QRDA I

Quality Reporting Document Architecture (QRDA) Category I file is an individual patient-level report. It contains quality data for one patient for one or more quality measures. Health Endeavors imports QRDA category I files twice a month in accordance with a fixed schedule that is available on the File Processing Calendar.

Each Participating TIN in the ACO will need an SFTP (Secure File Transfer Portal) account to securely transfer quality measure data via QRDA files to Health Endeavors. Click here for instructions on setting up an SFTP account.

Health Endeavors staff will screen the fist set of QRDA category I files provided by client. The following requirements must be met:

(Download PDF Instructions here)

There must be one QRDA category I file per patient that includes all measures.

2. Files must be generated for only the 4 or 5 measures that are tracked in Health Endeavors.

a. Files must be generated for only the four or five measures if you are utilizing Health Endeavors for Medicare CQM / MIPS CQM /eCQM reporting. (Mapping Table)

Medicare CQM/MIPS CQM/eCQM Mapping Table

ACO Measure #	QRDA eCQM ID (2024)	QRDA 2025 eCQM ID	MIPS Measure #	Measure Title
DM-2	CMS122v12	CMS122v13	001	Diabetes: Glycemic Status Assessment Greater than 9%
HTN-2	CMS165v12	CMS165v13	236	Controlling High Blood Pressure
PREV-12	CMS2v13	CMS2v14	134	Preventive Care and Screening: Screening for Depression and Follow-Up Plan
PREV-5	CMS125v12	CMS125v13	112	Breast Cancer Screening
PREV-6	CMS130v12	CMS130v13	113	Colorectal Cancer Screening

3. Files must contain Year to Date (YTD ) data.

4. Files must be generated in accordance with CMS' QRDA Category I specifications for current performance year. If a client provides files generated with prior year specifications, files will be accepted for import throughout the year but for the final end-of-year import, only current year specs will be accepted. Click here for updated CMS QRDA I guidelines.

5. For patient matching and deduplication , Health Endeavors will use the following data elements:

Patient ID
First Name
Last Name
Middle Name Initial
Gender
Date of Birth
Race
Ethnicity
Phone Number
Address House Number
City
State
Zip Code

6. TIN to be included in QRDA I file for patient assignment and user permissions. This represented Organization id/@root='2.16.840.1.113883.4.2' coupled with the id/@extension represents the organization's Tax Identification Number (TIN). The provided TIN must be in valid format (9 decimal digits). We can proceed without it.

7. NPI to be included in QRDA I file for patient assignment and user permissions - This assigned Entity id/@root='2.16.840.1.113883.4.6' coupled with the id/@extension represents the individual provider's National Provider Identification number (NPI). A valid NPI is 10 numeric digits where the 10th digit is a check digit computed using the Luhn algorithm. We can proceed without it.

QRDA Troubleshooting

Step 1: Review the EHR Feedback reports. Click here for more details on EHR Feedback Reports.

Step 2: If results are low, provide Appendix A to your EHR representative to verify these fields are generating in the QRDA I file.

Step 3: If your EHR representative confirms the fields are available and mapped to the QRDA I, then it is a data entry issue. We recommend training on the required discrete fields to be used for data entry.

Appendix A - QRDA Trouble Shooting

Download a PDF Version of Appendix A

Often, results are low because on or more required fields are blank in a QRDA I file. The common required fields are listed below. Provide this document to your EHR representative to check off that each of the required elements is populated in the QRDA I for performance and non-performance answers. You may also open an individual QRDA file in the Notepad program and search for these fields. If the field is blank, then no answer will be collected.

Diabetes Checklist	Required Field	Notes
	First Name
	Last Name
	Date of Birth
	Diabetes Diagnosis Code
	Encounter Date	Within the performance year
	HbA1c Value
	HbA1c Date	Within the performance year

Hypertension Checklist	Required Field	Notes
	First Name
	Last Name
	Date of Birth
	Hypertension Diagnosis Code
	Encounter Date	Within the performance year
	Blood Pressure Values (Systolic and Diastolic)
	Blood Pressure Date	Within the performance year

Depression Screening Checklist	Required Field	Notes
	First Name
	Last Name
	Date of Birth
	Encounter Date	Within the performance year
	Colorectal Cancer Screening Test
	Colorectal Cancer Screening Date	Within the measurement period for specific test

Breast Cancer Screening Checklist	Required Field	Notes
	First Name
	Last Name
	Date of Birth
	Encounter Date	Within the performance year
	Colorectal Cancer Screening Test
	Colorectal Cancer Screening Date	Within the measurement period for specific test

Colorectal Cancer Screening Checklist	Required Field	Notes
	First Name
	Last Name
	Date of Birth
	Encounter Date	Within the performance year
	Colorectal Cancer Screening Test
	Colorectal Cancer Screening Date	Within the measurement period for specific test