In development
Regulatory reporting that can show its work.
Health plans and providers file the same numbers to CMS, to states and to NCQA every year, and almost none of those numbers can be traced back to the claim, the rule and the version that produced them. PayerReporting is built around that trace: every figure in a filing carries a derivation record, so an auditor's question has a one-line answer.
HEDIS measure results
Admin, Hybrid and ECDS measures computed from your claims, enrollment and clinical feeds, with member-level evidence behind every numerator hit.
Encounter data
837 encounters validated against the edits that will actually reject them before they leave your building, and reconciled to the response files that come back.
Price-transparency files
Machine-readable files checked against the current data-element requirements, with the negotiated rates tied to the contract terms that set them.
Federal and state submissions
The recurring filings, each with a validated payload, a submission receipt, and a record of what changed since the last one.
Start with the HEDIS measure directory or the sample files.
Health plans
What a plan files, and what each filing depends on.
| Filing | To | Cadence | Depends on |
|---|---|---|---|
| HEDIS measure results | NCQA (IDSS); audited results to CMS for Medicare Advantage Star Ratings | Annual, June, for the prior measurement year | Claims, enrollment, pharmacy, supplemental clinical data; HEDIS Compliance Audit |
| Encounter data | CMS Encounter Data System (Medicare Advantage); state Medicaid agencies (managed care) | Continuous; state-specific deadlines | Adjudicated claims as 837 professional/institutional; 277CA and MAO-002 response reconciliation |
| Part C and Part D reporting requirements | CMS via HPMS | Annual and quarterly by section | Grievances, appeals, enrollment, SNP care management, plan oversight of agents |
| Medical loss ratio | CMS (MA/Part D); CCIIO (commercial) | Annual | Incurred claims, quality-improvement spend, premium revenue |
| Transparency in Coverage MRFs | Public posting; enforced by CMS | Monthly refresh | Every negotiated rate by provider and code; historical allowed amounts |
| Prior-authorization and payer APIs | Public FHIR APIs under CMS-0057-F | Continuous; compliance date January 1, 2027 | Prior-auth decisions with reasons; patient, provider and payer-to-payer access |
| Risk adjustment data validation | CMS (RADV) | On selection | Medical records supporting submitted diagnoses |
| State managed-care reporting | State Medicaid agencies | State-specific | Encounter, network adequacy, quality, financial |
Providers
The provider side of the same filings.
| Filing | To | Cadence | Depends on |
|---|---|---|---|
| Hospital price transparency MRF | Public posting; enforced by CMS (new data elements enforced from April 1, 2026) | Annual, with updates | Gross charges, payer-specific negotiated rates, discounted cash price, de-identified min/max, by item and service |
| Quality Payment Program / MIPS | CMS | Annual | Quality measures, promoting interoperability, improvement activities, cost |
| Hospital quality reporting (IQR, OQR) | CMS | Quarterly and annual | Chart-abstracted and eCQM measures, HCAHPS |
| eCQM submissions | CMS via QRDA | Annual | Certified EHR data |
| Supplemental data to plans | Health plans, for HEDIS ECDS and Hybrid measures | Continuous | Clinical results, immunizations, screenings the claim does not carry |
| Cost report | CMS (Medicare Cost Report) | Annual | Financial, statistical and wage data by cost center |
| Good-faith estimates and No Surprises Act | Patients; CMS enforcement | Per encounter | Expected charges by service |
HEDIS® measure directory
Every measure a plan can report, by domain.
Measurement Year 2026, reported in 2027. Filter by product line or collection method. Admin measures come from claims alone; Hybrid adds a chart-review sample; ECDS adds electronic clinical sources with no chart chase.
| Abbr | Measure | Method | Product lines |
|---|
Sample files
What the files look like.
Synthetic data, real structure. These are the two shapes every HEDIS conversation comes down to: the plan-level results that go into NCQA's submission system, and the member-level evidence an auditor asks for behind them.
Results file, first rows
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Connections
Where the filings go, and how they get there.
NCQA IDSS
HEDIS results submission. Audited plan-level rates, locked by the licensed auditor.
CMS Encounter Data System
837P/837I encounters for Medicare Advantage via EDFES; MAO-002 and 277CA response reconciliation.
CMS HPMS
Part C and Part D reporting requirements, plan benefit packages, formulary submissions.
State Medicaid encounter systems
State-specific 837 companion guides and response files for managed-care encounter reporting.
Public MRF endpoints
Transparency in Coverage and hospital standard-charges files, published and validated against current schema requirements.
FHIR APIs (CMS-0057-F)
Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs, due January 1, 2027.
Connectors are being built in the order plans actually need them. If yours is not listed, tell us which one.