# Marketplace MY2023 PLD File Specifications

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##### Revision date: February 14, 2024

### NYS MY2023 Patient-Level Detail File Specifications

#### MARKETPLACE

MEASURE | COLUMN LENGTH | COLUMN START | COLUMN END | FIELD | SPECIFICATION |
---|---|---|---|---|---|

GENERAL INFO | 1 | 1 | 1 | Record Identifier | Use the tilde (~) character to start the line. |

GENERAL INFO | 5 | 2 | 6 | Submission ID | The unique identifier assigned by NCQA for summary-level data submission |

GENERAL INFO | 18 | 7 | 24 | Product Line | QHP_HMO, QHP_POS, QHP_PPO, QHP_EPO |

GENERAL INFO | 30 | 25 | 54 | Member ID | Member ID should be the member's NYS-issued HIXNY Member ID. Do not report the identifier used in HEDIS. |

GENERAL INFO | 8 | 55 | 62 | Date of birth | The birth date must contain 8 digits with month, day, year Enter: MMDDYYYY (e.g., September 20, 1983 would be 09201983) |

GENERAL INFO | 2 | 63 | 64 | Member Months | The member month contribution this member adds according to enrollment data. Valid values are between 0 - 12. |

GENERAL INFO | 1 | 65 | 65 | Sex | Enter: The sex assigned at birth 'F' member is female 'M' member is male 'O' includes, but is not limited to: missing, refused, and unspecified No other characters are allowed |

GENERAL INFO | 2 | 66 | 67 | Race | Enter the member's race: 01=White 02=Black or African American 03=American Indian/Alaskan Native 04=Asian 05=Native Hawaiian/Pacific Islander 06=Some Other Race 07=Two or more races 08=Asked But No Answer 09=Unknown |

GENERAL INFO | 2 | 68 | 69 | Source of Race Data | Provide the source of race data: 20 = Health Plan Direct (Direct) 21 = CMS databases (Direct) 22 = State Databases (Direct) 23 = Surname Analysis (Indirect) 24 = Geo-coding Analysis (Indirect) 28 = Unknown - Use this as the race source value when the member's race is "UNK" for Unknown Race 29 = Other (Direct) 30 = Unknown (Indirect) |

GENERAL INFO | 1 | 70 | 70 | Ethnicity | Enter the Member's ethnicity: 1=Hispanic or Latino 2=Non-Hispanic or Latino 9=Unknown 0=Asked but not answered |

GENERAL INFO | 2 | 71 | 72 | Source of Ethnicity Data | Provide the source of ethnicity data: 20 = Health Plan Direct (Direct) 21 = CMS databases (Direct) 22 = State Databases (Direct) 23 = Surname Analysis (Indirect) 24 = Geo-coding Analysis (Indirect) 28 = Unknown - Use this as the race source value when the member's race is "UNK" for Unknown Race 29 = Other (Direct) 30 = Unknown (Indirect) |

GENERAL INFO | 2 | 73 | 74 | Asian American Subgroups | If member 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=Unknown 20=Declined 00=Not Asian |

GENERAL INFO | 1 | 75 | 75 | Native Hawaiian/Pacific Islander Subgroups | If member is Native Hawaiian or Pacific Islander then identify the subgroup: 1=Hawaiian 2=Guamanian/Chamorro 3=Samoan 4=Fijian 5=Tongan 6=Unknown 7=Declined 0=Not Native Hawaiian/Pacific Islander |

GENERAL INFO | 3 | 76 | 78 | Language Spoken | Enter the member's spoken language: 001=English *For all other languages other than English see the Language Value Set on the Managed Care > Information for Health Plans > Quality Assurance Reporting Requirements (QARR)> 2023> NYS QARR Language Value Set webpage. 197=Unknown 199=Declined |

GENERAL INFO | 3 | 79 | 81 | County of Residence | Enter the 3-digit county FIPS code for each member's residence of county. See the attachment for codes and values to enter here. ### = FIPS Code 000= Outside of NYS 999 = Unknown |

General Info | 1 | 82 | 82 | Metal Level | 1=Platinum 2 = Gold 3 = Silver 4 = Bronze 5 = Catastrophic 9 = Unknown |

General Info | 1 | 83 | 83 | Marketplace Product | Enter the '1' if the member enrolled through the Marketplace in an individual benefit, '2' if the member enrolled outside of the Marketplace in an individual benefit, '3' if the member enrolled in the Small Business Health Options Program (SHOP) through the Marketplace, '4' if the member enrolled in the Small Business outside the Marketplace, and '9' if unknown. |

AAB | 2 | 84 | 85 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 3 months-17 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |

AAB | 2 | 86 | 87 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 3 months-17 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |

AAB | 2 | 88 | 89 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 18-64 years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |

AAB | 2 | 90 | 91 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 18-64 years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |

AAB | 2 | 92 | 93 | Denominator for Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): 65+ years | Enter: The number of times this member is in the denominator '0' if the member is not in the denominator |

AAB | 2 | 94 | 95 | Numerator for Avoidance of Antibiotic treatment for Acute Bronchitis/Bronchiolitis (AAB): 65+ years | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |

AIS-E | 1 | 96 | 96 | Denominator 1 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 1) [Members 19 years and older] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AIS-E | 1 | 97 | 97 | Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 1) [Members 19 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 | 98 | 98 | Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 2) [ Members 19 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 | 99 | 99 | Denominator 3 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 years and older] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AIS-E | 1 | 100 | 100 | Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 3) [Members 50 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 | 101 | 101 | Denominator 4 for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 66 years and older] | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AIS-E | 1 | 102 | 102 | Numerator for Adult Immunization Status (AIS-E): Pneumococcal (Population Criteria 4) [Members 66 years and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMM | 1 | 103 | 103 | Denominator for Antidepressant Medication Management (AMM) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMM | 1 | 104 | 104 | Numerator for Antidepressant Medication Management (AMM): Effective Acute Phase Treatment | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMM | 1 | 105 | 105 | Numerator for Antidepressant Medication Management (AMM): Effective Continuation Phase Treatment | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMO | 1 | 106 | 106 | Denominator for Annual Monitoring for Persons on Long-term Opioid Therapy (AMO): 18+ years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMO | 1 | 107 | 107 | Numerator for Annual Monitoring for Persons on Long-term Opioid Therapy (AMO): 18+ years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMR | 1 | 108 | 108 | Denominator for Asthma Medication Ratio (AMR): 5-11 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMR | 1 | 109 | 109 | Numerator for Asthma Medication Ratio (AMR): 5-11 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMR | 1 | 110 | 110 | Denominator for Asthma Medication Ratio (AMR): 12-18 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMR | 1 | 111 | 111 | Numerator for Asthma Medication Ratio (AMR): 12-18 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMR | 1 | 112 | 112 | Denominator for Asthma Medication Ratio (AMR): 19-50 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMR | 1 | 113 | 113 | Numerator for Asthma Medication Ratio (AMR): 19-50 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AMR | 1 | 114 | 114 | Denominator for Asthma Medication Ratio (AMR): 51-64 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

AMR | 1 | 115 | 115 | Numerator for Asthma Medication Ratio (AMR): 51-64 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

BCS-E | 1 | 116 | 116 | Denominator for Breast Cancer Screening Electronic (BCS-E) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

BCS-E | 1 | 117 | 117 | Numerator for Breast Cancer Screening Electronic (BCS-E) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CBP | 1 | 118 | 118 | Denominator for Controlling High Blood Pressure (CBP) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CBP | 1 | 119 | 119 | Numerator for Controlling High Blood Pressure (CBP) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CCS | 1 | 120 | 120 | Denominator for Cervical Cancer Screening (CCS) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CCS | 1 | 121 | 121 | Numerator for Cervical Cancer Screening (CCS) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CCS-E | 1 | 122 | 122 | Denominator for Cervical Cancer Screening Electronic (CCS-E) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CCS-E | 1 | 123 | 123 | Numerator for Cervical Cancer Screening Electronic (CCS-E) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CHL | 1 | 124 | 124 | Denominator for Chlamydia Screening in Women (CHL): 16-20 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CHL | 1 | 125 | 125 | Numerator for Chlamydia Screening in Women (CHL): 16-20 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CHL | 1 | 126 | 126 | Denominator for Chlamydia Screening in Women (CHL): 21-24 years |
Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CHL | 1 | 127 | 127 | Numerator for Chlamydia Screening in Women (CHL): 21-24 years |
Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 128 | 128 | Denominator for Childhood Immunization Status (CIS) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CIS | 1 | 129 | 129 | Numerator for Childhood Immunization Status (CIS): DTaP | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 130 | 130 | Numerator for Childhood Immunization Status (CIS): IPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 131 | 131 | Numerator for Childhood Immunization Status (CIS): MMR | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 132 | 132 | Numerator for Childhood Immunization Status (CIS): HiB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 133 | 133 | Numerator for Childhood Immunization Status (CIS): HepB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 134 | 134 | Numerator for Childhood Immunization Status (CIS): VZV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 135 | 135 | Numerator for Childhood Immunization Status (CIS): PCV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 136 | 136 | Numerator for Childhood Immunization Status (CIS): Combo 10 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 137 | 137 | Numerator for Childhood Immunization Status (CIS): RV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS | 1 | 138 | 138 | Numerator for Childhood Immunization Status (CIS): HepA | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 139 | 139 | Denominator for Childhood Immunization Status Electronic (CIS-E) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

CIS-E | 1 | 140 | 140 | Numerator for Childhood Immunization Status Electronic (CIS- E): DTaP | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 141 | 141 | Numerator for Childhood Immunization Status Electronic (CIS- E): IPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 142 | 142 | Numerator for Childhood Immunization Status Electronic (CIS- E): MMR | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 143 | 143 | Numerator for Childhood Immunization Status Electronic (CIS- E): HiB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 144 | 144 | Numerator for Childhood Immunization Status Electronic (CIS- E): HepB | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 145 | 145 | Numerator for Childhood Immunization Status Electronic (CIS- E): VZV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 146 | 146 | Numerator for Childhood Immunization Status Electronic (CIS- E): PCV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 147 | 147 | Numerator for Childhood Immunization Status Electronic (CIS- E): HepA | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 148 | 148 | Numerator for Childhood Immunization Status Electronic (CIS- E): RV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 149 | 149 | Numerator for Childhood Immunization Status Electronic (CIS- E): Influenza | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

CIS-E | 1 | 150 | 150 | Numerator for Childhood Immunization Status Electronic (CIS- E): Combo 10 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

COL | 1 | 151 | 151 | Denominator for Colorectal Cancer Screening (COL): 46-50 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

COL | 1 | 152 | 152 | Numerator for Colorectal Cancer Screening (COL): 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 | 1 | 153 | 153 | Denominator for Colorectal Cancer Screening (COL): 51-75 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

COL | 1 | 154 | 154 | Numerator for Colorectal Cancer Screening (COL): 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 |

COL-E | 1 | 155 | 155 | 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 | 156 | 156 | 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 | 157 | 157 | 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 | 158 | 158 | 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 | 159 | 159 | Denominator for Eye Exam for Patients with Diabetes (EED) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

EED | 1 | 160 | 160 | Numerator for Eye Exam for Patients with Diabetes (EED) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

FUH | 2 | 161 | 162 | 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 | 163 | 164 | Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years, 30-day follow-up | Enter: The number of times this member is in denominator '0' if the member is not in the denominator |

FUH | 2 | 165 | 166 | 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 | 167 | 168 | 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 | 169 | 170 | 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 | 171 | 172 | 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 | 173 | 174 | 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 | 175 | 176 | 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 | 177 | 178 | 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 |

HBD | 1 | 179 | 179 | Denominator for Hemoglobin A1c Control for Patients with Diabetes (HBD) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

HBD | 1 | 180 | 180 | Numerator for HbA1c poor control (>9.0%) | 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 | 181 | 182 | 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 | 183 | 184 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 185 | 186 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 187 | 188 | 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 | 189 | 190 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 191 | 192 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 193 | 194 | 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 | 195 | 196 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 197 | 198 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 199 | 200 | 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 | 201 | 202 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 203 | 204 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 205 | 206 | 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 | 207 | 208 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 209 | 210 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 211 | 212 | 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 | 213 | 214 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 215 | 216 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 217 | 218 | 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 | 219 | 220 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 221 | 222 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 223 | 224 | 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 | 225 | 226 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Initiation of AOD 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 | 227 | 228 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of AOD 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 | 229 | 230 | 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 | 231 | 232 | 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 | 233 | 234 | Numerator for Initiation and Engagement of Substance Use Disorder Treatment (IET): Engagement of other substance use disorder 65+ other substance use disorder | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |

IMA | 1 | 235 | 235 | Denominator for Immunizations for Adolescents (IMA) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

IMA | 1 | 236 | 236 | Numerator for Immunizations for Adolescents (IMA): Meningococcal | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA | 1 | 237 | 237 | Numerator for Immunizations for Adolescents (IMA): Tdap | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA | 1 | 238 | 238 | Numerator for Immunizations for Adolescents (IMA): HPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA | 1 | 239 | 239 | Numerator for Immunizations for Adolescents (IMA): Combo 2 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA-E | 1 | 240 | 240 | Denominator for Immunizations for Adolescents Electronic (IMA-E) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

IMA-E | 1 | 241 | 241 | Numerator for Immunizations for Adolescents Electronic (IMA- E): Meningococcal | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA-E | 1 | 242 | 242 | Numerator for Immunizations for Adolescents Electronic (IMA- E): Tdap | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA-E | 1 | 243 | 243 | Removed - can leave blank '0' | |

IMA-E | 1 | 244 | 244 | Numerator for Immunizations for Adolescents Electronic (IMA- E): HPV | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

IMA-E | 1 | 245 | 245 | Numerator for Immunizations for Adolescents Electronic (IMA- E): Combo 2 | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

INR | 1 | 246 | 246 | Denominator for International Normalized ratio Monitoring for Individuals on Warfarin (INR) | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

INR | 1 | 247 | 247 | Numerator for International Normalized ratio Monitoring for Individuals on Warfarin (INR) | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

KED | 1 | 248 | 248 | 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 | 249 | 249 | 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 | 250 | 250 | Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 65-74 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

KED | 1 | 251 | 251 | Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 65-74 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

KED | 1 | 252 | 252 | Denominator for Kidney Health Evaluation for Patients With Diabetes (KED): 75-85 years | Enter: '1' if this member is in the denominator '0' if this member is not in the denominator |

KED | 1 | 253 | 253 | Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 75-85 years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

LBP | 1 | 254 | 254 | 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 | 255 | 255 | 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 | 256 | 256 | 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 | 257 | 257 | Numerator for Use of Imaging Studies for Low Back Pain (LBP), Ages 65-75 Years | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

PDC | 1 | 258 | 258 | 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 | 259 | 259 | 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 | 260 | 260 | 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 | 261 | 261 | 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 | 262 | 262 | 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 | 263 | 263 | 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 | 264 | 265 | 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 | 266 | 267 | 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 | 268 | 269 | 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 | 270 | 271 | Numerator for Prenatal and Postpartum Care (PPC): Postpartum Care | Enter: The number of times this member is in the numerator '0' if the member is not in the numerator OR the information is missing |

URI | 2 | 272 | 273 | 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 | 274 | 275 | 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 | 276 | 277 | 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 | 278 | 279 | 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 | 280 | 281 | 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 | 282 | 283 | 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 | 284 | 284 | 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 | 285 | 285 | 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 | 286 | 286 | 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 | 287 | 287 | 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 | 288 | 288 | 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 | 289 | 289 | 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 | 290 | 290 | 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 | 291 | 291 | 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 | 292 | 292 | 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 | 293 | 293 | 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 | 294 | 294 | 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 | 295 | 295 | 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 | 296 | 296 | 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 | 297 | 297 | 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 | 298 | 298 | 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 | 299 | 299 | 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 | 300 | 300 | 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 | 301 | 301 | 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 | 302 | 302 | 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 | 303 | 303 | 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 | 304 | 304 | 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 | 305 | 305 | 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 |

CIS | 1 | 306 | 306 | Numerator for Childhood Immunization Status (CIS): Influenza | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AIS-E | 1 | 307 | 307 | Denominator 2 for Adult Immunization Status (AIS-E): Influenza and Td/Tdap (Population Criteria 4) [Members 66 and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AIS-E | 1 | 308 | 308 | Numerator for Adult Immunization Status (AIS-E): Influenza (Population Criteria 4) [Members 66 and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AIS-E | 1 | 309 | 309 | Numerator for Adult Immunization Status (AIS-E): Td/Tdap (Population Criteria 4) [Members 66 and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AIS-E | 1 | 310 | 310 | Denominator 4 for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 66 and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

AIS-E | 1 | 311 | 311 | Numerator for Adult Immunization Status (AIS-E): Zoster (Population Criteria 4) [Members 66 and older] | Enter: '1' if this member is in the numerator '0' if this member is not in the numerator OR the information for this member is missing |

### NYS MY2023 Patient-Level Detail File Change Log

MARKETPLACE | |||
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Version | Date | Data Element | Change Summary |

Specification Release MY2023 | 1/9/2023 | Multiple | Initial MY2023 update per HEDIS 2022 specifications: This included removal of all unused columns either due to retirement or unnecessary totaling. These include the measure ABA, BCS, and MMA. There was a combining of measure columns when they were separated which impacted COL, COL-E, and IET. General information was grouped together at the top of the file. We have added requests for Asian American subgroup, Pacific Island group, and more detailed information for language other than English. HBD had an extra numerator which was removed. Measures are alphabetically arranged by shortname. Changes or additions will be added to the bottom of the file for 2023. The file will be re-sorted alphabetically for 2024. |

Clarification #1 | 6/5/2023 | Multiple | Field Source of Race Data: 22 = State Databases (Direct) was added as a response option. Field Source of Ethnicity Data: 22 = State Databases (Direct) was added as a response option Measure FUH: Denominator for Follow-Up After Hospitalization for Mental Illness (FUH): 6-17 years was missing and was added. Measure FUH: Numerator for Follow-Up After Hospitalization for Mental Illness (FUH): 65+ years, 7-day follow-up was missing and was added. Measure KED: Numerator for Kidney Health Evaluation for Patients With Diabetes (KED): 75- 85 years was missing and was added. ECDS measures: The following measures have been added as required reporting on the PLD: Adult Immunization Status (AIS-E) Cervical Cancer Screening (CCS-E) Childhood Immunization Status (CIS-E) Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) Social Need Screening and Intervention (SNS-E) |

Clarification #2 | 8/28/2023 | Multiple | Column Length Changed = 2 for Race Column Length Changed = 2 for Source of Race Data Source of Race Data field, valid values have been updated to align with NCQA/HEDIS specifications. Column Length Changed = 2 for Source of Ethnicity Data Source of Ethnicity Data field, valid values have been updated to align with NCQA/HEDIS specifications. The Language Spoken field has been updated to include a link to Language Value Set on the NYS QARR Language Value Set webpage. Measure COL (non-electronic version): Denominator and Numerator specifications have been added for all age-bands for this measure. Measure COL (electronic version): - Denominator and Numerator specifications have been added for 46-49 age-band for this measure.
ECDS measures: To align with CMS' Final Call letter for QRS, the following measures have been REMOVED as required reporting on the PLD: Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) Social Need Screening and Intervention (SNS-E) Column Start and Column End numbering was corrected. |

Clarification #3 | 10/17/2023 | General Info | Native Hawaiian/Pacific Islander Subgroups: Updated 0=Not Native Hawaiian/Pacific Islander Measure COL-E (electronic version):Denominator and Numerator specifications have been updated for 46-50 and 51-75 age-bands for this measure. To align with CMS' Final Call letter for QRS, the following measures have been REMOVED as required reporting on the PLD: Appropriate Testing for Pharyngitis (CWP)Column Start and Column End numbering was corrected. |

Clarification #4 | 11/7/2023 | Multiple | Measure AIS-E (electronic version):Labels and descriptions updated to match HEDIS numerator and denominator population criteria. Measure COL-E (electronic version)Beginning with column start 157 (COL-E 51 -75 age stratification denominator) all remaining column start and column end numbering has been corrected. Measure HBDPer QRS 2024 ratings year (MY2023) reporting guideline; "QHP issuers are required to submit data for the HbA1c Control for Patients with Diabetes: HbA1c poor control (>9.0%)", the numerator has been updated. Measure IMA-E (electronic version)Per QRS reporting guideline; removed reporting requirement for IMA-E for Combo 1; indicating it may be left blank "0". Measure CISNumerator specifications have been added to the end of the PLD (row #306 )to include Influenza reporting. |

Clarification #5 | 11/21/2023 | AIS-E | Measure AIS-E (electronic version):Label and description for Influenza and Td/Tdap denominator 1 has been updated to represent the 19-65 year old age band [column start 109].Labels and descriptions for Influenza and Td/Tdap numerators have been updated to represent the 19-65 year old age band [column starts 110-111].Label and description for Zoster denominator 3 has been updated to represent the 50-65 year old age band [column start 112].Label and description for Zoster numerator has been updated to represent the 50-65 year old age band [column start 113].Denominator 2 for Influenza and Td/Tdap has been added for the 66 years and older age band [column start 544].Numerators for Influenza and Td/Tdap have been added for the age band of 66 years and older [column starts 545-546].Denominator 4 for Zoster has been added for the 66 years and older age band [column start 547].Numerator for Zoster has been added for the 66 years and older age band [column start 548]. |

Clarification #7 | 12/14/2024 | Source of Race Data |
Updated: 28 = Unknown – Use this as the race source value when the member's race is "UNK" for Unknown Race
Updated: 30 = Other (Indirect) – Use when "other" indirect method is used to determine Race |

Source of Ethnicity Data |
Updated: 28 = Unknown – Use this as the race source value when the member's race is "UNK" for Unknown Ethnicity
Updated: 30 = Other (Indirect) – Use when "other" indirect method is used to determine Ethnicity |