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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2.14.2014 Osteoporosis Management in Women Who Had a Fracture When determining the eligible population, step 4 states to exclude members with a dispensed prescription to treat osteoporosis (Table OMW-C) during the 365 days (12 months) prior to the IESD. Does this include only osteoporosis prescriptions dispensed during the 365-day look-back period, or may it include an osteoporosis prescription that was dispensed prior to the look back period but is still “active” during the 365 days?

Members with an “active” prescription for osteoporosis treatment (Table OMW-C) during the 365 days prior to the IESD meet the step 4 exclusion criterion. The prescription does not need to be dispensed during the 365-day look-back period. NCQA does not specify how long organizations must look back prior to the IESD to identify an “active” prescription; organizations determine the look-back period, which should be applied consistently across all members.

This applies to the following Programs and Years:
HEDIS 2014

2.14.2014 Inpatient Utilization General Hospital/Acute Care In step 4, the text under the "Medicine" bullet states for the Newborns/Neonates MS-DRG Value Set, "Do not include newborn care rendered from birth to discharge home from delivery; only report newborn care rendered if the baby is discharged home from delivery and is subsequently rehospitalized." In HEDIS 2013, this instruction also applies to "Total Inpatient." Should newborn care rendered from birth to discharge home from delivery also be excluded from Total Inpatient?

Yes. Exclude newborn care rendered from birth to discharge home from delivery before reporting Total Inpatient (step 3).

This applies to the following Programs and Years:
HEDIS 2014

2.14.2014 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents For the BMI percentile indicator, does documentation of >99% or <1% meet criteria?

Yes. Documentation of >99% or <1% may be used when reporting because an exact BMI percentile value is evident (i.e., 100% or 0%). These examples are not considered ranges or thresholds, which are not permitted when reporting the BMI percentile indicator. Examples of non-permitted ranges and thresholds are "75-80th percentile" and ">90th percentile" because the exact BMI percentile value is not evident.

This applies to the following Programs and Years:
HEDIS 2014

1.24.2014 Controlling Blood Pressure for People with Hypertension (CBPH) The MY 2013 P4P Manual does not contain a Hypertension Value Set in the Controlling Blood Pressure for People With Hypertension (CBPH) measure or in the Diabetes Care (CDC) measure referenced in the 12/20/13 P4P FAQ. Where can I find these codes?

The Hypertension Value Set was not included in the MY 2013 P4P Value Directory. The codes included in the Hypertension Value Set are:

  • ICD-9-CM 401.1.
  • ICD-9-CM 401.
  • ICD-9-CM 401.9.
  • ICD-9-CM 401.0.

The Hypertension Value Set will be included in the next release of the P4P Value Set Directory.

This applies to the following Programs and Years:
IHA P4P

1.24.2014 Meaningful Use of Health IT: Overview There appears to be an error in Table 1 of the Domain Structure in the Overview section of the MUHIT Survey. In the first column, there is an overlap in percentage groups 45_64 and 64_84. What are the correct percentage ranges for this table?

There is an error in the percentage ranges listed in Table 1: MUHIT Points for ONC-ATCB Certified Software. The range to receive 4 points is 65_84.

This applies to the following Programs and Years:
IHA P4P

1.24.2014 Evidence-Based Cervical Cancer Screening of Average-Risk Asymptomatic Women (ECS) Step 1 of the ECS Administrative Specification Rate 1 states, “Identify the number of women 24–65 years of age with hysterectomies who had cervical cytology.”

In the MY 2012 P4P manual, step 1 of Rate 1 in the ECS Administrative Specification says, “…who had NO Pap tests.” Should the text in the MY 2013 P4P Manual say, “who had NO cervical cytology”?

Yes. Step 1 of the ECS Administrative Specification Rate 1 should say, “…who had NO cervical cytology.”

This will be corrected in the next release of the manual.

This applies to the following Programs and Years:
IHA P4P

1.24.2014 Proportion of Days Covered by Medications (PDC) The Oral Diabetes Tab includes the NDC code 47463051060, which may be incorrectly assigned to a GCN. This NDC (47463051060—metformin) is assigned to GCN 71160. However, for other NDCs with the same generic drug name (metformin), route and GPI are assigned to GCN 89863. Which GCN is correct?

The NDC code 47463051060 (Metformin HCl Tab SR 24HR 500 MG) is incorrectly assigned to GCN 71160. The correct GCN is 89863.

This particular NDC was recycled to the medication metformin and therefore should have a GCN of 89863, rather than the previous GCN linked to the obsolete NDC.

This applies to the following Programs and Years:
IHA P4P

1.15.2014 Board Certification as Verification of Education and Training for Nurse Practitioners (NP) and Physician Assistants (PA) Is it acceptable to use ANCC and NCCPA board certification as verification of highest level of education for nurse practitioners and physician assistants?

Yes, if the organization can obtain written confirmation from the ANCC and NCCPA that they perform primary-source verification of the professional school training.

This applies to the following Programs and Years:
CVO 2013|UM-CR 2013

1.15.2014 Distribution of the Member's Rights and Responsibilities Statement May a delegate distribute the statement of members' rights and responsibilities?

Yes. Distribution of member rights and responsibilities statement by a delegate is acceptable. The organization must perform oversight to ensure that this requirement is met.

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:
IHA P4P

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.

This applies to the following Programs and Years:
IHA P4P

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.

This applies to the following Programs and Years:
IHA P4P