NCQA is aware of the impact COVID-19 is having across the country. We are actively monitoring the risk because every day seems to bring new developments.

Updated: April 6, 2020
Posted: March 13, 2020
See also: Main NCQA COVID updates.

We realize that the virus may affect your operations, audits and the availability of documentation needed to meet HEDIS® program requirements.

NCQA realizes also that COVID-19 might have an effect on the HEDIS hybrid measures and the ability to collect medical record data because of imposed travel bans, quarantines and risk to staff. NCQA recommends using caution and limiting travel to ensure the safety of your employees and business partners. When possible, organizations should continue to use medical record procurement processes that do not require travel, including virtual/online reviews and fax/mail. We informed HEDIS auditors that they may conduct site visits remotely, and we recommend that auditors work with their clients to determine how best to conduct upcoming audits.

For commercial and Medicaid plans reporting to NCQA, for measures reported using the hybrid methodology only, we will allow plans to report their audited HEDIS 2019 hybrid rate if it is better than their HEDIS 2020 hybrid rate as a result of low chart retrieval. [Updated April 6: See COVID FAQs for clarification about low chart retrieval.]  If you choose to submit your HEDIS 2019 hybrid rate for a hybrid measure, work with your auditor to ensure that the rate is accurately reported in IDSS. No exceptions are being made for administrative rates which should be reported following HEDIS 2020 reporting requirements.

For plans in states with mandatory HEDIS reporting requirements, we recommend states allow the use of HEDIS 2019 rates if the plan has a low chart retrieval rate. [Updated April 6: See COVID FAQs for clarification about low chart retrieval.] We are communicating this recommendation directly to state Medicaid leadership as well. Additional guidance is forthcoming regarding Medicare health plans and commercial plans reporting for the Health Insurance Exchange Quality Ratings System. [Update: CMS’ Medicare guidance was received and incorporated into NCQA policy changes Friday, April 3.] We will keep you informed as we learn more.

If you have any questions, please contact us through My NCQA. Log in and select My Questions > Ask A Question > PCS > Product/Program Type: HEDIS  > General Content Area: COVID-19. 

Thank you,

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