No. HEDIS/CAHPS results will not be used to evaluate plans seeking accreditation through the Interim 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: HEDIS Reporting and Scoring Will NCQA review and score HEDIS/CAHPS measures if a plan submits them for the Interim Evaluation Option?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring Are HEDIS/CAHPS measures reported during the third annual HEDIS reporting cycle scored for the First Evaluation Option?
8.15.2012 Evaluation Options: HEDIS Reporting and Scoring How does NCQA differentiate among plans that are accredited through the Renewal Evaluation Option and plans that are accredited through the First Evaluation Option but do not report HEDIS/CAHPS measures?
8.15.2012 Evaluation Options: Status and Scoring Will currently accredited plans be scored 50 points for HEDIS/CAHPS and 50 points for standards?
8.15.2012 Evaluation Options: Status and Scoring Does NCQA publish denials for plans undergoing the Interim Evaluation Option or the First Evaluation Option?
8.15.2012 Evaluation Options: Status and Scoring Is it possible for plans to score higher than Accredited status during any First Evaluation Option years?
8.15.2012 Evaluation Options: Accreditation Surveys May a plan that was denied accreditation reapply for accreditation in less than a year from the date of the Denied status?
Yes, a plan may apply for a new Accreditation Survey (called an Expedited Survey) in less than a year under specific circumstances, including:
The plan was denied accreditation under the Interim Evaluation Option and may reapply after three months.
The organization demonstrates to NCQAs satisfaction that the issues identified in the original survey can be corrected within a six- to nine-month time frame as a result of the organizations activity.
Correction of the issues would raise the organizations accreditation status in a new survey.
To qualify for an Expedited Survey, a plan must submit a written request listing the steps it has taken to address the substantive issues that led to its Denied Accreditation status.
8.15.2012 Evaluation Options: Status and Scoring How are plans scored that do not report HEDIS/CAHPS?
8.15.2012 Evaluation Options: Accreditation Surveys What is the Resurvey timeline for plans that score less than 85 percent of the possible points during the First Evaluation Option or the Renewal Evaluation Option?
8.15.2012 Evaluation Options: Accreditation Surveys How do plans add an Exchange accreditation to an existing accreditation?
Plans submit an application identifying whether their Exchange product will be operated the same as the accredited product. If 70 percent of the Interim Evaluation Option elements are the same, the Exchange product line receives automatic accreditation under the plans accreditation. If the majority of the operations are not the same, plans undergo a streamlined Add-On Survey with a six-month look-back period.
8.15.2012 Evaluation Options: Accreditation Surveys How soon will plans be able to earn accreditation for their Exchange product line?
NCQA-Accredited plans can earn accreditation for their Exchange product line as early as February 2013. Plans without previous NCQA Accreditation can apply for the Interim Evaluation Option as early as September 2012 and have their Exchange product line accredited as early as October 2013.