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For Individuals: Becoming Certified to Perform HEDIS Compliance Audits

HEDIS Compliance Audits review whether organizations have capabilities for processing medical, member and provider information as a foundation for accurate and automated performance measurement. Audits help ensure accurate and reliable HEDIS data that can be used by employers, consumers and government to compare health plans.

Why become a certified HEDIS® Compliance Auditor?

All health plans that submit HEDIS data to NCQA must be audited every year—that means hundreds of HEDIS compliance audits. Only Certified HEDIS Compliance Auditors working for licensed health plans may complete HEDIS Compliance Audits, and must be sponsored by a licensed plan to become certified. Certified HEDIS Compliance Auditors are the only people allowed to complete HEDIS Compliance Audits. To earn this certification, you must be sponsored by a licensed organization.

For Individuals: How to Become a Certified HEDIS Compliance Auditor

  • Request an Application
    • Submit an inquiry through My NCQA. Select “HEDIS Audit” as the program type.
  • Review Handbook and Application
    • NCQA will send you the auditor requirements and an application to become certified auditor.
  • Submit Your Application
    • Submit your application to NCQA and pay your application fee. You must have a sponsor to apply. Individuals may not conduct audits unless they are employed by, or contracted with, a licensed HEDIS Compliance Audit organization.
  • NCQA Approves Your Application
    • NCQA will review your application, which usually takes about a week. If NCQA approves your application, you will sit for the exam at the next scheduled exam date and pay the exam fee. NCQA typically offers the exam twice a year. See the calendar.
  • Learn Requirements and Audit Process
    • Review the requirements NCQA sent to you, purchase HEDIS Volume 5, HEDIS Compliance Audit™: Standards, Policies and Procedures and work with your sponsor organization to learn the HEDIS Compliance Audit process.
  • Sit for Your Exam
    • The exam is a two-day process:
      • Day 1: Overview. NCQA conducts an overview of the HEDIS Compliance Audit program and methodologies in a half-day session.
      • Day 2: Take the exam. The exam is composed of conceptual and applied questions on HEDIS compliance audits and takes 4 hours.
      • Learn more about the exam.
    • Maintain Your Certification
      • You must be recertified every year to maintain certification and:
        • Participate in 2 audits per year.
        • Obtain 6 hours of continuing education credits.
        • Attend the auditor update conference every year.
        • Adhere to the Code of Professional Conduct.

There is a $2,100 annual fee to maintain certification.

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