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 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 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 2022

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

6.30.2022 PCSP July 2022 Summary of Updates What updates were made to the PCSP Standards and Guidelines for Version 5?

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”

This applies to the following Programs and Years:
PCSP 2019

6.30.2022 July 2022 Summary of Updates What changes were made to the PCMH Standards and Guidelines for Version 8?

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”

This applies to the following Programs and Years:
PCMH 2017

6.15.2022 Clarify scope for CVO 3, Element B What are the differences in scope for system controls at the factor level in CVO 3, Element B?

For CVO 3, Element B:

  • Factor 1 applies to verification source information from credentialing and recredentialing cycles, covered in CVO 4-12.
  • Factor 2 applies to modified credentialing verification information from initial credentialing and recredentialing cycles, covered in CVO 4-12.
  • Factors 3–5 apply to all information associated with credentialing/recredentialing of practitioners, covered in CVO 4-14.
  • Factor 6 requires a monitoring process that covers compliance with all policies and procedures described in factors 1–5.

This applies to the following Programs and Years:
CVO 2022