Marketplace MY2023 PLD File Specifications

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Revision date: February 14, 2024

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 sex 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
GENERAL INFO 2 66 67 Race Enter the member's race:
01=White
02=Black or African American
03=American Indian/Alaskan Native
04=Asian
05=Native Hawaiian/Pacific Islander
06=Some Other Race
07=Two or more races
08=Asked But No Answer
09=Unknown
GENERAL INFO 2 68 69 Source of Race Data Provide the source of race data:
20 = Health Plan Direct (Direct)
21 = CMS databases (Direct)
22 = State Databases (Direct)
23 = Surname Analysis (Indirect)
24 = Geo-coding Analysis (Indirect)
28 = Unknown - Use this as the race source value when the member's race is "UNK" for Unknown Race
29 = Other (Direct)
30 = Unknown (Indirect)
GENERAL INFO 1 70 70 Ethnicity Enter the Member's ethnicity:
1=Hispanic or Latino
2=Non-Hispanic or Latino
9=Unknown
0=Asked but not answered
GENERAL INFO 2 71 72 Source of Ethnicity Data Provide the source of ethnicity data:
20 = Health Plan Direct (Direct)
21 = CMS databases (Direct)
22 = State Databases (Direct)
23 = Surname Analysis (Indirect)
24 = Geo-coding Analysis (Indirect)
28 = Unknown - Use this as the race source value when the member's race is "UNK" for Unknown Race
29 = Other (Direct)
30 = Unknown (Indirect)
GENERAL INFO 2 73 74 Asian American Subgroups If member is Asian then identify the specific subgroup:
01=Chinese
02=Japanese
03=Filipino
04=Korean
05=Vietnamese
06=Asian Indian
07=Laotian
08=Cambodian
09=Bangladeshi
10=Hmong
11=Indonesian
12=Malaysian
13=Pakistani
14=Sri Lankan
15=Taiwanese
16=Nepalese
17=Burmese
18=Thai
19=Unknown 20=Declined
00=Not Asian
GENERAL INFO 1 75 75 Native Hawaiian/Pacific Islander Subgroups If member is Native Hawaiian or Pacific Islander then identify the subgroup:
1=Hawaiian
2=Guamanian/Chamorro
3=Samoan
4=Fijian
5=Tongan
6=Unknown
7=Declined
0=Not Native Hawaiian/Pacific Islander
GENERAL INFO 3 76 78 Language Spoken Enter the member's spoken language:
001=English
*For all other languages other than English see the Language Value Set on the Managed Care > Information for Health Plans > Quality Assurance Reporting Requirements (QARR)> 2023> NYS QARR Language Value Set webpage.

197=Unknown
199=Declined
GENERAL INFO 3 79 81 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 1 82 82 Metal Level 1=Platinum
2 = Gold
3 = Silver
4 = Bronze
5 = Catastrophic
9 = Unknown
General Info 1 83 83 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.
AAB 2 84 85 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 86 87 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 88 89 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 90 91 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 92 93 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 94 95 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
AIS-E 1 96 96 Denominator 1 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 1) [Members 19 years and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 97 97 Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 1) [Members 19 years and older] 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
AIS-E 1 98 98 Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 2) [ Members 19 years and older] 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
AIS-E 1 99 99 Denominator 3 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 years and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 100 100 Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 years and older] 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
AIS-E 1 101 101 Denominator 4 for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 66 years and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 102 102 Numerator for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 66 years and older] 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 1 103 103 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 1 104 104 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 1 105 105 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
AMO 1 106 106 Denominator for Annual Monitoring for Persons on Long-term Opioid Therapy (AMO): 18+ years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AMO 1 107 107 Numerator for Annual Monitoring for Persons on Long-term Opioid Therapy (AMO): 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 1 108 108 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 1 109 109 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 1 110 110 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 1 111 111 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 1 112 112 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 1 113 113 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 1 114 114 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 1 115 115 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
BCS-E 1 116 116 Denominator for Breast Cancer Screening Electronic (BCS-E) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
BCS-E 1 117 117 Numerator for Breast Cancer Screening Electronic (BCS-E) 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
CBP 1 118 118 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 1 119 119 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
CCS 1 120 120 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 1 121 121 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
CCS-E 1 122 122 Denominator for Cervical Cancer Screening Electronic (CCS-E) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
CCS-E 1 123 123 Numerator for Cervical Cancer Screening Electronic (CCS-E) 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 1 124 124 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 1 125 125 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 1 126 126 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 1 127 127 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
CIS 1 128 128 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 1 129 129 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 1 130 130 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 1 131 131 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 1 132 132 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 1 133 133 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 1 134 134 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 1 135 135 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 1 136 136 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 1 137 137 Numerator for Childhood Immunization Status (CIS): RV 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 1 138 138 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-E 1 139 139 Denominator for Childhood Immunization Status Electronic (CIS-E) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
CIS-E 1 140 140 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 141 141 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 142 142 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 143 143 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 144 144 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 145 145 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 146 146 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 147 147 Numerator for Childhood Immunization Status Electronic (CIS- E): 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-E 1 148 148 Numerator for Childhood Immunization Status Electronic (CIS- E): RV 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-E 1 149 149 Numerator for Childhood Immunization Status Electronic (CIS- E): 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
CIS-E 1 150 150 Numerator for Childhood Immunization Status Electronic (CIS- E): 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
COL 1 151 151 Denominator for Colorectal Cancer Screening (COL): 46-50 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
COL 1 152 152 Numerator for Colorectal Cancer Screening (COL): 46-50 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
COL 1 153 153 Denominator for Colorectal Cancer Screening (COL): 51-75 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
COL 1 154 154 Numerator for Colorectal Cancer Screening (COL): 51-75 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
COL-E 1 155 155 Denominator for Colorectal Cancer Screening Electronic (COL- E): 46-50 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
COL-E 1 156 156 Numerator for Colorectal Cancer Screening Electronic (COL-E): 46-50 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
COL-E 1 157 157 Denominator for Colorectal Cancer Screening (COL-E): 51-75 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
COL-E 1 158 158 Numerator for Colorectal Cancer Screening (COL-E): 51-75 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
EED 1 159 159 Denominator for Eye Exam for Patients with Diabetes (EED) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
EED 1 160 160 Numerator for Eye Exam for Patients with Diabetes (EED) 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 2 161 162 Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years Enter:
The number of times this member is in denominator
'0' if the member is not in the denominator
FUH 2 163 164 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 denominator
'0' if the member is not in the denominator
FUH 2 165 166 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 2 167 168 Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 18-64 years Enter:
The number of times this member is in denominator
'0' if the member is not in the denominator
FUH 2 169 170 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 2 171 172 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 2 173 174 Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years Enter:
The number of times this member is in denominator
'0' if the member is not in the denominator
FUH 2 175 176 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
FUH 2 177 178 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
HBD 1 179 179 Denominator for Hemoglobin A1c Control for Patients with Diabetes (HBD) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
HBD 1 180 180 Numerator for HbA1c poor control (>9.0%) 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 2 181 182 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 2 183 184 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 2 185 186 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 2 187 188 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 2 189 190 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 2 191 192 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 2 193 194 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 2 195 196 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 2 197 198 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 2 199 200 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 2 201 202 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 2 203 204 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 2 205 206 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 2 207 208 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 2 209 210 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 2 211 212 Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 18-64 other substance use disorder Enter:
The number of times this member is in denominator
'0' if the member is not in the denominator
IET 2 213 214 Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD Treatment, 18-64 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 2 215 216 Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD Treatment, 18- 64 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 2 217 218 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 2 219 220 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 2 221 222 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 2 223 224 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 2 225 226 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 2 227 228 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 2 229 230 Denominator for Initiation and Engagement of Substance Use Disorder Treatment (IET): 65+ other substance use disorder Enter:
The number of times this member is in denominator
'0' if the member is not in the denominator
IET 2 231 232 Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of Other substance use disorder, 65+ 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 2 233 234 Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of other substance use disorder 65+ 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
IMA 1 235 235 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 1 236 236 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 1 237 237 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 1 238 238 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 1 239 239 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
IMA-E 1 240 240 Denominator for Immunizations for Adolescents Electronic (IMA-E) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
IMA-E 1 241 241 Numerator for Immunizations for Adolescents Electronic (IMA- E): 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-E 1 242 242 Numerator for Immunizations for Adolescents Electronic (IMA- E): 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-E 1 243 243 Numerator for Immunizations for Adolescents Electronic (IMA- E): Combo 1 Removed - can leave blank '0'
IMA-E 1 244 244 Numerator for Immunizations for Adolescents Electronic (IMA- E): 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-E 1 245 245 Numerator for Immunizations for Adolescents Electronic (IMA- E): 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
INR 1 246 246 Denominator for International Normalized ratio Monitoring for Individuals on Warfarin (INR) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
INR 1 247 247 Numerator for International Normalized ratio Monitoring for Individuals on Warfarin (INR) 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
KED 1 248 248 Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 18-64 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
KED 1 249 249 Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 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
KED 1 250 250 Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 65-74 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
KED 1 251 251 Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 65-74 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
KED 1 252 252 Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 75-85 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
KED 1 253 253 Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 75-85 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 1 254 254 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 1 255 255 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 1 256 256 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 1 257 257 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
PDC 1 258 258 Proportion of Days Covered (PDC) 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 1 259 259 Proportion of Days Covered (PDC) 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 1 260 260 Proportion of Days Covered (PDC) 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 1 261 261 Proportion of Days Covered (PDC) 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 1 262 262 Proportion of Days Covered (PDC) Denominator for Rate 3: Statins Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
PDC 1 263 263 Proportion of Days Covered (PDC) 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
PPC 2 264 265 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 2 266 267 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 2 268 269 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 2 270 271 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
URI 2 272 273 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 2 274 275 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 2 276 277 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 2 278 279 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 2 280 281 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 2 282 283 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
W30 1 284 284 Denominator for Well-Child Visits in the First 15 Months (W30). 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 1 285 285 Numerator for Well-Child Visits in the First 15 Months (W30). 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 1 286 286 Denominator for Well-Child Visits for Age 15 Months-30 Months (W30). 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 1 287 287 Numerator for Well-Child Visits for Age 15 Months-30 Months (W30). 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
WCC 1 288 288 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 1 289 289 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 1 290 290 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 1 291 291 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 1 292 292 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 1 293 293 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 1 294 294 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 1 295 295 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 1 296 296 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 1 297 297 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 1 298 298 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 1 299 299 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
WCV 1 300 300 Denominator for Child and Adolescent Well-Care Visits (WCV): 3-11 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
WCV 1 301 301 Numerator for Child and Adolescent Well-Care Visits (WCV): 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 1 302 302 Denominator for Child and Adolescent Well-Care Visits (WCV): 12-17 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
WCV 1 303 303 Numerator for Child and Adolescent Well-Care Visits (WCV): 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 1 304 304 Denominator for Child and Adolescent Well-Care Visits (WCV): 18-21 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
WCV 1 305 305 Numerator for Child and Adolescent Well-Care Visits (WCV): 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
CIS 1 306 306 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
AIS-E 1 307 307 Denominator 2 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 4) [Members 66 and older] 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
AIS-E 1 308 308 Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 4) [Members 66 and older] 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
AIS-E 1 309 309 Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 4) [Members 66 and older] 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
AIS-E 1 310 310 Denominator 4 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 66 and older] 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
AIS-E 1 311 311 Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 66 and older] 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
MARKETPLACE
Version Date Data Element Change Summary
Specification Release MY2023 1/9/2023 Multiple Initial MY2023 update per HEDIS 2022 specifications: This included removal of all unused columns either due to retirement or unnecessary totaling. These include the measure ABA, BCS, and MMA. There was a combining of measure columns when they were separated which impacted COL, COL-E, and IET. General information was grouped together at the top of the file. We have added requests for Asian American subgroup, Pacific Island group, and more detailed information for language other than English. HBD had an extra numerator which was removed. Measures are alphabetically arranged by shortname. Changes or additions will be added to the bottom of the file for 2023. The file will be re-sorted alphabetically for 2024.
Clarification #1 6/5/2023 Multiple Field Source of Race Data:
22 = State Databases (Direct) was added as a response option.

Field Source of Ethnicity Data:
22 = State Databases (Direct) was added as a response option

Measure FUH: Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years was missing and was added.

Measure FUH: Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 7-day follow-up was missing and was added.

Measure KED: Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 75- 85 years was missing and was added.

ECDS measures: The following measures have been added as required reporting on the PLD:
     Adult Immunization Status (AIS-E)
     Cervical Cancer Screening (CCS-E)
     Childhood Immunization Status (CIS-E)
     Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
     Social Need Screening and Intervention (SNS-E)
Clarification #2 8/28/2023 Multiple Column Length Changed = 2 for Race

Column Length Changed = 2 for Source of Race Data

Source of Race Data field, valid values have been updated to align with NCQA/HEDIS specifications.

Column Length Changed = 2 for Source of Ethnicity Data

Source of Ethnicity Data field, valid values have been updated to align with NCQA/HEDIS specifications.

The Language Spoken field has been updated to include a link to Language Value Set on the NYS QARR Language Value Set webpage.

Measure COL (non-electronic version): Denominator and Numerator specifications have been added for all age-bands for this measure.

Measure COL (electronic version):
  • Denominator and Numerator specifications have been added for 46-49 age-band for this measure.

ECDS measures: To align with CMS' Final Call letter for QRS, the following measures have been REMOVED as required reporting on the PLD:
     Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
     Social Need Screening and Intervention (SNS-E)

Column Start and Column End numbering was corrected.
Clarification #3 10/17/2023 General Info Native Hawaiian/Pacific Islander Subgroups: Updated
0=Not Native Hawaiian/Pacific Islander

Measure COL-E (electronic version):
Denominator and Numerator specifications have been updated for 46-50 and 51-75 age-bands for this measure.

To align with CMS' Final Call letter for QRS, the following measures have been REMOVED as required reporting on the PLD:
     Appropriate Testing for Pharyngitis (CWP)

Column Start and Column End numbering was corrected.
Clarification #4 11/7/2023 Multiple Measure AIS-E (electronic version):
Labels and descriptions updated to match HEDIS numerator and denominator population criteria.

Measure COL-E (electronic version)
Beginning with column start 157 (COL-E 51 -75 age stratification denominator) all remaining column start and column end numbering has been corrected.

Measure HBD
Per QRS 2024 ratings year (MY2023) reporting guideline; "QHP issuers are required to submit data for the HbA1c Control for Patients with Diabetes: HbA1c poor control (>9.0%)", the numerator has been updated.

Measure IMA-E (electronic version)
Per QRS reporting guideline; removed reporting requirement for IMA-E for Combo 1; indicating it may be left blank "0".

Measure CIS
Numerator specifications have been added to the end of the PLD (row #306 )to include Influenza reporting.
Clarification #5 11/21/2023 AIS-E Measure AIS-E (electronic version):
Label and description for Influenza and Td/Tdap denominator 1 has been updated to represent the 19-65 year old age band [column start 109].

Labels and descriptions for Influenza and Td/Tdap numerators have been updated to represent the 19-65 year old age band [column starts 110-111].

Label and description for Zoster denominator 3 has been updated to represent the 50-65 year old age band [column start 112].

Label and description for Zoster numerator has been updated to represent the 50-65 year old age band [column start 113].

Denominator 2 for Influenza and Td/Tdap has been added for the 66 years and older age band [column start 544].

Numerators for Influenza and Td/Tdap have been added for the age band of 66 years and older [column starts 545-546].

Denominator 4 for Zoster has been added for the 66 years and older age band [column start 547].

Numerator for Zoster has been added for the 66 years and older age band [column start 548].
Clarification #7 12/14/2024 Source of Race Data Updated: 28 = Unknown – Use this as the race source value when the member's race is "UNK" for Unknown Race
Updated: 30 = Other (Indirect) – Use when "other" indirect method is used to determine Race
Source of Ethnicity Data Updated: 28 = Unknown – Use this as the race source value when the member's race is "UNK" for Unknown Ethnicity
Updated: 30 = Other (Indirect) – Use when "other" indirect method is used to determine Ethnicity