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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12.20.2013 Supplemental Data Guidelines Have the dates been extended for primary source verification and final approval of supplemental data for P4P Measurement Year 2013?

Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. Primary source verification and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. Primary source verification may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and primary source verification may not occur, under any circumstances, before January 1 and receipt of the Roadmap.

IHA 2013

12.20.2013 Evidence-Based Cervical Cancer Screening of Average-Risk, Asymptomatic Women (ECS) Step 3 of Rate 2 Underscreened does not specify what to do with the remaining population of women 30- 65 years with no hysterectomy who have no cervical cytology tests in the measurement year or two years prior to the measurement year and EITHER:
• Zero cervical cytology and HPV co-tests OR
• Two or more cervical cytology and HPV co-tests in the three or four years prior to the measurement year.

Could you clarify?

Per step 3 of Rate 3: Screened Too Frequently, a member with two or more cervical cytology and HPV co-tests in the third or fourth year prior to the measurement year is considered Screened Too Frequently.

IHA 2013

12.20.2013 Asthma Medication Ratio (AMR) Step 1 in the Event/Diagnosis section of the Eligible Population criteria refers to Table ASM-C for identifying asthma medication dispensing events. There is no Table ASM-C in the specification.

The table for identifying asthma medication dispensing events was inadvertently left out of the December 2, 2013, version of the MY 2013 manual. Table AMR-B is identical to Table ASM-C in HEDIS 2014 Volume 2.

IHA 2013

12.20.2013 Controlling Blood Pressure for People with Hypertension (CBPH) The CBPH measure is not listed in the P4P Value Set Directory. Where can we find the Value Sets for this measure?

The CBPH Value Sets can be found by filtering for Value Set Name in the P4P Value Sets to Codes tab of the P4P VSD file. The Value Sets for CBPH already exist as part of the CDC measure. The next release of the Value Set Directory will list the CBPH measure separately.

IHA 2013

12.16.2013 Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life Is a BMI growth chart sufficient for the physical requirement of the developmental history component?

No. Growth charts (height, weight, BMI or BMI percentile) do not meet criteria for physical developmental history for the W34 measure. The intent of the developmental history component (physical and mental) is to determine if the child was assessed for specific age-appropriate physical and mental developmental milestones, which are behaviors or physical skills seen in children as they grow and develop. For the W34 measure, examples of mental developmental milestones include ability to speak understandably, identify colors and define words appropriately. For the W34 measure, examples of physical developmental milestones include the ability to hop, throw a ball, draw and make a block tower. Documentation of "developing appropriately" or "normal development" meets criteria for both physical and mental development. Documentation of "growing appropriately" (without notation about "development") does not meet criteria for physical or mental developmental history.

Additional examples can be found in the Appendices of the Bright Futures Pocket Guide Guidelines for Health Supervision of Infants, Children, and Adolescents (http://brightfutures.aap.org/pdfs/bf3%20pocket%20guide_final.pdf).

HEDIS 2014

12.16.2013 General Guidelines Are HbA1c and LDL-C tests where the member collects a blood sample at home and sends it to a lab for results calculation allowed for HEDIS reporting?

No. Tests where the blood sample is collected by the member are considered self-administered tests and are not eligible for use in HEDIS reporting.

HEDIS 2014

12.16.2013 Cervical Cancer Screening In step 2 of the Administrative Specification, organizations identify women 30-64 years of age as of December 31 of the measurement year who had cervical cytology and a human papillomavirus (HPV) test, with service dates four or less days apart during the measurement year. When counting service dates, is the date of the cervical cytology considered day one or day zero of the four-day count?

The date of the cervical cytology is considered day zero. For example, if the service date for cervical cytology was December 1 of the measurement year, the HPV test must include a service date on or between December 1 and December 5 of the measurement year.

HEDIS 2014

12.16.2013 General Guidelines If an organization finds an undated lab result in a progress note, can the progress note date be used as the lab result date?

No. An undated lab result may not be used for HEDIS reporting. To be eligible for use, the date the test was performed (e.g., the date the sample was drawn) or the result date (e.g., the date the lab calculated the result) must be documented.

HEDIS 2014

11.15.2013 Scoring Cervical Cancer Screening in 2014 How will organizations be scored on the Cervical Cancer Screening (CCS) measure for HEDIS 2014 reporting?

All organizations will be scored NA for 2014 reporting due to significant specification changes. However, the NA will not count against the eight NA thresholds used to covert to Standards plus CAHPS or Standards Only scoring.

11.15.2013 Initiation and Engagement of Alcohol and Other Drug DependenceTreatment The list of code combinations to identify Initiation and Engagement visits do not include codes to identify inpatient admissions. Do inpatient admissions count as initiation and engagement of AOD treatment?

As stated in the paragraphs prior to the list of code combinations, an inpatient admission with a diagnosis of AOD meets criteria for both initiation and engagement. Because NCQA does not specify codes to identify inpatient admissions, inpatient admissions were not included in the list of code combinations. The lists of code combinations include only visits for which value sets exist (outpatient, intensive outpatient and partial hospitalization). Organizations should use their own methods for identifying inpatient admissions when identifying initiation and engagement visits.

HEDIS 2014

11.15.2013 General Guidelines Have the dates been extended for primary source verification (PSV) and final approval of supplemental data for HEDIS 2014?

Yes. Data collection and entry of all nonstandard and member-reported supplemental data must stop on March 3. PSV and final approval must be completed by March 14, for member-reported supplemental data, and by March 28, for nonstandard supplemental data. PSV may not occur before March 3 unless all supplemental data processes, collection and entry have stopped. Supplemental data approval and PSV may not occur, under any circumstances, before January 1 and receipt of the Roadmap.

HEDIS 2014

11.15.2013 Practitioners listed in the directory that require credentialing Are practitioners listed in the directory within the scope of credentialing?

Yes. Practitioners listed in the organization directory must be credentialed.