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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7.15.2013 General Guidelines Where can customers find additional information about the supplemental data changes for 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.

This applies to the following Programs and Years:
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?

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.

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

7.15.2013 Care for Older Adults If there is a list of medications in the progress note, is a prescribing practitioner or clinical pharmacist's signature alone considered evidence that the list was reviewed for the medication review indicator?

The medication review indicator requires both a medication list and evidence that it was reviewed by the appropriate practitioner. The presence of a medication list with the appropriate practitioner's signature is compliant if it is dated during the measurement year. The practitioner's signature is considered evidence that the medications were reviewed.

This applies to the following Programs and Years:
HEDIS 2014

6.15.2013 Distribution of materials for Interim Surveys Where elements require materials as a data source for all survey types, must the materials be distribute for Interim Surveys?

Organizations going through Interim Survey must present materials to meet the requirements of the element. Materials are not required to have been distributed, and do not have to be in final layout form, but must be approved by the organization. Draft materials are appropriate if approved by the organization.

This applies to the following Programs and Years:

6.15.2013 Documentation needed for Interim Surveys What documentation is expected for Interim Surveys in QI 7, Element B?

The organization must provide a documented process describing the system, and how it meets the requirements in the element.

This applies to the following Programs and Years:

6.15.2013 Delegation documentation for Interim Surveys For organizations coming through Interim Surveys, what documentation is expected to meet the delegation requirements?

For Interim evaluation options, if an organization has not finalized a delegation agreement with an intended delegate, NCQA will accept draft agreements and communications between organizations for delegation requirements. NCQA will review and score the draft agreement and communications defining when the agreement will be complete for Elements A (Written Delegation Agreement) and B (Provision of PHI) in the applicable categories (QI, UM, CR, RR). NCQA will also review documented processes and reports for Element D (Predelegation Evaluation). NCQA will score delegation Element C (Review/Approval of Program, Right to Approve and Terminate, Predelegation Agreement) as Not Applicable. NCQA reserves the right to review and score finalized delegation agreements.

This applies to the following Programs and Years:

6.15.2013 Look-back period for Exchange products coming through Renewal Survey What is the look-back period for Exchange products coming through a Renewal Survey (i.e. concurrently with an existing NCQA Accredited product)?

The look-back period is prior to the survey date for the Exchange product line.

This applies to the following Programs and Years:

6.15.2013 Practitioner involvement in the QI Committee for Interim Surveys Other than review and approveal of policies and procedures, what is expected to meet the requirement of practitioner involvement?

The organization must provide evidence that practitioners were involved in review and approval of policies and procedures.

This applies to the following Programs and Years:

6.15.2013 Documentation to meet structural standards if delegated to an NCQA Accredited or Certified organization According to the Automatic Credit for Delegating to an Accredited HP appendix, there are some structural requirements that do not receive automatic credit when delegating to an NCQA Accredited or Certified Health Plan. What documentation is required if the organization accepts the delegates structural requirement as its own?

For all standards/elements that have been identified as structural requirements, the organization must provide its own materials, processes and other data sources as evidence that it meets each structural component of the standard. Organizations may adopt other organizations' procedures as its own. If an organization adopts existing procedures from another organization, it must provide evidence of formal adoption by its governing body or other group or individuals with appropriate authority.

This applies to the following Programs and Years:

6.15.2013 Scoring for factors for Interim Surveys Factors 2, 4 and 5 require activities to have been in place for a period of time that is longer than is likely to be the case for organizations seeking Interim Accreditation, especially new health plans, like CO-OPs. How will these factors be scored?

Factors 2, 4 and 5 are scored NA for Interim Surveys.

This applies to the following Programs and Years:

6.15.2013 Documentation for Interim Surveys for interpreter services What is the required documentation for interpreter or bilingual services since there may be no membership? What is required as evidence?

The organization must provide a documented process describing how it plans to meet the requirements when it does have a membership with a need for such services.

This applies to the following Programs and Years: