FAQ Directory: HEDIS

Yes. Given the audit’s current and future importance, NCQA will use the HEDIS MY 2026 Technical Update to add program information to the Volume 2 publication.

This information resides in HEDIS Volume 5 and the Audit Program Code of Conduct. Adding it to Volume 2 enhances the information’s accessibility for all organizations participating in HEDIS.

Anticipate additional information in the following Volume 2 sections:  

NCQA HEDIS Compliance Audit Program Description

• References to the standardized HEDIS Compliance Audit methodology: All Licensed Organizations and Certified HEDIS Compliance Auditors use this method without deviation. All health plans reporting HEDIS are held to the same standards and requirements in HEDIS Volume 5. 
• References to the strict requirements for audit independence: All Licensed Organizations and auditors must avoid conflicts of interest, including perceived conflicts of interest, and are prohibited from providing technical assistance or advisory services to organizations that they audit. Noncompliance may result in revocation of licensure and certification status.

General Guideline: Preparing for the Audit

• A description of supplemental data validation: Information will summarize requirements and timing for all supplemental data sources undergoing validation. 
• A description of preliminary rate review: Information will summarize requirements for preliminary rate submission through the IDSS, and emphasize expectations for organizations to substantiate changes in performance rates.

HEDIS MY 2026