What Exactly Is It?

NCQA's HEDIS^® Software Certification℠ is precise, automated testing that verifies software compliance with HEDIS specifications and satisfies the source code review portion of the HEDIS Compliance Audit™. HEDIS Software Certification℠ is a service mark of the National Committee for Quality Assurance (NCQA).

Only vendors that have received a Certification Report and seal from NCQA indicating they have successfully passed the minimum required measures to complete the HEDIS Software Certification program can advertise or market software as Certified HEDIS Software.

How Often Must Vendors Certify Their Software?

Vendors that certify their software are required to do so every year, because the measure logic can change, new measures can be introduced and changes to vendor software can affect the prior year's certification. As a result, all measures must be re-certified each year, even if there has been no change to the HEDIS specifications.

Certification is only valid for the year certified, and only for certain portions of the vendor's product.

Why Would You Want To Use Certified Software?

Certified HEDIS Compliance Auditors, MCOs and companies that produce HEDIS software all dedicate substantial resources to reviewing HEDIS software. Even under the best circumstances, reviewing code for a large and complex program is not sufficient to ensure accuracy.

In 2000, NCQA launched a certification program for commercial software products that produce HEDIS results. The automated testing processes used in the program increase the rigor of a HEDIS software review and improve the accuracy of reporting measures based on complex software logic.

In addition, certification helps plans determine the software vendors who can help them to meet their accreditation goals.

How Does The Certification Process Work?

To validate vendor software, NCQA generates unique sets of sample data or "test decks" that vendors process using their HEDIS software product. Test decks are randomly generated member-level test data for each measure in the program. NCQA compares the vendors measure results to the expected results and determines if the software computes HEDIS correctly. The vendor can receive multiple test decks for each measure, gaining the opportunity to correct errors found in each round of testing. A tested measure receives a final status of pass or fail.

The vendor's HEDIS software is "NCQA Certified" when a minimum of 100% of the measures pass, and NCQA issues a report specifying for each measure the pass or fail status. You can request a copy of this report from any vendor.

Verisk Health prominently displays our status reports for all the years that we have participated in the program Verisk Health has achieved certification for all years. Please see our certification reports for a full disclosure.

How Does It Help You?

Vendors who achieve Certification status produce highly accurate results, and are exempt from manual source code review by auditors during the HEDIS Compliance Audit.

HEDIS auditors will still evaluate: MCO-to-vendor field mappings; data scrubbing and cleaning routines; MCO-specific data integrity and medical coding issues; application of idiosyncratic measure logic, for example MCO-specific methods for identifying live births for OB-related measures; and medical record abstraction tool logic. However, auditors will not ask for or review source code used to produce measures that receive a "pass" status.

If your vendor translates your data into their format for you, then that portion of their system is subject to audit.

Which Measures Are Certified?

For a list of certified measures, visit our Software Certification page

NCQA Software Certification Beta Test Program

Verisk Health is proud of the fact that we were chosen for the beta test portion of the HEDIS Software Certification Program since 2003. This is a testimony of our dedication to NCQA's program.

As a beta test vendor, Verisk Health assists NCQA each year as they ensure the programming for the Software Certification Program is thoroughly tested. This effort on our part and NCQA's confidence in us should be a strong indication to you of our commitment to excellence and the accuracy of our logic.

Summary

In summary, HEDIS Software Certification℠ is rigorous and vendors invest an enormous amount of time and resources in it.

All certified vendors have a serious commitment and dedication to reach a 100% certification status. It is not easy, but the result is producing measures that are accurate and consistent across all vendor systems.

View our extensive history of software certifications

For more information about NCQA, HEDIS^®, or the software certification process, please visit http://www.ncqa.org/.

Note: HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA). HEDIS Software Certification℠ is a Service Mark of NCQA.

NCQA HEDIS Compliance Audit™ is a trademark of NCQA.