{"id":3530,"date":"2018-07-24T11:46:32","date_gmt":"2018-07-24T15:46:32","guid":{"rendered":"https:\/\/www.ncqa.org\/?page_id=3530"},"modified":"2026-03-24T09:59:12","modified_gmt":"2026-03-24T13:59:12","slug":"hedis-compliance-audit-certification","status":"publish","type":"page","link":"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/","title":{"rendered":"HEDIS Compliance Audit Certification"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-7630 alignright\" src=\"https:\/\/wpcdn.ncqa.org\/www-prod\/2018\/08\/hedis_compliance_audit_certification.jpg\" alt=\"\" width=\"400\" height=\"288\" \/>The Healthcare Effectiveness Data and Information Set (HEDIS<sup>\u00ae<\/sup>) is widely used to measure and improve health care quality and is relied on by government regulators, health plans, provider organizations, employers and others to identify quality and compare plan performance.<\/p>\n<p>The accuracy of collecting, measuring and reporting HEDIS is vital to benchmarking and improving quality. The HEDIS Compliance Audit\u2122 helps ensure accurate, reliable data that can be used by employers, consumers and government to compare health plans.<\/p>\n<p>NCQA licenses organizations and certifies individuals affiliated with licensed organizations to conduct audits using NCQA&#8217;s standardized audit methodology. Auditors use the first half of the audit, the overall IS review, to identify data areas to focus on during the second half of the review (HEDIS Compliance Standards). This allows for customization of each audit depending on the individual health plan&#8217;s strengths and weaknesses. The audit adds a higher degree of integrity to HEDIS data, and enables organizations to provide consumers and purchasers with consistent and comparable HEDIS results.<\/p>\n<h2>About the Audit<\/h2>\n<p>In 1995 NCQA convened the HEDIS Audit Committee, which developed a precise, standardized method to verify the integrity of HEDIS collection and calculation processes: the NCQA HEDIS Compliance Audit. The audit is in two parts: evaluating a plan\u2019s overall information systems capabilities (the \u201cIS standards\u201d) and evaluating a plan&#8217;s ability to comply with HEDIS specifications (the \u201cHD standards\u201d).<\/p>\n<p>All health plans submitting HEDIS data to NCQA must undergo a HEDIS Compliance Audit, which may only be performed by licensed organizations and certified auditors. Certifying auditors and licensing qualified organizations helps verify that standard auditing methods are used during all NCQA HEDIS Compliance Audits.<\/p>\n<ul>\n<li><a href=\"\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/about-the-hedis-compliance-audit\/\">Learn more about the HEDIS Compliance Audit<\/a><\/li>\n<\/ul>\n<h2>Licensed HEDIS Compliance Audit Organizations<\/h2>\n<p>NCQA licenses organizations that perform HEDIS Compliance Audits to ensure that audits comply with standard methods.<\/p>\n<ul>\n<li>Learn more about <a href=\"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/become-a-licensed-organization\/\">becoming licensed by NCQA to perform HEDIS Compliance Audits.<\/a><\/li>\n<li>See a <a href=\"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/licensed-organizations\/\">list of licensed organizations.<\/a><\/li>\n<\/ul>\n<h2>Certified HEDIS Compliance Auditors<\/h2>\n<p>To become a HEDIS Compliance Auditor, you must be employed by, or contract with, a licensed HEDIS Compliance Audit Organization.<\/p>\n<ul>\n<li>Learn more about <a href=\"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/become-a-certified-hedis-compliance-auditor\/\">becoming a certified HEDIS Compliance Auditor.<\/a><\/li>\n<li>Learn more about <a href=\"\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/hedis-compliance-auditor-exam\/\">the HEDIS Compliance Auditor exam<\/a>.<\/li>\n<li>See a <a href=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/Certified_Hedis_Compliance_Auditors_3.1.2026.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">list of certified HEDIS Compliance Auditors (.pdf)<\/a>.<\/li>\n<li>View the <a href=\"https:\/\/www.ncqa.org\/wp-content\/uploads\/NCQA-HEDIS-Code-of-Professional-Conduct-for-Compliance-Auditors.pdf\" target=\"_blank\" rel=\"noopener\">Code of Professional Conduct for Compliance Auditors<\/a>.<\/li>\n<\/ul>\n<h2>DATA AGGREGATOR VALIDATION<\/h2>\n<p>The <a href=\"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/data-aggregator-validation\/\">Data Aggregator Validation<\/a> (DAV) program validates incoming and outgoing data from aggregators to confirm its soundness and integrity. The program will ensure that NCQA standards and protocols are met and that data provided from the original source accurately reflects data reported for use as standard supplemental data for HEDIS reporting.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Healthcare Effectiveness Data and Information Set (HEDIS\u00ae) is widely used to measure and improve health care quality and is relied on by government regulators, health plans, provider organizations, employers and others to identify quality and compare plan performance. The accuracy of collecting, measuring and reporting HEDIS is vital to benchmarking and improving quality. The [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":1172,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page.php","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-3530","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>HEDIS Compliance Audit Certification - NCQA<\/title>\n<meta name=\"description\" content=\"NCQA licenses organizations and certifies individuals affiliated with licensed organizations to conduct HEDIS compliance audits using NCQA\u2019s standardized audit methodology.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ncqa.org\/programs\/data-and-information-technology\/hit-and-data-certification\/hedis-compliance-audit-certification\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HEDIS Compliance Audit Certification - 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