The Public Comment is now open through March 25, 2026 on the Draft 2027 CMS QRDA I Implementation Guide, Schematron, and Sample File for Hospital Quality Reporting
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["Patient Characteristic, Payer": "Payer"]
Performance/Reporting Period
2023
Value Set Description from VSAC
Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
Inclusion Criteria: All codes in the code system
Exclusion Criteria: none
Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
Inclusion Criteria: All codes in the code system
Exclusion Criteria: none
Constrained to codes in the Patient Characteristic, Payer: Payer value set (2.16.840.1.114222.4.11.3591)
QDM Datatype and Definition
"Patient Characteristic, Payer"
Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set.
Timing:
The relevantPeriod addresses:
- startTime – the first day of insurance coverage with the referenced payer.
- stopTime – the last day of insurance coverage with the referenced payer.