Qualified Health Plans (QHP) MY2026 PLD File Specifications

Revision date: 7/22/2026

Qualified Health Plans

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. For more details regarding NPI reporting, refer to the 2026 NYS Patient-Level Detail (PLD) File Specifications section of the MY2026 QARR Technical Specifications Manual.
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 or Alaskan Native
04=Asian
05=Native Hawaiian or Pacific Islander
06=Middle Eastern or North African (MENA)
07=Some Other Race
08=Two or More Races
09=Asked But No Answer
10=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 2 91 92 Middle Eastern or North African Subgroups If member's race is White, Black or African American, American Indian/Alaskan Native, Asian, Native Hawaiian/Pacific Islander, Two Or More Races, Other Race, Asked But No Answer, or Unknown then Enter:
0=Not Applicable

If member's race is Middle Eastern or North African (MENA) then identify the specific subgroup:
01=Egyptian
02=Moroccan
03=Algerian
04=Sudanese
05=Tunisian
06=Libyan
07=Yemeni
08=Iranian
09=Palestinian
10=Iraqi
11=Lebanese
12=Israeli
13=Jordanian
14=Syrian
15=Armenian
16=Saudi
17=Two or more Middle Eastern or North African subgroups
18=Unknown Middle Eastern or North African groups
19=Declined
20=Other Middle Eastern or North African groups
GENERAL INFO 3 93 95 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)> 2026> NYS QARR Language Value Set webpage.
197=Unknown
199=Declined
GENERAL INFO 3 96 98 County of Residence Enter the 3-digit county FIPS code for each member's residence of county. For more details regarding FIPS Codes, refer to the FIPS County Codes section of the MY2026 QARR Technical Specifications Manual (PDF).
### = FIPS Code
000= Outside of NYS
999 = Unknown
GENERAL INFO 1 99 99 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 1 100 100 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 2 101 102 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 2 103 104 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 2 105 106 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 2 107 108 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 2 109 110 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 2 111 112 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
AAF-E 2 113 114 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 5-11 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 115 116 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 5-11 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
AAF-E 2 117 118 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 12-17 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 119 120 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 12-17 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
AAF-E 2 121 122 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 18-50 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 123 124 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 18-50 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
AAF-E 2 125 126 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 51-64 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 127 128 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Diagnosed: 51-64 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
AAF-E 2 129 130 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 5-11 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 131 132 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 5-11 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
AAF-E 2 133 134 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 12-17 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 135 136 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 12-17 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
AAF-E 2 137 138 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 18-50 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 139 140 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 18-50 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
AAF-E 2 141 142 Denominator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 51-64 years Enter:
The number of times this member is in the denominator
'0' if the member is not in the denominator
AAF-E 2 143 144 Numerator for Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E) COPD Not Diagnosed: 51-64 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
AIS-E 1 145 145 Denominator 1: Adult Immunization Status (AIS-E): Immunization status—Influenza [Members 19 - 64 years] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 146 146 Numerator 1: Adult Immunization Status (AIS-E): Immunization status—Influenza [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 1 147 147 Denominator 1: Adult Immunization Status (AIS-E): Immunization status—Influenza [Members 65 and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 148 148 Numerator 1: Adult Immunization Status (AIS-E): Immunization status—Influenza [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 1 149 149 Denominator 2: Adult Immunization Status (AIS-E): Immunization status—Td/Tdap [Members 19 - 64 years] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 150 150 Numerator 2: Adult Immunization Status (AIS-E): Immunization status—Td/Tdap [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 1 151 151 Denominator 2: Adult Immunization Status (AIS-E): Immunization status—Td/Tdap [Members 65 and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 152 152 Numerator 2: Adult Immunization Status (AIS-E): Immunization status—Td/Tdap [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 1 153 153 Denominator 3: Adult Immunization Status (AIS-E): Immunization status—Zoster [Members 50 - 64 years] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 154 154 Numerator 3: Adult Immunization Status (AIS-E): Immunization status—Zoster [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 1 155 155 Denominator 3: Adult Immunization Status (AIS-E): Immunization status—Zoster [Members 65 and older] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 156 156 Numerator 3: Adult Immunization Status (AIS-E): Immunization status—Zoster [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 1 157 157 Denominator 4: Adult Immunization Status (AIS-E):Immunization status—Pneumococcal [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 1 158 158 Numerator 4: Adult Immunization Status (AIS-E): Immunization status—Pneumococcal [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 1 159 159 Denominator 5: Adult Immunization Status (AIS-E): Immunization status—Hepatitis B [Members 19 - 30 years] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 160 160 Numerator 5: Adult Immunization Status (AIS-E): Immunization status—Hepatitis B [Members 19 - 30 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 1 161 161 Denominator 5: Adult Immunization Status (AIS-E): Immunization status—Hepatitis B [Members 31 - 59 years] Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
AIS-E 1 162 162 Numerator 5: Adult Immunization Status (AIS-E): Immunization status—Hepatitis B [Members 31 - 59 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 1 163 163 Denominator 6: Adult Immunization Status (AIS-E): Immunization status—COVID-19 [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 1 164 164 Numerator 6: Adult Immunization Status (AIS-E): Immunization status—COVID-19 [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
BCS-E 1 165 165 Denominator for Breast Cancer Screening (BCS-E): (42 - 51 years) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
BCS-E 1 166 166 Numerator for Breast Cancer Screening (BCS-E): (42 - 51 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 1 167 167 Denominator for Breast Cancer Screening (BCS-E): (52-74 years) Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
BCS-E 1 168 168 Numerator for Breast Cancer Screening (BCS-E): (52-74 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
BPC-E 1 169 169 Denominator for Blood Pressure Control for Patients With Hypertension (BPC-E): 18–85 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
BPC-E 1 170 170 Numerator for Blood Pressure Control for Patients With Hypertension (BPC-E): 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
CBP 1 171 171 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 1 172 172 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 1 173 173 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 1 174 174 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 1 175 175 Denominator for Chlamydia Screening (CHL): 16-20 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
CHL 1 176 176 Numerator for Chlamydia Screening (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 1 177 177 Denominator for Chlamydia Screening(CHL): 21-24 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
CHL 1 178 178 Numerator for Chlamydia Screening (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 1 179 179 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 1 180 180 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 1 181 181 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 1 182 182 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 1 183 183 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 1 184 184 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 1 185 185 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 1 186 186 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 1 187 187 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 1 188 188 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 1 189 189 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 1 190 190 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 1 191 191 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 1 192 192 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 1 193 193 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 1 194 194 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 1 195 195 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 1 196 196 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 1 197 197 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 1 198 198 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 1 199 199 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 1 200 200 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 1 201 201 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 1 202 202 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 1 203 203 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 1 204 204 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 1 205 205 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 1 206 206 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 1 207 207 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 1 208 208 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 2 209 210 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 2 211 212 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 numerator
'0' if the member is not in the numerator
FUH 2 213 214 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 2 215 216 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 2 217 218 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 2 219 220 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 2 221 222 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 2 223 224 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 2 225 226 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 1 227 227 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 1 228 228 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 2 229 230 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 2 231 232 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 2 233 234 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 2 235 236 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 2 237 238 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 2 239 240 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 2 241 242 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 2 243 244 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 2 245 246 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 2 247 248 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 2 249 250 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 2 251 252 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 2 253 254 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 2 255 256 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 2 257 258 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 2 259 260 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 2 261 262 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 2 263 264 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 2 265 266 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 2 267 268 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 2 269 270 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 2 271 272 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 2 273 274 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 2 275 276 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 2 277 278 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 2 279 280 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 2 281 282 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 1 283 283 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 1 284 284 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 1 285 285 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 1 286 286 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 1 287 287 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
KED 1 288 288 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 1 289 289 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 1 290 290 Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 65-75 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
KED 1 291 291 Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 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
KED 1 292 292 Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 76-85 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
KED 1 293 293 Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 76-85 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 1 294 294 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 1 295 295 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 1 296 296 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 1 297 297 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
OED 1 298 298 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 1 299 299 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 1 300 300 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 1 301 301 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 1 302 302 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 1 303 303 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 1 304 304 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 1 305 305 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 1 306 306 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 1 307 307 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 1 308 308 Proportion of Days Covered (PDC) Denominator for Rate 2: Diabetes Medications Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
PDC 1 309 309 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 1 310 310 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 1 311 311 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 2 312 313 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 2 314 315 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 2 316 317 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 2 318 319 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 1 320 320 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 1 321 321 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 1 322 322 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 1 323 323 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 1 324 324 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 1 325 325 Social Need Screening and Intervention (SNS-E) Numerator 3: Total Number of Members in denominator 3 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 1 326 326 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 1 327 327 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 1 328 328 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 1 329 329 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 1 330 330 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 1 331 331 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
TSC-E 1 332 332 Denominator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 12-17 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 333 333 Numerator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Tobacco Use Screening: Ages 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
TSC-E 1 334 334 Denominator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 12-17 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 335 335 Numerator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Cessation Intervention: Ages 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
TSC-E 1 336 336 Denominator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 18-64 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 337 337 Numerator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Tobacco Use Screening: 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
TSC-E 1 338 338 Denominator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 18-64 years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 339 339 Numerator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Cessation Intervention: 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
TSC-E 1 340 340 Denominator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 65+ years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 341 341 Numerator 1 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Tobacco Use Screening: Ages 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
TSC-E 1 342 342 Denominator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E): Ages 65+ years Enter:
'1' if this member is in the denominator
'0' if this member is not in the denominator
TSC-E 1 343 343 Numerator 2 for Tobacco Use Screening and Cessation Intervention (TSC-E) - Cessation Intervention: Ages 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
URI 2 344 345 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 2 346 347 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 2 348 349 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 2 350 351 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 2 352 353 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 2 354 355 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 1 356 356 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 1 357 357 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 1 358 358 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 1 359 359 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 1 360 360 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 1 361 361 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 1 362 362 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 1 363 363 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 1 364 364 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 1 365 365 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 1 366 366 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 1 367 367 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 1 368 368 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 1 369 369 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 1 370 370 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 1 371 371 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 1 372 372 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 1 373 373 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 1 374 374 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 1 375 375 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 1 376 376 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 1 377 377 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
Qualified Health Plans
Version Date Data Element Change Summary
MY2026 3/11/2026 Multiple To increase consistency across QARR documentation, beginning MY2026 all references to NYS "Exchange, Marketplace, and Qualified Health Plans (QHP)" lines of business will be referred to as: Qualified Health Plans (QHP)

Member Attributed Practice Tax ID# - REQUIRED for MY2026.

Member Attributed Physician NPI - REQUIRED for MY2026.

Race - HEDIS race reporting was updated to include ten race stratifications, as defined by the Office of Management and Budget (OMB) Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. To align with HEDIS updated categories, Middle Eastern or North African (MENA) has been added as a Race category.

Language Spoken: Updated Value Set and link to webpage.

County of Residence: Updated reference material information and link.

Adult Immunization Status (AIS-E): Updated specifications to align with HEDIS specifications for MY2026.

Asthma Medication Ratio (AMR): Has been retired by HEDIS for MY2026 and removed as a required measure. Column numbering has been updated accordingly.

Social Need Screening and Intervention (SNS-E): Updated specifications for Denominators 2, 4, & 6 and Numerators 1, 3 & 5 to align with HEDIS specifications for MY2026
Clarification 1 5/20/2026 Multiple Race: Stratification verbiage update: removed "Some" from "Some Other Race" to align with NCQA/HEDIS updates.

Asian American Subgroups: Added Middle Eastern or North African in element description to align with NCQA/HEDIS updates.

Asian American Subgroups: Removed "Some" from "Some Other Race" in element description to align with NCQA/HEDIS updates.

Native Hawaiian/Pacific Islander Subgroups: Added Middle Eastern or North African in element description to align with NCQA/HEDIS updates.

Native Hawaiian/Pacific Islander Subgroups: Removed "Some" from "Some Other Race" in element description to align with NCQA/HEDIS updates.

Middle Eastern or North African Subgroups: Added Middle Eastern or North African Subgroups field to align with NYS mandates.
Clarification 2 7/22/2026 Multiple Follow-Up After Acute and Urgent Care Visits for Asthma (AAF-E): Added reporting requirement for QHP line of business to align with QRS MY2026 (RY2027) guidelines.

Tobacco Use Screening and Cessation Intervention (TSC-E): Added reporting requirement for QHP line of business to align with QRS MY2026 (RY2027) guidelines.