No. NCQA does not require board certification for practitioners to be included within its network.
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.
Filter Results
- Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
- Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
- Print
Print this page.
Print this page.
8.29.2013 Verification of board certification Does NCQA require board certification for practitioners to be included in an organizations network?
8.29.2013 Use of Web crawlers for collection of credentialing information Does NCQA accept automated verifications obtained by a Web crawler or Internet grabber used in credentialing software?
8.29.2013 Verification of certification for an unrecognized board Does NCQA only accept ABMS and AOA sponsored boards as verification sources? What does NCQA require for verification of boards from non-ABMS or non-AOA boards if the practitioner claims to be board certified?
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.
8.29.2013 Lack of expiration date for board certification What is NCQA's documentation requirement if a medical board does not provide an expiration date?
8.29.2013 Expiration date for board certification not provided by ABMS member board American Board of Pediatrics How should organizations handle NCQA's expiration date and timeliness requirements if the Medical Board does not provide an expiration date for a practitioner's board certification?
8.29.2013 Documentation of work history review Must the review of a practitioner's work history be documented on the application?
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.
8.29.2013 Documentation requirements using NPDB-PDS Databank What are the documentation expectations for CVOs that use the NPDB-PDS Databank's Continuous Query for collecting and reporting malpractice history?
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.
8.29.2013 Future completion dates for education and training Does NCQA accept future completion dates when verifying education and training?
8.16.2013 Childhood Immunization Status On May 16, 2013, the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases released a document based on Sanofi Pasteurs Pentacel (DTaP-IPV/Hib) and Daptacel (DTaP) vaccine shortage. Because these vaccines are expected to be in short supply through summer 2013, does NCQA plan any changes to the CIS measure for HEDIS 2014?
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
7.15.2013 Prenatal and Postpartum Care For the PPC measure, a Pap test alone is acceptable for the Postpartum Care rate. Is documentation of a Pap test compliant for women under the age of 21?
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
7.15.2013 Using physician groups or IPAs to distribute information to practitioners If an organization contracts with a physician group or IPA, may the physician group or IPA distribute information to its practitioners if covered in the contract? Does NCQA consider this contractual arrangement to be delegation?
7.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for HEDIS 2014?
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