MY2025 Value Based Payment Reporting Requirements

Technical Specifications Manual

  • Manual is also available in Portable Document Format (PDF)

Table of Contents

  1. Submission Requirements
  2. NYS PCMH Patient-level detail file
  3. NYS VBP PATIENT ATTRIBUTION FILE
  4. APPENDIX
Important Dates & Contact Information
MAINSTREAM VBP MLTC VBP
Contact OHSQAVBP@health.ny.gov

Effective on January 1, 2026, New York State (NYS) Department of Health (Department) will no longer be administering the Managed Long-Term Care (MLTC) Value Based Payments (VBP) program until further notice.

We will not collect MLTC VBP data submissions for MLTC 2026. Health plans are not required to submit MLTC VBP files and any previously scheduled MLTC VBP reporting requirements for this period are discontinued.
Submission Date All files must be received electronically by 11:59 p.m. EST Friday, July 24, 2026.
Health Commerce System (HCS) https://commerce.health.state.ny.us
To: OHSQA VBP Evaluation

I. Submission Requirements

INTRODUCTION

The purpose of this document is to make stakeholders aware of the member attribution and quality measure reporting requirements for Medicaid Managed Care Organizations (MCOs) participating in the New York State (NYS) Medicaid Value Based Payment (VBP) program. The 2025 VBP Reporting Requirements refer to data for Measurement Year 2025 (MY2025).

The New York State Department of Health (Department) has completed the first phase of a health transformation effort, known as the State Innovation Model (SIM) award, which focused on the transformation of primary care delivery and payment models statewide. The New York State Patient Centered Medical Home (NYS PCMH) model was created as part of the SIM initiative. With NYS PCMH, a Primary Care Core measure set was developed, and multi-payer data is used to calculate results for practices for the measure. To reduce the burden on MCOs participating in both the NYS Primary Care measure set model and Medicaid VBP, we are aligning the reporting for both programs and utilizing the NYS Primary Care Core Set Scorecard data request to fulfill reporting requirements for both programs, where possible.

The Department requests that Medicaid Managed Care (MMC) plans submit data files leveraging their MY2025 Quality Assurance Reporting Requirements (QARR) (HEDIS®) submission which will be used to create aggregated quality results by VBP Contractor for all members in a VBP Arrangement. Specifically, the Department is asking insurers to provide a modified version of the NYS Patient-Level Detail (PLD) file, along with provider and practice information. Submission of the NYS PCMH Patient-Level Detail file for all members in a Level 1 or higher VBP Arrangement will fulfill this reporting requirement. The NYS PCMH Patient-Level Detail File requirement is included in Section II of this manual. The Department is also requesting a separate Patient Attribution file for all members in a Level 1 or higher VBP Arrangement. The Patient Attribution file layout is also included in Section III.

VBP ARRANGEMENTS

The VBP Roadmap, updated in May 2022, outlines six types of VBP arrangements to be included for MY2025:

  • Total Care for the General Population (TCGP) Arrangement: Includes all costs and outcomes for care, excluding certain populations (specified below).
  • Total Care for Special Needs Population Arrangements: Includes costs and outcomes of total care for all members within a special needs population exclusive of TCGP.
    • Children's Subpopulation: to address the unique needs of children at different developmental stages
    • Behavioral Health/Health and Recovery Plans (HARP): for those with Serious Mental Illness or Substance Use Disorders
    • People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
    • Managed Long-Term Care (MLTC) - We will not collect MLTC VBP data submissions for MY2025.
  • Episodic Care Arrangements
    • Maternity Care: Includes episodes associated with a pregnancy, including prenatal care, delivery, and postpartum care through 60 days post-discharge for the mother, and care provided to the newborn from birth through the first 30 days post-discharge.

MEASURE CHANGES

Changes to the Reporting Requirements for MY2025 VBP Measure Sets were made based on the feedback received by the Department from the Clinical Advisory Groups, HEDIS measurement changes, and other stakeholder groups. Those changes are indicated in the publicly posted MY2025 VBP Measure Sets under the "VBP Quality Measures" tab. All measures required for VBP reporting are outlined in NYS PCMH File Layout. Please follow any measure changes or updates as indicated by the measure steward, the QARR Technical Specifications, or the NYS PCMH file instructions.

ORGANIZATIONS REQUIRED TO REPORT AND QUESTIONS

Medicaid Managed Care Organizations with Level 1 or higher value based contracting arrangements are required to report. Please submit all questions to OHSQAVBP@health.ny.gov .

WHERE TO SUBMIT VBP REPORTING DATA

  • Electronically submit all files via a secure file transfer application. Do not mail materials.
  • Specific delivery instructions are given for each file.

WHAT TO SEND FOR VBP REPORTING

  • The Department is requesting a NYS PCMH file and a Patient Attribution file for ALL members in a VBP Level 1 or higher Arrangement.

*****All submissions must be received electronically by 11:59 p.m. ET on Friday, July 24, 2026.*****

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VBP REPORTING GUIDELINES

II. NYS PCMH Scorecard Patient-Level Detail File

NYS PCMH SCORECARD PATIENT-LEVEL DETAIL FILE

Please use your 2025 QARR/HEDIS data warehouse as the source for this information. Do not recalculate or update measure results. However, in addition to the measure elements that you reported for QARR/HEDIS for 2025, please include the provider/practice information that was attributed to the member using your plan's attribution methodology. Please continue to report the provider and practice site of the service as outlined in layout request, specifically including two separate fields for TIN: Practice TIN and Contractor TIN. The NYS Patient-Centered Medical Home (NYS PCMH) file is modeled after the NYS 2025 Patient-Level Detail file (PLD) that you prepared as part of your QARR submission, and many of the data elements in the NYS PCMH file follow the same definitions and format as used to define the data elements in the PLD. You may find it helpful to use the PLD as a resource or starting point in completing the NYS PCMH file. We ask that you populate the NYS PCMH with all Lines of Business that you serve (e.g., Medicaid).

Exceptions to the PLD file are noted below:

  • The NYS PCMH file requests Medicare HEDIS data, which is not required for QARR reporting.
  • The Plan ID is not your plan's QARR ID. The Plan ID field should be populated with the Organization ID that you used to submit the Interactive Data Submission System (IDSS) files to NCQA.
  • Note that the Organization ID is different from the Submission ID. Submission ID which is specific to a Line of Business.
  • The Organization ID provides six digits. If your plan's ID is smaller, please right-justify.
  • For Medicaid, HARP, and HIV/Special Needs Plan (SNP) we are asking that you populate the member's CIN in the ID field and not an internal ID number. For EP use the NYHX ID, and for all other products, please use an internally-defined ID number. In order to receive credit for VBP reporting, the Medicaid CIN must be populated for Medicaid, HARP, and HIV/SNP members.
  • Provider/Practice attribution information is required for NYS PCMH. This information is not required for QARR reporting.

SUMMARY OF CHANGES NYS PCMH FILE:

  • Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment (AMM); retired by NCQA.
  • NCQA retired the Administrative and Hybrid reporting methods for Childhood Immunization Status (CIS), Immunizations for Adolescents (IMA) and Cervical Cancer Screening (CCS). Only the ECDS Method will be used for these measures.

SPECIFIC INSTRUCTIONS FOR NYS PCMH FILE

  • PLEASE carefully review the reporting requirements and layout of the NYS MY2025 Patient Level Detail File Specifications and the NYS 2025 Patient-Centered Medical Home (PCMH). Numerous updates to streamline and consolidate reporting requirements have been made to the files.
  • Please be aware that although the member ID for all products except Medicaid is an internal number assigned by your plan, you will need to link the member to the provider of service. You should use a naming convention that will facilitate this process.
  • If a member is reported for a specific measure in more than one product line (e.g., duals), please report all member details for all applicable product lines.
  • A Member ID (Field #3) may be included on the file more than once if the member is in more than one product line during the reporting period.
  • For hybrid measures that you reported to NCQA/NYS using the hybrid methodology, which requires calculating the measure based on a sample rather than the entire eligible population, for NYS PCMH only, we are requesting that you report the administrative denominator (IDSS eligible population) and the administrative numerator (IDSS NumeratorByAdminElig).
  • Members in the file must be in at least one measure.
  • Measures that are not applicable to the member should be zero-filled.
  • A valid Practice Tax ID (TIN)(Field #6) is nine characters. If the TIN is not available, set the field value to "999999999".
  • Practice Name must be populated in the Practice Name Field (Field #9) only.
  • Practice Address Line 1 (Field #10) must contain the street address of the Practice, not the Practice Name.
  • For Fields #7-16, and #18-22, leave these fields blank if the member cannot be attributed to any provider or you are not able to identify the provider. Member-level details should not be removed from the file submission, even if a provider is not attributed.
  • For Field # 17 (Physician NPI), if the member cannot be attributed to any provider or you are not able to identify the provider, set the field value to '9999999999'.
  • For Field # 21, populate with valid TINs only. If a member is NOT attributed to a VBP Contractor set to '999999999'.
  • Only MCOs reporting their Medicaid Line of Business need report the following 8 VBP specific measures:
    1. Statin Therapy for Patients with Cardiovascular Disease (SPC),
    2. Diabetes Screening for Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD),
    3. Initiation of Pharmacotherapy upon New Episode of Opioid Dependence (POD-N),
    4. Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC; Administrative rate),
    5. Follow-Up Care for Children Prescribed ADHD Medication (ADD),
    6. Prenatal and Postpartum Care (PPC; Administrative rate),
    7. Depression Remission or Response for Adolescents and Adults (DRR-E) and
    8. Well-Child Visits in the First 30 Months of Life (W30).
    Medicaid plans submitting NYS PCMH data should add these additional variables to the NYS PCMH file layout and it will count towards the VBP reporting requirements.

FILE SUBMISSION:

Please upload the file to IPRO SEND site. A subfolder in the "QARR" folder where you will upload your 2025 QARR files entitled "NYS PCMH MY2025" will be created for your submission. If someone other than your QARR liaison will be responsible for NYS PCMH reporting, please contact the IPRO Team at abolagani@ipro.org for questions and access to the IPRO SEND site.

Please note that the deadline for submission is Friday, July 24, 2026

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III. Patient Attribution File

The Department is asking insurers to provide an attribution file for all members enrolled in a VBP arrangement during the 2025 Calendar Year per the methodology specified in your Department-approved contract. The attribution file will be used in combination with other quality measure sources (e.g., MY2025 NYS Patient-Level Detail File) to aggregate quality results for the 2025 Category 1 population-specific measures by VBP Contractor. Details of the Category 1 measures are provided in the publicly posted MY2025 VBP Measure Sets under the "VBP Quality Measures" tab.

FILE FORMAT:

Submit a comma-separated values (CSV) file with the following specifications:

  • The file must not have additional columns beyond those shown in the following table.
  • Data must include column names. The first row in the file must be the column names as documented in the following table.
  • Please be advised that significant changes have been made to the data elements for MY2025 VBP Attribution file, as outlined in the table below. Please carefully review the updated element table and ensure the data is populated accordingly.
  • All fields are mandatory. Do not leave any fields blank.
  • After submission, each health plan will receive a quality assurance (QA) report summarizing any data errors, data quality concerns, or compliance issues identified during validation and review. The report will indicate which issues require correction prior to acceptance and which are informational, and plans will be expected to address identified issues in accordance with the resubmission timelines.

Naming Convention:

VBP_PlanID_2025.csv (Refer to field 1 in the table below.)

Example: VBP_123456_2025.csv

Element # Name Direction Allowed Values Data Type Length Start End
1 Plan_ID# Organization ID is used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business. ####### VARCHAR 6 1 6
2 Product_Line A member's product line at the end of the measurement period. 01 = MEDICAID
02 = SNP
11 = HARP		 NUMBER 2 7 8
3 Unique_Member_ ID# Medicaid Client ID Number (CIN) *The field is alphanumeric and should be treated as a text field. ######## VARCHAR 8 9 16
4 Practice_Tax_ID# Populate with valid TINs only. ######### NUMBER 9 17 25
5 Provider_NPI National Provider Identifier – 10 Digit ID ########## NUMBER 10 26 35
6 VBP_Contractor_ Tax_ID# Populate withvalid TINs only. Please include the TIN of the VBP Contractor. If the member is NOT in a VBP level 1 or higher arrangement set to '999999999'. ######### NUMBER 9 36 44
7 VBP_Contractor_ DBA_Name Enter the DBA name listed on your VBP contract/arrangement.   VARCHAR 50 45 94
8 VBP_Contractor_ Type   1 = Provider/ Hospital
2 = IPA
3 = ACO
9 = Unknown		 NUMBER 1 95 95
9 VBP_
Arrangement_ Type		 Refer to Section C, #2b of the DOH 4255 –Provider Contract Statement and Certification form. 1 = TCGP
3 = HARP
4 = HIV/AIDs
5 = Maternity
6 = Children's
7 = Off Menu		 NUMBER 1 96 96
10 DOH_VBP_
Contract_ID#		 The number provided by the Department in the Agreement approval letter begins with DOH ID ####.
Please identify the more recent contracts appropriate for attribution. As the VBP measure set is updated annually, accurate attribution to the more recent contracts is essential to ensure valid monitoring of VBP quality measures.		 #### NUMBER 4 97 100
11 MCO_Unique_ Contract_ID# Plan generated ID used to submit contract to the Department; Section A, #3 of the 4255.   VARCHAR 255 101 355
12 Prov_Att_start_ date MMDDYYYY – Must be between 1/1/2025 and 12/31/2025 MMDDYYYY DATE 8 356 363
13 Prov_Att_end_ date MMDDYYYY – Must be
between 1/1/2025 and 12/31/2025		 MMDDYYYY DATE 8 364 371

Element # Name Description/Specifications
1 Plan_ID# Enter your Organization ID used to submit the IDSS to NCQA. This ID is consistent across all Lines of Business.
2 Product_Line Enter the member's product line at the end of the measurement period. Enter the corresponding number (01) Medicaid, (02) SNP, (11) HARP.
3 Unique_Member_ID# Enter member's Medicaid Client Identification Number (CIN). The field should be continuous without any spaces or hyphens. The field is alpha-numeric and should be treated as a text field.
4 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. This field is mandatory – do not leave it blank!
5 Provider_NPI This is the unique 10-digit National Provider Identifier (NPI) of the provider organization associated with the member under a specific VBP contract during the reporting period. Members may be attributed to more than one VBP contract during the same reporting period and, therefore, may be associated with multiple NPIs. The plan should submit one row of data per member, per VBP contracted provider.
6 VBP_Contractor_Tax_I D# This is the unique 9-digit tax identification number of theVBP Contractor (not the provider) that the member is assigned to a Level 1 or higher VBP arrangement during the reporting period. If not applicable, fill with 999999999.
7 VBP_Contractor_DBA_ Name The "Doing Business As" (DBA) name is the operating name of a company, as opposed to the legal name of the company. The VBP Contractor may be an ACO, IPA, individual provider, or hospital.
8 VBP_Contractor_Type In this field, enter '1' if the contractor is a provider (provider includes hospitals), '2' if the contractor is an IPA, '3' if the contractor is an ACO, '9' if Unknown
9 VBP_Arrangement_Ty pe In this field, enter "1" if the VBP arrangement type is a TCGP arrangement, "3" if it is a HARP arrangement, "4" if it is an HIV/AIDs arrangement, "5" if it is a Maternity arrangement, "6" if it is a Children's arrangement, "7" if it is an Off-Menu arrangement. This information can be found in Section C, #2b of theDOH 4255 – Provider Contract Statement and Certification form.
10 DOH_VBP_Contract_I D# This is the number provided by the Department in the Agreement approval letter for your VBP arrangement, it begins with DOH ID ####.If you need assistance obtaining your correct DOH VBP Contract Identifier, please email NYS VBP mailbox at OHSQAVBP@health.ny.gov
11 MCO_Unique_Contract
_ID#		 This is the contract identifier created by your plan, which is a required component of all contracts submitted for review (it can be found in Section A, #3 of the DOH 4255, it is also typically in the footer of your contract documents.If you need assistance obtaining your correct MCO Unique Contract Identifier, please email the VBP mailbox at OHSQAVBP@health.ny.gov
12 Prov_Att_start_date This is the attribution start date with the provider when the member was first attributed to the provider.This date must be during the reporting period. It
should be in the format of MMDDYYYY with no intervening "- "or "/". The format is the same if data is submitted via a fixed-width file or CSV.
13 Prov_Att_end_date This is the attribution end date with the provider when the member was last attributed to the provider.This date must be during the reporting period. It should be in the format of MMDDYYYY with no intervening "- "or "/". The
format is the same if data is submitted via a fixed-width file or CSV.

SUBMISSION EXAMPLES AND DATA REQUIREMENTS CHECKLIST

Please referto Section IV Appendix 2 at the end of this manual for layout examples and further instruction on the CSV submission requirements.

Please refer to Section IV Appendix 3 at the end of this manual, for attribution file checklists for the MCO attribution file. The checklist is designed to ensure fields in the attribution file are standardized appropriately and are not required to be submitted with the attribution files.

FILE SUBMISSION:

Files for all arrangement types are to be submitted to the New York State Department of Health via the Secure File Transfer 2.0 of the Health Commerce System (HCS). Files should be submitted to OHSQA VBP Evaluation or OHSQAVBP@health.ny.gov via HCS.

Files must be received electronically by 11:59 p.m. ET; Friday, July 24, 2026.

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IV. Appendix

APPENDIX 1: NYS FIPS CODES BY COUNTY

County Name FIPS Code County Name FIPS Code County Name FIPS Code
Albany 001 Jefferson 045 St. Lawrence 089
Allegany 003 Kings 047 Saratoga 091
Bronx 005 Lewis 049 Schenectady 093
Broome 007 Livingston 051 Schoharie 095
Cattaraugus 009 Madison 053 Schuyler 097
Cayuga 011 Monroe 055 Seneca 099
Chautauqua 013 Montgomery 057 Steuben 101
Chemung 015 Nassau 059 Suffolk 103
Chenango 017 New York 061 Sullivan 105
Clinton 019 Niagara 063 Tioga 107
Columbia 021 Oneida 065 Tompkins 109
Cortland 023 Onondaga 067 Ulster 111
Delaware 025 Ontario 069 Warren 113
Dutchess 027 Orange 071 Washington 115
Erie 029 Orleans 073 Wayne 117
Essex 031 Oswego 075 Westchester 119
Franklin 033 Otsego 077 Wyoming 121
Fulton 035 Putnam 079 Yates 123
Genesee 037 Queens 081 Out of State 000
Greene 039 Rensselaer 083 Unknown/Missing 999
Hamilton 041 Richmond 085    
Herkimer 043 Rockland 087    
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APPENDIX 2: MAINSTREAM VBP SUBMISSION EXAMPLES

The example below illustrates one member's data submitted as a CSV file.
Fields 1-8:

Plan ID# Product Line Unique Member ID (CIN) Practice Tax ID (TIN) Provider NPI VBP Contractor Tax ID# VBP Contractor DBA Name VBP Contractor Type
Fields 1-8:
123456 01 WA12345X 123456789 N987654321 123456789 Health Clinic NY 1
Fields 9-13:
VBP Arrangement Type DOH VBP Contract ID MCO Unique Contract ID# Provider Attribution Start Date Provider Attribution End Date
1 2983 ABC.HealthClinic4.12.18 01012025 12312025

The example below illustrates one member attributed to two different providers in the same VBP arrangement within the reporting period submitted as a CSV file.

Member Data, attributed to Provider 1 from 1/1/2025 to 04/30/2025 Fields 1-8:

Fields 1-8:
Plan ID# Product Line Unique Member ID (CIN) Practice Tax ID (TIN) Provider NPI VBP Contractor Tax ID# VBP Contractor DBA Name VBP Contractor Type
123456 01 WA12345X 123456789 N987654321 123456789 Health Clinic NY 1
Fields 9-13:
VBP Arrangement Type DOH VBP Contract ID MCO Unique Contract ID# Provider Attribution Start Date Provider Attribution End Date
1 2983 ABC.HealthClinic4.12.18 01012025 04302025

Member Data, attributed to Provider 2 from 5/1/2025 to 12/31/2025Fields 1-8:

Fields 1-8:
Plan ID# Product Line Unique Member ID (CIN) Practice Tax ID (TIN) Provider NPI VBP Contractor Tax ID# VBP Contractor DBA Name VBP Contractor Type
123456 01 WA12345X 123456789 N123456789 123456789 Health Clinic NY 1
Fields 9-13:
VBP Arrangement Type DOH VBP Contract ID MCO Unique Contract ID# Provider Attribution Start Date Provider Attribution End Date
1 2983 ABC.HealthClinic4.12.18 05012025 12312025
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APPENDIX 3: MAINSTREAM VBP (MCO) ATTRIBUTION FILE – DATA QUALITY CHECKLIST

Data Quality Check Value Notes
Value used for Plan_ID# is the Organization ID used to submit IDSS to NCQA ☐Yes
☐ No		  
Every record includes a valid Medicaid Client Identification Number (CIN) ☐Yes
☐ No		 The field is alpha-numeric and must be a valid CIN. Do not use internal organization member identification numbers.
Total number of records submitted    
Number of unique members included in the file    
Number of unique members by product line MMC (01) =
SNP (02) =
HARP (11) =		  
All records include a valid Practice_Tax_ID# ☐Yes
☐ No		  
All records include a valid VBP_Contractor_Tax_ID#
(if the member is not in a VBP level 1 or higher, then the value is set to '999999999')		 ☐Yes
☐ No		  
For members in a VBP level 1 or higher arrangement, the VBP_Contractor_Tax_ID# represents the higher umbrella Tax ID # of the Contractor organization ☐Yes
☐ No		  
All records include a valid VBP_Contractor_DBA_Name (if the member is not in a VBP level 1 or higher than the value is set to '999999999') ☐Yes
☐ No		  
Number of members assigned to each VBP_Contractor_Type Provider/Hospital
(1) =
IPA (2) =
ACO (3) =
Unknown (9) =		  
Number of members in each VBP_Arrangement_Type TCGP (1) =
HARP (3) =
HIV/AIDS (4) =
Maternity (5) =
Children's (6) =
Off Menu (7) =		  
Every record includes either a valid DOH_VBP_Contract_ID# and a valid MCO_Unique_Contract_ID# ☐Yes
☐ No		 You must populate the DOH_VBP_Contract_ID# field and the MCO_Unique_Contract_ID# field. If you need assistance obtaining your correct DOH VBP Contract Identifier, please email the VBP mailbox at OHSQAVBP@health.ny.gov
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1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).1

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