For CM 2, Element E, which is a file review element, NCQA is looking for documentation of whether or not you completed the applicable activities listed in CM 2, Element D: Initial Assessment Process. For your program, you would note in your documentation that certain factors are not applicable for that particular patient population.
FAQ Directory
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10.15.2012 Standards If some factors are not applicable for our case management program, how would we address it to meet the requirements in CM 2, Element E: Initial Assessment?
10.15.2012 Standards Does NCQA require specific certifications for organization staff?
While NCQA does not include in requirements that your staff to hold specific certifications for case management, NCQA does have standards requiring organizations to verifying licensure for clinical staff who are required to maintain a license. "Clinical staff" is defined as individuals who are licensed to treat patients. Organizations would determine which certifications are appropriate for staff serving their patient population.
CM 2014
10.15.2012 Excluding ER denial files from the UM denial file review With the elimination of the ER file review (UM 12, Elements B and C), will ER denial files be included in the UM denial file review for UM 4 - 7?
10.11.2012 Submission of NCQA WHP Performance Measures When must organizations submit NCQA WHP Performance Measures in order to obtain Accredited With Performance Reporting (AWPR) status?
Organizations coming through the WHP accreditation process for the first time and that wants to earn AWPR status must submit audited measures with the ISS Survey Tool submission. Organizations with current AWPR status must submit measures on April 15 to maintain the AWPR status. Organizations that do not submit performance measures with their Survey Tool can apply for an upgrade to AWPR status at the next annual submission date (the April 15 following receipt of accreditation status).
WHP 2013
9.16.2012 Cervical Cancer Screening The USPSTF released new recommendations for cervical cancer screening in March 2012. It recommends cytology (Pap test) screening every three years for women 21_65 years of age or, for women 30_65 years of age who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every five years. In light of the new recommendations, will NCQA update the CCS measure to account for the lengthened screening for women 30_65 years?
In response to USPSTF recommendations, NCQA has scheduled the CCS measure for reevaluation in 2012. The appropriate staff and panels will review updates and other relevant guidelines and will evaluate potential changes to the measure. Proposed changes, if any, will be posted for Public Comment in February 2013 and, pending final approval by the NCQA Committee on Performance Measurement, will be included in HEDIS 2014.
HEDIS 2013
9.16.2012 General Guidelines Can an organization continue to collect medical records for members in the hybrid sample after the May 15 medical record review deadline and record them in supplemental database for use in the current reporting year?
9.16.2012 Medication Reconciliation Post-Discharge The Medication Therapy Management (MTM) program is required for CMS Parts C and D data validation audits. May we use data from the MTM program to satisfy the "medication reconciliation" requirements in the MRP measure?
Data from the MTM program may be used only if the organization can distinguish a member's discharge medications from the member's current medications. The reconciliation must have occurred on or within 30 days of discharge by a prescribing practitioner, clinical pharmacist or registered nurse to meet the intent of the measure.
HEDIS 2013
9.15.2012 Basics I only have my Commercial HMO accredited. Can I bring my Exchange PPO through the Exchange Add-on Survey?
9.15.2012 Basics What happens after the Exchanges Add-on Survey accreditation status expires?
9.15.2012 "In-print" format Is including a "print" option in an online document enough to meet NCQA's "in print" requirement?
9.15.2012 Pricing What is due at the time of the actual survey date?
Base fee is $15,000 if an organization qualifies for automatic accreditation and $22,500 if an organization must go through a review. However, this includes the already submitted application submission fee. Actual additional amount required prior to NCQA awarding automatic accreditation is $5,000 or prior to the survey date if a review is required is $12,500. NCQA will bill organizations for the remainder of the fees due prior to awarding automatic accreditation or conducting the survey.
9.15.2012 Basics How is the Exchange Add-on Survey different from the regular Add-on Survey?
The Exchange Add-on Survey is a streamlined version of the regular Add-on Survey:
Plans do not submit HEDIS/CAHPS
Since HEDIS/CAHPS are not submitted, plans are capped at Accredited status.
NCQA reviews documentation of standards only when the organization manages functions differently from key elements. (The Application defines which standards are required and how many functions are permitted to be performed differently).
No file review for the Exchange product line.