MEM standards apply only to commercial product lines for the First Evaluation Option and the Renewal Evaluation Option.
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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8.15.2012 Evaluation Options: Standards and Guidelines To which product lines and evaluation options do the Member Connections (MEM) standards apply?
8.15.2012 Evaluation Options: Basics In what order do organizations progress through the Evaluation Options?
For the Interim Evaluation Option: Interim, to First, to Renewal.
For the First Evaluation Option: First to Renewal.
After a plan progresses to the Renewal Evaluation Option, all subsequent surveys will be for that Evaluation Option, unless the accreditation lapses for more than two years.
8.15.2012 Evaluation Options: Basics For which Evaluation Options are organizations eligible if their accreditation has expired?
A plan whose accreditation status has expired or has been withdrawn for less than two years is eligible for the Renewal Evaluation Option with a 24-month look-back period.
A plan whose accreditation expired more than two years ago is eligible for accreditation through the Interim Evaluation Option or First Evaluation Options with a six-month look-back period.
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring Plans that are not scored on HEDIS/CAHPS are capped at Accredited status. Will NCQA grandfather plans that earned Commendable status but were not scored on HEDIS/CAHPS?
8.15.2012 Evaluation Options: Eligibility How long must a plan be in operation before applying for NCQA Accreditation?
Plans may apply for the Interim Evaluation Option and the First Evaluation Option at any time, regardless of how long they have been in operation.
For the Interim Evaluation Option, plans must show evidence that they met the requirements before the survey start date.
For the First Evaluation Option, plans must show that they met the requirements for the six months before their survey date.
8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans choose if they have not been accredited by NCQA?
8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans with New Health Plan accreditation apply for next?
8.15.2012 Evaluation Options: Basics How are the Interim Option and the First Evaluation Option different?
The Interim Evaluation Option has half of the number of elements as the First Evaluation Option, focuses on policies and procedures and is valid for 18 months.
The First Evaluation Option is valid for 36 months and focuses on policies and procedures, initial measurement and analysis of programs and file review.
Plans going through the Interim Evaluation Option can earn Interim status (HEDIS/CAHPS reporting is not required); plans going through the First Evaluation Option can earn either Provisional or Accredited status (if they are not scored on HEDIS/CAHPS).
Reporting is required during the third annual HEDIS reporting cycle for organizations going through the First Evaluation Option, which also gives plans the option to be scored on HEDIS/CAHPS results, allowing them to earn an accreditation status higher than Accredited.
8.15.2012 Evaluation Options: Standards and Guidelines Several elements in the First Evaluation Option require annual evaluation, even though the Evaluation Option has a six-month look-back period for all other elements. How do plans meet this annual requirement?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring When must plans report HEDIS/CAHPS measures if they are going through the First Evaluation Option?
8.15.2012 UPDATED: Completely overturned denials excluded from file review Are overturned denials excluded from file review for only UM 9, Elements C and D, or from all elements in UM 9?
7.16.2012 Initiation and Engagement of Alcohol and Other Drug DependenceTreatment The Engagement of AOD Treatment indicator requires initiation of AOD treatment and two or more inpatient admissions, outpatient visits, intensive outpatient encounters or partial hospitalizations with any AOD diagnosis within 30 days AFTER the date of the Initiation encounter (inclusive). Does "inclusive" mean that the initiation visit is included when determining compliance for engagement? What does "after" mean?
"Inclusive" means that the initiation visit is included when determining compliance for the Engagement of AOD Treatment indicator; therefore, the initiation visit is day 1 in the 30-day count. "After" means that the two additional visits must occur after the date of the initiation encounter. For example, if a members initiation visit occurred on August 1, the engagement visits must occur on August 2 through August 30.
HEDIS 2013