Marketplace MY2024 PLD File Specifications

  • Document is also available in Portable Document Format (PDF)
Revision date: 7/1/2024

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 = 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, 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:
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
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, 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:
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
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