Ratings Examiner Report on New York Health Plan Methodologies

Frequently Asked Questions

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 requirements different among the plans?
A: To assure that the requirements represent best practices, NCQA – with the approval of the New York Attorney General and notice to the plans – periodically updates the requirements. The most recent update was effective for reviews conducted after January 1, 2011; these updated requirements are described below. When you view an individual plan’s results on that plan's detail page, it will show the requirements used at the time of the plan's review.

Q: Why are some plans results showing a score with a percentage (100%) and others have a score in words ("Met" or "Not Met")?
A: Plans must meet specific requirements in order to comply with the Agreements they have with the New York Attorney General. When the requirements were updated for 2011, the report was simplified to state whether the plan met the requirement or not, instead of assigning a number.

Q: Where scores are reported as a percentage, 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 so most plans meet the requirements. Plans that do not meet a requirement must take corrective action and be re-evaluated to confirm that 100% compliance is attained.

Q: What does it mean when it says a requirement is "Not Applicable"?
A: The New York Attorney General requires that if a plan is doing certain physician measurement or reporting activities, the plan must meet certain requirements. However, the plan is not always required to perform an activity. For example, if a plan measures the cost of a physician, it must meet some requirements that are related to cost only. However, if the plan is only measuring quality and not cost, then requirements that only apply to cost are scored "Not Applicable".
Another instance would be if there is not enough information to review the plan on a requirement. For example, NCQA reviews a sample of complaints from members about physician measurement programs to see that the plan responded appropriately to the complaint. However, if the plan had too few complaints from members about the program to give a valid score (a minimum of 8 are required), the requirement would be scored as "Not Applicable".

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