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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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.
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.
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).
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.
NCQA's Health Plan Ratings will be publicly displayed on or around September 15 on NCQA's Health Plan Report Card.
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.
No. QI 2, Element C does not require bidirectional data sharing.
The intent of the requirement is for health plans to share data required for at least one HEDIS measure identified in QI 2, Element C. This enables behavioral health organizations to collect HEDIS measure data to meet NCQA’s Behavioral Health Accreditation program requirements. The health plan and the behavioral health entity collaboratively select the specific HEDIS measure(s), review the technical specifications outlined in Volume 2, and determine which data elements need to be shared to support accurate and efficient reporting.
Members with an unknown or nonbinary gender do not qualify for the risk adjusted utilization measures (PCR, HFS, HFC, HFG, HFO, HFU, AHU, EDU, HPC, EDH) because these measures require a gender to assign age/gender weights. These members should be removed from the measures.
This is not a change; measure models have always included male and female weights. The use of the administrative gender codes for MY 2026 clarify which members are included in the initial population.
