Measurement Year 2019 Data Submission Guide and File Layout
Health Plans Only
NCQA Vendor Certification Requirement
NCQA is updating their measure certification and audit program requirements. Beginning in MY 2019, health plans and POs that use vendors to calculate their AMP program results must use NCQA-certified vendors. Health plans and POs that run their own measure results (without a vendor) may do so until MY 2021 and must either undergo manual source code review by a certified auditor or certify their measure logic using NCQA’s automated source code review (ASCR). Beginning in MY 2021, all health plans and POs must either transition to an NCQA-certified vendor or contract directly with NCQA for certification of their software via the ASCR process.
HEDIS Compliance Auditors
Health plans and physician organizations that report quality results in AMP Commercial HMO must contract with a HEDIS compliance auditor. The National Committee for Quality Assurance (NCQA) licenses individuals and organizations to conduct Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Audits, including audits for AMP Commercial HMO. Use of an individual auditor or audit firm is a matter of organizational preference; any NCQA licensed auditor or audit firm is sufficient for AMP Commercial HMO.
Audit Review Guidelines
Audit Review standards are derived from NCQA's HEDIS Compliance Audit Standards, the foundation on which Certified HEDIS Compliance Auditors assess a health plan's ability to report HEDIS data accurately and reliably. The audit standards represent key processes involved in clinical data collection and reporting and include standards and assessments that apply to physician organizations that opt to self-report clinical data. HEDIS® is a registered trademark of the NCQA.
Value Set Directory
The MY 2019 AMP Program Manual and VSDs are required resources for California stakeholders participating in the Integrated Healthcare Association’s (IHA) AMP programs. The Value Set Directory consists of an electronic Excel file that is sortable and provides an easy way to incorporate CPT®, ICD-9-CM, ICD-10-CM, ICD-10-PCS, POS, MS-DRG, HCPCS, LOINC, TOB and UB codes into your organization's data collection program – saving programming hours, eliminating the manual search for codes and reducing keying errors. NCQA converts all code tables for the AMP Program Manual to an electronic format, called Value Set Directories (VSDs) which are available free of charge to download from the NCQA website.