NCQA PRIME Audit

To learn more, contact:
Jeff Wussow
Business Development Manager
1-800-362-2320 or 1-608-274-1940, ext. 8264

MetaStar’s NCQA PRIME Audit Services

As both a HEDIS® Licensed Organization and experienced contractor for the Centers for Medicare & Medicaid Services (CMS) working with hospitals, MetaStar is well prepared to help hospitals approach this new audit in 2017. The Public Hospital Redesign and Incentives in Medi-Cal (PRIME) Program includes Designated Public Hospital (DPH) systems and District/Municipal Public Hospitals (DMPH) and is part of the Medi-Cal 2020 waiver approved by CMS. These two types of entities choose projects to report from three domains: Outpatient Delivery System Transformation and Prevention, Targeted High-Risk or High-Cost Populations, and Resource Utilization Efficiency.

While an NCQA PRIME Audit is not required in 2017, it is recommended by NCQA as a way to prepare for this future requirement. PRIME entities who desire an audit for 2017 must contract with an NCQA Licensed HEDIS Organization by March 31, 2017.

Our breadth of experience

MetaStar was among the first organizations licensed in 1998 by the National Committee for Quality Assurance (NCQA) to provide HEDIS Compliance Audit services. MetaStar is NCQA compliant without any corrective actions. In addition to our work as an NCQA Licensed Organization for HEDIS, MetaStar:

  • Provides Medicare Part C and Part D Data Validation for health plans, serving as a contractor since audit inception in 2011.
  • Provides Initial Validation Audits (IVAs) for Risk Adjusted Data Validation (RADV) customers, serving as an IVA entity during the first audits in 2016.
  • Represents Wisconsin in the Lake Superior Quality Improvement Network (Lake Superior QIN), serving as the local change agent to help CMS achieve national health care quality goals. MetaStar has served in similar roles for Wisconsin for more than 40 years.
  • Serves as the External Quality Review Organization (EQRO), continually contracted to the State of Wisconsin Department of Health Services for more than 30 years.
  • Serves as the Minnesota Department of Human Services performance measure validation firm since 2005.

Our audit philosophy: Quality with accuracy

As a quality improvement organization, we bring a focus on quality to all of our work. We approach each audit in a collaborative and educational manner.

What makes our NCQA PRIME Audit service unique?

  • MetaStar’s HEDIS audit services team includes certified auditors, registered nurses, certified medical coders, and dedicated IT staff. Many team members are Certified Professionals in Healthcare Quality (CPHQ).
  • MetaStar auditors provide quick responses to customer requests and provide actionable feedback for improvement.
  • Our customer portal, MyMetaStar, provides a one-stop-shop approach for easy and secure communication and file sharing.
  • Our lead auditor serves on a panel for NCQA, offering insight and expertise.
  • MetaStar is a non-profit organization and has been focused on health care quality for more than 40 years.

What our customers say:

“Working with MetaStar is a pleasure. Everyone is very knowledgeable, their service outstanding, and they are with you every step of the way. We are a better organization because of them.” – HEDIS Compliance Audit Customer in 2016

Request a proposal

For more information, or to request a proposal from MetaStar, click here.

 

MetaStar also provides Medicare Part C and Part D Data Validation Audit services, HEDIS Compliance Audit services, URAC Accreditation Validation Audit services and Initial Validation Audit services.

MetaStar’s HITRUST Certification is pending.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). NCQA HEDIS Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).