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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9.15.2022 Backdating effective dates Can an organization backdate an effective date for a practitioner to the practitioner’s start date in the network?

NCQA requires organizations to credential practitioners before they provide care to members. NCQA uses the date of the Credentialing Committee or medical director’s decision (in the case of clean files) to determine credentialing timeliness requirements.

This applies to the following Programs and Years:
HP 2022|MBHO 2022|UM-CR-PN 2022|CVO 2022

9.15.2022 Quality Compass Sharing Restrictions What are the sharing restrictions and guidelines for distributing the data available on Quality Compass?

You can find the standard guidelines and restrictions for data usage in Section 2 of the Quality Compass license agreement. This agreement in located on our website as well as on the NCQA store site, prior to any purchase of a license. If you expect your data usage to fall outside of the permissions set forth in the standard agreement, NCQA offers customized agreements to grant extended permissions and use cases, subject to a separate fee.

If you are unsure if your use case falls outside the standard license terms, submit your question via my.ncqa.org for further assistance.
 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 Quality Compass Release Dates 2022 What are the release dates for the Quality Compass 2022(MY2021) product lines?

The expected release dates for Quality Compass 2022(MY2021) are as follows:

    • Commercial – July 29th, 2022
    • Medicaid – September 30th, 2022
    • Medicare – October 28th, 2022
    • Exchange – November 2022 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 Quality Compass Medicare Include CAHPS Data Does the Medicare dataset include CAHPS data?

The Medicare product line does not include CAHPS survey results. We recommend contacting Centers for Medicare and Medicaid Services (CMS) if you are interested in obtaining Medicare CAHPS data.

 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 File Review Scope for NCQA-Accredited Health Plans seeking UM-CR-PN Accreditation How many files are reviewed in a UM-CR-PN Survey for Accredited Health Plans?

For UM Accreditation, 75 files are reviewed per product line.  For CR Accreditation, 75 initial credentialing files and 75 recredentialing files are reviewed. 

Note: For non-health plan organizations, 30 files are reviewed per product line.  

This applies to the following Programs and Years:
HP 2022, 2023|UM-CR-PN 2022

9.15.2022 Quality Compass Prior Year Data or Trended Data Does Quality Compass allow users to access prior year data or trended results?

Customers interested in accessing prior year data can choose to add up to three years of trended results to their Quality Compass purchase. For example, if you purchase Quality Compass 2022 (MY 2021), you can choose to add the trended data feature to access MY 2020 MY 2019 results.

It is important to note that not all data can be trended due to significant changes in the measure specifications. Quality Compass indicates when measures should be trended with caution or if there has been a break in trending and results should not be trended year-to-year. These trending determinations can be found on the Help tab within the Quality Compass tool or in the Volume 2 HEDIS technical specifications.

Access to the latest data year must be purchased annually.
 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 Quality Compass Exchange Product Does NCQA have Exchange data available on Quality Compass?

In 2022, NCQA will be releasing  Quality Compass Exchange data for the first time. Exchange data will be available outside of the Quality Compass tool via a data file delivered on NCQA’s Download Center. The data file will contain individual plan level performance and benchmarks (averages and percentiles) for Exchange plans. It will contain results for QRS measure indicators used in the QRS Scoring program only. The Exchange data file is available for purchase now and will be released in November 2022.
 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 Quality Compass Appearance Prior to Purchasing How can I see what Quality Compass looks like prior to purchase?

You can experience Quality Compass’ functionality by watching the demo videos available on the Quality Compass webpage (https://www.ncqa.org/programs/data-and-information-technology/data-purchase-and-licensing/quality-compass/). The demo videos walks viewers through some of the key features of Quality Compass as well as how to navigate the tool.

You can also request a walk-through live demo from the Information Products team. Please submit your request through your my.NCQA.org account or contact NCQA’s Customer Support team.
 

This applies to the following Programs and Years:
HEDIS MY 2022

9.15.2022 Invoice for Quality Compass How do I obtain an invoice to purchase Quality Compass?

If your organization needs an invoice prior to placing your order for Quality Compass, please reach out to our Information Products team by submitting a case through your my.NCQA.org account.
 

This applies to the following Programs and Years:
HEDIS MY 2021

9.15.2022 PCS Questions Do answers from the Policy Clarification Support system have an expiration date?

We recommend that organizations not use PCS responses that are over 3 years old. If a question relates directly to a measure specification or a general guideline that was revised from a previous measurement year, you should resubmit the question.

This applies to the following Programs and Years:
HEDIS MY 2023

9.15.2022 General Guideline 32: Medicare Socioeconomic Status Stratification Which measures does General Guideline 32: Medicare Socioeconomic Status Stratification apply to?

The Hemoglobin A1c Control for Patients With Diabetes measure should be removed from the measure list. The Plan All-Cause Readmissions measure should be added to the list. This clarification will be in the MY 2023 Technical Update.

This applies to the following Programs and Years:
HEDIS MY 2023

9.15.2022 Oral Evaluation, Dental Services (OED) The OED measure references the NUCC Provider Taxonomy Value Set to identify dental providers. Is this correct?

No. Replace “NUCC Provider Taxonomy Value Set” with “Dental Provider Value Set.” This correction will be in the MY 2023 Technical Update.

This applies to the following Programs and Years:
HEDIS MY 2023