Qualified Entity (QE)
A Qualified Entity (QE) is an organization approved by CMS under the Qualified Entity Program to receive Medicare claims data and combine it with other sources to produce provider and supplier performance reports for public reporting.
What is a Qualified Entity (QE)?
A Qualified Entity (QE) is an organization approved by the Centers for Medicare & Medicaid Services (CMS) under the Qualified Entity Program to receive Medicare claims data. Once certified, a QE may combine that data with information from other payers and sources to evaluate how providers and suppliers perform.
The program is built around standards meant to ensure the resulting analyses are accurate and the underlying data is handled securely. QEs use their combined datasets to generate performance reports that can be released publicly.
Why do Qualified Entities matter?
By blending Medicare data with commercial and other claims, QEs can produce a fuller view of provider performance than any single payer's data would allow. This supports public reporting that patients, purchasers, and providers can use to compare quality and cost.
For organizations analyzing provider markets, QE-produced measures offer another credible reference point on utilization and performance, complementing publicly released datasets in market and quality assessment.
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