"Participation"

Performance/Reporting Period

2021

QDM Datatype (QDM Version 5.5 Guidance Update):

Data elements that meet criteria using this datatype should document the type of plan or program in which the patient is expected to be enrolled. The program is identified as the Issuer (e.g., Aetna, Blue Cross Blue Shield Association, Cigna). The code attribute indicates the coverage type indicating the program in which the subject of record participates (e.g., health insurance plan policy, disease specific policy, health maintenance organization policy)

Timing:

participationPeriod addresses:

enrollmentStartdate - The time the patient enrolled in the program.
enrollmentEnddate - The time the patient’s enrollment in the program ends.

QDM Category (QDM Version 5.5 Guidance Update)

Participation

Participation represents a patient's coverage by a program such as an insurance or medical plan or a payment agreement. Such programs can include patient-centered medical home, disease-specific programs, etc.

Data Elements defined by this QDM Datatype:

["Participation": "Medicare payer"]

QDM Attributes

participationPeriod

The time from:

enrollmentStartdate - The time the patient enrolled in the program.

to

enrollmentEndDate - The time the patient's enrollement in the program ends.

Note: participationPeriod references the QDM datatype "Participation", representing a patient's coverage by a program such as an insurance or medical plan or a payment agreement. The participationPeriod is not to be confused with the QDM participant attribute used with the "Encounter, Performed" QDM datatype.