Element #	Name	Direction	Allowed Values	Required/ Optional	Length	Start	End
1	Plan ID#	Organization ID used to submit the IDSS to NCQA.	###### = IDSS Organization ID	R	6	1	6
2	Product Line	A member´s product line at the end of the measurement period.	1 = MA 2 = HIVSNP 3 = Medicare 4 = CPPO 5 = CHMO 6 = QHMO 7 = QPOS 8 = QPPO 9 = QEPO 10 = CEPO 11 = HARP 12 = EP	R	2	7	8
3	Unique Member ID#	For Medicaid, populate with the member´s CIN, for other products, provide a unique identification number assigned by the plan. The field is alphanumeric and should be treated as a text field. This field is mandatory – do not leave it blank!		R	15	9	23
4	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	R	3	24	26
5	Zip Code of Residence			R	5	27	31
6	Practice Tax ID#	Populate with valid TINs only. If unavailable or invalid set to ´999999999´	#########	R	9	32	40
7	PCMH Site ID#	If available plan must include a PCMH Site ID# or a Internal plan practice site ID# (see element #8)		O	10	41	50
8	Practice Site ID#	Internal plan practice site ID#		O	15	51	65
9	Practice Name			R	50	66	115
10	Practice Address Line 1			R	35	116	150
11	Practice Address Line 2			O	35	151	185
12	Practice Address Line 3			O	35	186	220
13	Practice Address City			R	25	221	245
14	Practice Address State			R	2	246	247
15	Practice Address Zip Code		#####	R	5	248	252
16	Practice Telephone Number		##########	O	10	253	262
17	Physician NPI			R	10	263	272
18	Physician First Name			R	15	273	287
19	Physician Middle Name			O	1	288	288
20	Physician Last Name			R	35	289	323
21	Contractor Tax ID#	Populate with valid TINs only. If unavailable or invalid set to ´999999999´	#########	R	9	324	332
22	Practice Address Zip Code + 4	Populate with last four digits only	####	R	4	333	336
23	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (WCC): BMI Percentile, 3–years	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator.	1= Yes 0 = No	R	1	337	337
24	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (WCC): BMI Percentile, 3–11 years	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	338	338
25	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (WCC): BMI Percentile, 12–17 years	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator.	1= Yes 0 = No	R	1	339	339
26	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (WCC): BMI Percentile, 12–17 years	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	340	340
27	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	341	341
28	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	342	342
29	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	343	343
30	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	344	344
31	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	345	345
32	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	346	346
33	Denominator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	347	347
34	Numerator for Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adoldescents (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.	1= Yes 0 = No	R	1	348	348
35	Denominator for Childhood Immunization (CIS)	Enter: ´1´ if this member is in the denominator of the CIS measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	349	349
36	Numerator for CIS – Combination 3	Enter: ´1´ if this member received Combination 3 vaccinations meeting HEDIS specifications. Enter ´0´ if this member did not receive Combination 3 vaccinations meeting HEDIS specifications. This differs from the QARR Member Level file request, only the Combination 3 indicator requested.	1= Yes 0 = No	R	1	350	350
37	Denominator for Breast Cancer Screening (BCS)	Enter: ´1´ if this member is in the denominator for the Breast Cancer Screening measures, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	351	351
38	Numerator for Breast Cancer Screening (BCS)	Enter: ´1´ if this member is in the numerator of the Breast Cancer Screening measure, ´0´ if the member is not in the numerator for this measure.	1= Yes 0 = No	R	1	352	352
39	Denominator for Cervical Cancer Screening (CCS)	Enter: ´1´ if this member is in the denominator for the Cervical Cancer Screening measures, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	353	353
40	Numerator for Cervical Cancer Screening (CCS)	Enter: ´1´ if this member is in the numerator of the Cervical Cancer Screening measure, ´0´ if the member is not in the numerator for this measure	1= Yes 0 = No	R	1	354	354
41	Denominator for Chlamydia Screening in Women (CHL): 16 – 20 Years	Enter: ´1´ if this member is in the denominator of the Chlamydia Screening in Women (16 – 20 Years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	355	355
42	Numerator for Chlamydia Screening in Women (CHL): 16 – 20 Years	Enter: ´1´ if this member is in the numerator of the Chlamydia Screening in Women (16 – 20 Years) measure, ´0´ if the member is not in the numerator or the information is missing.	1= Yes 0 = No	R	1	356	356
43	Denominator for Chlamydia Screening in Women (CHL): 21 – 24 Years	Enter: ´1´ if this member is in the denominator of the Chlamydia Screening in Women (21–24 Years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	357	357
44	Numerator for Chlamydia Screening in Women (CHL): 21 – 24 Years	Enter: ´1´ if this member is in the numerator of the Chlamydia Screening in Women (21–24 Years) measure, ´0´ if the member is not in the numerator or the information is missing.	1= Yes 0 = No	R	1	358	358
45	Denominator for Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator.	1= Yes 0 = No	R	1	359	359
46	Numerator for Use of Spirometry Testing in the Assessment and Diagnosis of COPD (SPR)	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	360	360
47	Denominator 1 for Medication Management for People with Asthma (MMA): 5–11 years	Enter: ´1´ if this member is in the denominator of the Medication Management for People with Asthma (5–11 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	361	361
48	Numerator 1A for Medication Management for People with Asthma (MMA): 5–11 years, 50%	Enter: ´1´ if this member is in the numerator of ≥ 50% medication compliance of the Medication Management for People with Asthma (5–11 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	362	362
49	Numerator 1B for Medication Management for People with Asthma (MMA): 5–11 years, 75%	Enter: ´1´ if this member is in the numerator of ≥ 75% medication compliance of the Medication Management for People with Asthma (5–11 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	363	363
50	Denominator 2 for Medication Management for People with Asthma (MMA): 12–18 years	Enter: ´1´ if this member is in the denominator of the Medication Management for People with Asthma (12–18 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	364	364
51	Numerator 2A for Medication Management for People with Asthma (MMA): 12–18 years, 50%	Enter: ´1´ if this member is in the numerator of ≥ 50% medication compliance of the Medication Management for People with Asthma (12–18 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	365	365
52	Numerator 2B for Medication Management for People with Asthma (MMA): 12–18 years, 75%	Enter: ´1´ if this member is in the numerator of ≥ 75% medication compliance of the Medication Management for People with Asthma (12–18 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	366	366
53	Denominator 3 for Medication Management for People with Asthma (MMA): 19–50 years	Enter: ´1´ if this member is in the denominator of the Medication Management for People with Asthma (19–50 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	367	367
54	Numerator 3A for Medication Management for People with Asthma (MMA): 19–50 years, 50%	Enter: ´1´ if this member is in the numerator of ≥ 50% medication compliance of the Medication Management for People with Asthma (19–50 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	368	368
55	Numerator 3B for Medication Management for People with Asthma (MMA): 19–50 years, 75%	Enter: ´1´ if this member is in the numerator of ≥ 75% medication compliance of the Medication Management for People with Asthma (19–50 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	369	369
56	Denominator 4 for Medication Management for People with Asthma (MMA): 51–64 years	Enter: ´1´ if this member is in the denominator of the Medication Management for People with Asthma (51–64 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	370	370
57	Numerator 4A for Medication Management for People with Asthma (MMA): 51–64 years, 50%	Enter: ´1´ if this member is in the numerator of ≥ 50% medication compliance of the Medication Management for People with Asthma (51–64 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	371	371
58	Numerator 4B for Medication Management for People with Asthma (MMA): 51–64 years, 75%	Enter: ´1´ if this member is in the numerator of ≥ 75% medication compliance of the Medication Management for People with Asthma (51–64 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	372	372
59	Denominator 5 for Medication Management for People with Asthma (MMA): 65–85 years	Enter: ´1´ if this member is in the denominator of the Medication Management for People with Asthma (65–85 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	373	373
60	Numerator 5A for Medication Management for People with Asthma (MMA): 65–85 years, 50%	Enter: ´1´ if this member is in the numerator of ≥ 50% medication compliance of the Medication Management for People with Asthma (65–85 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	374	374
61	Numerator 5B for Medication Management for People with Asthma (MMA): 65–85 years, 75%	Enter: ´1´ if this member is in the numerator of ≥ 75% medication compliance of the Medication Management for People with Asthma (65–85 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	375	375
62	Denominator for Persistent Beta Blocker Treatment After Heart Attack (PBH)	Enter: ´1´ if this member is in the denominator of the Persistent Beta Blocker Treatment After Heart Attack measure, ´0´ if the member is not in the e denominator of this measure.	1= Yes 0 = No	R	1	376	376
63	Numerator for Persistent Beta Blocker Treatment After Heart Attack (PBH)	Enter: ´1´ if this member is in the numerator of the Persistent Beta Blocker Treatment After Heart Attack measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	377	377
64	Denominator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Males 21–75, Received Statin Therapy	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	378	378
65	Numerator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Males 21–75, Received Statin Therapy	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	379	379
66	Denominator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Males 21–75, Statin Adherence 80%	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	380	380
67	Numerator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Males 21–75, Statin Adherence 80%	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	381	381
68	Denominator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Females 40–75, Received Statin Therapy	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	382	382
69	Numerator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Females 40–75, Received Statin Therapy	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	383	383
70	Denominator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Females 40–75, Statin Adherence 80%	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	384	384
71	Numerator for Statin Therapy for Patients With Cardiovascular Disease (SPC): Females 40–75, Statin Adherence 80%	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	385	385
72	Denominator for Comprehensive Diabetes Care (CDC)	Enter: ´1´ if this member is in the denominator of the CDC measures, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	386	386
73	Numerator for CDC – HbA1c Test	Enter: ´1´ if this member is in the numerator of the CDC HbA1c Test measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	387	387
74	Numerator for CDC – HbA1c Poor Control (>9.0%)	Enter: ´1´ if this member is in the numerator of the CDC HbA1c Poor Control (>9.0%) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	388	388
75	Numerator for CDC – Eye Exam	Enter: ´1´ if this member is in the numerator of the CDC Eye Exam measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	389	389
76	Numerator for CDC – Nephropathy Monitor	Enter: ´1´ if this member is in the numerator of the CDC Nephropathy Monitor measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	390	390
77	Denominator for Antidepressant Medication Management (AMM)	Enter: ´1´ if this member is in the denominator for the Antidepressant Medication Management measures, ´0´ if the member is not in the denominator of this measure	1= Yes 0 = No	R	1	391	391
78	Numerator for Antidepressant Medication Management (AMM): Effective Acute Phase Treatment	Enter: ´1´ if this member is in the numerator of the Antidepressant Medication Management – Effective Acute Phase Treatment measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	392	392
79	Numerator for Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment	Enter: ´1´ if this member is in the numerator of the Antidepressant Medication Management – Effective Continuation Phase Treatment measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	393	393
80	Denominator for Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	394	394
81	Numerator for Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD)	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	395	395
82	Denominator for Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)	Enter: ´1´ if this member is in the denominator of the Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	396	396
83	Numerator for Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)	Enter: ´1´ if this member is in the numerator of the Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	397	397
84	Denominator for Use of Imaging Studies for Low Back Pain (LBP)	Enter: ´1´ if this member is in the denominator of the Use of Imaging Studies for Low Back Pain measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	398	398
85	Numerator for Use of Imaging Studies for Low Back Pain (LBP)	Enter: ´1´ if this member is in the numerator of the Use of Imaging Studies for Low Back Pain measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	399	399
86	Denominator for Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET): 13– 17 years	Enter: ´1´ if this member is in the denominator of the Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (13–17 years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	400	400
87	Numerator for Initiation of Alcohol and Other Drug Dependence Treatment (IET): 13–17 years	Enter: ´1´ if this member is in the numerator of the Initiation of Alcohol and Other Drug Dependence Treatment (13–17 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	401	401
88	Numerator for Engagement of Alcohol and Other Drug Dependence Treatment (IET): 13–17 years	Enter: ´1´ if this member is in the numerator of the Engagement of Alcohol and Other Drug Dependence Treatment (13–17 years) measure, ´0´ if the member is not in the numerator	1= Yes 0 = No	R	1	402	402
89	Denominator for Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: 18+ years	Enter: ´1´ if this member is in the denominator of the Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (18+ years) measure, ´0´ if the member is not in the denominator of this measure.	1= Yes 0 = No	R	1	403	403
90	Numerator for Initiation of Alcohol and Other Drug Dependence Treatment (IET): 18+ years	Enter: ´1´ if this member is in the numerator of the Initiation of Alcohol and Other Drug Dependence Treatment (18+ years) measure, ´0´ if the member is not in the numerator.	1= Yes 0 = No	R	1	404	404
91	Numerator for Engagement of Alcohol and Other Drug Dependence Treatment (IET): 18+ years	Enter: ´1´ if this member is in the numerator of the Engagement of Alcohol and Other Drug Dependence Treatment (18+ years) measure, ´0´ if the member is not in the numerator.	1= Yes 0 = No	R	1	405	405
92	Ambulatory Care (AMB): Outpatient Visits	Enter the total number of Outpatient visits for this member, ´0´ if the member does not have Oupatient visits.	###	R	3	406	408
93	Ambulatory Care (AMB): ED Visits	Enter the total number of ED visits for this member, ´0´ if the member does not have ED visits.	###	R	3	409	411
94	Inpatient Utilization—General Hospital/Acute Care (IPU): Total Inpatient	Enter the total Inpatient discharges for this member, ´0´ if the member does not have Inpatient discharges.	###	R	3	412	414
95	Inpatient Utilization—General Hospital/Acute Care (IPU): Medicine Discharges	Enter the total Medicine discharges for this member, ´0´ if the member does not have Medicine discharges.	###	R	3	415	417
96	Inpatient Utilization—General Hospital/Acute Care (IPU): Surgery Discharges	Enter the total Surgery discharges for this member, ´0´ if the member does not have Surgery discharges.	###	R	3	418	420
97	Inpatient Utilization—General Hospital/Acute Care (IPU): Maternity Discharges	Enter the total Maternity discharges for this member, ´0´ if the member does not have Maternity discharges.	###	R	3	421	423
98	Denominator for Initiation of Pharmacotherapy upon New Episode of Opioid Dependence	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator.	1= Yes 0 = No	R	1	424	424
99	Numerator for Initiation of Pharmacotherapy upon New Episode of Opioid Dependence	Enter: ´1´ if this member is in the numerator, ´0´ if this member is not in the numerator.	1= Yes 0 = No	R	1	425	425
100	Denominator for Immunizations for Adolescents (IMA)	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	426	426
101	Numerator for Immunizations for Adolescents (IMA): Combo 2	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	427	427
102	Denominator for Follow–Up Care for Children Prescribed ADHD Medication (ADD): Initiation Phase	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	428	428
103	Numerator for Follow–Up Care for Children Prescribed ADHD Medication (ADD): Initiation Phase	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	429	429
104	Denominator for Follow–Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance (C&M) Phase	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	430	430
105	Numerator for Follow–Up Care for Children Prescribed ADHD Medication (ADD): Continuation and Maintenance (C&M) Phase	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	431	431
106	Denominator for Annual Dental Visit (ADV): 2–3 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	432	432
107	Numerator for Annual Dental Visit (ADV): 2–3 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	1= Yes 0 = No	R	1	433	433
108	Denominator for Annual Dental Visit (ADV): 4–6 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	434	434
109	Numerator for Annual Dental Visit (ADV): 4–6 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	1= Yes 0 = No	R	1	435	435
110	Denominator for Annual Dental Visit (ADV): 7–10 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	436	436
111	Numerator for Annual Dental Visit (ADV): 7–10 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	1= Yes 0 = No	R	1	437	437
112	Denominator for Annual Dental Visit (ADV): 11–14 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	438	438
113	Numerator for Annual Dental Visit (ADV): 11–14 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	1= Yes 0 = No	R	1	439	439
114	Denominator for Annual Dental Visit (ADV): 15–18 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	440	440
115	Numerator for Annual Dental Visit (ADV): 15–18 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	1= Yes 0 = No	R	1	441	441
116	Denominator for Annual Dental Visit (ADV): 19–20 years	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	442	442
117	Numerator for Annual Dental Visit (ADV): 19–20 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	1= Yes 0 = No	R	1	443	443
118	Denominator for Well–Child Visits in the First 15 Months of Life (W15)	Enter: ´1´ if this member is in the denominator, ´0´ if this member is not in the denominator.	1= Yes 0 = No	R	1	444	444
119	Numerator for Well–Child Visits in the First 15 Months of Life (W15): Five 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	1= Yes 0 = No	R	1	445	445
120	Numerator for Well–Child Visits in the First 15 Months of Life (W15): 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	1= Yes 0 = No	R	1	446	446
121	Denominator for Well–Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	447	447
122	Numerator for Well–Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34)	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	448	448
123	Denominator for Adolescent Well–Care Visits (AWC)	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	449	449
124	Numerator for Adolescent Well–Care Visits (AWC)	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	450	450
125	Denominator for Colorectal Cancer Screening (COL)	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	451	451
126	Numerator for Colorectal Cancer Screening (COL)	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	452	452
127	Denominator for Controlling High Blood Pressure (CBP)	Enter: ´1´ if this member is in the denominator ´0´ if this member is not in the denominator	1= Yes 0 = No	R	1	453	453
128	Numerator for Controlling High Blood Pressure (CBP)	Enter: ´1´ if this member is in the numerator ´0´ if this member is not in the numerator OR the information for this member is missing	1= Yes 0 = No	R	1	454	454

Changes from APC 2018 file layout:

1. Contractor Tax ID field moved to element #21
2. Practice Zip Code + field moved to element #22
3. One Measure has been added for reporting:
   1. Colorectal Cancer Screening
4. Seven new measures have been added for Medicaid Value Based Payment reporting:
   1. Immunizations for Adolescents (IMA)
   2. Follow–Up Care for Children Prescribed ADHD Medication (ADD)
   3. Annual Dental Visit (ADV)
   4. Well–Child Visits in the First 15 Months of Life (W15)
   5. Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life (W34)
   6. Adolescent Well–Care Visits(AWC)
   7. Controlling High Blood Pressure
5. Two measures have been removed from Medicaid Value Based Payment reporting:
   1. Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%)
   2. Statin Therapy for Patients with Diabetes

Please refer to the 2019 User Notes below for comprehensive instructions for completeing the File Layout Request

NYS PCMH Measure Reporting – 2019 Primary Care Data Request

User Notes
Instructions for Completing the File Layout Request

Summary of Changes for 2019 Reporting

One Measure has been added for reporting:

• Colorectal Cancer Screening

Seven new measures have been added for Medicaid Value Based Payment reporting:

• Immunizations for Adolescents (IMA)
• Follow–Up Care for Children Prescribed ADHD Medication (ADD)
• Annual Dental Visit (ADV)
• Well–Child Visits in the First 15 Months of Life (W15)
• Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life (W34)
• Adolescent Well–Care Visits (AWC)
• Controlling High Blood Pressure

Two measures have been removed from Medicaid Value Based Payment reporting:

• Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Control (<8.0%)
• Statin Therapy for Patients with Diabetes

Please use your 2019 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 in 2019, we are requesting that you include the provider/practice that was attributed to the member using your own plan´s attribution methodology. Several fields regarding the provider and practice site of the service have been added to the layout request for this purpose (Fields #6–22). This information has been added to allow us to aggregate the results by Practice across all New York State MCOs and Lines of Business.

Please note that the file layout contains 12 measures for the Medicaid Value Based Payment initiative: Statin therapy for patients with cardiovascular disease, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Diabetes Screening for Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications, Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (Administrative rate), Initiation of Pharmacotherapy upon New Episode of Opioid Dependence, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (Administrative rate), Immunization for Adolescents, Follow–Up Care for Children Prescribed ADHD Medication, Annual Dental Visit, Well–Child Visits in the First 15 Months of Life, Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life, and Adolescent Well–Care visits.

These 12 measures are not being reported for NYS PCMH. Only MCOs with a Medicaid LOB will need to report these measures, which have been added to the NYS PCMH file layout to alleviate the burden of responding to two data requests.

The NYS PCMH data file is modeled after the NYS 2019 Patient Level Detail file (PLD) that you prepared as part of your HEDIS/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 NYS PLD. You may find it helpful to use the PLD as a resource or starting point in completing the NYS PCMH file. We are asking that you populate the PLD with all Lines of Business that you serve, e.g., Medicaid, Medicare, Commercial. Once completed, please upload the file to IPRO´s ftp site. A subfolder in the "QARR 2019" folder where you upload your 2019 QARR files entitled "NYS PCMH 2019" will be created for your submission. If someone other than your QARR liaison will be responsible for NYS PCMH reporting, please contact Margaret Morris at the email address below for access to the FTP site. Please note that the deadline for submission is Thursday, August 1, 2019.

Exceptions to the NYS QARR PLD file are noted below:

1. The NYS PCMH file requests Medicare HEDIS data, which is not required for QARR reporting.
2. The Plan ID field should be populated with the Organization ID that you used to submit the IDSS to NCQA. Note that the Organization ID is different from the Submission ID, which is specific to a particular Line of Business. The Organization ID provides for six digits. If your plan´s ID is smaller, please right justify.
3. For Medicaid, we are asking that you populate the member´s CIN in the ID field and not an internal ID number, for 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 members.
4. Provider/Practice attribution information is required for NYS PCMH. Such information is not required for QARR.

Specific Instructions:

1. 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.
2. If a member is reported for a specific measure in more than one product line (e.g., duals), please report the member for only one product, using the following priority: Commercial, then Medicare, then Medicaid. This instruction affects only members who may be reported twice in the same measure.
3. 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.
4. 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 and administrative numerator (and not the hybrid data), which is populated on the IDSS.
5. Members in the file must be in at least one measure.
6. Measures that are not applicable to the member should be zero–filled.
7. A valid Tax ID (TIN) is nine characters. If the TIN is not available, set the field value to "999999999".
8. Practice Name must be populated in the Practice Name (Field #9) only.
9. Practice Address Line 1 (Field #10) must contain the street address of the Practice, not the Practice Name.
10. For Fields #7–22, leave these fields blank if the member cannot be attributed to any provider and you are not able to identify the provider.
11. For Field # 21, Populate with valid TINs only. If member is NOT attributed to a VBP Contractor set to ´999999999´.
12. The IET Engagement numerator (Field #88 and 91) value must be less than or equal to the Initiation numerator (Field #87 and 90) value.
13. The ADD Continuation and Maintenance (C&M) Phase denominator (Field #104) and numerator (Field #105) must be less than or equal to the Initiation Phase denominator (Field #102) and numerator (Field #103).
14. For the AAB (Field #83) and LBP (Field #85) measures, provide the actual numerator (non–inverted), e.g., for AAB, the numerator would be members receiving the antibiotic.
15. For the AMB measure, please populate the fields with the number of events for each LOB you are reporting. Member Months is not required for 2019.
16. For the IPU measure, please populate the fields with number of events for each LOB you are reporting. Member Months is not required for 2019.
17. IMA has been added in fields 100–101. IMA has one numerator: Combo 2. Report the administrative denominator and numerator.
18. ADD has been added in fields 102–105. ADD has two numerators: Initiation Phase and Continuation and Maintenance (C&M) Phase.
19. ADV has been added in fields 106–117. ADV has six numerators: 2–3 years, 4–6 years, 7–10 years, 11–14 years, 15–18 years, and 19–20 years.
20. W15 has been added in fields 118–120. W15 has two numerators: Five Well–Child Visits and Six or more Well–Child Visits.
21. W34 has been added in fields 121–122.
22. AWC has been added in fields 123–124.
23. COL has been added in fields 125–126. Report the administrative denominator and numerator.
24. CBP has been added in fields 127–128. Report the administrative denominator and numerator.
25. Only MCOs reporting their Medicaid line of Business need report the following 12 VBP specific measures: Controlling High Blood Pressure, Statin therapy for patients with cardiovascular disease, Use of Spirometry Testing in the Assessment and Diagnosis of COPD, Diabetes Screening for Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications, Initiation of Pharmacotherapy upon New Episode of Opioid Dependence, Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (Administrative rate), Immunization for Adolescents, Follow–Up Care for Children Prescribed ADHD Medication, Annual Dental Visit, Well–Child Visits in the First 15 Months of Life, Well–Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life, and Adolescent Well–Care visits. 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.

Contact Information
For questions regarding this request, please contact Margaret Morris of IPRO at mmorris@ipro.org or 516–589–3988.

NYS Counties	FIPS Code	NYS Counties	FIPS Code	NYS Counties	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	NEWYORK	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	OUTOFSTATE	000
GREENE	039	RENSSELAER	083	UKNOWN/MISSING	999
HAMILTON	041	RICHMOND	085
HERKIMER	043	ROCKLAND	087