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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5.16.2022 MY 2022 Technical Update – COL-E Measure In the updated version of the COL-E measure that was re-released in the MY 2022 Technical Update, the “Total” data element listed in the age column is not highlighted in Table COL-E-A-3: Data Elements for Colorectal Cancer Screening. Should this cell be highlighted?

Yes. The cell should be highlighted to indicate that it is calculated by IDSS.

HEDIS 2022

5.16.2022 Reducing the Sample for CIS for MY 2022 Reporting May organizations reduce the minimum required sample size for the Childhood Immunization Status measure when reporting MY 2022?

Yes. Disregard the “N” in Table 1. Organizations may reduce the sample size for the CIS measure using the prior year’s rate or the current year’s administrative rate.

**This FAQ applies to QRS MY 2022.

Exchange 2022

5.15.2022 MBHO: Delegation Oversight System Controls Monitoring - Audits Are both the organization and delegate required to conduct system controls audits for factor 5 in UM 12, Element C and CR 8, Element C?

Both the organization and delegate must monitor the delegate’s system security controls as part of the delegation oversight requirements and may choose audit as the monitoring method. If auditing is the chosen method, the delegate provides an audit report of modifications that did not comply with its policies and procedures or with the delegation agreement.

The organization is not required to conduct an audit if it determines that the delegate adequately monitored and reported noncompliant modifications, but must provide documentation (a report, meeting minutes or other evidence) that it reviewed and agreed with the delegate’s findings. If the organization determines that the delegate did not adequately monitor noncompliant modifications, it must conduct its own audit of the delegate’s system controls.

The organization must submit its documentation and the delegate’s documentation as part of the survey.
 

MBHO 2022

5.15.2022 MBHO: Clarify scope for UM 11, Elements A and C What are the differences in scope for system controls at the factor level in UM 11, Elements A and C?

For UM 11, Elements A and C:

  • Factors 1–5 apply to receipt and notification dates, covered in UM 5 and UM 8–UM 9.
  • Factor 6 applies to all UM system data for managing denials and appeals (not only the dates specified in factors 1–5), covered in UM 4–UM 7 and UM 8–UM 9.

MBHO 2022

5.15.2022 UM and CR Advanced System Controls—Policies and Procedures Are organizations that provide evidence of “advanced system controls” eligible to receive Met for UM 12, Elements A and C, and for CR 1, Element C?

No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for UM 12, Elements A and C and for CR 1, Element C. Policies and procedures must address all factors regarding advanced system control capabilities.

Organizations are only eligible to receive a score of Met for UM 12, Elements B and D, and for CR 1, Element D if they provide evidence of advanced system control capabilities that both automatically record dates and prevent changes that do not meet the organization’s policies and procedures.

HP 2022

5.15.2022 Boilerplate Language in Delegation Agreements for System Controls May organizations’ delegation agreements contain boilerplate language for system controls delegates?

Yes, if the language specifies that the delegate must meet NCQA requirements (UM 12, Elements A and B, factor 6; UM 13, Element C, factor 5; CR 1, Element C, factor 4; CR 8, Element C, factor 5), template language may be used in the delegation agreement. Language specific to each delegate is not required.

HP 2022

5.15.2022 MBHO: System Controls Goal for Analysis Is a goal required for system controls monitoring analysis for UM 11, Elements B and D, factor 2 and CR 1, Element D, factor 2?

No. Although the organization may set a monitoring goal, NCQA does not require it for UM 11, Elements B and D, factor 2 and CR 1, Element D, factor 2. The intent is that the organization reviews all instances of modifications that did not meet its policies and procedures.

MBHO 2022

5.15.2022 Clarify scope for CR 1, Element C What are the differences in scope for system controls at the factor level in CR 1, Element C?

For CR 1, Element C:

  • Factor 1 applies to verification source information from credentialing and recredentialing cycles, covered in CR 3, Elements A–C.
  • Factor 2 applies to modified credentialing verification information from initial credentialing and recredentialing cycles, covered in CR 3, elements A–C.
  • Factors 3–4 apply to all information associated with credentialing/recredentialing of practitioners, covered in CR 2–CR 5.

Factor 5 requires a monitoring process that covers compliance with all policies and procedures described in factors 1–4.

HP 2022

5.15.2022 System Control Requirements Review by Product Line If auditing is used to monitor an organization’s system controls or a delegate’s system controls, is sampling by product line required?

No. Sampling is not required by product line if the product lines are managed the same (a single system is used to manage all product lines).

HP 2022

5.15.2022 MBHO: UM and CR Advanced System Controls—Policies and Procedures Are organizations that provide evidence of “advanced system controls” eligible to receive Met for UM 11, Elements A and C, and for CR 1, Element C?

No. If the organization provides evidence of advanced system controls capabilities, it must submit policies and procedures for UM 11, Elements A and C and for CR 1, Element C. Policies and procedures must address all factors regarding advanced system control capabilities.

Organizations are only eligible to receive a score of Met for UM 11, Elements B and D, and for CR 1, Element D if they provide evidence of advanced system control capabilities that both automatically record dates and prevent changes that do not meet the organization’s policies and procedures.

MBHO 2022

5.15.2022 System Controls Goal for Analysis Is a goal required for system controls monitoring analysis for UM 12, Elements B and D, factor 2 and CR 1, Element D, factor 2?

No. Although the organization may set a monitoring goal, NCQA does not require it for UM 12, Elements B and D, factor 2 and CR 1, Element D, factor 2. The intent is that the organization reviews all instances of modifications that did not meet its policies and procedures.

HP 2022

5.15.2022 Clarify scope for new UM System Controls Oversight requirement (UM 12, Elements B and D) How are the new oversight requirements, UM 12 Elements B and D, different from the monitoring requirements in factor 7 in UM 12, Element A and C?

UM 12, Elements A and C, factor 7 require organizations to have a process for monitoring that policies and procedures are followed for all other factors (factors 1–6) in this element at least annually. Policies and procedures must describe the monitoring process for factor 7.

For UM 12, Elements B and D, the organization submits evidence that it identified, analyzed and acted only on modifications to receipt and notification dates (UM 5) that did not meet the organization’s policies and procedures.

HP 2022