HealthSparq Recognized with NCQA HIP Certification

Quality and compliance are important to supporting our health plan clients. That’s why we’re thrilled that we have once again received NCQA’s Health Information Product (HIP) 4 (Physician and Hospital Directories) certification. NCQA certification is mission critical for HealthSparq as we know it is for our clients. Our HealthSparq One®-based provider search capabilities were awarded an overall total of 100.0 points (maximum possible score).

First of all, what is NCQA HIP and why is it important to HealthSparq?

The NCQA Health Information Product Certification program highlights organizations that provide pharmacy benefit information, health information lines, support for healthy living or physician and hospital directories services to health plans and Managed Behavioral Healthcare Organizations (MBHO).

HealthSparq’s certification shows our commitment to meeting quality standards. By certifying our Provider Directory, NCQA is recognizing that HealthSparq One achieved substantial performance against the requirements in the HIP 4 category for Physician and Hospital Directories).

This is important to us because it helps ease the burden for our clients, so that they can achieve easier accreditation and have fewer administrative responsibilities in the process. We routinely work with our clients to implement NCQA HIP 4 delegation agreements to support their bids for NCQA (re)accreditation. By working with HealthSparq, we offer our health plans clients the ability to leverage our certification as they work to get their own. This commitment to standards and quality excellence is a win-win all around.

HealthSparq’s NCQA certification

HealthSparq is a NCQA HIP 4 (Physician and Hospital Directories) certified vendor. Obtaining NCQA certification for provider directories involves a rigorous procedure in which vendors must objectively demonstrate how they comply with each element of the relevant NCQA standard (NET 6 in the case of HealthSparq products). Policies and procedures must be provided to NCQA as applicable (e.g. to validate the directory update process). Vendors must present evidence supporting compliance in other areas, such as search tools and validating that the required provider information is displayed.

Provider directory applications must receive a passing grade in each of these areas:

• Physician Directory Data – required elements are displayed
• Physician Directory Updates – timely updates within 30 days of receiving new information
• Physician Information Validation – display sources, accuracy, and limitations of data
• Searchable Web-based Physician Directory – features helping users to find desired information
• Hospital Directory Data – required elements are displayed
• Hospital Directory Updates – timely updates within 30 days of receiving new information
• Hospital Information Validation – display sources, accuracy, and limitations of data
• Searchable Web-based Hospital Directory – features helping users to find desired information
• Usability Testing – the application is easy to understand and users are able to efficiently obtain the data they need

HealthSparq One was reviewed twice as part of the NCQA certification process.  First, a healthcare industry specialist reviewed the materials submitted to NCQA by HealthSparq to ensure that compliance in all areas was well documented. This allows vendors like HealthSparq to provide additional information that helps the reviewers understand how the application complies with requirements. The second review is performed by an elite panel of reviewers consisting of physicians, health plan executives and industry subject matter experts.  This Review Oversight Committee (ROC) determines if an application is truly NCQA compliant.

What’s Next?

HealthSparq has completed the NCQA recertification process for HealthSparq One®. NCQA has certified the application compliant with NCQA HIP-4 (2016 NET 6) requirements through 11/13/2020.  We ensure that compliance with the relevant standards is maintained throughout the 24-month certification period as required by NCQA to retain certification.