Qualified Entity Program

Overview

On March 23, 2010, the Patient Protection and Affordable Care Act, (‘‘Affordable Care Act’’) Public Law 111– 148, was enacted. Effective January 1, 2012, section 10332 of the Affordable Care Act will amend section 1874 of the Social Security Act (the Act) by adding a new subsection (e) requiring standardized extracts of Medicare claims data under parts A, B, and D be made available to ‘‘qualified entities’’ for the evaluation of the performance of providers of services and suppliers. For more information, please see the Final Rule for Availability of Medicare Data for Performance Measurement.

Qualified entities may use the information obtained under section 1874(e) of the Act for the sole purpose of evaluating the performance of providers of services and suppliers, and to generate specified public reports. Qualified entities may receive data for one or more specified geographic areas and must pay a fee equal to the cost of making the data available. Congress also required that qualified entities combine the Medicare claims data from at least one other claims data source to evaluate the performance of providers of services and suppliers.

CMS believes the sharing of Medicare data with qualified entities through this program and the resulting reports produced by qualified entities will be an important driver of improving quality and reducing costs in Medicare, as well as for the healthcare system in general. Additionally, CMS believes this program will increase the transparency of provider and supplier performance, while ensuring beneficiary privacy.

Become a Qualified Entity

To be eligible to receive data as a qualified entity under section 10332, CMS has established eligibility criteria, which can be reviewed in Section 401.703 of the Final Rule. Applicants to the Qualified Entity Certification for Medicare Data Program (QECP) will be evaluated individually to ensure they are prepared to meet the requirements in the statute for serving as a qualified entity. CMS will not limit the number of qualified entities. Any entity that meets the eligibility criteria, as determined by CMS, will be able to become a qualified entity.

To apply to become a qualified entity, visit the QECP Portal.

For more information, please visit: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Progr...

Data Available

To review the available files under the QE program, please see the QE program files page. Information on the scheduled release of QE files can be found under Question 34 on the FAQs page of the QE Medicare website.

Request Data

After receiving certification as a qualified entity, you must submit a request application in order to obtain a Medicare Data Use Agreement (DUA) and request data from CMS. View the flow diagram of the data request and CCW onboarding process at the bottom of this page to understand the steps involved in requesting and receiving data.

PDF iconQualified Entity Data Request Process Flow Chart.pdf

To submit the initial request, email the following materials in their original format (.xls, .pdf, .doc) to resdac@umn.edu.

 
To update your existing DUA (add new years or files), email the following materials in their original format to resdac@umn.edu. ResDAC will assist with obtaining a cost invoice and submitting the request to CMS.

QE-relevant Data Dictionaries

Data dictionaries for the Qualified Entity Program are included as embedded hyperlinks in the QE Specifications Worksheet.

Technical Support

ResDAC is available to provide technical support to qualified entities in understanding and using the Medicare claims data. Please contact us by phone at 1-888-973-7322 or by email at resdac@umn.edu for assistance.

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