NCQA Data Quality Solutions

 

Standards‑based confidence for digital quality measurement

Trusted data is the foundation of credible quality improvement. NCQA Data Quality Solutions help organizations in making sure clinical data is accurate,  complete and fit for use earlier in the data lifecycle—ensuring it can reliably support HEDIS^® reporting and digital quality workflows.

Built on nationally recognized standards, these solutions enable automated, upstream data quality checks that reduce manual effort, preserve trusted rigor and support scalable digital measurement across interoperable data ecosystems.

With NCQA Data Quality Solutions, you can:

• Move data confidence upstream with standardized, automated checks.
• Preserve the rigor and trust built on decades of HEDIS quality measurement.
• Support digital quality measurement across modern, interoperable data pipelines.

NCQA Data Quality Solutions help establish confidence in clinical data earlier in the lifecycle, supporting more automated, scalable validation while preserving the rigor of Primary Source Verification (PSV).

Three Integrated Quality Offerings

NCQA Data Quality Solutions are designed as a modular, forward‑looking framework that strengthens data confidence across the ecosystem.

• HEDIS Data Quality Specifications: Delivers standardized rules and standards that define whether data is fit for quality use, enabling organizations to embed them directly into technology solutions or use as a reference framework.
• Prevalidation for HEDIS Data Quality Specifications (Coming Soon): Certifies that data quality rules embedded in technology solutions are implemented correctly, giving organizations confidence that automated data quality checks are functioning as intended.
• Validated Data Streams (Coming Soon) : Validates aggregated clinical data so organizations can trust its accuracy and know it is fit for use in HEDIS reporting.

Core Offering: Data Quality Specifications

The HEDIS Data Quality Specifications are the foundation of the Data Quality Solutions portfolio. They provide a consistent, repeatable approach to evaluating whether clinical data is complete, accurate, plausible and conformant—ensuring it is truly fit for HEDIS and digital quality workflows.

Designed to integrate directly into existing tools and data pipelines, the specifications support automated, upstream validation that helps organizations identify and resolve data quality issues earlier. Our flexible licensing options enable vendors to embed the specifications for commercial use, while enterprise organizations can integrate them into their existing workflows to strengthen internal data and prepare for digital reporting.

 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.

Improve Data Integrity Upstream

Catch errors before they reach reporting or analytic systems.

Reduce Manual Effort

Standardized rules help automate QA processes and decrease time‑consuming rework.

Accelerate Digital Transformation

Support FHIR®, digital measures and interoperability initiatives with authoritative guidance.

Build Trust & Readiness

Strengthen confidence across partners and stakeholders with a transparent, repeatable approach to data validation.

Part of a Trusted Data Quality Ecosystem

NCQA Data Quality Solutions are designed to complement—not replace—the HEDIS® Compliance Audit and Data Aggregator Validation program. The audit remains a critical safeguard to ensure HEDIS results are reliable, comparable and suitable for benchmarking across organizations.

As standardized FHIR® data and digital quality measurement continue to mature, NCQA will incorporate more automation into audit processes over time, helping reduce manual burden while preserving the rigor and consistency the industry depends on.