Who Can Apply to Become a QE?
Any organization that would like to use Medicare data to supplement its existing claims data in order to better report on the performance of health care providers and suppliers is encouraged to apply.
To become a QE, applicants must meet certain criteria; among other requirements, they must:
- Have access to claims data from other sources to combine with the Medicare data;*
- Have strong systems to ensure that the data are secure and protected; and
- 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.
To assess an organization’s compliance with program requirements, the Qualified Entity Certification Program (QECP implements a four-phase application process. The diagram below shows the phases of the application process, including the standards to be assessed and the estimated completion time for each phase.
- Phase 1: The QECP team examines an entity’s organizational structure, its ability to successfully function as a QE, and its access to additional sources of claims data.*
- Phase 2: The QECP team examines the QE’s compliance with the data security and privacy requirements of the program.
- Phase 3: The QECP team examines the QE’s compliance with the remaining program requirements related to the QE's measurement, reporting, and corrections and appeals processes. Prior to submitting evidence for the Phase 3 review, the QE must integrate the QE Medicare data with its claims data from other sources and calculate provider performance measures.
- Phase 4: Public reporting, during which the QE engages providers in the corrections and appeals process and releases its public performance reports. The QECP team periodically reviews a QE’s public performance reports as part of Ongoing Program Administration (OPA).
QECP Phased Application Process
Click to download the above image as a JPG.
How to Apply
Your QECP Program Manager (PM), assigned after you register
, will work with you throughout the phased application process. The QECP Operations Manual contains more detailed information on what to expect during each step of the application process. A public copy of the QECP Operations Manual is available
- a. Complete the registration form here
- b. You will be contacted by the QECP within 2 business days.
- Request Application
- a. Once you have registered, please review the
QECP Operations Manual and Appendices.
- i. The Operations Manual lists the minimum requirements to become certified
as a QE or quasi QE.*
- b. Hold a kickoff call with your PM to discuss the QECP and application process.
- c. If your organization would like to become a QE or quasi QE,* request an application from your PM.
You will be given a link to a secure application site, along with a unique username and password.
- Complete Phase 1 of the Application for Certification
- a. Receive Application Phase 1 Review outcome.
- b. After an organization is Phase 1 approved, it is considered a “Certified Qualified Entity” or "Certified quasi Qualified Entity.”*
Qualified Clinical Data Registries (QCDRs) applying to become quasi QEs 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.