As a participant, you’ll find data submission resources below for the current measurement year from our vendors, Onpoint Health Data and TransUnion, as well as comprehensive information on audit requirements and guidelines.
Complete and accurate results are important for the AMP Program. Despite a thorough validation and quality assurance process, it is possible for discrepancies to occur in the AMP preliminary results. We rely on a formal review process, the Questions and Appeals Period, to allow both participating provider organizations (POs) and health plans to request more information about their preliminary results and to request an appeal for corrections before results are finalized for the measurement year.
NCQA has updated its measure certification and audit requirements. As of MY 2019, health plans and providers organizations that use vendors to calculate their AMP program results must use NCQA-certified vendors. Beginning in MY 2021, all health plans and provider organizations must either transition to an NCQA-certified vendor or contract directly with NCQA for certification of their software via the automated source code review (ASCR) process.
If your health plan or provider organization reports quality results in AMP Commercial HMO and AMP Medicare Advantage, you must contract with a HEDIS compliance auditor. The choice of Licensed Organization (LO) or audit firm is a matter of organizational preference. Any NCQA-licensed auditor or audit firm is sufficient for AMP Commercial HMO and AMP Medicare Advantage.
IHA follows NCQA’s HEDIS Compliance Audit Standards. Certified HEDIS Compliance Auditors use these standards to assess a health plan’s ability to report HEDIS data accurately and reliably. The audit standards represent key processes in clinical data collection and reporting and include standards and assessments that apply to physician organizations that opt to self-report clinical data.
As a companion to the AMP Program Manual, the Value Set Directory (VSD) provides time-saving resources to participants. The directory is an Excel file that is sortable and provides an easy way to incorporate CPT, ICD-9, ICD-10, HCPCS, and other medical coding systems into your organization’s data collection program. The VSD saves programming hours, eliminates the manual search for codes, and reduces keying errors. The Value Set Directory is available for download free of charge.