Sign In
Background

What is the Qualified Entity Medicare Data Sharing Program?

The Qualified Entity Program (also known as the Medicare Data Sharing for Performance Measurement Program) facilitates the creation of actionable performance reports that cover all, or most, of a provider’s practice. Under the QE program, CMS is authorized to disclose standardized extracts of Medicare Parts A and B claims data and Part D prescription drug event data to ‘‘qualified entities’’ (QEs). QEs must combine the Medicare data with claims data from other sources to create public reports that evaluate provider performance. QEs are also permitted to use the Medicare data to create non-public analyses and provide or sell such analyses to authorized users. In addition, QEs may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized users.

For more information, please see the final rule establishing the program and the final rule modifying the program.

What is the Qualified Entity Certification Program?

The Qualified Entity Certification Program (QECP) is the certification arm of the Qualified Entity Program. The purpose of the QECP is to evaluate and certify an entity’s ability to serve as a qualified entity (QE). Once certified, QEs are eligible to receive standardized extracts of Medicare Parts A and B claims data and Part D prescription drug event data for the purpose of evaluating the performance of providers. QEs are also permitted to create non-public analyses and provide or sell such analyses to authorized users. In addition, QEs may provide or sell combined data, or provide Medicare claims data alone at no cost, to certain authorized users. QEs must comply with all QECP requirements described in the QECP Operations Manual, including, but not limited to, the QECP phased minimum requirements review and public reporting. The QE Medicare Data Sharing for Performance Measurement Program regulations establish the criteria that entities must satisfy to obtain QE certification.


QE Eligibility Criteria: Who Can Apply to Become a QE?

To be eligible to participate in the program as a QE, an applicant (either itself or through contracts with other entities) must:
  1. Have access to claims data from other sources to combine with the Medicare data*
  2. Have strong systems to ensure that the data are secure and protected; and
  3. Have experience in a variety of tasks related to the calculation and reporting of performance measures, including
    • a. combining claims data from different payers,
    • b. designing performance reports,
    • c. sharing performance reports with the public,
    • d. working with providers and suppliers regarding requests for error correction, and
    • e. ensuring the privacy and security of data.

Additional information is available here.

*Qualified Clinical Data Registries (QCDRs) applying to become quasi qualified entities are exempt from the requirement to have other sources of claims data. For more information, see Section 3.1 of the 2016 QECP Operations Manual and Appendices.


How Can My Organization Find Out More Information About the QECP?

If you are interested in learning more about the QECP, please register to be assigned a dedicated QECP program manager who will answer your questions and guide your organization through the QE application process.

You can also review the QECP Operations Manual and Appendices., which explain the Qualified Entity Program requirements and guides entities through the QECP process. The manual includes all CMS requirements that entities must meet to become certified as a QE and to maintain their QE status, as well as step-by-step instructions on the application process.

In addition, you may review the webinars , FAQs, and other QECP documents located in the Resources tab.