The Hemoglobin A1c Control for Patients With Diabetes measure should be removed from the measure list. The Plan All-Cause Readmissions measure should be added to the list. This clarification will be in the MY 2023 Technical Update.
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 General Guideline 32: Medicare Socioeconomic Status Stratification Which measures does General Guideline 32: Medicare Socioeconomic Status Stratification apply to?
9.15.2022 Race/Ethnicity Diversity of Membership (RDM) The RDM measure references General Guideline 31: Race and Ethnicity Stratification, but the MY 2023 Value Set Directory does not list race/ethnicity value sets or direct reference codes. Are these used when reporting the RDM measure?
9.15.2022 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 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 Quality Compass Release Dates 2022 What are the release dates for the Quality Compass 2022(MY2021) product lines?
9.15.2022 Retaining practitioner records How long should practitioner records be retained?
9.15.2022 Difference Between HPR and Quality Compass How are HPR and Quality Compass different?
Quality Compass is NCQA’s 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. It reports individual plan data from plans that chose to publicly report their performance results. Benchmark results comprise all plan data submitted to NCQA, regardless of reporting status.
NCQA Health Plan Ratings (HPR) is a separate method of evaluating and distributing information related to health plan quality and performance. It assesses and reports plan performance in several domains. The goal of HPR is to give plans a scale to assess their current operating status, to help ensure quality. HPR provides consumers with information that helps them select a high-quality health plan that suits their needs.
NCQA’s Health Plan Ratings 2022 assesses commercial, Medicare, and Medicaid health plans. The overall rating is the weighted average of a plan’s HEDIS® and CAHPS® measure ratings, plus bonus points for plans with a current Accreditation status. Please visit our HPR website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2022/) to learn more.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 Invoice for Quality Compass How do I obtain an invoice to purchase Quality Compass?
9.15.2022 Quality Compass Exchange Product Does NCQA have Exchange data available on Quality Compass?
In 2022, NCQA will be releasing Quality Compass Exchange data for the first time. Exchange data will be available outside of the Quality Compass tool via a data file delivered on NCQA’s Download Center. The data file will contain individual plan level performance and benchmarks (averages and percentiles) for Exchange plans. It will contain results for QRS measure indicators used in the QRS Scoring program only. The Exchange data file is available for purchase now and will be released in November 2022.
This applies to the following Programs and Years:
HEDIS MY 20219.15.2022 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?
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.
This applies to the following Programs and Years:
HP 2022, 2023|UM-CR-PN 20229.15.2022 Use of future dates to verify education and training Are future dates acceptable for verifying education and training?
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.
