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Marketplace MY2024 PLD File Specifications

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+NYS MY2024 Patient-Level Detail File Specifications

Revision date: March 5, 2025

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 = Other (Indirect) - Use when "other" indirect method is used to determine Race.
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 ethnicity source value when the member's ethnicity is "UNK" for Unknown Ethnicity. 29 = Other (Direct) 30 = Other (Indirect) - Use when "other" indirect method is used to determine Ethnicity
GENERAL INFO	2	73	74	Asian American Subgroups	If member's race is White, Black or African American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Some Other Race, Asked But No Answer, or Unknown then Enter: 00=Not Applicable If member's race 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=Two or more subgroups 20=Unknown Asian Subgroup 21=Declined 22=Other Asian Subgroup [1]
GENERAL INFO	1	75	75	Native Hawaiian/Pacific Islander Subgroups	If member's race is White, Black or African American, American Indian/Alaskan Native, Asian, Some Other Race, Two or more races, Asked But No Answer, or Unknown then Enter: 0=Not Applicable If member's race is Native Hawaiian/Pacific Islander then identify the specific subgroup: 1=Hawaiian 2=Guamanian/Chamorro 3=Samoan 4=Fijian 5=Tongan 6=Two or more subgroups 7=Unknown Native Hawaiian/Pacific Islander Subgroup 8=Declined 9=Other Native Hawaiian/Pacific Islander Subgroup
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)> 2024> NYS QARR Language Value Setwebpage. 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	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	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 -65 years]	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 -65 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
AIS-E	1	98	98	Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 2) [Members 19 -65 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
AIS-E	1	99	99	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	100	100	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	101	101	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	102	102	Denominator 3 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 - 65 years]	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
AIS-E	1	103	103	Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 - 65 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
AIS-E	1	104	104	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	105	105	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
AIS-E	1	106	106	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	107	107	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	108	108	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	109	109	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	110	110	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	111	111	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	112	112	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	113	113	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	114	114	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	115	115	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	116	116	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	117	117	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	118	118	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	119	119	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	120	120	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	121	121	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	122	122	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	123	123	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	124	124	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	125	125	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	126	126	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	127	127	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	128	128	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	129	129	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	130	130	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	131	131	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	132	132	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	133	133	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
CIS	1	134	134	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	135	135	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	136	136	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	137	137	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	138	138	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	139	139	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	140	140	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	141	141	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	142	142	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	143	143	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	144	144	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	145	145	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	146	146	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	147	147	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	148	148	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	149	149	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	150	150	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	151	151	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	152	152	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	153	153	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	154	154	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	155	155	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	156	156	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-E	1	157	157	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	158	158	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	159	159	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	160	160	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	161	161	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	162	162	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
DSF-E	1	163	163	Denominator 1 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 12-17 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	164	164	Numerator Depression Screening (Population Criteria 1) (DSF-E): 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
DSF-E	1	165	165	Denominator 1 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 18-64 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	166	166	Numerator Depression Screening (Population Criteria 1) (DSF-E): 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
DSF-E	1	167	167	Denominator 1 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 65+ years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	168	168	Numerator Depression Screening (Population Criteria 1) (DSF-E): 65+ 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
DSF-E	1	169	169	Denominator 2 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 12-17 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	170	170	Numerator Follow-Up on Positive Screen (Population Criteria 2) (DSF-E): 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
DSF-E	1	171	171	Denominator 2 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 18-64 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	172	172	Numerator Follow-Up on Positive Screen (Population Criteria 2) (DSF-E): 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
DSF-E	1	173	173	Denominator 2 for Depression Screening and Follow-up for Adolescents and Adults (DSF-E): 65+ years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
DSF-E	1	174	174	Numerator Follow-Up on Positive Screen (Population Criteria 2) (DSF-E): 65+ 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	175	176	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	177	178	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	179	180	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	181	182	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	183	184	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	185	186	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	187	188	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	189	190	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	191	192	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
GSD	1	193	193	Denominator for Glycemic Status Assessment for Patients With Diabetes (GSD)	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
GSD	1	194	194	Numerator for Glycemic Status >9.0% (GSD)	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	195	196	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	197	198	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	199	200	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	201	202	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	203	204	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	205	206	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	207	208	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	209	210	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	211	212	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	213	214	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	215	216	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	217	218	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	219	220	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	221	222	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	223	224	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	225	226	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	227	228	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	229	230	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	231	232	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	233	234	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	235	236	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	237	238	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	239	240	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of SUD 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	241	242	Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of SUD 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	243	244	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	245	246	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	247	248	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	249	249	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	250	250	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	251	251	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	252	252	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	253	253	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	254	254	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	255	255	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	256	256	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	257	257	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	258	258	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	259	259	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	260	260	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	261	261	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	262	262	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	263	263	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	264	264	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	265	265	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	266	266	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	267	267	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	268	268	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	269	269	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	270	270	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	271	271	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	272	272	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	273	273	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
OED	1	274	274	Denominator: Oral Evaluation, Dental Services (OED) - 0-2 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
OED	1	275	275	Numerator: Oral Evaluation, Dental Services (OED) - 0-2 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
OED	1	276	276	Denominator: Oral Evaluation, Dental Services (OED) -3-5 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
OED	1	277	277	Numerator: Oral Evaluation, Dental Services (OED) -3-5 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
OED	1	278	278	Denominator: Oral Evaluation, Dental Services (OED) - 6-14 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
OED	1	279	279	Numerator: Oral Evaluation, Dental Services (OED) - 6-14 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
OED	1	280	280	Denominator: Oral Evaluation, Dental Services (OED) - 15-20 years	Enter: '1' if this member is in the denominator '0' if this member is not in the denominator
OED	1	281	281	Numerator: Oral Evaluation, Dental Services (OED) - 15-20 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
PDC	1	282	282	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	283	283	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	284	284	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	285	286	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	287	288	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	289	290	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	291	292	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	293	294	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	295	296	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	297	298	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	299	300	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	301	302	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	303	304	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	305	305	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	306	306	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	307	307	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	308	308	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	309	309	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	310	310	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	311	311	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	312	312	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	313	313	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	314	314	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	315	315	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	316	316	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	317	317	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	318	318	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	319	319	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	320	320	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	321	321	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	322	322	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	323	323	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	324	324	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	325	325	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	326	326	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

+NYS MY2024 Patient-Level Detail File Change Log

MARKETPLACE
Version	Date	Data Element	Change Summary
Specification Release MY2024	12/11/2024	Multiple	Asian American Subgroups Adding a "two or more subgroups" option Native Hawaiian/Pacific Islander Subgroups Adding a "two or more subgroups" option Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) has been added as a required ECDS measure. The following Measures have been removed due to retirement by the steward: Colorectal Cancer Screening (COL)* Only the COL-E, will be reported. Hemoglobin A1c (HbA1c) Control for Patients With Diabetes (HBD)* has been replaced by Glycemic Status Assessment for Patients With Diabetes (GSD) Oral Evaluation, Dental Services (OED) To align with CMS' 2024 QHP Technical Specifications, OED has been ADDED as required reporting on the PLD.
Clarification #1	5/9/2024	Multiple	Source of Race Data Valid values have been updated to align with NCQA/HEDIS specifications 28 = Unknown 30 = Other (indirect) Source of Ethnicity Data Valid values have been updated to align with NCQA/HEDIS specifications 28=Unknown 30=Other (indirect) Asian American Subgroups Updated values 19=Two or more subgroups 20=Unknown 21=Declined 00=Not Asian
Clarification #2	7/2/2024	Multiple	Asian American Subgroups Updated description and values: If member's race is White, Black or African American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander, Two Or More Races, Some Other Race, Asked But No Answer, or Unknown then Enter: 00= Not applicable If member's race is Asian, then identify the specific subgroup: 20=Unknown Asian subgroup 22=Other Asian subgroup Native Hawaiian/Pacific Islander Subgroups Updated description and values: If member's race is White, Black or African American, American Indian/Alaskan Native, Asian, Two Or More Races, Some Other Race, Asked But No Answer, or Unknown then Enter: 0=Not Applicable If member's race is Native Hawaiian/Pacific Islander then identify the specific subgroup: 7=Unknown Native Hawaiian/Pacific Islander Subgroup 9=Other Native Hawaiian/Pacific Islander Subgroup
Clarification #8	1/28/2025	Exchange PLD - PDF version	Metal Level Field: Updated Metal level of coverage the enrollee is covered under to include: 9 = Unknown
Clarification #9	2/28/2025	Patient-Level Detail File (PLD) MY2024
			Exchange PLD:: Kidney Health Evaluation for Patients With Diabetes (KED): The age stratifications listed in the PLD differ slightly from the age stratification ranges in the HEDIS® 2024 specifications. It is acceptable to populate with the HEDIS® 2024 specifications as noted in the *QARR Reporting Requirements, Table 1: NYS MY2024 QARR List of Required Measures.* The Metal Level Field: For NYS QARR reporting, all "Bronze" Metal Levels should be reported as "4=Bronze" regardless of expansion.

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+NYS MY2024 Patient-Level Detail File Change Log

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+NYS MY2024 Patient-Level Detail File Specifications

Revision date: March 5, 2025

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+NYS MY2024 Patient-Level Detail File Change Log

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