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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1.17.2011 Prenatal and Postpartum Care The LOINC codes listed for rubella for Decision Rule 3 in Table PPC-C are inconsistent with the LOINC codes listed for rubella in other sections of Table PPC-C. Is this accurate?

No. LOINC codes listed in the Rubella/ABO/Rh category for Decision Rule 3 should match the LOINC codes listed in other categories (e.g., the LOINC codes listed for the Rubella/ABO/Rh category in Decision Rule 2).

1.17.2011 Comprehensive Ischemic Vascular Disease Care Should CPT Category II codes 3074F and 3075F be included in Table IVD-G?

Yes. 3074F (systolic less than 130 mm Hg) and 3075F (systolic 130_139 mm Hg) were inadvertently removed from Table IVD-G, but they should be included because they define BP systolic levels of less than 140 mm Hg.

1.17.2011 Comprehensive Ischemic Vascular Disease Care CPT Category II code 3076F became obsolete January 1, 2007. Should it be deleted from Table IVD-G?

11.15.2010 Use of the term "days" within the Standards & Guidelines Do all references to "days" in the standards and guidelines mean "calendar days"?

Yes. Unless otherwise specified, all references to "days" in the standards and guidelines mean calendar days.

PHQ 2013

9.16.2010 General Guidelines What is the annual release date of the WHP Technical Specifications, and when are the data due to NCQA?

The WHP Technical Specifications are released annually on March 30. Data are due by April 15.

9.16.2010 General Guidelines What is the annual release date of the DM Technical Specifications, and when are the data due to NCQA?

The DM Technical Specifications are released annually on July 31. Data are due by June 30.

9.16.2010 Comprehensive Diabetes Care Considering the release of several new relevant studies, is NCQA changing the threshold of the BP control <130/80 mm Hg indicator?

Yes. In light of recent studies, and after discussion with the Joint Diabetes Expert Panel, NCQA decided to change the BP control “<130/80 mm Hg” indicator to BP control <140/80 mm Hg. This change will be in the Volume 2 Technical Update that will be released October 1, 2010.

9.15.2010 ABMS or AOA board performance-based improvement module Are physicians required to update their performance improvement module (PIM) data every two years, or must the organization check every two years to find out who has completed a PIM?

The organization must verify that a physician has completed a PIM within two years of the organization taking an action, or within the period specified for the corrective action process, which must be within a two-year period to qualify as a quality measurement activity.

8.13.2010 Acceptable threshold for percentage of physicians in a practice necessary to designate a practice If our organization designates at the practice level, is an individual measure (e.g. meeting an e-prescribing measure or practicing in a designated center of excellence) acceptable for designating the group based on a percentage of physicians in the group who meet the measure?

Yes, with a caveat: your organizations methodology must specify a threshold for the percentage of physicians meeting the measure, which must not be less than 50%. If the percentage of physicians meets or exceeds this threshold, then your organization may use an individual measure to designate the practice.

7.16.2010 General Guidelines Does upgrading to Accredited With Performance Reporting status extend the accreditation expiration date?

Yes. The Accredited With Performance Reporting status is valid for up to three years from the date of the final results of the Initial Survey, subject to revision from annual WHP Performance Measures results submission.

7.15.2010 Notification of information available on the Web site Which methods are acceptable for notifying members or practitioners in writing that information is available on the Web site?

Organizations may use mail, fax or e-mail to notify members or practitioners that information is available on the Web site.

3.29.2010 Automatic credit for file review Does the 70 percent criterion for automatic credit apply to file-review elements when using an NCQA Accredited or NCQA Certified delegate?

No. The 70 percent criterion for automatic credit does not apply to CR or UM file review elements in which the delegate is NCQA Accredited or NCQA Certified in CR or UM. All CR or UM files from NCQA Accredited or Certified delegates are eligible for automatic credit regardless of the percentage of the organizations membership covered by the delegates services.