FAQ Directory

Yes. Using UM 13: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 13, Element A: Delegation Agreement

• Factor 3 (semiannual reporting): This factor is NA for mail service organization delegates that only perform annual distribution (e.g., UM 11, Element B (annual updates for pharmaceutical restrictions/preferences).
  • Note: Factor 4 (performance monitoring): Annual distribution must be specified as part of the organization’s process for monitoring delegate performance, if applicable.
  • Factor 3 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).
• Factor 5 (process for providing member experience and clinical performance data to delegates when requested): This factor is NA for mail service organization delegates.

UM 13, Element C: Review of the UM Program

• Factor 1 (annual review of delegate’s UM program): This factor is NA for mail service organization delegates.
• Factor 4 (semiannual evaluation of reports): This factor is NA for mail service organization delegates that only perform annual distribution.
  • Factor 4 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).

Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.
 

This applies to the following Programs and Years:

Yes. Using UM 12: Delegation of UM as an example, the following describes factors that would be considered NA:
UM 12, Element A: Delegation Agreement

• Factor 3 (semiannual reporting): This factor is NA for mail service organization delegates that only perform annual distribution
  • Note: Factor 4 (performance monitoring): Annual distribution must be specified as part of the organization’s process for monitoring delegate performance.
  • Factor 3 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).
• Factor 5 (process for providing member experience and clinical performance data to delegates when requested): This factor is NA for mail service organization delegates.

UM 12, Element C: Review of the UM Program

• Factor 1 (annual review of delegate’s UM program): This factor is NA for mail service organization delegates
• Factor 4 (semiannual evaluation of reports): This factor is NA for mail service organization delegates that only perform annual distribution.
  • Factor 4 is not scored NA for distribution that occurs more frequently than annually (e.g., denial and appeal notices).

Note: Factor 2 (annual audits): This factor is not scored NA, but the organization may submit the delegate’s timeliness report of mail distribution in lieu of an audit. This must be specified in the delegation agreement.

This applies to the following Programs and Years:

The Statin Therapy for Patients With Cardiovascular Disease (SPC) and Statin Therapy for Patients With Diabetes (SPD) measures include an exclusion for members with myalgia, myositis, myopathy or rhabdomyolysis during the measurement year. However, an allergy or history of an intolerance to a statin medication is not considered an exclusion for the measure.  
The general guidance NCQA received from our experts, as well as guidance from the American College of Cardiology , is that patients with atherosclerotic cardiovascular disease should be rechallenged on lower statin doses and alternative statins before being put on non-statin therapies (e.g., PCSK-9 inhibitors) due to statin intolerance. The decision-making process might vary from case to case. Although we incorporated exclusions for muscle-related statin side effects, we acknowledge that the measure may not address all instances of true statin intolerance. We will consider all feedback on this issue, while also ensuring that changes to the measure are valid, scientifically sound and true to the measure's intent (to measure the quality of cardiovascular care provided at the population level).

This applies to the following Programs and Years:

No. Members who die during the measurement year must be removed from all applicable measures. For episode-based measures, a member who died during the measurement year must be removed for all events (even if they meet numerator criteria for an event).

This applies to the following Programs and Years:

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:

No. NCQA does not accept future dates of program completion as valid verification of completion of education and training.

This applies to the following Programs and Years:

No. The Roadmap is due January 31. All sections must be submitted by this date. The “March 1” date for Sections 5 and 5a is meant to account for the rare occasion where a supplemental data source is identified after the January 31 deadline and must be considered for audit. These sources must be identified no later than March 1, with a completed Roadmap section. This should be the exception, not the standard process.

This applies to the following Programs and Years:

Yes. Use the race/ethnicity value sets and direct reference codes in Tables RES-C-1/2/3 and RES-D-1/2/3 (in General Guideline 31) to report the RDM measure. This clarification will be in the MY 2023 Technical Update.

This applies to the following Programs and Years:

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:

No. A correction will be in the MY 2023 Technical Update. The Ages section in the Eligible Population should read as follows:
Members who were 3 months of age or older as of the Episode Date. Report three age stratifications and a total rate:

• 3 months–17 years.
• 18–64 years.
• 65 years and older.
• Total.

The total is the sum of the age stratifications.

This applies to the following Programs and Years:

You can contact the Information Products team for assistance in expanding your permissions to meet your data usage needs. This includes any changes to the amount of data being shared (number of indicators) and how/with who the data is being shared with (internally for quality analysis purposes, external reporting on a brochure, email broadcast, website, blog) or commercial use of the data.
 

This applies to the following Programs and Years:

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: