Marketplace MY2025 PLD File Specifications
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NYS MY2025 Patient-Level Detail File Specifications
Revision date: December 13, 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 | 9 | 55 | 63 | Member Attributed Practice Tax ID#* | Enter the 9-digit Federally assigned Tax Identification Number for the Practice of the member's provider. Populate with valid TINs only. If unavailable or invalid set to '999999999' |
GENERAL INFO | 10 | 64 | 73 | Member Attributed Physician NPI* | Populate with valid NPIs only. This is the unique 10-digit National Provider Identifier (NPI) of the provider/organization the member was serviced by during the reporting period. This should be a provider that had frequent contact with the member and, therefore, could potentially affect the need for hospitalization or not. [1] |
GENERAL INFO | 8 | 74 | 81 | Member 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 | 82 | 83 | Member Months | The member month contribution this member adds according to enrollment data. Valid values are between 0 - 12. |
GENERAL INFO | 1 | 84 | 84 | 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 | 85 | 86 | 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 | 1 | 87 | 87 | 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 | 88 | 89 | 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 | 90 | 90 | 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 | 91 | 93 | 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)> 2025> NYS QARR Language Value Set webpage. 197=Unknown 199=Declined |
GENERAL INFO | 3 | 94 | 96 | 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 | 97 | 97 | 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 | 98 | 98 | 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 | 99 | 100 | 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 | 101 | 102 | 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 | 103 | 104 | 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 | 105 | 106 | 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 | 107 | 108 | 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 | 109 | 110 | 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 | 111 | 111 | Denominator 1 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 1) [Members 19 -64 years] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
AIS-E | 1 | 112 | 112 | Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 1) [Members 19 -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 |
AIS-E | 1 | 113 | 113 | Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 2) [Members 19 -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 |
AIS-E | 1 | 114 | 114 | Denominator 2 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 4) [Members 65 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 | 115 | 115 | Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 4) [Members 65 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 | 116 | 116 | Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 4) [Members 65 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 | 117 | 117 | Denominator 3 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 - 64 years] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
AIS-E | 1 | 118 | 118 | Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 - 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 |
AIS-E | 1 | 119 | 119 | Denominator 4 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 65 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 | 120 | 120 | Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 65 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 | 121 | 121 | Denominator 4 for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 65 years and older] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
AIS-E | 1 | 122 | 122 | Numerator for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 65 years and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
AIS-E | 1 | 123 | 123 | Denominator for Adult Immunization Status (AIS-E): Hepatitis B (Population Criteria 5) [Members 19 -30 years] [2] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
AIS-E | 1 | 124 | 124 | Numerator for Adult Immunization Status (AIS-E): Hepatitis B (Population Criteria 5) [Members 19 -30 years] [3] | Enter: '1' 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 | 125 | 125 | Denominator 4 for Adult Immunization Status (AIS-E): Hepatitis B (Population Criteria 5) [Members 31- 59 years] [4] | Enter: '1' 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 | 126 | 126 | Numerator for Adult Immunization Status (AIS-E): Hepatitis B (Population Criteria 5) [Members 31- 59 years] [5] | Enter: '1' 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 | 127 | 127 | 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 | 128 | 128 | 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 | 129 | 129 | 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 | 130 | 130 | 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 | 131 | 131 | 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 | 132 | 132 | 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 | 133 | 133 | 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 | 134 | 134 | 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 | 135 | 135 | 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 | 136 | 136 | 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 | 137 | 137 | Denominator for Breast Cancer Screening (BCS-E): (50-74 years) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
BCS-E | 1 | 138 | 138 | Numerator for Breast Cancer Screening (BCS-E): (50-74 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 |
CBP | 1 | 139 | 139 | Denominator for Controlling High Blood Pressure (CBP): 18-85 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
CBP | 1 | 140 | 140 | Numerator for Controlling High Blood Pressure (CBP): 18-85 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 |
CCS-E | 1 | 141 | 141 | Denominator for Cervical Cancer Screening Electronic (CCS-E): 21-64 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
CCS-E | 1 | 142 | 142 | Numerator for Cervical Cancer Screening Electronic (CCS-E): 21-64 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 |
CHL | 1 | 143 | 143 | 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 | 144 | 144 | 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 | 145 | 145 | 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 | 146 | 146 | 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-E | 1 | 147 | 147 | Denominator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
CIS-E | 1 | 148 | 148 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 149 | 149 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 150 | 150 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 151 | 151 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 152 | 152 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 153 | 153 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 154 | 154 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 155 | 155 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 156 | 156 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 157 | 157 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 158 | 158 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - Combo 3 | Enter: '1' 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 | Numerator for Childhood Immunization Status Electronic (CIS-E): completed by age 2 - Combo 7 | 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 Childhood Immunization Status Electronic (CIS-E): completed by age 2 - 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 | 161 | 161 | 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 | 162 | 162 | 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 | 163 | 163 | Denominator for Eye Exam for Patients with Diabetes (EED): 18-75 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
EED | 1 | 164 | 164 | Numerator for Eye Exam for Patients with Diabetes (EED): 18-75 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 |
DSF-E | 1 | 165 | 165 | 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 | 166 | 166 | 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 | 167 | 167 | 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 | 168 | 168 | 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 | 169 | 169 | 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 | 170 | 170 | 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 | 171 | 171 | 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 | 172 | 172 | 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 | 173 | 173 | 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 | 174 | 174 | 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 | 175 | 175 | 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 | 176 | 176 | 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 | 177 | 178 | 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 | 179 | 180 | 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 | 181 | 182 | 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 | 183 | 184 | 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 | 185 | 186 | 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 | 187 | 188 | 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 | 189 | 190 | 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 | 191 | 192 | 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 | 193 | 194 | 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 | 195 | 195 | Denominator for Glycemic Status Assessment for Patients With Diabetes (GSD): 18-75 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
GSD | 1 | 196 | 196 | Numerator for Glycemic Status >9.0% (GSD): 18-75 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 |
IET | 2 | 197 | 198 | 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 | 199 | 200 | 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 | 201 | 202 | 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 | 203 | 204 | 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 | 205 | 206 | 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 | 207 | 208 | 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 | 209 | 210 | 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 | 211 | 212 | 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 | 213 | 214 | 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 | 215 | 216 | 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 | 217 | 218 | 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 | 219 | 220 | 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 | 221 | 222 | 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 | 223 | 224 | 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 | 225 | 226 | 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 | 227 | 228 | 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 | 229 | 230 | 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 | 231 | 232 | 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 | 233 | 234 | 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 | 235 | 236 | 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 | 237 | 238 | 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 | 239 | 240 | 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 | 241 | 242 | 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 | 243 | 244 | 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 | 245 | 246 | 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 | 247 | 248 | 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 | 249 | 250 | 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-E | 1 | 251 | 251 | Denominator for Immunizations for Adolescents Electronic (IMA-E): completed by age 13 | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
IMA-E | 1 | 252 | 252 | Numerator for Immunizations for Adolescents Electronic (IMA-E): completed by age 13 -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 | 253 | 253 | Numerator for Immunizations for Adolescents Electronic (IMA-E): completed by age 13 - 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 | 254 | 254 | Numerator for Immunizations for Adolescents Electronic (IMA-E): completed by age 13 - 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 | 255 | 255 | Numerator for Immunizations for Adolescents Electronic (IMA-E): completed by age 13 - 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 | 256 | 256 | 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 | 257 | 257 | 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 | 258 | 258 | 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 | 259 | 259 | 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 | 260 | 260 | 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 | 261 | 261 | 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 | 262 | 262 | 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 | 263 | 263 | 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 | 264 | 264 | 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 | 265 | 265 | 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 | 266 | 266 | 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 | 267 | 267 | 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 | 268 | 268 | 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 | 269 | 269 | 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 | 270 | 270 | 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 | 271 | 271 | 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 | 272 | 272 | 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 | 273 | 273 | 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 | 274 | 274 | 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 | 275 | 275 | 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 | 276 | 276 | 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 | 277 | 277 | 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 | 278 | 278 | 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 | 279 | 279 | 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 | 280 | 280 | 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 | 281 | 281 | 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 | 282 | 283 | 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 | 284 | 285 | 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 | 286 | 287 | 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 | 288 | 289 | 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 |
SNS-E | 1 | 290 | 290 | Social Need Screening and Intervention (SNS-E) Denominator 1: The initial population, minus exclusions. | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 291 | 291 | Social Need Screening and Intervention (SNS-E) Numerator 1— Total Number of Members in denominator 1 with a documented result for food insecurity screening performed between January 1 and December 1 of the measurement period. | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
SNS-E | 1 | 292 | 292 | Social Need Screening and Intervention (SNS-E) Denominator 2: All members in numerator 1 with a positive food insecurity screen finding between January 1 and December 1 of the measurement period. | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 293 | 293 | Social Need Screening and Intervention (SNS-E) Numerator 2: Total Number of Members in denominator 2 receiving a food insecurity intervention on or up to 30 days after the date of the first positive food insecurity screen (31 days total). | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
SNS-E | 1 | 294 | 294 | Social Need Screening and Intervention (SNS-E)Denominator 3 : The initial population, minus exclusions | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 295 | 295 | Social Need Screening and Intervention (SNS-E) Numerator 3: Total Number of Members in denominator 1 with a documented result for housing instability, homelessness or housing inadequacy screening performed between January 1 and December 1 of the measurement period. | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
SNS-E | 1 | 296 | 296 | Social Need Screening and Intervention (SNS-E) Denominator 4: All members in numerator 3 with a positive housing instability, homelessness or housing inadequacy screen finding between January 1 and December 1 of the measurement period. | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 297 | 297 | Social Need Screening and Intervention (SNS-E) Numerator 4—Total Number of Members in denominator 4 receiving an intervention corresponding to the type of housing need identified on or up to 30 days after the date of the first positive housing screen (31 days total). | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
SNS-E | 1 | 298 | 298 | Social Need Screening and Intervention (SNS-E) Denominator 5: The initial population, minus exclusions. | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 299 | 299 | Social Need Screening and Intervention (SNS-E) Numerator 5: Total Number of Members in denominator 5 with a documented result for transportation insecurity screening performed between January 1 and December 1 of the measurement period. |
Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
SNS-E | 1 | 300 | 300 | Social Need Screening and Intervention (SNS-E) Denominator 6: All members in numerator 5 with a positive transportation insecurity screen finding between January 1 and December 1 of the measurement period | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |
SNS-E | 1 | 301 | 301 | Social Need Screening and Intervention (SNS-E) Numerator 6: Total Number of Members in denominator 6 receiving a transportation insecurity intervention on or up to 30 days after the date of the first positive transportation screen (31 days total). | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |
URI | 2 | 302 | 303 | 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 | 304 | 305 | 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 | 306 | 307 | 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 | 308 | 309 | 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 | 310 | 311 | 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 | 312 | 313 | 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 | 314 | 314 | 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 | 315 | 315 | 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 | 316 | 316 | 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 | 317 | 317 | 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 | 318 | 318 | 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 | 319 | 319 | 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 | 320 | 320 | 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 | 321 | 321 | 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 | 322 | 322 | 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 | 323 | 323 | 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 | 324 | 324 | 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 | 325 | 325 | 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 | 326 | 326 | 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 | 327 | 327 | 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 | 328 | 328 | 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 | 329 | 329 | 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 | 330 | 330 | 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 | 331 | 331 | 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 | 332 | 332 | 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 | 333 | 333 | 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 | 334 | 334 | 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 | 335 | 335 | 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 |
*Optional reporting requirement for MY2025
NYS MY2025 Patient-Level Detail File Change Log
MARKETPLACE | |||
---|---|---|---|
Version | Date | Data Element | Change Summary |
MY2025 | 12/16/2024 | Multiple | Member Attributed Practice Tax ID# Field added for MY2025 as OPTIONAL reporting requirement, will become REQUIRED for MY2026. Member Attributed Physician NPI* Field added for MY2025 as OPTIONAL reporting requirement, will become REQUIRED for MY2026. Source of Race Data Removed the data source reporting requirement from the race stratification. Source of Ethnicity Data Removed the data source reporting requirement from the ethnicity stratification. Language Spoken Updated NYS QARR Language Value Set webpage link The following measures have been removed due to retirement by the steward:
*Column Start and Column End numbering has been updated Adult Immunization Status (AIS-E)
BCS-E CBP CCS-E CIS-E EED GSD IMA-E |