Marketplace MY2022 PLD File Specifications
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+NYS MY2022 Patient-Level Detail File Specifications
Revision date: November 22, 2022
MARKETPLACE
| MEASURE | COLUMN LENGTH | COLUMN START | COLUMN END | FIELD | SPECIFICATION |
|---|---|---|---|---|---|
| GENERAL INFO | 1 | 1 | 1 | Record Identifier | Use the tilde (~) character to start the line. |
| GENERAL INFO | 5 | 2 | 6 | Submission ID | The unique identifier assigned by NCQA for summary-level data submission |
| GENERAL INFO | 18 | 7 | 24 | Product Line | QHP_HMO, QHP_POS, QHP_PPO, QHP_EPO |
| GENERAL INFO | 30 | 25 | 54 | Member ID | Member ID should be the member's NYS-issued HIXNY Member ID. Do not report the identifier used in HEDIS. |
| GENERAL INFO | 8 | 55 | 62 | Date of birth | The birth date must contain 8 digits with month, day, year Enter: MMDDYYYY (e.g., September 20, 1983 would be 09201983) |
| GENERAL INFO | 2 | 63 | 64 | Member Months | The member month contribution this member adds according to enrollment data. Valid values are between 0-12. |
| GENERAL INFO | 1 | 65 | 65 | Sex | Enter: The gender assigned at birth 'F' member is female 'M' member is male 'O' includes, but is not limited to: missing, refused, and unspecified No other characters are allowed |
| ABA | 1 | 66 | 66 | Measure Retired | blank |
| ABA | 1 | 67 | 67 | Measure Retired | blank |
| WCC | 1 | 68 | 68 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): BMI Percentile, 3-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 69 | 69 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): BMI Percentile, 3-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCC | 1 | 70 | 70 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): BMI Percentile, 12-17 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 71 | 71 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): BMI Percentile, 12-17 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCC | 1 | 72 | 72 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Nutrition, 3-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 73 | 73 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Nutrition, 3-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCC | 1 | 74 | 74 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Nutrition, 12-17 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 75 | 75 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Nutrition, 12-17 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCC | 1 | 76 | 76 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Physical Activity, 3-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 77 | 77 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Physical Activity, 3-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCC | 1 | 78 | 78 | Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Physical Activity, 12-17 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCC | 1 | 79 | 79 | Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC): Counseling for Physical Activity, 12-17 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 80 | 80 | Denominator for Childhood Immunization Status (CIS) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| CIS | 1 | 81 | 81 | Numerator for Childhood Immunization Status (CIS): DTaP | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 82 | 82 | Numerator for Childhood Immunization Status (CIS): IPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 83 | 83 | Numerator for Childhood Immunization Status (CIS): MMR | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 84 | 84 | Numerator for Childhood Immunization Status (CIS): HiB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 85 | 85 | Numerator for Childhood Immunization Status (CIS): HepB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 86 | 86 | Numerator for Childhood Immunization Status (CIS): VZV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 87 | 87 | Numerator for Childhood Immunization Status (CIS): PCV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 88 | 88 | Numerator for Childhood Immunization Status (CIS): Combo 10 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 89 | 89 | Numerator for Childhood Immunization Status (CIS): Rotavirus | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 90 | 90 | Numerator for Childhood Immunization Status (CIS): HepA | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CIS | 1 | 91 | 91 | Numerator for Childhood Immunization Status (CIS): Influenza | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IMA | 1 | 92 | 92 | Denominator for Immunizations for Adolescents (IMA) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| IMA | 1 | 93 | 93 | Numerator for Immunizations for Adolescents (IMA): Meningococcal | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IMA | 1 | 94 | 94 | Numerator for Immunizations for Adolescents (IMA): Tdap | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IMA | 1 | 95 | 95 | Numerator for Immunizations for Adolescents (IMA): HPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IMA | 1 | 96 | 96 | Numerator for Immunizations for Adolescents (IMA): Combo 2 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| BCS | 1 | 97 | 97 | Denominator for Breast Cancer Screening (BCS) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| BCS | 1 | 98 | 98 | Numerator for Breast Cancer Screening (BCS) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CCS | 1 | 99 | 99 | Denominator for Cervical Cancer Screening (CCS) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| CCS | 1 | 100 | 100 | Numerator for Cervical Cancer Screening (CCS) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| COL | 1 | 101 | 101 | removed to allow for new groupings | blank |
| COL | 1 | 102 | 102 | removed to allow for new groupings | blank |
| CHL | 1 | 103 | 103 | Denominator for Chlamydia Screening in Women (CHL): 16-20 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| CHL | 1 | 104 | 104 | Numerator for Chlamydia Screening in Women (CHL): 16-20 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CHL | 1 | 105 | 105 | Denominator for Chlamydia Screening in Women (CHL): 21-24 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| CHL | 1 | 106 | 106 | Numerator for Chlamydia Screening in Women (CHL): 21-24 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CWP | 2 | 107 | 108 | Denominator for Appropriate Testing Pharyngitis (CWP): 3-17 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| CWP | 2 | 109 | 110 | Numerator for Appropriate Testing Pharyngitis (CWP): 3-17 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| CWP | 2 | 111 | 112 | Denominator for Appropriate Testing Pharyngitis (CWP): 18-64 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| CWP | 2 | 113 | 114 | Numerator for Appropriate Testing Pharyngitis (CWP): 18-64 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| CWP | 2 | 115 | 116 | Denominator for Appropriate Testing Pharyngitis (CWP): 65+ years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| CWP | 2 | 117 | 118 | Numerator for Appropriate Testing Pharyngitis (CWP): 65+ years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| CWP | 2 | 119 | 120 | Denominator Total Removed | blank |
| CWP | 2 | 121 | 122 | Numerator Total Removed | blank |
| MMA | 1 | 123 | 123 | Measure Retired | blank |
| MMA | 1 | 124 | 124 | Measure Retired | blank |
| MMA | 1 | 125 | 125 | Measure Retired | blank |
| MMA | 1 | 126 | 126 | Measure Retired | blank |
| MMA | 1 | 127 | 127 | Measure Retired | blank |
| MMA | 1 | 128 | 128 | Measure Retired | blank |
| MMA | 1 | 129 | 129 | Measure Retired | blank |
| MMA | 1 | 130 | 130 | Measure Retired | blank |
| CBP | 1 | 131 | 131 | Denominator for Controlling High Blood Pressure (CBP) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| CBP | 1 | 132 | 132 | Numerator for Controlling High Blood Pressure (CBP) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| CDC | 1 | 133 | 133 | Measure Retired | blank |
| CDC | 1 | 134 | 134 | Measure Retired | blank |
| CDC | 1 | 135 | 135 | Measure Retired | blank |
| CDC | 1 | 136 | 136 | Measure Retired | blank |
| CDC | 1 | 137 | 137 | Measure Retired | blank |
| CDC | 1 | 138 | 138 | Measure Retired | blank |
| AMM | 1 | 139 | 139 | Denominator for Antidepressant Medication Management (AMM) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMM | 1 | 140 | 140 | Numerator for Antidepressant Medication Management (AMM): Effective Acute Phase Treatment | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMM | 1 | 141 | 141 | Numerator for Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| FUH | 2 | 142 | 143 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years, 7-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 144 | 145 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years, 7-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| FUH | 2 | 146 | 147 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 18-64 years, 7-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 148 | 149 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 18-64 years, 7-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| FUH | 2 | 150 | 151 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 7-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 152 | 153 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 7-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| URI | 2 | 154 | 155 | Denominator for Appropriate Treatment for Upper Respiratory Infection (URI): 3 months-17 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| URI | 2 | 156 | 157 | Numerator for Appropriate Treatment for Upper Respiratory Infection (URI): 3 months-17 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| URI | 2 | 158 | 159 | Denominator for Appropriate Treatment for Upper Respiratory Infection (URI): 18-64 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| URI | 2 | 160 | 161 | Numerator for Appropriate Treatment for Upper Respiratory Infection (URI): 18-64 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| URI | 2 | 162 | 163 | Denominator for Appropriate Treatment for Upper Respiratory Infection (URI): 65+ years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| URI | 2 | 164 | 165 | Numerator for Appropriate Treatment for Upper Respiratory Infection (URI): 65+ years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| URI | 2 | 166 | 167 | Denominator Total - Remove | blank |
| URI | 2 | 168 | 169 | Numerator Total - Remove | blank |
| AAB | 2 | 170 | 171 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 3 months-17 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| AAB | 2 | 172 | 173 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 3 months-17 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| AAB | 2 | 174 | 175 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 18-64 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| AAB | 2 | 176 | 177 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 18-64 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| AAB | 2 | 178 | 179 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 65+ years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |
| AAB | 2 | 180 | 181 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 65+ years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| AAB | 2 | 182 | 183 | Denominator Total - Remove | blank |
| AAB | 2 | 184 | 185 | Numerator Total - Remove | blank |
| LBP | 1 | 186 | 186 | removed to allow for new groupings | blank |
| LBP | 1 | 187 | 187 | removed to allow for new groupings | blank |
| ADV | 1 | 188 | 188 | Denominator for Annual Dental Visit (ADV): 2-3 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 189 | 189 | Numerator for Annual Dental Visit (ADV): 2-3 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| ADV | 1 | 190 | 190 | Denominator for Annual Dental Visit (ADV): 4-6 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 191 | 191 | Numerator for Annual Dental Visit (ADV): 4-6 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| ADV | 1 | 192 | 192 | Denominator for Annual Dental Visit (ADV): 7-10 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 193 | 193 | Numerator for Annual Dental Visit (ADV): 7-10 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| ADV | 1 | 194 | 194 | Denominator for Annual Dental Visit (ADV): 11-14 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 195 | 195 | Numerator for Annual Dental Visit (ADV): 11-14 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| ADV | 1 | 196 | 196 | Denominator for Annual Dental Visit (ADV): 15-18 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 197 | 197 | Numerator for Annual Dental Visit (ADV): 15-18 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| ADV | 1 | 198 | 198 | Denominator for Annual Dental Visit (ADV): 19-20 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| ADV | 1 | 199 | 199 | Numerator for Annual Dental Visit (ADV): 19-20 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IET | 1 | 200 | 201 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 13-17 years Alcohol Use Disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 202 | 203 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 13-17 years Alcohol Use DIsorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 204 | 205 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 13-17 years Alcohol Use Disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 206 | 207 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 13-17 years Opioid Use Disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 208 | 209 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 13-17 years Opioid Use Disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 210 | 211 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 13-17 years Opioid Use Disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 212 | 213 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 13-17 years Other substance use disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 214 | 215 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 13-17 years Other substance use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 216 | 217 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 13-17 years Other substance use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 218 | 219 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 18-64 years Alcohol use disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 220 | 221 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 18-64 years Alcohol use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 222 | 223 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 18 64 years Alcohol use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 224 | 225 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 18-64 years Opioid use disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 226 | 227 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 18-64 years Opioid use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 228 | 229 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 18 64 years Opioid use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 230 | 231 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 18-64 other substance use disoder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 232 | 233 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 18-64 other substance use disoder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 234 | 235 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 18 64 other substance use disoder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| PPC | 2 | 236 | 237 | Denominator for Prenatal and Postpartum Care (PPC): Timeliness of Prenatal Care | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| PPC | 2 | 238 | 239 | Numerator for Prenatal and Postpartum Care (PPC): Timeliness of Prenatal Care | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| PPC | 2 | 240 | 241 | Denominator for Prenatal and Postpartum Care (PPC): Postpartum Care | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| PPC | 2 | 242 | 243 | Numerator for Prenatal and Postpartum Care (PPC): Postpartum Care | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| W15 | 1 | 244 | 244 | Measure removed | blank |
| W15 | 1 | 245 | 245 | Measure removed | blank |
| W34 | 1 | 246 | 246 | Measure removed | blank |
| W34 | 1 | 247 | 247 | Measure removed | blank |
| PDC | 1 | 248 | 248 | Denominator for Rate 1: Renin Angiotensin System (RAS) Antagonists | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| PDC | 1 | 249 | 249 | Numerator for Rate 1: Renin Angiotensin System (RAS) Antagonists | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| PDC | 1 | 250 | 250 | Denominator for Rate 2: Diabetes Medications | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| PDC | 1 | 251 | 251 | Numerator for Rate 2: Diabetes Medications | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| PDC | 1 | 252 | 252 | Denominator for Rate 3: Statins | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| PDC | 1 | 253 | 253 | Numerator for Rate 3: Statins | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| General Info | 2 | 254 | 255 | Age Grouping for the member as of December 31 of the measurement year | Enter the age grouping for the member's age as of December 31 of the measurement year. 00 = < 1 year 01 = 1-4 yrs. 02 = 5-9 yrs. 03 = 10-14 yrs. 04 = 15-17 yrs. 05 = 18-19 yrs. 06 = 20-24 yrs. 07 = 25-29 yrs. 08 = 30-34 yrs. 09 = 35-39 yrs. 10 = 40-44 yrs. 11 = 45-49 yrs. 12 = 50-54 yrs. 13 = 55-59 yrs. 14 = 60-64 yrs. 15 = 65 and up 99 = Unknown |
| General Info | 1 | 256 | 256 | Race | Enter the member's race: 1=White 2=Black or African American 3=American Indian/Alaskan Native 4=Asian 5=Native Hawaiian/Pacific Islander 6=SomeOtherRace 7=Two or more races 8=AskedButNoAnswer 9=Unknown |
| General Info | 1 | 257 | 257 | Ethnicity | Enter the Member's ethnicity: 1=Hispanic or Latino 2=Non-Hispanic or Latino 9=Unknown 0=Asked but not answered |
| General Info | 1 | 258 | 258 | Language Spoken | Enter the member's spoken language: 1=English 2=Non-English 9=Unknown 0=Declined |
| General Info | 3 | 259 | 261 | County of Residence | Enter the 3-digit county FIPS code for each member's residence of county. See the attachment for codes and values to enter here. ### = FIPS Code 000 = Outside of NYS 999 = Unknown |
| General Info | 3 | 262 | 263 | 20 = Health Plan Direct (Direct) 21 = CMS databases (Direct) 23 = Surname Analysis (Indirect) 24 = Geo-coding Analysis (Indirect) 28 = Unknown (use this when race is unknown or asked but no answer) 29= Other (direct) 30 = Other (indirect) |
|
| General Info | 3 | 264 | 265 | 20 = Health Plan Direct (Direct) 21 = CMS databases (Direct) 23 = Surname Analysis (Indirect) 24 = Geo-coding Analysis (Indirect) 28 = Unknown (use this when race is unknown or asked but no answer) 29= Other (direct) 30 = Other (indirect) |
|
| General Info | 3 | 266 | 268 | Removed - can leave blank '000' | |
| General Info | 3 | 269 | 271 | Removed - can leave blank '000' | |
| General Info | 3 | 272 | 274 | Removed - can leave blank '000' | |
| General Info | 3 | 275 | 277 | Removed - can leave blank '000' | |
| General Info | 1 | 278 | 278 | Metal Level | Enter the Metal level of coverage the enrollee is covered under. 1=Platinum 2=Gold 3=Silver 4=Bronze 5=Catastrophic 9=Unknown |
| General Info | 1 | 279 | 279 | Marketplace Product | Enter the '1' if the member enrolled through the Marketplace in an individual benefit, '2' if the member enrolled outside of the Marketplace in an individual benefit, '3' if the member enrolled in the Small Business Health Options Program (SHOP) through the Marketplace, '4' if the member enrolled in the Small Business outside the Marketplace, and '9' if unknown. |
| INR | 1 | 280 | 280 | Denominator for International Normalized ratio Monitoring for Individuals on Warfarin | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| INR | 1 | 281 | 281 | Numerator for International Normalized ratio Monitoring for Individuals on Warfarin | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| W30 | 1 | 282 | 282 | Denominator for Well-Child Visits in the First 15 Months. Children who turned 15 months old during MY: Six or more well-child visits | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| W30 | 1 | 283 | 283 | Numerator for Well-Child Visits in the First 15 Months. Children who turned 15 months old during MY: Six or more well-child visits | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| W30 | 1 | 284 | 284 | Denominator for Well-Child Visits for Age 15 Months-30 Months. Children who turned 30 months old during the MY: Two or more well-child visits. | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| W30 | 1 | 285 | 285 | Numerator for Well-Child Visits for Age 15 Months-30 Months. Children who turned 30 months old during the MY: Two or more well-child visits. | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCV | 1 | 286 | 286 | Denominator for Child and Adolescent Well-Care Visits: 3-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCV | 1 | 287 | 287 | Numerator for Child and Adolescent Well-Care Visits: 3-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCV | 1 | 288 | 288 | Denominator for Child and Adolescent Well-Care Visits: 12-17 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCV | 1 | 289 | 289 | Numerator for Child and Adolescent Well-Care Visits: 12-17 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| WCV | 1 | 290 | 290 | Denominator for Child and Adolescent Well-Care Visits: 18-21 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| WCV | 1 | 291 | 291 | Numerator for Child and Adolescent Well-Care Visits: 18-21 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMO | 1 | 292 | 292 | Denominator for Annual Monitoring for Persons on Long-term Opioid Therapy: 18+ years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMO | 1 | 293 | 293 | Numerator for Annual Monitoring for Persons on Long-term Opioid Therapy: 18+ years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMR | 1 | 294 | 294 | Denominator for Asthma Medication Ratio (AMR): 5-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMR | 1 | 295 | 295 | Numerator for Asthma Medication Ratio (AMR): 5-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMR | 1 | 296 | 296 | Denominator for Asthma Medication Ratio (AMR): 12-18 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMR | 1 | 297 | 297 | Numerator for Asthma Medication Ratio (AMR): 12-18 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMR | 1 | 298 | 298 | Denominator for Asthma Medication Ratio (AMR): 19-50 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMR | 1 | 299 | 299 | Numerator for Asthma Medication Ratio (AMR): 19-50 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| AMR | 1 | 300 | 300 | Denominator for Asthma Medication Ratio (AMR): 51-64 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| AMR | 1 | 301 | 301 | Numerator for Asthma Medication Ratio (AMR): 51-64 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| FUH | 2 | 302 | 303 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years, 30-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 304 | 305 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years, 30-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| FUH | 2 | 306 | 307 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 18-64 years, 30-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 308 | 309 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 18-64 years, 30-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| FUH | 2 | 310 | 311 | Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 30-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| FUH | 2 | 312 | 313 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 30-day follow-up | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| BPD | 1 | 314 | 314 | Measure removed | Blank |
| BPD | 1 | 315 | 315 | Measure removed | Blank |
| HBD | 1 | 316 | 316 | Denominator for Hemoglobin A1c Control for Patients with Diabetes | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| HBD | 1 | 317 | 317 | Numerator for HbA1c Control <8% | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| HBD | 1 | 318 | 318 | Removed | Removed |
| EED | 1 | 319 | 319 | Denominator for Eye Exam for Patients with Diabetes | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| EED | 1 | 320 | 320 | Numerator for Eye Exam for Patients with Diabetes | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| IET | 1 | 321 | 322 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 65+ years Alcohol Use Disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 323 | 324 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 65+ years Alcohol use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 325 | 326 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 65+ years Alcohol use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 327 | 328 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 65+ years Opioid use disorder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 329 | 330 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 65+ years Opioid use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 331 | 332 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 65+ years Opioid use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 333 | 334 | Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 65+ other substance use disoder | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |
| IET | 1 | 335 | 336 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of Other substance use disorder, 65+ other substance use disoder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| IET | 1 | 337 | 338 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagment of other substance use disorder 65+ other substance use disoder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |
| General Info | 3 | 339 | 341 | Blank | Removed - can leave blank '000' |
| General Info | 3 | 342 | 344 | Blank | Removed - can leave blank '000' |
| General Info | 3 | 345 | 347 | Blank | Enter the indirectly estimated probability of the member's race being Two or other other races as a percentage of 100 |
| General Info | 3 | 348 | 350 | Blank | Removed - can leave blank '000' |
| General Info | 3 | 351 | 353 | Blank | Removed - can leave blank '000' |
| General Info | 3 | 354 | 356 | Blank | Removed - can leave blank '000' |
| COL | 1 | 357 | 357 | Denominator for Colorectal Cancer Screening (COL): 46-49 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| COL | 1 | 358 | 358 | Numerator for Colorectal Cancer Screening (COL): 46-49 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| COL | 1 | 359 | 359 | Denominator for Colorectal Cancer Screening (COL): 50-75 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| COL | 1 | 360 | 360 | Numerator for Colorectal Cancer Screening (COL): 50-75 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| LBP | 1 | 361 | 361 | Denominator for Use of Imaging Studies for Low Back Pain (LBP), Ages 18-64 Years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| LBP | 1 | 362 | 362 | Numerator for Use of Imaging Studies for Low Back Pain (LBP), Ages 18-64 Years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
| LBP | 1 | 363 | 363 | Denominator for Use of Imaging Studies for Low Back Pain (LBP), Ages 65-75 Years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
| LBP | 1 | 364 | 364 | Numerator for Use of Imaging Studies for Low Back Pain (LBP), Ages 65-75 Years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
+NYS MY2022 Patient-Level Detail File Change Log
MARKETPLACE
| MARKETPLACE | Revision date: November 22, 2022 | ||
|---|---|---|---|
| Version | Date | Data Element | Change Summary |
| Specification Release MY2022 | 11/9/2021 | Multiple | Initial MY2022 update per HEDIS 2022 specifications. |
| Clarification #2 | 12/21/2021 | Multiple | There were multiple places where the column start did not begin in the correct location, creating duplicate column figures. This has been corrected. |
| Clarification #4 | 6/16/2022 | COL | Removed colorectal to allow for age stratification grouping 101-102. |
| Clarification #4 | 6/16/2022 | COL | Added the new colorectal stratifications 333-339. |
| Clarification #6 | 9/1/2022 | Multiple | Beginning in column 332, the new measure, COL, had two spaces for data entry. This has been corrected to 1 space. This impacts 332-335. |
| Clarification #7 | 10/19/2022 | HBD | There were duplicate numerators for HBD. One has been removed on 302. |
| Clarification #7 | 10/19/2022 | IET | Changed the numerator and denominator language to reflect the episodic language. |
| Clarification #7 | 10/19/2022 | LBP | Removed the measure from 186-187 Combined both age stratifications and located them in 336-339. |
| Clarification #8 | 11/15/2022 | IET | Removed the measure from 186?187 Combined both age stratifications and located them in 336-339. |
| Clarification #8 | 11/15/2022 | General Info | Removed the indirect race and ethnicity estimates from columns 262 to 277 and 340 to 356. Add source of race data to columns 262 to 263. Added source of ethnicity data to 264 to 265. Reduced the column field size (length) from 3 to 2 for columns 262 to 265. |
| Clarification #9 | 11/21/2022 | BPD | Removed from required reporting for PPO/EPO and HMO/POS product lines. This impacts columns 314 to 315 of the Exchange PLD. |
