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.
NCQA considers the following standards to be a delegation relationship if an organization uses a mail service organization to meet the distribution requirements:
MBHO 2023
Plans can have multiple ratings for one product within the same state because they might have certain state or contractual submission requirements that fall outside of the combined submission requisite that they send to NCQA for Accreditation purposes. Therefore, this results in plans submitting one combined submission (required) for Accreditation and then they still elect to select other submissions for state or other contractual obligations, which NCQA includes as part of its Ratings program.
HPR
We need you to confirm your plan details (e.g., Accreditation status, State Coverage, Family Association, Organization ID, Submission ID) because this impacts how you will be listed publicly when we release HPR on or around September 15, regardless of your Accreditation status or Public Reporting decision.
HPR
NCQA’s Health Plan Report Card has some information regarding this in the Glossary page and can be found here: https://reportcards.ncqa.org/glossary. Also, we have ECDS page which can be found here: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.
HPR
We use your Accreditation status as of June 30 for display purposes and to calculate bonus points. If a plan has an NCQA status modifier (e.g., Under Review by NCQA, Under Corrective Action, Merger Review in Process, Appealed by Plan) as of June 30, it will be appended to the Accreditation status. Display options during the Plan Confirmation, Projected Ratings and Final Ratings releases are: Yes; Yes (Interim); Yes (Provisional); Yes – CAP; Yes (Interim) – CAP; Yes (Provisional) – CAP; Yes – Under Review by NCQA; Yes (Interim) – Under Review by NCQA; Yes (Provisional) – Under Review by NCQA; No; No (Scheduled); No (In Process).
Accreditation status display options for the public release of the Ratings on NCQA's Health Plan Report Card website on September 15 are: Accredited; Not Accredited; Accredited – Interim; Accredited – Provisional; Accredited – Under Review by NCQA; Under Corrective Action; Scheduled; In Process; Expired; Denied.
HPR
NCQA’s HPR overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS (Medicare only) measure ratings, plus Accreditation bonus points (if the plan is Accredited by NCQA), rounded to the nearest half point displayed as Stars. Dozens of measures are calculated on a 0–5 scale in half-points (5 is highest) by comparing the plan submitted rate to The National All Lines of Business 10th, 33.33rd, 66.67th and 90th measure benchmarks.
HPR
For HPR, NCQA inverts all final rates and percentiles where a lower value represents better performance to a higher value represents better performance scale in the HPR scoresheets and then truncates to 3 decimals. For example, a raw rates of .2325 would display as .767 (1-.2325 = .7675, truncated at 3 decimals).
HPR
Please go to the 2023 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2023/), where you’ll find our Marketing Guidelines (once they're posted) for how you can market your plans’ scores.
HPR 2023
