Jul 19, 2023
MHR Blog Vendors Benefit

 Word count:  593

Estimated time to read:   3 minutes

Health Information Technology (HIT) solutions have evolved into sophisticated tools for organizations to optimize their data for their population health management (PHM) programs and activities. To help organizations save time and ease the administrative burden of data management and vendor relationships, NCQA developed a process called PHM Prevalidation.

Read how PHM Prevalidation benefits vendors and organizations alike, the process to achieve this designation, and how MHR can help.

What is NCQA PHM Prevalidation?

Prevalidation is the process by which vendors with HIT solutions for PHM functions apply to NCQA for a determination if their solution fulfills certain elements and factors for one or more of the following:

  • risk stratification
  • data aggregation
  • case management
  • population assessment

These PHM functions are critical to NCQA accreditation programs for:

  • Case Management
  • Health Plan
  • Managed Behavioral Healthcare Organization
  • Population Health

Vendors must demonstrate fulfillment of NCQA elements and factors for PHM functions and show that their HIT solution adds value by saving organizations time, easing administrative burdens, and producing detailed reports.

How do vendors benefit from NCQA PHM Prevalidation? 

  • Organizations that utilize HIT solution(s) designated by NCQA as Eligible for Automatic Credit are eligible to receive automatic credit for certain NCQA elements and factors at the time of their NCQA survey.

Alternatively, vendors can receive the designation of Organization Support if their HIT solution meets NCQA requirements, but they do not perform the functions directly. They may offer the ability to produce required reports. 

 NCQA PHM Prevalidation designation is given to the specific version of the HIT solution, not the vendor.

  • Vendors with NCQA PHM Prevalidation may have a competitive edge! They are listed on NCQA’s website as being NCQA PHM Prevalidated and are permitted to advertise their designation according to NCQA’s Advertising and Marketing Guidelines.

Currently, there are 18 vendors representing multiple HIT products on NCQA’s list for PHM Prevalidation.

Important points to know about organizations

  • Organizations must implement a HIT solution designated as Eligible for Automatic Credit for 70% or more of their applicable population to receive automatic credit.
  • Organizations must submit the vendor’s NCQA approval letter to the NCQA surveyor.

What is the process for vendors to become NCQA PHM Prevalidated?

  • Purchase the NCQA PHM Prevalidation Handbook in the NCQA Store.
  • Complete the checklist of Elements and Factors eligible for review.
  • Review guidelines for working with organizations, following advertising and marketing guidelines, fees, and potential system upgrades.
  • Complete the application and legal agreement.
  • Present a live virtual demonstration to NCQA. (Prototype tools are not)
  • Retain your eligibility letter from NCQA and proactively share this with all organizations that use that HIT solution. Don’t wait for the organizations to ask!
  • Verify your company’s information on NCQA’s website.
  • Pay your annual maintenance fee.
  • Notify NCQA if a system upgrade results in significant changes to that version of the HIT solution, which may necessitate another review. If NCQA issues another letter, then proactively share this with the organizations.
  • Ensure you meet NCQA’s Advertising and Marketing Guidelines.

How can MHR help?

MHR has experience working with vendors on NCQA PHM Prevalidation and can help facilitate your position.

Our consultants will walk you through the process, identify gaps in the software and documentation, help you prepare for your live virtual system demonstration, and, if desired, assist you in developing documentation and storyboards to explain your solution to clients and potential clients. Call us first before you start! or email 


By Nancy Ross Bell


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