cms_ig.yml

CMS Programs:
  ep:
    '2020':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - CPCPLUS
      - PCF
    '2021':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - PCF
    '2022':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MIPS_SUBGROUP
      - PCF
    '2023':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MIPS_SUBGROUP
      - PCF
    '2024':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MIPS_SUBGROUP
      - PCF
      - MCP_STANDARD
      - MCP_FQHC
      - APP_PLUS_INDIV
      - APP_PLUS_GROUP
      - APP_PLUS_APMENTITY
    '2025':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MIPS_SUBGROUP
      - APP_PLUS_INDIV
      - APP_PLUS_GROUP
      - APP_PLUS_APMENTITY
    '2026':
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MIPS_SUBGROUP
      - APP_PLUS_INDIV
      - APP_PLUS_GROUP
      - APP_PLUS_APMENTITY
      - ASM_INDIV
      - ASM_GROUP
      - LEAD_APM_ENTITY
  eh:
    '2020':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
    '2021':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
    '2022':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_OQR
    '2023':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_OQR
    '2024':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_OQR
    '2025':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_OQR
    '2026':
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_OQR
      - HQR_REHQR
Program Specific Measures:
  PCF:
    # CMS122v9, CMS130v9, CMS165v9
    '2020':
      [ '2C928085-7198-38EE-0171-9D78A0D406B3',
        '2C928085-7198-38EE-0171-9D6E026B066B',
        '2C928085-7198-38EE-0171-9DA6456007AB']
    # CMS122v10, CMS130v10, CMS165v10
    '2021':
      [ '2C928082-74C2-3313-0174-C60BD07B02A6',
        '2C928082-74C2-3313-0174-DAF39F2C0658',
        '2C928082-7505-CAF9-0175-2382D1BD06B1']
    # CMS122v11, CMS130v11, CMS165v11
    '2022':
      [ '2C928085-7B2A-EB52-017B-56761E0218D0',
        '2C928083-7ACE-2267-017B-11FBB9C913C4',
        '2C928082-7A14-D92C-017A-67B6F9971EA8']
    # CMS122v12, CMS130v12, CMS165v12
    '2023':
      [ '2C928084-83D3-1B44-0183-EB75DC8A03DB',
        '2C928084-82EA-D7C5-0183-6BF2944520DC',
        '2C928085-806C-39A2-0180-7092FA9B0145']
    # CMS122v13, CMS130v13, CMS165v13
    '2024':
      [ '2C928083-8907-CE68-0189-2BC5FA0D0739',
        '2C928083-8907-CE68-0189-2BC134CF06BB',
        '2C928083-8907-CE68-0189-2BBD31D6064E']
Program Criterion:
  CCN:
    name: 'CMS Certification Number'
    description:
      eh: 'The organizations Facility CMS Certification Number (CCN). CCN is required for HQR.'
    conf:
      eh: '(CONF:4509-28241_C01)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
  HIC:
    name: 'Medicare HIC Number'
    optional:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
    description:
      eh: 'Medicare HIC Number is not required for HQR but should be submitted if the payer is Medicare and the patient has an HIC number assigned.'
    conf:
      eh: '(CONF:4509- 16857_C01)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
  Patient Identification Number:
    name: 'Patient Identification Number'
    description:
      eh: 'Patient Identification Number is required for HQR.'
    conf:
      eh: '(CONF:CMS_0009)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
  MBI:
    name: 'Medicare Beneficiary Identifier'
    optional:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
    description:
      eh: 'Medicare Beneficiary Identifier (MBI) is not required for HQR but should be submitted if the payer is Medicare and the patient has an MBI number assigned.'
    conf:
      eh: '(CONF:4509- 28697_C01)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
  CMS EHR Certification ID:
    name: 'CMS EHR Certification ID'
    description:
      CPCPLUS: 'For CPC+, all QRDA III files must include a CMS EHR Certification ID. Nulls will not be allowed.'
      PCF: 'For PCF, all QRDA III files must include a CMS EHR Certification ID. Nulls will not be allowed.'
      MIPS_GROUP: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_INDIV: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_VIRTUALGROUP: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_APMENTITY: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_APP1_INDIV: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_APP1_GROUP: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      MIPS_APP1_APMENTITY: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      ASM_INDIV: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      ASM_GROUP: 'For MIPS and ASM submissions, CMS EHR Certification ID is required for the Quality performance category.'
      eh: 'The Certified Health Information Technology (IT) Product List (CHPL) is the authoritative and comprehensive listing of health IT certified through the Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program. A CMS EHR Certification Identification Number is a number generated by the CHPL and used for reporting to CMS.'
    conf:
      eh: '(CONF:CMS_0005)'
      ep: '(CONF:CMS_85)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
      - CPCPLUS
      - PCF
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_VIRTUALGROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
      - MCP_STANDARD
      - MCP_FQHC
      - ASM_INDIV
      - ASM_GROUP
  TIN:
    name: 'Tax Identification Number'
    optional:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
    description:
      CPCPLUS: 'For CPC+: it must contain at least one performer, each performer contains one TIN and one NPI'
      PCF: 'For PCF: it must contain at least one performer, each performer contains one TIN and one NPI'
      MIPS_GROUP: 'For MIPS group reporting: it must contain exactly one performer, which contains one TIN. No NPI is allowed.'
      MIPS_INDIV: 'For MIPS individual reporting: it must contain exactly one performer, which contains one TIN and one NPI.'
      MIPS_APP1_INDIV: 'Required for APP group reporting and APP individual reporting'
      MIPS_APP1_GROUP: 'Required for APP group reporting and APP individual reporting'
      APP_PLUS_INDIV: 'Required for APP Plus group reporting and APP Plus individual reporting'
      APP_PLUS_GROUP: 'Required for APP Plus group reporting and APP Plus individual reporting'
      ASM_INDIV: 'Required for ASM individual and group reporting'
      ASM_GROUP: 'Required for ASM individual and group reporting'
      eh: 'For HQR, TIN may not be applicable. If TIN is submitted for HQR, then it SHALL conform to the constraints specified for TIN. and the TIN must be in valid format (9 decimal digits).'
    conf:
      eh: '(CMS_0119)'
      ep: '(CONF:3338-18190)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
      - MIPS_GROUP
      - MIPS_APP1_GROUP
      - MIPS_INDIV
      - MIPS_APP1_INDIV
      - CPCPLUS
      - PCF
      - MCP_STANDARD
      - MCP_FQHC
      - APP_PLUS_INDIV
      - APP_PLUS_GROUP
      - ASM_INDIV
      - ASM_GROUP
  Virtual Group Identifier:
    name: 'Virtual Group Identifier'
    description:
      MIPS_VIRTUALGROUP: 'For MIPS virtual group reporting: it must contain exactly one performer, which contains one Virtual Group Identifier. No NPI is allowed.'
    conf:
      ep: '(CONF:CMS_81)'
    programs:
      - MIPS_VIRTUALGROUP
  NPI:
    name: 'National Provider Identification number'
    optional:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
    description:
      CPCPLUS: 'For CPC+: it must contain at least one performer, each performer contains one TIN and one NPI'
      PCF: 'For PCF: it must contain at least one performer, each performer contains one TIN and one NPI'
      MIPS_INDIV: 'For MIPS individual reporting: it must contain exactly one performer, which contains one TIN and one NPI.'
      MIPS_APP1_INDIV: 'Required for APP individual reporting'
      APP_PLUS_INDIV: 'Required for APP Plus individual reporting'
      ASM_INDIV: 'Required for ASM individual and group reporting'
      ASM_GROUP: 'Required for ASM individual and group reporting'
      eh: 'For HQR, NPI may not be applicable. If NPI is submitted for HQR, then the NPI SHALL conform to the constraints specified for NPI and the NPI must be in the correct format.'
      ep:
    conf:
      eh: '(CMS_0115)'
      ep: '(CONF:5562-18247)'
    programs:
      - HQR_PI
      - HQR_IQR
      - HQR_PI_IQR
      - HQR_IQR_VOL
      - HQR_OQR
      - HQR_REHQR
      - MIPS_INDIV
      - MIPS_APP1_INDIV
      - CPCPLUS
      - PCF
      - MCP_STANDARD
      - APP_PLUS_INDIV
      - ASM_INDIV
      - ASM_GROUP
  CPCPLUS APM Entity Identifier:
    name: 'CPCPLUS APM Entity Identifier'
    description:
      ep: 'The CPCPLUS APM Entity Identifier assigned to the CPC+ practice site.'
    conf:
      ep: '(CONF:CMS_21)'
    programs:
      - CPCPLUS
  PCF APM Entity Identifier:
    name: 'PCF APM Entity Identifier'
    description:
      ep: 'This is the PCF APM Entity Identifier assigned to the PCF practice site.'
    conf:
      ep: '(CONF:CMS_101)'
    programs:
      - PCF
  MCP APM Entity Identifier:
    name: 'MCP APM Entity Identifier'
    description:
      ep: 'This is the MCP Participant Identifier.'
    conf:
      ep: '(CONF:CMS_109)'
    programs:
      - MCP_STANDARD
      - MCP_FQHC
  MIPS APM Entity Identifier:
    name: 'APM Entity Identifier'
    description:
      ep: 'This is the APM Entity Identifier assigned to the practice site.'
    conf:
      ep: '(CONF:CMS_109)'
    programs:
      - MIPS_APMENTITY
      - MIPS_APP1_APMENTITY
      - APP_PLUS_APMENTITY
      - LEAD_APM_ENTITY
  MIPS Subgroup Identifier:
    name: 'MIPS Subgroup Identifier'
    description:
      ep: 'This is the Subgroup Identifier.'
    conf:
      ep: '(CONF:CMS_117)'
    programs:
      - MIPS_SUBGROUP
  MVP Code:
    name: 'MIPS Value Pathway'
    description:
      ep: 'Each MIPS individual, group, subgroup, or APM Entity can select one MVP to report.'
    conf:
      ep: '(CONF:CMS_118)'
    programs:
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_APMENTITY
      - MIPS_SUBGROUP
    optional:
      - MIPS_GROUP
      - MIPS_INDIV
      - MIPS_APMENTITY
      - MIPS_SUBGROUP
  SSP PI Reporting:
    name: 'SSP PI reporting Identifier'
    description:
      ep: 'Use value SSP_PI to indicate that the Promoting Interoperability data included in the file will be used for the SSP PI reporting
requirement.'
    conf:
      ep: '(CONF:CMS_125)'
    programs:
      - MIPS_INDIV
      - MIPS_GROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
    optional:
      - MIPS_INDIV
      - MIPS_GROUP
      - MIPS_APMENTITY
      - MIPS_APP1_INDIV
      - MIPS_APP1_GROUP
      - MIPS_APP1_APMENTITY
  ASM Cohort:
    name: 'ASM Cohort'
    description:
      ep: 'Each ASM participant is assigned to a specific cohort.'
    conf:
      ep: '(CONF:CMS_160)'
    programs:
      - ASM_INDIV
      - ASM_GROUP
    optional:
      - ASM_INDIV
      - ASM_GROUP