NCQA Physician and Hospital Quality Certification — Frequently Asked Questions
Last updated: April 2026
Answers to the most common questions about NCQA PHQ Certification, eligibility, standards, and IHS consulting support.
What is NCQA Physician and Hospital Quality (PHQ) Certification?
NCQA PHQ Certification evaluates how well health plans measure and report the quality and cost of physicians and hospitals. It assesses the methodology, transparency, stakeholder engagement, and improvement processes behind a health plan's physician and hospital quality measurement program. Health plans use this information for value-based contracting, provider tiering, pay-for-performance programs, and quality transparency initiatives.
Which organizations are eligible for PHQ Certification?
PHQ Certification is available to health plans that measure and report quality and cost information about physicians and hospitals. This includes commercial health plans, Medicare Advantage plans, and Medicaid managed care organizations with active physician or hospital quality measurement programs. The plan must have an existing measurement program in operation to be eligible for the survey.
What does NCQA evaluate in a PHQ Certification survey?
NCQA evaluates three primary domains: (1) Measures and Methods — the technical quality of the plan's measurement methodology, including measure selection, risk adjustment, attribution logic, and cost measurement; (2) Working with Customers — transparency with physicians and hospitals about their performance data, dispute resolution processes, and consumer-facing quality reporting; and (3) Program Input and Improvement — stakeholder engagement in program design and ongoing quality improvement of measurement processes.
How long does PHQ Certification last?
PHQ Certification is awarded for a two-year period. At the end of the certification term, the organization must complete a new agreement, submit required fees, and undergo a full survey to renew certification status.
What is the difference between PHQ Certification and NCQA Health Plan Accreditation?
NCQA Health Plan Accreditation (HPA) evaluates the overall operations of a licensed health plan across multiple functional domains. PHQ Certification is a focused program specifically evaluating the health plan's physician and hospital quality measurement infrastructure. A health plan can hold both HPA and PHQ Certification; they address different operational domains. PHQ does not substitute for HPA.
Why do health plans pursue PHQ Certification?
Health plans pursue PHQ Certification to demonstrate credibility of their value-based contracting programs to employer clients and state purchasers; to reduce legal and regulatory risk by having independently validated measurement methodology; to improve physician engagement by demonstrating that their quality measurement is fair, transparent, and methodologically sound; and to differentiate in competitive commercial markets where quality measurement credibility is a procurement criterion.
What are the provider transparency requirements under PHQ standards?
PHQ standards require health plans to give physicians access to review their own quality and cost data before it is used in public reporting or benefit design decisions. Plans must have a documented dispute resolution process through which providers can challenge their performance data. Methodology changes must be communicated to affected providers in advance. Consumer-facing quality reports must present information accurately and in a way that members can understand.
What risk adjustment and attribution methodology does NCQA require for PHQ?
NCQA does not mandate a single risk adjustment or attribution methodology but requires that the methodology selected be documented, applied consistently, statistically sound, and appropriate for the patient population being measured. The plan must be able to defend its methodology choices. NCQA evaluates whether the plan's approach addresses the potential for unfair comparisons across providers with different patient populations.
How does PHQ Certification interact with Medicare Advantage Star Ratings?
PHQ Certification does not directly affect Medicare Advantage Star Ratings, but the measurement infrastructure required for PHQ Certification directly supports the quality improvement activities that drive star rating performance. Health plans with PHQ-certified measurement programs typically have more mature data analytics, provider engagement, and performance improvement processes — capabilities that support star rating improvement strategies.
What common gaps do health plans encounter in PHQ Certification surveys?
Common gaps include: inadequate documentation of risk adjustment methodology; absence of a formal pre-publication provider preview and dispute resolution process; failure to communicate methodology changes to providers before implementation; consumer-facing quality reports that lack sufficient contextual information for member decision-making; and quality measurement programs that do not incorporate systematic stakeholder input into design or improvement processes.
How does IHS prepare health plans for PHQ Certification?
IHS conducts a baseline assessment of the health plan's existing physician and hospital quality measurement program against PHQ standards, identifies gaps in methodology documentation, transparency practices, and governance processes, and provides direct support for remediation. IHS also conducts a mock survey using NCQA's current standards before the actual survey to identify and address remaining deficiencies.
Is PHQ Certification relevant for plans that only measure physician quality, not hospital quality?
Yes. The PHQ Certification program addresses physician quality measurement and hospital quality measurement but does not require plans to measure both. Plans that measure only physician quality or only hospital quality can pursue certification for the applicable component of their program. The scope of the survey is tailored to the plan's actual measurement activities.
What makes IHS qualified to advise on PHQ Certification?
IHS is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. His background encompasses healthcare quality standards, regulatory compliance, and health plan operations at an institutional level. IHS works across the full NCQA program portfolio and brings cross-program perspective that helps health plans build efficient, integrated certification strategies.
Questions About PHQ Certification?
Schedule a free discovery session with IHS to discuss your health plan's quality measurement program and readiness for PHQ Certification.
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