Getting Ready for NCQA’s Digital Quality Future

HealthTeam Advantage is moving quality reporting from supplemental data to claims data. Here’s what your practice needs to do — and how we’ll help you get there. 

Across every provider group we partner with, one trend stands out: quality care that happens in the exam room but never reaches the claim. The most common culprit is missing CPT Category II (CPT-II) codes.  

With the National Committee for Quality Assurance (NCQA) transitioning to digital quality measures effective January 1, 2030, closing that gap is about to matter more than ever — and the time to build the habit is now. 

Why This Is Changing

Today, we close many quality measures using supplemental data through the information we collect after the visit through medical record review, chart chases, and EHR data feeds. Under NCQA’s digital quality measure framework, that retrospective approach is being phased out. Going forward, the claim itself becomes the system of record for quality. Put simply: If the work isn’t coded, it won’t count. 

CPT-II codes are how clinical actions like a blood pressure reading, a medication review, or an A1c result travel from your documentation into the claim. Building them into your workflow now delivers three wins:  

• a seamless transition in 2030 
• fewer chart chases and record requests in the meantime 
• quality scores that finally reflect the care you’re already providing 

And the benefit isn’t limited to your HealthTeam Advantage patients. Because NCQA’s digital transition applies across the industry, accurate CPT-II coding strengthens your quality performance with every health plan you contract with. You make the change once in your workflow, and it counts everywhere. 

What We’re Asking Providers to Do

A single, well-documented visit can close several gaps at once — the blood pressure you record, the medications you review, and the labs you order each map to a distinct quality measure.  Any medications impacting the visit should also be documented with the appropriate and correct diagnosis codes for those medications. Capture the following clinical actions during the encounter and submit the matching CPT-II codes. (Use the link below for a printable PDF.)