FAQ Directory

An error was identified in the HEDIS MY 2024 Medication List Directory (released on April 1, 2024). For the Asthma Medication Ratio (AMR) measure, “package size” and “unit” are required to perform calculations. If we cannot find package size and unit for NDC codes, we cannot include the codes in the AMR medication lists. For the MY 2024 Update release of the MLD, an alternative method was used to identify package size and unit so more codes could be included in the medication lists. Because this method resulted in incorrect information, we removed these codes from 11 medication lists.

• Albuterol Medications
• Asthma Controller and Reliever Medications
• Beclomethasone Medications
• Budesonide Formoterol Medications
• Budesonide Medications
• Ciclesonide Medications
• Fluticasone Medications
• Fluticasone Salmeterol Medications
• Formoterol Mometasone Medications
• Levalbuterol Medications
• Mometasone Medications

Three medication lists were removed from the AMR measure.

• Fluticasone Furoate Umeclidinium Vilanterol Medications
• Salmeterol Medications
• Tiotropium Medications

Customers who purchased the HEDIS MY 2024 Medication List Directory should re-download the file from the My Downloads section of their My NCQA account. Customers who purchased a product that contains the AMR measure specification should delete the three medication lists, consistent with how changes from the technical update are applied.

This applies to the following Programs and Years:

No. Documents produced using the C-CDA standard are structured summaries or snapshots of information used to facilitate data exchange. They are not eligible as proof of service for HEDIS MY 2024, and should not be used for medical record review abstraction.  

This applies to the following Programs and Years:

For CM 7, Element E, organizations must verify the license of clinical staff only in states where they provide services to patients.

This applies to the following Programs and Years:

No. Plans that are responsible for both the Medicare and Medicaid components for dual-eligible members may select Medicare, Medicaid, or both, for Accreditation purposes. 

This applies to the following Programs and Years:

This applies to the following Programs and Years:

This applies to the following Programs and Years:

No. The requirement is that organizations verify Medicare sanctions from any of those sources, but there is no requirement to verify sanctions from all of them. 

This applies to the following Programs and Years:

NCQA will remove the RAND table from the Guidelines for Calculations and Sampling with the release of the HEDIS MY 2025 Technical Update on March 31, 2025. Future releases of the HEDIS Volume 2: Technical Specifications for Health Plans publication will not contain a RAND table.

Beginning MY 2025, NCQA will use an alternative timeline and approach to distribute RAND numbers for HEDIS reporting. This information will be released in the NCQA store for purchasers of HEDIS Volume 2 in the November before production of systematic samples for hybrid reporting (e.g., November 2025, for MY 2025).  

Organizations participating in NCQA’s Measure Certification program will receive separate guidance on how NCQA will accommodate this change for certification of systematic sampling logic.

This applies to the following Programs and Years:

This applies to the following Programs and Years:

No. Verification of sanctions and exclusions are not product line–specific requirements. For each practitioner in the scope of credentialing, the organization must verify Medicare and Medicaid sanctions regardless of the product line for which practitioners are contracted.

This applies to the following Programs and Years:

Example: During a new-patient office visit, the patient reports receiving a colonoscopy in the previous year to their primary care provider. During the discussion, the provider documents the details (when and where the procedure occurred, findings) in the office visit progress notes in the patient’s EHR.

This example represents the intent behind the HEDIS guidelines because:

• The provider collecting the information has the appropriate clinical experience to interpret what the patient is sharing and assumes clinical accountability for that aspect of the patient’s clinical care.
• The provider documents the colonoscopy in the patient’s medical record allowing it to be accessible to other care team providers and to the member for clinical decision making.

This applies to the following Programs and Years:

HEDIS Volume 2 provides guidance in several places:

• Member-reported services and biometric values general guideline.
  This general guideline states that member-reported services may be used only if collected by a primary care practitioner or specialist (if the specialist is providing a primary care service related to the condition being assessed, in the course of taking a member’s history), and if the information is included in the member’s health record.
• Supplemental data general guideline.
  Information on services reported by members often reside in non-standard supplemental sources. The supplemental data general guideline states that there must be evidence of provider accountability for the information documented. The guideline also states that documentation of member-reported services must be complete (e.g., date, place of service, procedure, prescription, test result or finding, practitioner type).
• Electronic Clinical Data Systems general guidelines.
  Organizations may develop workflows that result in documentation of member-reported services. A common example is documentation in systems identified as case management. The ECDS general guideline states that case management systems are shared, meaning that there is bidirectional access to the data. These data would be accessible to members and to members’ care teams for care coordination and planning.

This applies to the following Programs and Years: