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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10.15.2017 ECDS How do vendors get the ECDS technical specifications for the submission file format?

HEDIS ECDS technical specifications are available in the NCQA store in PDF format: http://store.ncqa.org/index.php/catalog/product/view/id/2822/s/hedis-2018-volume-2-measures-for-electronic-clinical-data-systems/. They are also available in HEDIS 2018 Technical Specifications for Health Plans, which can be purchased at the NCQA store.

Complete digital measure packages for HEDIS ECDS measures will be available for download at a future date.

HEDIS 2018

10.15.2017 ECDS If case management information resides solely within the plan and is not shared with the PCP, may it be used as a supplemental data source for the numerator?

Case management data that are available to the PCP on request meet the requirement for use in ECDS reporting.

Supplemental data may not be used for any part of an ECDS measure unless it meets all ECDS requirements.

HEDIS 2018

10.15.2017 ECDS Must measures be audited for public reporting, or may unaudited data be reported?

Measures using the ECDS reporting method must be audited before being approved for use in a NCQA program. Measures in the HEDIS domain that use the ECDS reporting method have not yet been approved for use in any NCQA program at this time.

HEDIS 2018

10.15.2017 ECDS For IP-ECDS coverage, does NCQA look for the number of members in the initial population?

IP-ECDS coverage count includes all members in the initial population who are being managed by at least one provider with the capacity to send, receive and use electronic data for quality improvement purposes.The Initial Population includes all members (covered and not covered by ECDS) who are identified as eligible for the measure reported by the data source category used to determine eligibility.

HEDIS 2018

10.15.2017 ECDS May we use claims for ECDS reporting?

Administrative claims are considered an ECDS data source if the payment system is automated and data are accessible by the practitioner/practitioner group that is accountable for clinical services provided to plan members (e.g., if claims are used to identify an inpatient stay, the primary care provider must be able to access the details of the stay). Report all measure results identified by claims in the “Administrative claims” source system of record (SSoR) category.

HEDIS 2018

10.15.2017 Breast Cancer Screening, Colorectal Cancer Screening, Controlling High Blood Pressure, and Osteoporosis Management in Women Who Had a Fracture The Medicare Monthly Membership File includes a run date and a payment date. Which date should be used to determine that a member had an LTI flag during the measurement year?

Use the run date to determine that a member had an LTI flag during the measurement year.

HEDIS 2018

10.15.2017 ECDS Will ECDS measures be used for Health Plan Accreditation or ratings?

ECDS measures are currently not approved for public reporting by NCQA, and are not eligible for use in HPA or health plan ratings. All measures must be approved for public reporting by the Committee on Performance Measurement (CPM) before they can be considered for inclusion in an NCQA program.

HEDIS 2018

10.15.2017 ECDS What file formats are acceptable for transmitting data between the plan and the care team at the point of service?

NCQA does not specify file formats for exchanging clinical information, but strongly encourages adherence to Health Level Seven International (HL7) standards for clinical document exchange (e.g., QRDA, CCD) and electronic health care information exchange (e.g., FHIR).

HEDIS 2018

10.15.2017 ECDS How are ECDS measures different from the eMeasures in Meaningful Use?

HEDIS ECDS and eClinical Quality Measures (eCQM) developed for Meaningful Use are specified using the same data standards. eCQMs are specifically designed to use data extracted from an EHR, and HEDIS ECDS measures use multiple data sources to complete the picture of member experience across the care continuum.

HEDIS 2018

10.15.2017 Children With Chronic Conditions When assessing Prescreen Status Code criteria, does the visit code and diagnosis code have to be on the same claim?

Yes; because the Prescreen Status Code criteria requires a code to be in conjunction with another code, the codes must be on the same claim (claims on the same date of service cannot be combined to meet criteria).

HEDIS 2018

10.15.2017 Unhealthy Alcohol Use Screening and Follow-Up In the updated measure specification that was released with the HEDIS 2018 Volume 2 Technical Update, the Data Elements table includes a stratification for ages 44-64. Should this age stratification be 45-64?

Yes. The correct age stratifications are 18-44, 45-64, 65+.

HEDIS 2018

10.15.2017 ECDS Does the denominator only include plan members covered by ECDS who are in the initial population?

Yes. The denominator should be all members covered by ECDS who do not meet exclusion criteria.

HEDIS 2018