FAQ Directory: HEDIS

The State of Healthcare Report includes data that is publicly available on the NCQA site. It contains national averages based on the prior measurement year and is updated once a year. The State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
To get access to the most recent data as well as additional data points such as plan level performance and percentiles check out Quality Compass. at this link:

https://www.ncqa.org/programs/data-and-information-technology/data-purchase-and-licensing/quality-compass/

If you would like to discuss Quality Compass further, please reach out to our Information products team by submitting a case through your my.NCQA.org account.
 

HEDIS MY 2021

Quality Compass is priced according to the number of users, years of trended data, and whether your organization needs access to the Data Exporter feature. The cost breakdown is available on our pricing table on the NCQA Store .
 

HEDIS MY 2021

Yes. The Residential Program Detoxification Value Set and codes will be included in the Update release of the Value Set Directory on March 31, 2023. The OID for the value set is 2.16.840.1.113883.3.464.1004.2408, and it includes two HCPCS codes:

• H0010     Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) (H0010)
• H0011   Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) (H0011)

HEDIS MY 2023

In step 1 identify all children in the specified age range who were dispensed an ADHD medication during the 12-month Intake Period. This clarification will be in the MY 2023 Technical Update.

HEDIS MY 2023

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.

HEDIS MY 2023

If your organization needs an invoice prior to placing your order for Quality Compass, please reach out to our Information Products team by submitting a case through your my.NCQA.org account.
 

HEDIS MY 2021

The Medicare product line does not include CAHPS survey results. We recommend contacting Centers for Medicare and Medicaid Services (CMS) if you are interested in obtaining Medicare CAHPS data.

HEDIS MY 2021

Customers interested in accessing prior year data can choose to add up to three years of trended results to their Quality Compass purchase. For example, if you purchase Quality Compass 2022 (MY 2021), you can choose to add the trended data feature to access MY 2020 MY 2019 results.

It is important to note that not all data can be trended due to significant changes in the measure specifications. Quality Compass indicates when measures should be trended with caution or if there has been a break in trending and results should not be trended year-to-year. These trending determinations can be found on the Help tab within the Quality Compass tool or in the Volume 2 HEDIS technical specifications.

Access to the latest data year must be purchased annually.
 

HEDIS MY 2021

Quality Compass is NCQA’s interactive database containing individual plan performance results for HEDIS® and CAHPS® measures, as well as benchmark data at the national, regional (Census, HHS) and state levels. It reports individual plan data from plans that chose to publicly report their performance results. Benchmark results comprise all plan data submitted to NCQA, regardless of reporting status.
NCQA Health Plan Ratings (HPR) is a separate method of evaluating and distributing information related to health plan quality and performance. It assesses and reports plan performance in several domains. The goal of HPR is to give plans a scale to assess their current operating status, to help ensure quality. HPR provides consumers with information that helps them select a high-quality health plan that suits their needs.
NCQA’s Health Plan Ratings 2022 assesses commercial, Medicare, and Medicaid health plans. The overall rating is the weighted average of a plan’s HEDIS® and CAHPS® measure ratings, plus bonus points for plans with a current Accreditation status. Please visit our HPR website (https://www.ncqa.org/hedis/reports-and-research/ncqas-health-plan-ratings-2022/) to learn more.
 

HEDIS MY 2021

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.
 

HEDIS MY 2021

If you do not need access to all the data results available within Quality Compass, you can request a custom data extract. Pricing for data extracts start at $2,500 and are determined by the amount of data requested and the client’s use case.

You can obtain a custom quote by reaching out to the Information Products team and completing a data request form that details your data needs and requested permissions.
 

HEDIS MY 2021

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.

HEDIS MY 2023