|
Q: |
Why do some plans have to meet a certain number of requirements while other plans
have to meet a different number of requirements? |
|
A: |
Health plans that started their physician performance measurement programs after
the New York Attorney General defined its requirements must meet all of the requirements.
Health plans that had started programs before the Attorney General set the requirements
were not required to immediately change their existing measurement methodologies,
but these plans must currently meet all of the requirements related to transparency
of their programs, including following processes for physicians to request corrections
or changes or members to file complaints. The next time these plans measure their
network physicians, they must comply with 100% of the requirements. Requirements
that are not currently applicable to a particular plan are indicated in the plan
results as "Not required at this time."
|
|
Q: |
Why are only certain plans in New York listed on this report? |
|
A: |
Not all health plans in New York have programs in place to measure and report on
the performance of physicians in their networks. Only plans with such programs in
place and that have entered into agreements with the New York Attorney General are
currently subject to a Ratings Examiner review.
|
|
Q: |
Does this website provide information on specific physicians and tell you which
plans have better physicians? |
|
A: |
No. This website was designed and developed to provide information on the results
of the Ratings Examiner’s evaluation of how health plans, through their internal
programs, assess physician performance and if those programs meet certain standards
set by the New York Attorney General. For more details about specific plans’ measurement
programs or about physicians in a particular plan’s network, please contact the
plan directly.
|
|
Q: |
Why are the plan scores for most requirements 100%? |
|
A: |
The New York Attorney General requires that plans meet the 100% compliance level
on all requirements applicable to them. Plans that do not score 100% on a requirement
must take corrective action and be re-evaluated to confirm that 100% compliance
is attained.
|
|
Q: |
How do I file a complaint? |
|
A: |
Health plans have a process for accepting and responding to oral and written member
complaints about their physician measurement programs. If you are a member of a
health plan included on this report and have a complaint about that plan’s physician
performance measurement program, you may contact the plan directly. Please visit
the plan’s web site for more information on filing a complaint.
Alternately, you may register your complaint in writing to NCQA at
customersupport@ncqa.org or to NCQA Customer Support, 1100 13th Street,
NW, Suite 1000, Washington, DC, 20005
|