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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2.01.2024 Health Plan Ratings Release Date When will the Health Plan Ratings be publicly displayed?

NCQA's Health Plan Ratings will be publicly displayed on or around September 15 at NCQA's Health Plan Report Card, which can be found here: https://reportcards.ncqa.org/health-plans. 


2.01.2024 Advertise/Market Health Plan Ratings Scores How can I market or advertise my plan's 2024 Health Plan Ratings scores?

Please go to the 2024 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2024/), where we outline our Marketing Guidelines. Please note that this document is updated annually no later than early September. 

HPR 2024

2.01.2024 Health Plan Ratings Medicare CAHPS and HOS Data Does Not Match CMS Data Why doesn’t my Medicare CAHPS and HOS data match what my vendor provided?

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.


2.01.2024 Health Plan Ratings Medicare CAHPS Sub ID Why does my Medicare CAHPS Sub ID look incorrect?

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. 


2.01.2024 Health Plan Ratings Sites Login (Plan Confirmation, Projected Ratings, Final Ratings) Why can’t I log on to Plan Confirmation/Projected Ratings/Final Ratings? Or I can log on, but I don’t see any plans?

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of the sites. Please contact this individual at your organization to request access.


2.01.2024 Health Plan Ratings Historical Data Where can I access prior year HPR scores or retrospective HPR data?

2.01.2024 Health Plan Ratings 2022 Measure Weights How does NCQA weigh measures used in HPR 2022?

  • "1” = Process measures (e.g., screenings, visits)
  • “1.5” = Patient experience measures (CAHPS)
  • “3” = Outcome and intermediate outcome measures (e.g., HbA1c Control, Blood pressure control)

HPR 2022

2.01.2024 Health Plan Ratings Exchange Plans Why don’t I see my Exchange plan in Health Plan Ratings?

NCQA currently does not rate Exchange plans for Health Plan Ratings/Health Plan Accreditation (HPR/HPA). This is primarily because CMS has their own Quality Rating System (QRS), and NCQA has to receive special permission from CMS to use the data for our Accreditation program. NCQA is actively participating in these discussions, and any changes to this policy will be communicated to all organizations in a timely manner.


2.01.2024 Health Plan Ratings Standards Only (Yes)/"No" to Public Reporting How will I be listed for Ratings if I am “Standards Only,” I don’t submit data and say “No” to public reporting on the Attestation?

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


2.01.2024 Health Plan Ratings Data Does Not Match IDSS Rates Why don’t my IDSS rates match the projected ratings scoresheet?

HPR truncates final raw rates and percentiles to 3 decimals, so if your IDSS workbook shows 78.47, HPR will show the raw rate of .784 (truncated at 3 decimals).


2.01.2024 Health Plan Ratings State Coverage How does NCQA define “state coverage”?

NCQA defines “state coverage” as the states where a plan is licensed to operate. Plans that submit HEDIS/CAHPS data provide this information each year during the HOQ process. If plans do not submit these data, NCQA uses state licensing and membership data provided for Accreditation or gathered from external sources.


2.01.2024 Health Plan Ratings Impact of Not Reporting a Measure Not on CMS' Required Measure List What happens if a Medicare plan fails to report a HPR-required measure that is not on CMS’-required measure list?

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