NCQA Data Quality Solutions
A Shared, Standards-based Approach to Know When Data is Fit for HEDIS®
Most data quality issues are not uncovered until late in the process—during reporting, audit or submission—when fixes are costly and disruptive to address.
NCQA Data Quality Solutions help organizations determine whether clinical data are fit for use earlier in the data lifecycle, so they can be trusted for HEDIS, digital quality measurement, analytics and real‑world decision making.
Built on nationally recognized standards, our solutions bring automated, upstream data quality checks into modern, interoperable data pipelines—reducing manual effort while preserving the rigor the industry relies on.
The problem
Why Data Quality Still Breaks
Despite significant investment in data and technology, the same persist across the ecosystem.
No shared definition of “fit-for-use” data.
“Good data” means something different to everyone. Without a shared, measurable standard, organizations struggle to determine when data can be trusted —leading to inconsistency, rework and unreliable results as data moves across systems.
Data quality issues are discovered too late.
Data problems often surface during reporting or audit, after workflows have already been disrupted and risk introduced. Late discovery dramatically increases cost and effort compared to identifying issues upstream.
Data quality isn’t continuously monitored.
For most organizations, data quality checks are performed retrospectively instead of embedded into workflows. Without ongoing monitoring, issues go undetected until they impact performance.
Manual processes don’t scale.
One‑off checks and manual reviews require constant rework, creating operational burden and limiting progress towards digital measurement as data volumes grow.
Lack of trust limits use.
When teams don’t trust the data, they don’t use it. Uncertainty undermines confidence in reporting, analytics, payment models and decision‑making—leading to second‑guessing and stalled progress.
Teams act on the wrong signals.
False gaps are chased, real issues are missed, and organizations lack reliable data to manage patients and improve outcomes.
How it works
What NCQA Data Quality Solutions Do
NCQA Data Quality Solutions establish a consistent, repeatable way to determine whether clinical data are fit for use before they are leveraged in reporting, analytics or care workflows.
What NCQA Data Quality Solutions Do
NCQA Data Quality Solutions establish a consistent, repeatable way to determine whether clinical data are fit for use before they are leveraged in reporting, analytics or care workflows.
With NCQA Data Quality Solutions, organizations can:
Define “fit for use” data using standardized specifications aligned to HEDIS.
Identify issues earlier through automated, upstream data quality checks.
Monitor data quality across workflows, not just at a single point in time.
Reduce manual effort and rework through consistent, repeatable validation.
Support digital quality measurement across FHIR® based and interoperable systems.
How It Works
The HEDIS Data Quality Specifications provide a standardized way to evaluate whether electronic clinical data are complete, valid and fit-for-use across quality measurement, reporting and care use cases.
Each specification applies consistent, pass/fail quality checks to targeted clinical data—such as labs, immunizations, conditions and medications—based on clearly defined expectations. Results show how often a data source meets requirements across key dimensions of data quality, including completeness, conformance, accuracy, plausibility and timeliness.
Apply standardized pass/fail checks to electronic clinical data to determine whether it is fit for use and improve confidence in HEDIS results and downstream analytics.
Supporting a Data Quality Lifecycle
Rather than discovering issues at the end of the process, standardized checks are applied earlier and continuously, allowing organizations to address problems before they affect performance, reporting or decision‑making.
The result is greater confidence in the data powering HEDIS measurement, analytics and downstream clinical and operational use.
A Path to Trusted Data
NCQA Data Quality Solutions are designed as a modular framework that strengthens data confidence across the ecosystem.
HEDIS® Data Quality Specifications — Determine Fit for Use Data
Build standardized data quality checks directly into technology platforms or data pipelines using HEDIS Data Quality Specifications. These rules create a shared, transparent definition of what “fit for use” means for HEDIS and digital quality workflows.
Software Prevalidation — Assess How Systems Apply the Specifications
Prevalidate that technology solutions are implementing data quality checks consistently and correctly before data are used downstream—building confidence in how automated validation operates before data is used downstream.
Evaluate whether aggregated clinical data streams meet the standard in practice, supporting confidence in their use for reporting, analytics and care.
Now in Beta: HEDIS Data Quality Specifications
The HEDIS Data Quality Specifications provide a consistent, repeatable way to evaluate whether clinical data are complete, accurate, plausible and conformant—so teams know when data are truly fit for HEDIS and digital quality use.
Designed to integrate into existing tools and data pipelines, the specifications support automated, upstream data quality checks that help organizations identify and resolve issues earlier.
Flexible licensing supports both:
- Vendors, embedding the specifications commercially, and
- Enterprise organizations, integrating them into internal workflows to prepare for digital measurement.
What’s Included
- Over 100+ data quality checks spanning completeness, conformance, plausibility, accuracy and timeliness.
- Alignment with HEDIS Volume 2 value sets for consistency across clinical concepts.
- Patient-level test data and a score key to support implementation, validation and real-world scenario testing.
- Support for both in-flight and at-rest data, enabling use across pipelines and at scale.
- Annual updates to maintain consistency with HEDIS and digital quality standards.
Join the Beta Program
Be among the first organizations to implement standardized, upstream data quality checks aligned to HEDIS and digital quality measurement.
Become a beta participant and help shape the future of data quality.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
