ISG Playbook
APIs
Beneficiary and Provider Data
| Schema | Description | CDR Hive Schema | CDR Table Layouts | Data Dictionaries and Supplemental Information | Most Recent Refresh | Refresh Frequency | Next Refresh | DUA Required |
|---|---|---|---|---|---|---|---|---|
Assessment (iQIES) | QIES underwent a series of modernizing, system enhancements resulting in what is now called the Internet Quality Improvement and Evaluation System (iQIES). IQIES data in the CDR includes assessment data for HHA, MDS, LTCH, IRF, and Hospice schemas. This data is extracted from iQIES system and the "Most Recent Refresh" column reflects the date at which the data was extracted. The data is generally made available in the CDR within 2 business days of extraction. | assessment_iqies | 3/3/2021 | Monthly | 4/5/2021 | Yes | ||
| Beneficiary | This source contains beneficiary demographics, entitlement, enrollment, premium, health status and other coverage information from the Beneficiary Information on the Cloud (BIC) source. CDR Hive tables point directly to BIC data in the CMS Enterprise Data Lake (EDL). This data is refreshed each weekend in the CMS EDL and it is made available by Monday in the CDR. | beneficiary_data | 3/15/2021 | Weekly | 3/22/2021 | Yes | ||
| CRIS | The Case Review Information System (CRIS) was the predecessor to the QMARS system (see below). It was decommissioned October 31, 2018. All data in this system is archival. | legacy_cris | 1/13/2020 | None | Never | Yes | ||
| DARRT QII | This source includes Quality Improvement Initiative (QII) Data from the Deliverable Administration Review Repository Tool (DARRT). A QII is any formal plan designed to assist a provider(s) and/or practitioner(s) in identifying the root cause of a confirmed quality of care concern, develop a framework in which to address the concern and improve a process or system. QIIs may consist of system-wide (organization-based) and/or non-system-wide (practitioner-based) activities. QII initiation and tracking are performed in DARRT and QII data in the CDR are refreshed every Wednesday at 1:00 AM ET. | quality_measures_darrt_qii | 3/17/2021 | Weekly | 3/24/2021 | Yes | ||
Hospital Quality Reporting (HQR) | Public Reporting data provides Hospital Quality Reporting (HQR) data to the Hospital Compare website. The data educates consumers by providing them with detailed information on a hospital’s quality of care. This schema is a replacement for ‘legacy_hqr_public_reporting’ and is being made available from the permanent cloud source of data. CDR Hive tables point directly to Hospital Quality Reporting (HQR) data in the HQR cloud. The data refresh frequency is controlled by the HQR ADO. | quality_measures_hqr_pub_report | 3/18/2020 | Quarterly | 6/17/2021 | Yes | ||
Data Form, formerly known as Structural Measures or Web-Based Data Collection Tool, allows IQR, OQR, ASCQR, IPFQR, MU, PCHQR, and HCAHPS providers (or authorized vendors) to enter information related to the environment in which care is provided. CDR Hive tables point directly to Hospital Quality Reporting (HQR) data in the HQR cloud. The data refresh frequency is controlled by the HQR ADO. This schema is the replacement for the following legacy schemas:
| quality_measures_hqr_data_form | N/A | Daily | 1200 UTC Daily | Yes | |||
| HQR - Legacy | These schema are copies of the former HQR Oracle databases and applications in SDOL, QNOL, and CLDW. | legacy_hqr_cart(QNOL) | 12/3/2020 | None | Never | Yes | ||
| legacy_hqr_cart_final (CLDW) | 12/3/2020 | None | Never | Yes | ||||
| legacy_hqr_ehqr | 11/16/2020 | None | Never | Yes | ||||
| legacy_hqr_hvbp | 10/19/2020 | None | Never | Yes | ||||
| legacy_hqr_oat_app | 12/2/2020 | None | Never | Yes | ||||
| legacy_hqr_ipledge_app | 12/9/2020 | None | Never | Yes | ||||
| legacy_hqr_nop_app | 12/10/2020 | None | Never | Yes | ||||
| legacy_hqr_opledge_app | 12/9/2020 | None | Never | Yes | ||||
| legacy_hqr_opps | 12/4/2020 | None | Never | Yes | ||||
| legacy_hqr_validation_app | 12/7/2020 | None | Never | Yes | ||||
| legacy_hqr_cart_cdac | 8/11/2020 | None | Never | Yes | ||||
| legacy_hqr_ci_rpt | 12/10/2020 | None | Never | Yes | ||||
| legacy_hqr_opps_import | 12/10/2020 | None | Never | Yes | ||||
| Miscellaneous data from the legacy CLDW and QNOL systems | legacy_cldw_prod_data_mgmt | Misc_prod_data_mgmt_TableLayout.xlsx | 12/9/2020 | None | Never | Yes | ||
| legacy_qnol_user_admin | 12/9/2020 | None | Never | Yes | ||||
| legacy_sdol_ifmc_common | 3/6/2020 | None | Never | Yes | ||||
Program Resource System (PRS) | Program Resource System (PRS) is a repository of demographic information for hospital providers in the Centers for Medicare & Medicaid Services (CMS), Survey and Certification System (CASPER), and Quality Improvement and Evaluation System (QIES). PRS assists Quality Improvement Organizations (QIOs) and Program Support Contractors in maintaining CMS Programs. PRS data is extracted from the HQR source database and the "Most Recent Refresh" column indicates the date at which the data was extracted. The refreshed data is available each Monday morning however it is typically extracted 1-2 business days earlier. The resource_hqr_prs schema is a replacement for legacy_sdol_np_sdps and resource_hqr_prs_supplemental schema is a replacement for legacy_sddw_np_sdps. | resource_hqr_prs resource_hqr_prs_supplemental | 3/18/2021 | Weekly | 3/29/2021 | Yes | ||
| NPPES | The National Plan and Provider Enumeration System contains provider NPIs, names, and location information. | nppes | NPPES dissemination information on CMS Website | 2/12/2021 | Quarterly | 5/12/2021 | No | |
CMS Master Data Management (MDM) Provider Master Index/ Shared Provider Profile (PMI/SPP) | The PMI/SPP contains an integrated view of identity resolved provider data across multiple CMS provider data systems. It includes data from PECOS, NPPES, NPICS, QIES, and T-MSIS. It provides both "current" and "historical" provider data from multiple CMS source systems of record. This data will be the source of provider data (including PECOS) within the CDR. CDR Hive tables point directly to PMI/SPP data in the CMS Enterprise Data Lake (EDL). This data is refreshed each weekend in the CMS EDL and it is made available by Monday in the CDR. | provider_pmi_data | MDM PMI SPP Physical Data Dictionary_01.07.2020.pdf DDES Quarterly Training February 2021.pptx MDM NPI Tables Model Diagram.pdf MDM PMI SPP Logical Data Model Diagram.pdf Guide to Using the MDM Comprehensive PMI and SPP Tables_V2_F_7.30.2020.docx Guide to Using the MDM PMI_SPP_NPI Profile Tables_V3_F_11.10.2020.docx Password for all documents above: royalrabbit | 3/15/2021 | Weekly | 3/22/2021 | Yes | |
| Provider (iQIES) | QIES underwent a series of modernizing, system enhancements resulting in what is now called the Internet Quality Improvement and Evaluation System (iQIES). iQIES data in the CDR includes provider data from CASPER and iQIES_CMN schemas. This data is extracted from iQIES system and the "Most Recent Refresh" column reflects the date at which the data was extracted. The data is generally made available in the CDR within 2 business days of extraction. | provider_iqies | 3/3/2021 | Monthly | 4/5/2021 | Yes | ||
| Quality Management and Review Systems (QMARS) is a system for case management and review. This data is extracted from QMARS system and the "Most Recent Refresh" column reflects the date at which the data was extracted. The data is generally made available in the CDR within 2 business days of extraction. | qmars | 3/5/2021 | Monthly | 4/7/2021 | Yes | |||
| Quality Payment Program (QPP) Universal Data Set (UDS) | The Quality Payment Program (QPP) Universal Data Set (UDS) is a curated data warehouse of all QPP data for analytics and reporting. The QPP team provides an extract of the UDS each month. The "Most Recent Refresh" column reflects the date at which the extract was made available in the CDR however the extract may be several days older. | quality_measures_qpp_uds | 2/25/2020 | Monthly | 3/26/2021 | Yes |
Mapping DUA to Beneficiary and Provider Data
| Schema | CDR Hive Schema | Preferred DUA Entry | Acceptable DUA Entry |
|---|---|---|---|
Assessment (iQIES) | assessment_iqies | IQIES - Internet-based Quality Improvement and Evaluation System | QIESWB - QUALITY IMPROVEMENT EVALUATION SYSTEM (QIES) WORKBENCH |
| Beneficiary | beneficiary_data | EDB | |
| CRIS | legacy_cris | NCH-SS NATIONAL CLAIMS HISTORY - 100% STATE SPECIFIC | Mandatory: EDB Plus one of the following for FFS Claims: NCHDB - NATIONAL CLAIMS HISTORY DATABASE Plus one of the following for Prescription Drug Claims: DDPS - DRUG DATA PROCESSING SYSTEM |
| HQR | quality_measures_hqr_pub_report | OTHER-OTHER (SPECIFY)
| |
| HQR - Legacy | legacy_hqr_asc | OTHER-OTHER (SPECIFY)
| |
| legacy_hqr_cart(QNOL) | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_cart_final (CLDW) | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_ehqr | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_sdol_extfilapp | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_qnol_extfilapp | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_hai | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_hcahps | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_hcahps_final | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_hvbp | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_oat_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_ipledge_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_nop_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_opledge_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_opps | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_opps_prs | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_pprs_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_struct_msrs | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_validation_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_cldw_rpt_etl | OTHER-OTHER (SPECIFY)
| ||
| legacy_qnol_pch_app | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_cart_cdac | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_ci_rpt | OTHER-OTHER (SPECIFY)
| ||
| legacy_hqr_opps_import | OTHER-OTHER (SPECIFY)
| ||
| legacy_cldw_prod_data_mgmt | OTHER-OTHER (SPECIFY)
| ||
| legacy_qnol_user_admin | OTHER-OTHER (SPECIFY)
| ||
| legacy_sdol_ifmc_common | OTHER-OTHER (SPECIFY)
| ||
| PRS | legacy_hqr_prs | PECOS - PROVIDER/PHYSICIAN DATA | Mandatory: HPMS - HEALTH PLAN MGMT SYS Plus one of the following for Providers: PECOS - SYSTEM FOR TRACKING HHA OWNERSHIP |
| NPPES | nppes | N/A - Public | |
CMS Master Data Management (MDM) Provider Master Index/ Shared Provider Profile (PMI/SPP) | provider_pmi_data | PECOS - PROVIDER/PHYSICIAN DATA | PECOS - SYSTEM FOR TRACKING HHA OWNERSHIP |
| Provider (iQIES) | provider_iqies | IQIES - Quality Improvement and Evaluation System | CASPER CASPER - CERTIFICATION AND SURVEY PROVIDER ENHANCED REPORT SYSTEM (CASPER) QIESWB - QUALITY IMPROVEMENT EVALUATION SYSTEM (QIES) WORKBENCH |
| QMARS | qmars | NCH, DDPS, EDB and PECOS | |
| Quality Payment Program (QPP) Universal Data Set (UDS) | quality_measures_qpp_uds | QPP - QUALITY AND PERFORMANCE DATA | |
| SDDW | legacy_sddw_np_sdps | SDPS - STANDARD DATA PROCESSING SYSTEM | Mandatory: EDB Plus one of the following for FFS Claims: NCHDB - NATIONAL CLAIMS HISTORY DATABASE Plus one of the following for Prescription Drug Claims: DDPS - DRUG DATA PROCESSING SYSTEM |
| SDOL | legacy_sdol_np_sdps | SDPS - STANDARD DATA PROCESSING SYSTEM | EDB - ENROLLMENT DATA BASE |
Important Notes
- The CDR follows NCH logic, as such Part A claims are split into multiple records when the number of revenue center line items is greater than 45. In HAJI, these were merged into a single claim.
- The CDR includes claim types 61, 62, 63, 64, 80, and 81, which HAJI did not include.
- The CDR includes claim adjustments older than five years, which HAJI did not include.
- In Part A Claims, dates showing as '1970-01-01' in the rev_cntr_dt field should be treated as blank or null values
- Recommended data catalog documentation for CDR contributors is located on the CDR Contributor Documentation Requirements Page