Utah Admin. Code R428-13-4 - Submission of Performance Measures
(1)
Each carrier shall compile and submit HEDIS data for the preceding calendar
year to the program by July 1 of each year.
(2) By January 1 of each year, each carrier
shall submit to the department a plan for creating and providing HEDIS data for
the preceding calendar year.
(3)
(a) Before submitting data to the department,
each carrier shall contract with an independent audit agency certified by the
National Committee for Quality Assurance (NCQA) to verify the HEDIS
data.
(b) The independent audit
agency shall verify the HEDIS data using NCQA HEDIS Specifications referenced
in Subsection R428-1-4(3).
(4) Each carrier may use the rotation
strategy for HEDIS measures developed and updated by NCQA and included in the
NCQA HEDIS Specifications.
(5) If a
carrier presents Not Reported (NR) for a required measure, it must document why
it did not report the required measure.
(6) By August 15 of the submission year, each
carrier shall require its contracted audit agency to submit a copy of the audit
agency's final report to the department. The final report shall incorporate the
carrier's comments.
Notes
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