FAQ Directory

The overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points (if the plan is Accredited by NCQA), calculated on a 0–5 scale in half-points (5 is highest), displayed as stars and rounded to the nearest half-point.

This applies to the following Programs and Years:

"1" = Race/Ethnicity Diversity of Membership and Language Diversity of Membership
"1” = Process measures (e.g., screenings, visits)
“1.5” = Patient experience measures (CAHPS)
“3” = Outcome and intermediate outcome measures (e.g., Glycemic Status, Blood Pressure Control)

This applies to the following Programs and Years:

HPR utilizes HEDIS, CAHPS and HOS data sets, and Measurement Years are dependent on HPR year as well as product lines. To find specific data information on each HPR year, please access that year's Measure List by navigating to NCQA’s Health Plan Ratings site.

This applies to the following Programs and Years:

NCQA requires plans to review their projected rating as a final quality assurance step in the Ratings process. Although the projected information is subject to change (from continued quality checks), plans must affirm that they have reviewed their information and have no questions regarding their Accreditation status or projected rating.

This applies to the following Programs and Years:

The plan will receive a “0” on the measure and the measure weight will be included in its Ratings calculation.

This applies to the following Programs and Years:

Measure rates in the IDSS data workbook are multiplied by 100 and rounded to two decimal places, except for certain metrics (e.g., Observed/Expected, Count Variance, Expected Count), which are rounded to four decimal places.

HPR truncates final unrounded raw measure rates and The National All Lines of Business percentiles to 3 decimals.

For example, if the IDSS workbook displays a rate of 78.47, the HPR scoresheet will display .784 (raw rate truncated to 3 decimals).

This applies to the following Programs and Years:

Your overall rating will be “Partial Data Reported” and your measures will display as “NC” (No Credit) on the September 15 release of HPR on the NCQA Health Plan Report Card.

This applies to the following Programs and Years:

HPR uses the prior year Medicare CAHPS data so NCQA will use the corresponding Sub ID, therefore, could differ from the Medicare plan's CAHPS Sub ID of the HPR release year. 
 

This applies to the following Programs and Years:

Using Medicare CAHPS and HOS data in HPR depends on yearly approval by the Centers for Medicare & Medicaid Services (CMS). Because the submission schedule for Medicare CAHPS and HOS measures differs from the HEDIS submission schedule, NCQA scores organizations using the previous year’s data and percentiles for measures in the CAHPS and HOS domain.

There are also calculation differences between NCQA’s Medicare CAHPS and CMS. For example, NCQA scores some items based on a two-question composite where CMS uses a three-question composite. CMS case-mixes CAHPS results, NCQA does not. NCQA uses top-box scoring for HPR, CMS uses linear mean scoring converted from a 0-100 scale.

This applies to the following Programs and Years:

NCQA's Health Plan Ratings will be publicly displayed on or around September 15 on NCQA's Health Plan Report Card.

This applies to the following Programs and Years:

Please visit NCQA’s Health Plan Ratings website and select the applicable year to view our Advertising and Publicity Guidelines. Please note that this document is updated annually, no later than early September. 

This applies to the following Programs and Years:

Your CAHPS Component selection was made in the HOQ, which closed in February and was confirmed during Plan Confirmation in May. It is final and cannot be modified.

This applies to the following Programs and Years: