About measure certification
NCQA’s Measure Certification program validates organizations’ HEDIS®, “Align. Measure. Perform. (AMP)” and other quality measure logic used to calculate measure results or select eligible patients’ administrative or clinical data sources to ensure production of accurate results.
Accuracy is critical for health plans, provider organizations and other organizations that rely on quality measurement data to make decisions for quality reporting and inform value-based contracting. By earning NCQA Measure Certification, organizations know their measure logic has gone through the industry’s most rigorous assessment.
Who must be certified?
Organizations interested in offering a product or service using NCQA’s HEDIS measures or the Integrated Healthcare Association’s (IHA) AMP measures must first earn NCQA Measure Certification to demonstrate to partners and customers that coded measures meet current NCQA standards and produce accurate and comparable results.
Federal, state and other public-sector entities that use a third-party vendor to calculate HEDIS measure rates in their public-sector program may be required to use an NCQA-Certified vendor or have their selected vendor complete NCQA’s Measure Certification program.
Health plans that submit HEDIS measure rates to NCQA may contract directly with NCQA to certify their measure logic instead of using an NCQA-Certified vendor. Health plans and provider organizations that submit measure rates for the AMP program may contract directly with NCQA to certify their measure logic.
What certification programs are available?
- HEDIS Health Plan Certification. Certifies unadjusted HEDIS health plan measures. Vendors must be certified for all certifiable measures they report to NCQA. Entities that do not submit HEDIS data to NCQA, but use HEDIS measures and specifications in a commercial product or service, must be certified for all measures used. Organizations that earn Health Plan Certification also receive credit for HEDIS Allowable Adjustments Certification at no additional cost.
- HEDIS Allowable Adjustments Certification. Organizations that do not calculate HEDIS measures using health plan attribution (continuous enrollment) are eligible for this certification. Entities that do not submit HEDIS measure rates to NCQA, but use HEDIS measures and specifications in a commercial product or service, must be certified on all measures used.
- NCQA’s AMP Certification. Certifies IHA AMP measures. Vendors that submit AMP measure rates to IHA must be certified for all certifiable measures being reported to IHA.
- eCQM Certification. For more information on this program, visit the eCQM Certification program page. A custom commercial use license with NCQA is required for use of NCQA’s publicly available electronic clinical quality measures (eCQM).
- Save time.
- Certified measures are exempt from manual source code review during the HEDIS Compliance Audit® and the AMP Audit Compliance Review. Learn more about this benefit. Manual source code review will phase out in 2021. For reporting in 2022, plans and provider organizations that code their own measure logic must switch to an NCQA-Certified vendor in 2021 or contract directly with NCQA to certify their measure logic.
- Certification incorporates new HEDIS measures into the testing process, reducing time and resource use.
- Demonstrate accuracy to your customers. Measure certification helps ensure data integrity—vital to value-based and other contractual arrangements.
- Help customers become more efficient. Reduces the burden on health plans and other reporting organizations to verify accuracy of calculations.
- Become a more attractive partner. Display the NCQA seal to show customers that you are a trusted partner. Certified vendors are also listed on the NCQA website.
Find Certified Vendors
Health plans and other health care organizations can learn more about how to choose a vendor for HEDIS or AMP reporting or see a list of organizations that have earned NCQA Measure Certification.
Interested in becoming an NCQA-Certified vendor? Learn more about the process. The first step is completing an application and signing a certification agreement. Request an application through My.NCQA, select Ask a Question > PCS > Measure Certification as the product/program type.
HEDIS uncertifiable measures
Measures that are not eligible for certification under NCQA’s HEDIS Measure Certification program are noted below. Any external or commercial use of these measures requires a license and inclusion of the appropriate disclaimers.
- Measures Collected Through the Medicare Health Outcomes Survey
- Fall Risk Management
- Management of Urinary Incontinence in Older Adults
- Osteoporosis Testing in Older Women
- Physical Activity in Older Adults
- Measures Collected Through the CAHPS® Health Plan Survey
- Flu Vaccinations for Adults Ages 18–64
- Flu Vaccinations for Adults Ages 65 and Older
- Medical Assistance With Smoking and Tobacco Use Cessation
- Pneumococcal Vaccination Status for Older Adults
- Health Plan Descriptive Information
- Board Certification
Using certified vendors
Before accessing a NCQA-certified vendor’s product that uses or contains NCQA intellectual property, you must agree to NCQA’s End User License Agreement (EULA). The EULA will be provided to you by a:
- Certified vendor as a Direct Customer of the certified vendor.
- Direct Customer of the certified vendor as an Authorized User of the Direct Customer.
- Reseller of the certified vendor’s product as a Licensed User of the Reseller.
- Licensed User of a Reseller as a Participant of the Licensed User.
Direct Customers and Licensed Users will receive a slightly modified EULA from a certified vendor or Reseller, as applicable, that grants permission to provide access to (but not remarket, resell or license) the certified vendor’s product to third parties, whether affiliated or unaffiliated with the Direct Customer or Licensed User, termed “Authorized Users” or “Participants”, subject to passing through the slightly modified EULA to the Authorized Users or Participants. Direct Customers and Licensed Users are responsible for the acts and omissions of their Authorized Users and Participants, as applicable.
Authorized Users and Participants may not remarket, resell, distribute or license the certified vendor product to third parties.
The EULA may be modified or replaced on a going-forward basis and will be identified as the most recent version by the date. Please check NCQA’s website periodically for changes to the EULA; however, NCQA will attempt to notify all certified vendors if any material modifications are made. Some NCQA-Certified Vendors have been provided a slightly customized EULA. In these cases, all use of the certified vendors’ product by their end users shall be governed by the slightly customized EULA provided to the end user by the certified vendor, their Reseller, Direct Customer or Licensed User.