Now Accepting Public Comments through June 8, 2026 on the Draft 2027 CMS QRDA III Implementation Guide, Schematron, and Sample File for Eligible Clinicians
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["Patient Characteristic, Payer": "Medicare Advantage Payer"]
Performance/Reporting Period
2026
Value Set Description from VSAC
Clinical Focus: The purpose of this value set is to identify concepts for Medicare Advantage payer types.
Data Element Scope: This value set may use a model element related to Patient Characteristic.
Inclusion Criteria: Includes concepts that identify a patient with Medicare Advantage as a payer source.
Exclusion Criteria: Excludes concepts that represent Medicare Fee-For-Service as a payer source.
Data Element Scope: This value set may use a model element related to Patient Characteristic.
Inclusion Criteria: Includes concepts that identify a patient with Medicare Advantage as a payer source.
Exclusion Criteria: Excludes concepts that represent Medicare Fee-For-Service as a payer source.
Constrained to codes in the Medicare Advantage Payer value set (2.16.840.1.113762.1.4.1104.12)
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.
eCQMs using this data element:
Last Updated: Jul 15, 2025