FAQ Directory

As long as you submit scorable rates for at least 50% of the HPR measures by weight, we will calculate and display your measure rates and a numerical overall Star rating (1-5) on the September 15 release of HPR on the NCQA Health Plan Report Card.

This applies to the following Programs and Years:

NCQA's Health Plan Ratings will be publicly displayed on or around September 15 at NCQA's Health Plan Report Card, which can be found here: https://reportcards.ncqa.org/health-plans. 

This applies to the following Programs and Years:

Please go to the 2024 Health Plan Ratings website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2024/), where we outline our Marketing Guidelines. Please note that this document is updated annually no later than early September. 

This applies to the following Programs and Years:

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.

This applies to the following Programs and Years:

HPR uses the prior year Medicare CAHPS data so NCQA will use the corresponding sub ID, therefore, could differ from the Medicare plan's CAHPS sub ID of the HPR release year. 
 

This applies to the following Programs and Years:

Access is controlled by the plan’s Primary HEDIS Contact, who can grant access through the “Manage Users” section of the sites. Please contact this individual at your organization to request access.

This applies to the following Programs and Years:

NCQA currently maintains prior year HPR scores here: https://reviewratingsfinal.ncqa.org. You can also purchase the HPR detailed results file which lists plan’s overall rating, composite, subcomposite and measure level scores: https://store.ncqa.org/other-products/health-plan-rankings.html

This applies to the following Programs and Years:

• "1” = Process measures (e.g., screenings, visits)
• “1.5” = Patient experience measures (CAHPS)
• “3” = Outcome and intermediate outcome measures (e.g., HbA1c Control, Blood pressure control)

This applies to the following Programs and Years:

NCQA currently does not rate Exchange plans for Health Plan Ratings/Health Plan Accreditation (HPR/HPA). This is primarily because CMS has their own Quality Rating System (QRS), and NCQA has to receive special permission from CMS to use the data for our Accreditation program. NCQA is actively participating in these discussions, and any changes to this policy will be communicated to all organizations in a timely manner.

This applies to the following Programs and Years:

Your overall rating will be “Partial Data Reported” and your measure rates will be displayed as “NC” (No Credit) on the September 15 release of HPR on the NCQA Health Plan Report Card.

This applies to the following Programs and Years:

HPR truncates final raw rates and percentiles to 3 decimals, so if your IDSS workbook shows 78.47, HPR will show the raw rate of .784 (truncated at 3 decimals).

This applies to the following Programs and Years:

NCQA defines “state coverage” as the states where a plan is licensed to operate. Plans that submit HEDIS/CAHPS data provide this information each year during the HOQ process. If plans do not submit these data, NCQA uses state licensing and membership data provided for Accreditation or gathered from external sources.

This applies to the following Programs and Years: