For Organizations: Becoming Licensed 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. These audits help ensure accurate and reliable HEDIS data that can be used by employers, consumers and government to compare health plans.

Why become licensed to perform HEDIS audits?

All organizations that submit HEDIS data to NCQA must be audited every year—that means thousands of HEDIS compliance audits. Only Certified HEDIS Compliance Auditors working for licensed organizations may complete HEDIS Compliance Audits, and must be sponsored by a licensed organization to become certified.

Process: Becoming Licensed

  • Request an application
  • Review Handbook and Application
    • NCQA will send you the handbook and application. Review them to make sure you meet requirements. Purchase HEDIS Volume 2 and 5 for background information on HEDIS and the HEDIS audit.
  • Submit the Application and Pay the Application Fee
  • NCQA Reviews the Application
    • NCQA determines whether you are eligible to be a licensed organization. This usually takes 2–3 weeks.
  • Pay the Final Fee and Earn Your License
    • If NCQA approves your application, pay your license fee and become a licensed organization! You will be listed on NCQA’s website. Certified auditors working with your organization can complete HEDIS Compliance Audits.
  • Maintain Your License
    • Maintain a practice leader (must be a Certified HEDIS Compliance Auditor).
    • Employ or contract with 1 other Certified HEDIS Compliance Auditor.
    • Perform audits and stay in good standing with NCQA.
    • Renew your license every year.
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