Plans that do not report HEDIS/CAHPS are capped at Accredited status. The list of plans that report HEDIS/CAHPS (or do not report) is available on NCQAs publicly reported Health Plan Report Card.
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.
Filter Results
-
Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
-
Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
-
Print
Print this page.
Print this page.
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: Basics What is the difference between an Evaluation Option and a survey?
An Evaluation Option is defined by a distinct combination of requirements (standards and measures), scoring, statuses and length of accreditation. Health Plan Accreditation (HPA) 2013 has three Evaluation Options: Interim, First and Renewal. Plans are surveyed under one of the three evaluation options based on eligibility.
NCQA administers seven types of surveys to plans seeking accreditation: Full Survey, Follow-Up Survey, Resurvey, Add-On Survey, Expedited Survey, Corporate Survey and State and Federal Agency Survey.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Basics Must NCQA-Accredited plans go through the Renewal Evaluation Option?
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A plan whose accreditation status has expired or has been withdrawn for less than two years is eligible for the Renewal Evaluation Option with a 24-month look-back period.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.
This applies to the following Programs and Years:
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 First Evaluation Option and the Renewal Evaluation Option different?
The First Evaluation Option is for plans without existing NCQA Accreditation, and plans may, but are not required to report HEDIS/CAHPS until the third annual HEDIS reporting cycle. HEDIS/CAHPS reporting and scoring are required at the time of survey submission and annually thereafter for the Renewal Evaluation Option.
This applies to the following Programs and Years:
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?
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.
This applies to the following Programs and Years:
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.
This applies to the following Programs and Years:
8.15.2012 Evaluation Options: Basics Which Evaluation Option should plans choose if they have not been accredited by NCQA?
Plans new to NCQA can earn accreditation through the Interim Evaluation Option or the First Evaluation Optionplans decide which Evaluation Option fits their needs. The two options give plans flexibility to choose based on their readiness and the comprehensiveness of their services.
This applies to the following Programs and Years:
7.16.2012 Medical Record Review Validation Does NCQA expect a decrease in rates with this new policy?
7.16.2012 Medical Record Review Validation Why was a new statistical test chosen for MRRV?
The new test will reduce the number of errors allowed in the systematic sample collected using the Hybrid Method. Auditors will use the Squeglia Zero-based Sampling Plan, which includes more measures but has a smaller sample of 16 charts.