FAQ Directory

No. NCQA does not require board certification for practitioners to be included within its network.

Yes, if such mechanisms can legitimately access, retrieve and share the data from approved/recognized sources. All credentialing documentation requirements must be met, and there must be clear documentation that the organizations staff reviewed the credentialing information.

No. With the exception of ABMS or AOA sponsored boards, NCQA requires organizations to determine and list specialty boards they accept within their credentialing policies and procedures. At a minimum, at least annually, organizations must obtain confirmation from specialty boards that they perform primary-source verification of education and training. A specialty board that provides annual written confirmation that it conducts primary source verification of education and training can be used as an acceptable source for verification of education and training if the organization names the specialty board in its policies and procedures.

The organization must verify board certification status for any practitioner claiming to be certified by an ABMS or AOA sponsored boards, or by a specialty board recognized by the organization.

If the medical board does not provide the expiration date for a practitioner's board certification, the organization must verify and document that the board certification is current within 180 calendar days of the credentialing decision date.

If the medical board does not provide the expiration date for a practitioner's board certification, the organization must verify that the board certification is current. Verification must be documented 180 calendar days prior to the recredentialing decision date.

No. The review of work history may be documented on the application, CV or a checklist. Documentation must include the signature or initials of the staff person who reviewed the history and the date of the review.It must be clear that the signature or initials and date apply to the work history review.

The CVO must provide NCQA with evidence of a practitioners current or continuous enrollment in the NPDB-PDS Databank, and of review and reporting of databank activity to the organizations client within 120 calendar days.

If no malpractice history is reported by the databank, the CVO must document this in the file and must report to clients that no malpractice settlements were reported. NCQA does not prescribe how the organization documents this information.

No. Verification of future completion date does not meet NCQA requirements for verification of the highest level of education and training completed by the practitioner. NCQA requires an actual completion date.

No. NCQA will not make any changes to the vaccine requirements for HEDIS 2014. As indicated by the CDC, "Single-component DTaP, IPV, HepB, and Hib vaccines and other age-appropriate licensed combination vaccines are available to complete series begun with Pentacel or Pediarix. Currently, there is a sufficient supply of these products to meet the anticipated demand." You can find additional information in the Guidance for Vaccinating Children during the 2013 Pentacel, Daptacel and Pediarix Shortage article at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/pentacel-guidance.pdf.

HEDIS 2014

NCQA is aware that recent guidelines recommend pap tests NOT be performed for women under 21 years of age under general circumstances. However, for the PPC measure, a pap test will remain in the specifications as a way to determine that postpartum care occurred. NCQA allows documentation of only a Pap test because this test indicates that a pelvic exam was performed. This measure includes deliveries in any age group.

NCQA is re-evaluating the PPC measure based on clinical practice guideline updates. Any changes will be included in future HEDIS specifications.

HEDIS 2014

The physician group or IPA may distribute information to its physicians if this language is in the contractual agreement. NCQA does not consider this to be delegation. The organization must provide the required information to the physician group or IPA.

UM-CR 2013

All supplemental data requirements are included in General Guideline 39 in the HEDIS 2014 Volume 2 Technical Specification. Customers can find additional information about the supplemental data policy (including FAQs specific to supplemental data) at the following link, http://www.ncqa.org/Newsroom/MediaEvents/HEDIS2014CodeTransitionSupplementalDataUse.aspx.

HEDIS 2014