Yes. There were two previously posted FAQs that have been recently updated. One FAQ was posted in September and the second was posted in November. Both FAQs were updated and can be found on the FAQ page with the date of 12.3.2021.
HEDIS MY 2021
FAQ Directory: HEDIS
Filter Results
- Save
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
Save your favorite pages and receive notifications whenever they’re updated.
You will be prompted to log in to your NCQA account.
- Email
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
Share this page with a friend or colleague by Email.
We do not share your information with third parties.
- Print
Print this page.
Print this page.
12.15.2021 Updated FAQs Were there previously posted FAQs that have been updated?
12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?
Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.
Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:
Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297
Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411
HEDIS MY 2022
12.03.2021 Guidelines for Calculations and Sampling: Hybrid Measures How should exclusions be applied when found during an administrative data refresh for hybrid measures?
Per General Guideline 32, there are two ways to apply exclusions after samples have been pulled and chart review has begun. Because the sample must be reproducible, the members remain in the eligible population but are removed from the sample and reflected in the denominator. Organizations should indicate the exclusions by reporting them as the number of administrative data records excluded. When the population is larger than the MRSS, replace those members with members from the oversample.
Remember that the denominator is used to calculate and report the measure. All exclusions and replacements are reflected in the denominator calculation. The following are examples:
Example 1:
Eligible population = 300
MRSS = 300
Oversample Rate = 0%
Oversample Records Number = 0
Number of administrative data records excluded = 3
Oversample Records Added = 0
Denominator = 297
Example 2:
Eligible population = 5,800
MRSS = 411
Oversample Rate = 5%
Oversample Record Number = 21
Number of administrative data records excluded = 11
Oversample Records Added = 11
Denominator = 411
HEDIS MY 2021
12.03.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?
The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.
Note: This re-issued FAQ only applies to MY 2022 reporting.
HEDIS MY 2022
11.15.2021 NCQA DAV Data May organizations use NCQA-validated data resulting from Data Aggregator Validation (DAV) as standard supplemental data when reporting HEDIS measures?
Yes. NCQA DAV data may be used as standard supplemental data if the auditor receives a completed current year’s Roadmap Section 5 from the reporting entity using the data. The Roadmap must explain how data from the validated DAV entity is transferred to the reporting entity and what the entity does to the data. The Roadmap is completed by the health plan; no documentation is required from the DAV entity except for the final list of validated ingestion sites and clusters, along with the date they were approved. If the reporting entity processes the validated CCD in any way after receipt, the auditor must validate the file back to the original validated CCD to ensure that no data were changed.
If an NCQA-validated DAV entity includes data from an unvalidated data cluster, the auditor must validate that data, following the nonstandard supplemental data guidelines, before the data can be used for HEDIS reporting. The auditor may not perform PSV on any validated data files.
The NCQA DAV data definition will be included in General Guideline 31 for MY 2022.
HEDIS MY 2021
11.15.2021 General Guideline 18: Deceased Members How should we apply the “deceased members” exclusion in General Guideline 18: Deceased Members for episode-based measures?
The guideline for deceased members (General Guideline 18) is a member-level exclusion. For episode-based measures, if one event does not meet numerator criteria, and the organization chooses to use this optional exclusion, remove all member events/episodes from the measure.
HEDIS MY 2021
11.15.2021 Comprehensive Diabetes Care If medical record documentation indicates that an eye exam result is “unknown,” does this qualify as a result when reporting the eye exam indicator of the CDC measure or the EED measure?
11.15.2021 Comprehensive Diabetes Care If medical record documentation indicates that an eye exam result is “unknown,” does this qualify as a result when reporting the eye exam indicator of the CDC measure or the EED measure?
10.15.2021 General Guideline 32: Obtaining Information for the Systematic Sample Should the number of numerator events by administrative data in the eligible population (before exclusions), the number of required exclusions and the current year’s administrative rate (before exclusions) data elements change with a data refresh after the sample has been drawn?
10.15.2021 Transitions of Care The TRC measure includes a summary of change (SOC) to indicate that it the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC text that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table TRC-3: Data Elements for Transitions of Care to ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.
HEDIS MY 2022
10.15.2021 Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents The WCC measure includes a summary of change (SOC) to indicate that the value is stratified. Should this be removed from the SOC?
Yes. Remove the SOC that reads, “Revised the Reporting Instructions for the ‘NumeratorByAdminElig’ data element in Table WCC-1/2 to read ‘For each Metric and Stratification.’” Organizations reported “NumeratorByAdminElig” by age stratification in the past, so this is not a change to the measure for MY 2020 & MY 2021 reporting.
HEDIS MY 2022