FAQ Directory

No. An organization that measures its physicians every two years can meet the requirement by seeking feedback and assessing the program every two years.

This applies to the following Programs and Years:

If the organization is seeking certification on a program that is part of a collaborative, those measures must be included.

This applies to the following Programs and Years:

Yes. In prior versions of PHQ, NCQA required organizations to include all programs that met the definition of taking action in the survey, NCQA had a narrower definition. Because under PHQ 2013 organization chooses which programs to include or exclude in a PHQ survey, NCQA has broadened the definition so that if it chooses, an organization may opt to have programs certified that may not have been required under the prior PHQ.

For PHQ 2013, NCQA has defined taking action as: 1) Publicly reporting performance on quality or cost, resource use or utilization; 2) Using performance on quality or cost, resource-use or utilization measures as a basis for network design (such as tiering) or benefit design; 3) Using performance on quality or cost, resource-use or utilization measures to allocate rewards under a systematic, pay-for-performance program; 4) Reporting performance on quality, cost, resource use or utilization to physicians to support referral decisions.

If an organization is interested in certification for a program that includes actions not include an action defined above, it should contact NCQA to determine eligibility.

This applies to the following Programs and Years:

For Element F, the organization must demonstrate that it has a process to verify that it has followed the specifications outlined in Element C (e.g., sample sizes, attribution, statistical validity). If the organization uses a vendor to administer the survey, this process may be performed by the vendor, but documentation demonstrating how the element is met must be included for the PHQ Survey.

This applies to the following Programs and Years:

No. HEDIS RRU measures are specified for assessment at the plan level, not for measurement of individual physician performance.

This applies to the following Programs and Years:

No. NCQA does not evaluate an organizations code; it reviews the organizations measure specifications and compares them to the original source specification (if applicable). Note that to be considered from a standardized source, the measure must be the version specified for the level measured; e.g. HEDIS physician level measures, not plan level measures.

This applies to the following Programs and Years:

It depends on the relationship between the organization and the practitioners, and what the state licensing agency allows. If the organization contracts with the IHS and directs its members to Indian Health Clinics, there is no need to credential individual practitioners for NCQA purposes, and consequently, no need to verify practitioner licenses. The clinics would fall under CR 8 in the 2013 HP Standards and Guidelines.

However, if the organization has an independent relationship with practitioners in a clinic and directs its members to these practitioners for care, the organization must credential the practitioners. The organization must verify practitioner licenses if the state licensing agency does not recognize the IHS license as a proxy for state license. Conversely, if the state licensing agency recognizes the IHS license as a proxy for the state license, there is no need to verify practitioner licenses. The organization must provide documentation showing state acceptance of the IHS license, during its survey.

This applies to the following Programs and Years:

NCQA prices a program and any programs it qualifies as derivative programs using the pricing tier that includes the total number of physicians measured in all the programs an organization brings forward. No individual physician is counted more than once for the purposes of determining which pricing tier is used, but the total of all physicians in all programs determines the tier used for every program.

This applies to the following Programs and Years:

Organizations may use State Relay services to meet the TDD/TTY requirement, but must be able to provide alternative phone numbers or services if members are not able reach 711 due to technology restrictions.

This applies to the following Programs and Years:

Though an organization may not have members in the way a health plan does, Web sites have users or consumers who might want to submit complaints (e.g., user complaints). Therefore, to meet the intent of Elements C and D, an organization must have policies and procedures to process, register and respond to consumer complaints; and must provide a documented process and evidence for how it handled those complaints.

This applies to the following Programs and Years:

Organizations are responsible for reporting NCQA WHP performance measure results exactly as specified if they are seeking AWPR status. Organizations must submit performance measure results to NCQA and attain a score of 50% or higher on WHP 12, Element A.

In order to retain AWPR status, organizations must annually submit performance measure results. Organizations that are NCQA Accredited in Wellness and Health Promotion and want to upgrade to AWPR status must submit measure results by the next annual reporting date (April 15) in any year during the accreditation cycle.

Organizations typically complete the WHP Performance Measures Reporting Tool, an Excel workbook. They send the workbook to an NCQA-Certified Auditor to have their measure results audited before submission. The auditor completes the audit worksheet in the Reporting Tool and locks the workbook, the returns the workbook to the organization, which subsequently submits the tool to NCQA.

This applies to the following Programs and Years:

Board certification alone does not count as a quality measure. The organization may take action based on physician completion of an ABMS or AOA board performance-based improvement module (generally, in conjunction with maintenance of certification) at least every two years. These activities may be used as a quality measurement activity to meet PQ 1 Element A. Under certain circumstances, the organization may use measures from other national or regional performance-based designation programs to satisfy some or all requirements for PQ 1, Element A. The organization must discuss this in advance with NCQA to determine if the designation program meets the criteria.

This applies to the following Programs and Years: