Audit Process

The Audit

As part of the Annual Reporting process, NCQA audits a sample of practices (by specific criteria or at random) to validate evidence, procedures, attestations, and other responses in their Q-PASS submission.

Practice sites selected for Recognition Audit are notified and emailed instructions. The first level of review is verification of the Q-PASS submission. The practice may be asked to forward copies of source documents and explanations to substantiate information in the submission.

NCQA notifies the practice of audit findings and Recognition status within 30 days of the audit’s conclusion.

Before Audit

  • The practice receives initial notification of the Recognition Audit in the Submission Wizard after submitting, on the organization dashboard, with an “Audit” banner, and via email.
  • Practices must acknowledge the audit, upload evidence and schedule a virtual audit review within 3–10 business days of the notification date.
  • The Annual Reporting submission is placed on temporary hold. Practices receive a 90-day extension to allow time to complete Annual Reporting without a lapse in Recognition.
  • Failure to agree to a Recognition Audit may result in denial of Recognition.

During Audit

  • The Recognition Audit is virtual and is conducted via Zoom.
  • The audit involves a demonstration of the practice’s processes as they relate to PCMH standards.
  • Any component may be selected for audit, based on the practice’s submission. All data should be within the past 12 months of the reporting date.
  • The person who has access to the practice’s Q-PASS account and the person who is most knowledgeable about the practice’s systems and processes should be present.
  • The entire process takes around 2 hours, depending on the criteria selected for audit.

After Audit

  • The practice receives Recognition Audit results after the audit is completed.
  • A practice that does not meet core criteria during the audit has the opportunity to upload corrected evidence and schedule a second review within 30 days of notification of results.
  • A practice that does not update its submission within 30 days notification of results loses Recognition status.
  • Failure to pass an audit may result in denial of Recognition.
  • The practice has the option to restore Recognition status through an accelerated “transform” process within 12 months of its initial reporting date; after that period, it must submit for the full transformation process as if seeking Recognition for the first time.
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