- Due to COVID-19, NCQA will not release 2020–2021 Health Plan Ratings for any product line. See our COVID-19 resource page for more information (Updated April 16, 2020)
- Changes to the 2020 WHP Standards and Measures (Updated September 17, 2019)
- Changes to NCQA Accreditation Standards for 2019 and 2020 Standards Years (July 9, 2019)
- Changes to NCQA Accreditation and Certification Standards for 2018 and 2019 (June 26, 2018)
- Modifying NCQA Requirements in Response to Hurricanes and other Natural Disasters (September 7, 2017)
- Utilization Management: Changes to UM 4, Appropriate Classification of Denials; the Future of Utilization Management (July 31, 2017)
- Changes to NCQA Accreditation and Certification Standards for 2016 and 2017 (March 27, 2017)
Corrections, Clarifications and Policy Changes
NCQA makes updates or clarifications to Standards & Guidelines several times per year, as needed. Review the corrections, clarifications and policy changes to the most recent Standards and Guidelines for NCQA programs and incorporate them into your implementation processes.
Resources and Supplemental Documents
- Benchmarks and Thresholds: National benchmarks and national and regional thresholds for HEDIS® measures and HEDIS/CAHPS® 5.0H survey results.
- HEDIS Measures for Accreditation: HEDIS Measures for Accreditation 2020 scoring
- Accredited commercial and Medicaid plans must still submit the required HEDIS and CAHPS measures in order to meet annual reporting requirements; however, organizations will not be rated on measure results.
- 8/30 File Review Methodology: An explanation of the “8 and 30” file sampling procedure used by NCQA during accreditation survey visits.
- Guidelines for Medical Record Documentation: A review of the commonly accepted standards for medical record documentation.
Frequently Asked Questions
NCQA maintains a database of frequently asked questions about NCQA standards and interpretation of requirements. New FAQs are posted on the 15 of every month (unless the 15 falls on a weekend).
Have A Question?
Can’t find the answer to your question in the FAQs? Submit a question to NCQA’s policy team through My NCQA.