NCQA eMeasure certification means that NCQA’s HEDIS® and the Centers for Medicare & Medicaid Services (CMS) Medicare Star reporting programs can use certified eCQM data for performance measurement. Specifically, certified data can be used as supplemental data and added to other records to calculate HEDIS measures at the health plan level.
Using standard supplemental data from certified vendors has three significant business benefits for health plans. First, the burden and risk of a primary source audit is greatly reduced while data quality is improved. Second, the cost of chart chases is significantly reduced. Additionally, consistent data file formats streamline the mapping process and reduce time consuming, costly data mapping and cleansing.
Supplemental data fills gaps in claims data and defines incremental numerator inclusions and optional exclusions. Supplemental data may not help determine conditions that change or correct billing or coding errors.
Impact of Standard Supplemental Data on HEDIS Measures
The impact of Standard supplemental clinical data varies according to the measure requirements and the content of the clinical data source.