The Healthcare Effectiveness Data and Information Set (HEDIS®) is widely used to measure and improve health care quality and is relied on by government regulators, health plans, provider organizations, employers and others to identify quality and compare plan performance.
The accuracy of collecting, measuring and reporting HEDIS is vital to benchmarking and improving quality. The HEDIS Compliance Audit™ helps ensure accurate, reliable data that can be used by employers, consumers and government to compare health plans.
NCQA licenses organizations and certifies individuals affiliated with licensed organizations to conduct audits using NCQA’s standardized audit methodology. Auditors use the first half of the audit, the overall IS review, to identify data areas to focus on during the second half of the review (HEDIS Compliance Standards). This allows for customization of each audit depending on the individual health plan’s strengths and weaknesses. The audit adds a higher degree of integrity to HEDIS data, and enables organizations to provide consumers and purchasers with consistent and comparable HEDIS results.
About the Audit
In 1995 NCQA convened the HEDIS Audit Committee, which developed a precise, standardized method to verify the integrity of HEDIS collection and calculation processes: the NCQA HEDIS Compliance Audit. The audit is in two parts: evaluating a plan’s overall information systems capabilities (the “IS standards”) and evaluating a plan’s ability to comply with HEDIS specifications (the “HD standards”).
All health plans submitting HEDIS data to NCQA must undergo a HEDIS Compliance Audit, which may only be performed by licensed organizations and certified auditors. Certifying auditors and licensing qualified organizations helps verify that standard auditing methods are used during all NCQA HEDIS Compliance Audits.
Licensed HEDIS Compliance Audit Organizations
NCQA licenses organizations that perform HEDIS Compliance Audits to ensure that audits comply with standard methods.
- Learn more about becoming licensed by NCQA to perform HEDIS Compliance Audits.
- See a list of licensed organizations.
Certified HEDIS Compliance Auditors
To become a HEDIS Compliance Auditor, you must be employed by, or contract with, a licensed HEDIS Compliance Audit Organization.
- Learn more about becoming a certified HEDIS Compliance Auditor.
- Learn more about the HEDIS Compliance Auditor exam.
- See a list of certified HEDIS Compliance Auditors (.pdf).
DATA AGGREGATOR PREVALIDATION (CONCEPT)
Data Aggregator Prevalidation is an idea for a new program that NCQA might create to ease the burden of audit on health plans using data from aggregators. The new program would confer an NCQA seal to data companies that show they can pass valid data files for plans to use as supplemental data.