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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Yes. The language should read, "where the organization can confirm that the visit was in an outpatient setting (POS 53 is not specific to setting)." The intent is to include only codes where the organization can confirm that the visit was in an outpatient setting.
For Medicare, Medicaid and Exchange surveys beginning on or before June 30, 2015, NCQA will review and score the organization on their submitted implementation plan. The implementation plan must address all requirements of the applicable elements and factors, during the first year of review (July 1, 2014-June 30, 2015). NCQA will not resurvey or reevaluate organizations in 2015 to determine if MEM functions are operational. For Medicare, Medicaid and Exchange surveys beginning on or after July 1, 2015, the organization must demonstrate that MEM functions are operational in order to receive the associated points. We do not expect organizations to submit additional documentation between surveys.
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.
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.
The CVO must provide NCQA with evidence of current or continuous enrollment of the practitioner in the NPDB-PDS, and of review and reporting of NPDB-PDS activity within 120 calendar days to the organizations client. If no sanction information is reported by the NPDB-PDS, the CVO must provide documentation of this in the file and must report to clients that no sanctions were reported. The organization determines its method of documentation.
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.
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.
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. 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.
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.
