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Tool. Unless otherwise noted, organizations must meet the requirement throughout the
look-back period.

Explanation: Specific requirements that the organization must meet, and guidance for
demonstrating performance against the element.

Examples: Descriptive information illustrating performance against an element‘s
requirements. Examples are provided for guidance only and are not specifically required
or all-inclusive.
Be sure to consider all pertinent information provided by NCQA under each measure and
element in the Survey Tool (e.g., each of the information sources described in the section
above). If the data source specifies ―documented process‖ and the organization provides a
report, it has not demonstrated full performance. Likewise, if the look-back period specifies 6
months, and the organization provides evidence of completion of the activities that is dated 12
months prior to the survey date, then it has not demonstrated performance with the
requirements.
Document Preparation
NCQA surveyors serve as fact finders for organizations, verifying that that the documentation
presented meets the intent of the requirements.
The organization‘s obligation is to present the documentation that demonstrates performance
and to do so in a manner that facilitates review by the NCQA survey team. The organization is
expected to:

Provide the required documents

Present them in an organized, readable format

Limit documentation to the minimum necessary to demonstrate performance

Use available software features and tools (such as highlighting and comments) to direct
the surveyors to evidence of performance.
If the surveyors do not find the specified evidence in the documents, they will ask for clarification
during Plan Comment and provide the organization an opportunity to respond. The survey team
does not summarily score an element less than 100 percent without notification to the
organization of the issues.
When an organization provides numerous documents, clear evidence of performance may not
be obvious or apparent to the surveyor.
However, the onus is on the organization to demonstrate its performance with each of the
requirements.
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