What is NCQA audit?
The NCQA HEDIS® Compliance Audit™ indicates whether an organization has capabilities for processing medical, member and provider information as a foundation for accurate and automated performance measurement, including HEDIS reporting. The audit addresses an organization’s: Information practices and control procedures.
Is NCQA and HEDIS the same?
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
How often are NCQA audits?
2 audits per year
You must be recertified every year to maintain certification and: Participate in 2 audits per year.
Is HEDIS an audit?
The Healthcare Effectiveness Data and Information Set (HEDIS®) is an audit used among government regulators, healthcare providers and others for evaluating and bettering the quality of health care plans across the country.
What are NCQA requirements?
NCQA requirements are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Categories include: Quality Management and Improvement.
What are NCQA standards?
NCQA standards are a roadmap for improvement—organizations use them to perform a gap analysis and align improvement activities with areas that are most important to states and employers, such as network adequacy and consumer protection. Standards evaluate plans on: Quality Management and Improvement.
What does NCQA review?
NCQA Health Plan Accreditation is a widely recognized, evidence-based program dedicated to quality improvement and measurement. It provides a comprehensive framework for organizations to align and improve operations in areas that are most important to states, employers and consumers.
What is NCQA standards for credentialing?
NCQA Credentialing Accreditation is designed to ensure that organizations can maintain a high-quality network for members and contracted clients. Requirements cover these key areas: An internal QI process. Ensuring appropriate agreements and collaboration with clients.
What is the difference between stars and HEDIS?
For HEDIS measures, Star Ratings use a clustering algorithm that identifies “gaps” in the data and creates five categories (one for each Star Rating). Star Ratings incorporate a measure on improvement into plans’ overall score, with a weight of 5. HPR does not incorporate an improvement bonus.
What are the six categories of standards guidelines that NCQA looks at when evaluating for accreditation?
NCQA assesses the organization for performance against each standard….Standards for evaluation include:
- Quality Management and Improvement (QI).
- Population Health Management (PHM).
- Network Management (NET).
- Utilization Management (UM).
- Credentialing and Recredentialing (CR).
- Member Experience (ME).
What are the NCQA accreditation levels?
Accredited plans will earn ratings once they submit HEDIS® and CAHPS® reporting and can advertise them with their accreditation….Based on my status level today, what star rating should I expect?
| Current Status | Projected Stars |
|---|---|
| Excellent | 4.5-5.0 |
| Commendable | 3.5-4.0 |
| Accredited | 2.5-3.0 |
| Provisional | 1.0-2.0 |