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Phase 1 Application Readiness
Checklist

Phase 1 Application Readiness Checklist
This checklist helps entities through the Phase 1 application by providing a brief overview of each
application component.
Table 1: Application Readiness Checklist
Element

1.1 Entity

Readiness Assessment


Completed QECP Letter of Commitment (template provided by QECP Team
and in both the QECP Phase 1 Toolkit and online application) signed by a
senior executive (e.g., CEO, president, vice president, etc.) demonstrating
commitment to participate fully as a Qualified Entity (QE)



Incorporation documentation and, if applicable, licensure for lead entity,
contractors, vendors, partners and/or subsidiaries, as applicable



As applicable for contractors, vendors, partners, or subsidiaries only: list
name, role(s) on QE project, and effective agreement dates



As applicable: attestation of cloud service provider (CSP) the applicant plans
to use for Medicare data storage



As applicable: attestation of CMS Quality Improvement Organization (QIO)



Attestation (yes or no) of whether the applicant is a CMS-approved qualified
clinical data registry (QCDR) applying for quasi-QE statusAs applicable, an
attestation on identified status of clinical data and their QCDR name.



Description of the entity’s business model and resources to support the cost
of the data and report development, including a budget with line item(s) to
cover QECP participation and the following:

1.2 Financial
Resources

Checkbox

 Line item for purchasing the Medicare data
 Line item for producing the public reports


Compiled evidence according to the QECP Program Guide to demonstrate at
least 3 years of experience in the following areas, or a rationale as to why the
applicant does not plan on engaging in one of the following areas:
 Combining claims data
 Attributing patients to providers
 Establishing statistical validity requirements for quality measures

1.3 Experience

 Establishing statistical validity requirements for efficiency/resource use
measures
 Risk adjustment
 Identification of outliers
 Defining comparison groups
 Measurement & reporting verification process
 Public reporting
 Corrections process

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Phase 1 Application Readiness
Checklist

Element

Readiness Assessment


Checkbox

Completed QECP Data Source Attestation in the online application (a sample
version of the DSA is in the QECP Phase 1 Toolkit), including the following:
 Name of applying entity, number of claims data suppliers, geographic
area the report will cover, level of analysis for public report (regional vs.
provider-identified)
 General information for data suppliers (legal name, effective dates of
agreement, URL, volume of other-payer claims data, and geographic
area of coverage
 Whether providers are individually identified
 Pharmacy claims data volume and intention to include in measures, as
applicable
 Whether all claims received are pre-adjudicated
 The years of historical data received from that supplier
 Whether there are multiple claim setting types
 Whether Medicare Advantage Covered Lives are included in supplier
volume

1.4 Claims
Data

 An explanation of variance in total covered lives between the data
supplier tab(s) and the covered lives calculator (if applicable)
 A question to understand which years of historical data are included in
the claims by the supplier to each supplier profile
A question to verify if the supplier claims are from more than one setting type
A question about the beneficiary identification status in the other payer claims
data.


Covered Lives: minimum thresholds (at least 10% of Covered Lives in the
geographic area excluding Medicare FFS data or at least 25% of Covered Lives
including Medicare FFS data) must be met for each state and/or county in
which the entity requests Medicare FFS data



An explicit statement for a 5% national sample, if applicable



Completed DSA signature box in the Element 1.4 section of the Phase 1
application



If applicable, an explanation of the variation of the Covered Lives numbers
from the supplier(s) tab and the Covered Lives tab

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