All delegates that have been delegated activities included in the HP Medicare Advantage Deeming Module are subject to review under MA 21. Delegates that handle non-deemable activities are not within the scope of review for MA 21.
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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9.15.2011 Types of Delegates What types of delegates are reviewed in MA 21?
9.15.2011 Text under Complaint and Appeal Categories The following text has been added to Billing and Financial Issues under the Complaint and Appeal Categories subhead: (1) Appeals for denials of out-of-network services where members are balance billed (2) Physicians who code the claim incorrectly (3) Practitioners who balance bill members for services (4) Disputes of deductibles and copayments. Are these new requirements?
9.15.2011 Options for Denied Accreditation What options are available for organizations that have been denied accreditation, but still want to become accredited?
An organization may reapply for accreditation one year after the date when it receives the Denied status, or it may request an Expedited Survey if it has corrected the issues that led to the denial of accreditation. Upon receipt of the organization's written request, NCQA may grant an Expedited Survey in six or nine months of the Denied status if the organization demonstrates that the issues can be corrected within the six-to-nine month time frame and the corrective actions undertaken would raise the organization's accreditation status. (Refer to Policies and Procedures – Section 2: The Accreditation Process, for more information)
This applies to the following Programs and Years:
5.16.2011 Removal of Chronic Care Improvement Projects (CCIP) and Quality Improvement Projects (QIP) from Deeming CMS recently announced that CCIPs and QIPs are no longer deemable. Will you continue to review organizations against these requirements?
5.16.2011 Use of Performance-based Improvement Module (PIM) Element A states that If an organization takes 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, those activities may be used as a quality measure for the purposes of meeting this standard. When counting the quality measures for Element A, for how many measures does NCQA award credit (e.g. for each measure in the PIM or for each PIM)?
Regardless of the number of measures within a PIM, each PIM counts as one standardized measure for PHQ 1, Element A. This is consistent with the current language in the PHQ standards and guidelines (i.e., activities may be used as a measure). To receive credit for using PIMs and for the survey team to verify that the Board requires a PIM as part of certification maintenance, the organization must list in the Survey Tool's Element A Measure Worksheet: (1) the PIMs on which it bases the action; (2) list the source of the measures as Specialty Medical Boards; and (3) provide a direct link to the Board where the PIM and its measures can be found.
This applies to the following Programs and Years:
5.16.2011 General Guidelines If a DM organization does not meet the 15,000 minimum enrollment threshold, may it submit DM measure results to NCQA to be scored as a part of accreditation?
Yes. NCQA is lowering the enrollment threshold for DM 2012 and allowing optional reporting for organizations that do not meet this requirement. Because the threshold will change next year, DM organizations that do not meet the threshold may report in 2011 and earn the Accredited With Performance Reporting status.
