC 04 [Tracking Lab Test Results], and AR-CC 05 [Tracking Imaging Test Results].
