Colorectal screening, twelve members
Roster generated from a seeded stream (seed 2102) and placed by an oracle implementation of synthetic measure QM-CRC (src/tasks/pop.ts). Every member carries at least one boundary — age, enrolment, event window, exclusion, or numerator window — drawn from the same traps the single-member family uses.
Field mean
95.2
across 28 models
Models scoring 100
26
of 28
Models scoring 0
1
of 28
What the model was given
MEASURE QM-CRC — COLORECTAL CANCER SCREENING
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION (denominator)
Age: 46 through 75 years as of 2026-12-31.
Continuous enrolment: the full measurement year with no more than one gap of up
to 45 days.
NUMERATOR — any one of the following, by the look-back window measured back from
2026-12-31:
N1. Faecal occult blood test or faecal immunochemical test during 2026.
N2. Stool DNA test during 2026 or the two years prior (three-year window).
N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year
window).
N4. CT colonography during 2026 or the four years prior (five-year window).
N5. Colonoscopy during 2026 or the nine years prior (ten-year window).
REQUIRED EXCLUSIONS
E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31.
E2. Total colectomy any time on or before 2026-12-31.
E3. Hospice at any time during the measurement year.
E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness
documented during the measurement year. Frailty alone does not exclude, and
advanced illness alone does not exclude.ROSTER — 12 members
MEMBER 71021. Date of birth 1980-08-11, so 46 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-11-23 Stool DNA test.
Other history:
2026-10-14 Hospice election.
MEMBER 71022. Date of birth 1971-12-22, so 55 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2024-08-05 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71023. Date of birth 1963-07-10, so 63 years old on 2026-12-31. Female.
Enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10.
Screening history:
2018-02-20 Colonoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71024. Date of birth 1976-04-19, so 50 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2016-03-04 Colonoscopy.
Other history:
2026-08-18 Frailty documented (gait abnormality, R26.2).
2026-02-04 Advanced illness documented (heart failure, I50.22).
MEMBER 71025. Date of birth 1976-05-12, so 50 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-09-25 Flexible sigmoidoscopy.
2025-02-14 Faecal immunochemical test.
Other history:
2026-07-12 Frailty documented (gait abnormality, R26.2).
MEMBER 71026. Date of birth 1950-06-09, so 76 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-05-08 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71027. Date of birth 1979-10-14, so 47 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-07-26 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71028. Date of birth 1981-08-16, so 45 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2024-10-15 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71029. Date of birth 1960-09-06, so 66 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2019-04-22 Colonoscopy.
2024-09-15 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71030. Date of birth 1950-02-11, so 76 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2025-12-12 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71031. Date of birth 1951-11-26, so 75 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
No colorectal screening on record.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71032. Date of birth 1963-12-19, so 63 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days.
Screening history:
2015-10-17 Colonoscopy.
Other history:
2026-02-04 Frailty documented (gait abnormality, R26.2).json{
"kind": "fields",
"fields": {
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
}Every model's answer
Sorted by score. Open a row for the response and, where the vendor exposes it, the reasoning behind it.
100Claude Fable 5.1 · Anthropic9.3s · 755 out | 13.1s · 813 out | 12.2s · 745 out
Reasoning · 596 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 654 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 586 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.7 Flash · Google16.9s · 2,241 out | 14.5s · 2,176 out | 19.2s · 2,279 out
Reasoning · 2,032 tokens
**Examining eligibility criteria**
I'm currently focused on defining the eligible population for the QM-CRC measure. My thoughts are centered on establishing the correct age range, specifically 46 through 75, for the screening period of 2026. This forms the initial denominator before any exclusions are applied.
**Refining patient exclusions**
I'm now working through specific patient cases to refine the exclusion criteria. For instance, patient 71021 was excluded due to hospice enrollment, and I'm verifying the numerator criteria for patient 71022's stool DNA test within the defined look-back period.
**Evaluating patient 71027**
I'm processing patient 71027, who is within the eligible age range of 46-75 and has continuous enrollment. My next step is to determine if they meet the numerator criteria for compliance.
**Processing new patient data**
I'm now analyzing several more patients. 71028 and 71030 are out of the eligible age range. 71029 is compliant with two numerator criteria, and 71031 is non-compliant due to a lack of screening. 71032 failed continuous enrollment.
**Calculating final rate**
I have now processed the remaining patient data, classifying them as compliant, non-compliant, excluded, or not eligible. This allows me to determine the final denominator and numerator values, leading to the QM-CRC measure's rate calculation.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,967 tokens
**Analyzing QM-CRC Eligibility**
I'm currently refining the eligibility criteria for QM-CRC. My focus is on ensuring the correct cohort is identified, specifically looking at the 2026 measurement year and the age range of 46-75 as of year-end. I'm also meticulously reviewing the continuous enrollment requirement, accounting for potential brief gaps.
**Validating Screening Data**
I'm now meticulously cross-referencing the defined screening intervals with specific member data. My current focus is on accurately applying the look-back periods for each screening modality, ensuring alignment with the 2026 measurement year and correctly evaluating exclusions like hospice.
**Processing Member Data**
I've continued to process individual member data. Some are ineligible due to enrollment gaps or age, while others are non-compliant because their screening occurred outside the required windows. I've successfully identified compliant members, like 71025 and 71027, based on their screening modality and dates within the specified periods.
**Reviewing Specific Cases**
I'm now specifically reviewing members 71029 and 71031. Member 71029 is compliant with both age and screening requirements, while 71031, though within age limits and continuously enrolled, lacks the necessary screening. I'm also examining the continuous enrollment definition further.
**Evaluating Member Compliance**
I'm continuing to evaluate members against the defined criteria. My recent work focused on members 71024 and 71031, confirming 71024 is non-compliant due to an out-of-window screening, while 71031 lacks screening altogether. Members 71025, 71027, and 71029 are confirmed compliant, and I've also determined 71032 is ineligible due to enrollment gaps.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,070 tokens
**Reviewing eligibility criteria**
I'm currently dissecting the criteria for member eligibility, specifically focusing on the measurement year of 2026 and the age parameters. My analysis is zeroing in on the birth date range required for individuals aged 46 to 75 by year's end.
**Refining exclusion criteria**
My focus has shifted to applying the exclusion criteria to specific member cases, particularly for E3 (hospice) and the complex E4. I'm verifying if individuals are excluded based on these conditions.
**Evaluating member eligibility**
I am now processing individual member cases, cross-referencing their age, enrollment history, and screening status against the established criteria. My current focus is on determining compliance, identifying those eligible, non-compliant, or ineligible based on these factors.
**Checking member details**
I am now meticulously reviewing individual member records, confirming their eligibility status based on age, enrollment continuity, and screening history. The recent analysis highlighted specific cases like 71029 as compliant, while 71032 was flagged due to enrollment gaps, despite meeting age and screening requirements.
**Classifying member statuses**
I've finalized the classification for several members. Notably, cases 71025, 71027, and 71029 are deemed compliant based on recent screening, while 71024 and 71031 are non-compliant. Members outside the age range or with excessive enrollment gaps are marked as not eligible.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.5 · OpenAI8.4s · 821 out | 10.5s · 954 out | 10.6s · 863 out
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Sol · OpenAI4.6s · 350 out | 4.5s · 350 out | 6.0s · 388 out
Reasoning · 224 tokens
**Analyzing enrollment criteria**
I need to classify and check the eligibility. Enrollment permits a maximum of one gap of 45 days or less. For example, 71032 has two gaps, making it ineligible. The windows for DNA stool testing are between 2024-2026, while 71021 is outside the compliant time but hospice is excluded. Moving to 2023 enrollment isn't compliant. A colonoscopy from 2016 is non-compliant for counting back from the required date. Overall, I’m calculating eligible counts based on compliance!json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.6 · xAI24.7s · 1,822 out | 30.6s · 1,945 out | 28.5s · 2,136 out
Reasoning · 1,697 tokens
The user wants me to evaluate a roster of members against the QM-CRC colorectal cancer screening measure and output JSON.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,820 tokens
The user wants me to evaluate members against a colorectal cancer screening measure and output JSON.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,011 tokens
The user wants me to evaluate members against a colorectal cancer screening measure and output JSON.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.5 · xAI19.0s · 1,352 out | 22.0s · 1,555 out | 26.2s · 1,918 out
Reasoning · 1,227 tokens
The task requires me to analyze the roster against the measure specification and output JSON with the population counts and member lists.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,430 tokens
I need to evaluate each member against the QM-CRC measure specification.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,793 tokens
The task requires me to evaluate each member against the QM-CRC measure specification and report the population in a specific JSON format.
{
"71021": "not_eligible",
"71022": "compliant",
"71023": "compliant",
"71024": "excluded",
"71025": "excluded",
"71026": "compliant",
"71027": "compliant",
"71028": "compliant",
"71029": "compliant",
"71030": "compliant",
"71031": "not_eligible",
"71032": "excluded"
} Wait, I think I made a mistake in the JSON above. Let me correct it based on the analysis.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.1 Pro · Google28.2s · 3,440 out | 29.0s · 3,381 out | 30.7s · 3,484 out
Reasoning · 3,231 tokens
**Population Status Determination for 12 Members**
My task here is to meticulously assess the population status of 12 individual members against a defined set of measure specifications. This involves a systematic evaluation of each member's eligibility based on age and enrollment criteria, followed by a check for any applicable exclusions, and finally, a determination of whether they've met the required numerator actions within the specified measurement year (January 1, 2026, through December 31, 2026).
Let's break down the criteria:
* **Eligible Population (Denominator):**
* Age: Members must be between 46 and 75 years old, inclusive, as of December 31, 2026.
* Continuous Enrollment: They need to have been continuously enrolled for the entire measurement year, with no more than one gap in enrollment lasting up to 45 days.
* **Numerator:** To be considered compliant, a member must have undergone one of the following screenings within the specified timeframes:
* **N1. FOBT or FIT:** Performed during 2026.
* **N2. Stool DNA test:** Performed in 2026 or the two years prior (2024, 2025).
* **N3. Flexible sigmoidoscopy:** Performed in 2026 or the four years prior (2022-2025).
* **N4. CT colonography:** Performed in 2026 or the four years prior (2022-2025).
* **N5. Colonoscopy:** Performed in 2026 or the nine years prior (2017-2025).
* **Exclusions:** Certain conditions render a member ineligible for compliance, even if they meet the numerator criteria:
* **E1. Colorectal cancer:** Diagnosed at any point.
* **E2. Total colectomy:** Performed at any point.
* **E3. Hospice:** During the measurement year (2026).
* **E4. Age 66+ with frailty/advanced illness:** Members aged 66 or older on December 31, 2026, with documented frailty and advanced illness in 2026.
Now, I'll process each member's data:
* **MEMBER 71021:**
* Age: 46 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: Had hospice in 2026 (Meets E3).
* **Status: excluded.** Even if a numerator action was met (which it wasn't, as Stool DNA in 2023 is outside the 2024-2026 window), the hospice exclusion takes precedence.
* **MEMBER 71022:**
* Age: 55 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: None.
* Numerator: Stool DNA test on 2024-08-05. This falls within the N2 window (2024-2026).
* **Status: compliant.**
* **MEMBER 71023:**
* Age: 63 on 2026-12-31 (Meets age).
* Enrollment: Enrolled from 2026-04-10 to 2026-12-31. This represents a gap of 99 days from the start of the measurement year (2026-01-01 to 2026-04-09). This gap exceeds the allowed 45 days.
* **Status: not_eligible.**
* **MEMBER 71024:**
* Age: 50 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: Documented frailty and advanced illness in 2026. However, their age (50) is less than 66, so E4 does not apply. No other exclusions are met.
* Numerator: Colonoscopy on 2016-03-04. The N5 window for a colonoscopy is 2017-2026 (9 years prior to 2026). 2016 is 10 years prior, so it does not meet N5.
* **Status: non_compliant.**
* **MEMBER 71025:**
* Age: 50 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: No exclusions apply.
* Numerator: Flexible sigmoidoscopy on 2023-09-25. The N3 window is 2022-2026. This date falls within the window.
* **Status: compliant.**
* **MEMBER 71026:**
* Age: 76 on 2026-12-31. This is outside the eligible age range (46-75).
* **Status: not_eligible.**
* **MEMBER 71027:**
* Age: 47 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: None.
* Numerator: FIT performed on 2026-07-26. This meets N1.
* **Status: compliant.**
* **MEMBER 71028:**
* Age: 45 on 2026-12-31. This is below the eligible age range (46-75).
* **Status: not_eligible.**
* **MEMBER 71029:**
* Age: 66 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: None.
* Numerator: Stool DNA test on 2024-09-15. This meets N2 (2024-2026). (A colonoscopy in 2019 also meets N5).
* **Status: compliant.**
* **MEMBER 71030:**
* Age: 76 on 2026-12-31. This is outside the eligible age range (46-75).
* **Status: not_eligible.**
* **MEMBER 71031:**
* Age: 75 on 2026-12-31 (Meets age).
* Enrollment: Continuous (Meets enrollment).
* Exclusions: None.
* Numerator: No screening documented. Does not meet any numerator criteria.
* **Status: non_compliant.**
* **MEMBER 71032:**
* Age: 63 on 2026-12-31 (Meets age).
* Enrollment: This member has two gaps in their enrollment (one of 17 days and another of 12 days). The specification allows for *no more than one gap of up to 45 days*. Having two distinct gaps disqualifies them.
* **Status: not_eligible.**
Finally, I'll aggregate these findings:
* **Compliant Members:** 71022, 71025, 71027, 71029 (Count: 4)
* **Non-compliant Members:** 71024, 71031 (Count: 2)
* **Excluded Members:** 71021 (Count: 1)
* **Not Eligible Members:** 71023, 71026, 71028, 71030, 71032 (Count: 5)
Now, I can calculate the overall metrics:
* **Denominator:** Compliant members + Non-compliant members = 4 + 2 = 6
* **Numerator:** Compliant members = 4
* **Excluded:** 1
* **Not Eligible:** 5
* **Rate:** (Numerator / Denominator) * 100 = (4 / 6) * 100 = 66.666...%, rounded to **66.7%**.
This comprehensive breakdown covers every member according to the defined measure specifications.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,172 tokens
**My Thought Process for Evaluating the QM-CRC Measure for 12 Members**
My primary objective here is to meticulously assess 12 individuals against the Quality Measure - Colorectal Cancer Screening (QM-CRC) for the 2026 measurement year. This means I need to determine, for each member, if they meet the criteria for being eligible, if they are compliant with the screening requirements, if they are non-compliant, or if they are excluded from the measure altogether. I'm working with the measurement period of January 1, 2026, through December 31, 2026.
First, I’ve laid out the fundamental requirements. For eligibility, a member must be between the ages of 46 and 75, inclusive, as of December 31, 2026. They also need to have been continuously enrolled throughout the entire year, with the allowance of no more than one gap in enrollment lasting up to 45 days.
Then, I’ve defined what constitutes compliance, or the "numerator" for this measure. This is where things get a bit nuanced, as there are several pathways to meet the screening requirement. A member is considered compliant if they have had one of the following within the specified timeframes:
* **N1:** A Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT) performed in 2026. This is a single-year window.
* **N2:** A Stool DNA test performed in 2026, or in either of the two preceding years (2024 or 2025). This creates a three-year lookback window.
* **N3:** A Flexible Sigmoidoscopy performed in 2026, or in any of the four preceding years (2022 through 2025). This is a five-year window.
* **N4:** A CT Colonography performed in 2026, or in any of the four preceding years (2022 through 2025). Another five-year window.
* **N5:** A Colonoscopy performed in 2026, or in any of the nine preceding years (2017 through 2025). This is the most extensive ten-year lookback window.
Crucially, I also need to identify any reasons for exclusion. These are situations where a member, even if they meet screening criteria, is removed from the measure's denominator. The exclusions are:
* **E1:** A diagnosis of colorectal cancer at any point on or before December 31, 2026.
* **E2:** A total colectomy performed at any point on or before December 31, 2026.
* **E3:** A member being on hospice at any point during 2026.
* **E4:** A member who is aged 66 or older as of December 31, 2026, AND also has documented frailty AND advanced illness during 2026. This is a specific conditional exclusion for older, more vulnerable patients.
Now, the real work begins: evaluating each member one by one.
**Member 71021:** I noted their age is 46 as of the end of 2026, which is within the eligible age range. Their enrollment is continuous, so that's also good. However, when I checked exclusions, I found they elected hospice on October 14, 2026. This falls under exclusion E3, meaning they are **excluded** from the measure.
**Member 71022:** This individual is 55 at year-end, so age-eligible. Enrollment is continuous. No exclusions apply. For numerator compliance, I saw a Stool DNA test performed on August 5, 2024. The Stool DNA window (N2) is 2024-2026, so this test falls squarely within the acceptable timeframe. Therefore, this member is **compliant**.
**Member 71023:** They are 63, so age-eligible. However, their enrollment history shows they were enrolled from April 10, 2026, through the end of the year. This means there was a gap from January 1, 2026, to April 9, 2026. Calculating that gap, it's 99 days. This significantly exceeds the maximum allowed gap of 45 days. Thus, this member is **not_eligible** due to enrollment issues.
**Member 71024:** This person is 50, which is within the eligible age range, and their enrollment is continuous. They do have documented frailty and advanced illness in 2026. However, exclusion E4 only applies to members aged 66 and older. Since they are only 50, this exclusion does not apply. Now, for numerator compliance, I see a colonoscopy from March 4, 2016. The colonoscopy window (N5) is for 2017-2026. Since 2016 is outside this ten-year window, this member is **non_compliant**.
**Member 71025:** Age 50, eligible. Continuous enrollment, good. No exclusions. For numerator compliance, I found a flexible sigmoidoscopy on September 25, 2023. The flexible sigmoidoscopy window (N3) is 2022-2026, so this is compliant. I also saw a FIT test from February 14, 2025. While a FIT test is an N1 item, the N1 window is strictly 2026. The flexible sigmoidoscopy is within its window, so the member is **compliant**.
**Member 71026:** This individual is 76 years old as of December 31, 2026. The eligible age range is 46-75. Therefore, they are **not_eligible**.
**Member 71027:** This member is 47, so within the eligible age. Enrollment is continuous. No exclusions apply. They had a FIT test on July 26, 2026. The FIT test window (N1) is 2026, so this is compliant. This member is **compliant**.
**Member 71028:** Their age is 45 as of December 31, 2026. The eligible age range starts at 46. So, they are **not_eligible**.
**Member 71029:** This person is 66, which is within the eligible age range. Enrollment is continuous. No exclusions apply. For numerator compliance, I see a colonoscopy from April 22, 2019. The colonoscopy window (N5) is 2017-2026, making this compliant. They also had a Stool DNA test on September 15, 2024. The Stool DNA window (N2) is 2024-2026, which also makes this compliant. Since at least one screening method meets the criteria, this member is **compliant**.
**Member 71030:** Like Member 71026, this individual is 76 years old at the end of 2026. This is outside the eligible age range of 46-75. Therefore, they are **not_eligible**.
**Member 71031:** This member is 75, fitting the eligible age. Enrollment is continuous, and there are no exclusions. However, upon reviewing their record, I found no evidence of any screening test within the defined numerator windows. Consequently, they are **non_compliant**.
**Member 71032:** This individual is 63, so age-eligible. Their enrollment, however, shows multiple gaps: one from March 31 to April 16 (17 days) and another from June 27 to July 8 (12 days). The rule states "no more than one gap of up to 45 days." Since this member has *two* separate gaps, they fail the continuous enrollment requirement. Therefore, they are **not_eligible**. I double-checked the specific dates and confirmed the two distinct gaps.
Having evaluated each member individually, I can now categorize them:
* **Not Eligible:** Members 71023 (enrollment gap too large), 71026 (age 76), 71028 (age 45), 71030 (age 76), and 71032 (two enrollment gaps). That’s 5 members.
* **Excluded:** Member 71021 (due to hospice). That’s 1 member.
* **Compliant:** Members 71022, 71025, 71027, and 71029. That’s 4 members.
* **Non-Compliant:** Members 71024 and 71031. That’s 2 members.
I then confirmed that the sum of these categories equals the total number of members I was asked to evaluate: 5 (not eligible) + 1 (excluded) + 4 (compliant) + 2 (non-compliant) = 12 members. Everything adds up.
For the measure's calculation, the denominator comprises those who are eligible and not excluded, which means the compliant and non-compliant members. So, the denominator is 4 (compliant) + 2 (non-compliant) = 6 members.
The numerator is the number of compliant members, which is 4.
The rate is then calculated as (Numerator / Denominator) * 100. So, (4 / 6) * 100 = 66.666...%. Rounding this to one decimal place as per standard practice, I get 66.7%.
I also took a moment to re-verify some specific points, like the E4 exclusion criteria for Member 71024, confirming their age prevented the exclusion. Similarly, I re-checked the enrollment gap calculations for Members 71023 and 71032 to ensure they correctly triggered the "not eligible" status. I also confirmed the specific screening windows (N1 through N5) for the compliant members to ensure the tests fell within the correct timeframes. All checks confirmed my initial assessments.
Finally, I compiled this into the required JSON format, ensuring all the counts and lists were accurate. The structure includes the denominator, numerator, number excluded, number not eligible, the calculated rate, and the lists of members in each category. I'm confident in the accuracy of these results.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,275 tokens
**My Thought Process for Evaluating QM-CRC Colorectal Cancer Screening**
Alright, the core of this task is to assess 12 individuals against the QM-CRC colorectal cancer screening measure and then compile the results into a JSON output. I need to be meticulous about the defined criteria for the measurement year (MY), eligibility, numerator actions, and exclusions.
First, I'll establish the parameters for the **Measurement Year (MY)**, which is clearly defined as January 1, 2026, to December 31, 2026. This is my primary temporal anchor.
Next, I'll focus on the **Eligible Population**. My key checks here are:
* **Age**: The individual must be between 46 and 75 years old *as of December 31, 2026*. This translates to a date of birth falling between January 1, 1951, and December 31, 1980.
* **Enrollment**: They need continuous enrollment throughout the MY, with a strict limit of *one* gap in coverage, and that gap cannot exceed 45 days.
Then, I’ll break down the **Numerator** requirements. A member is considered compliant if they meet *any one* of these conditions:
* **N1 (FOBT or FIT)**: Performed in the MY (2026).
* **N2 (Stool DNA)**: Performed in 2024, 2025, or 2026 (MY or the two preceding years).
* **N3 (Flexible Sigmoidoscopy)**: Performed in 2022, 2023, 2024, 2025, or 2026 (MY or the four preceding years).
* **N4 (CT Colonography)**: Performed between 2022 and 2026 (MY or the four preceding years).
* **N5 (Colonoscopy)**: Performed between 2017 and 2026 (MY or the nine preceding years).
Crucially, I also need to consider the **Exclusions**. If any of these apply, the member is removed from the denominator, regardless of whether they met a numerator action:
* **E1 (Colorectal Cancer)**: Diagnosed on or before December 31, 2026.
* **E2 (Total Colectomy)**: Performed on or before December 31, 2026.
* **E3 (Hospice)**: Enrolled in hospice during the MY.
* **E4 (Frailty and Advanced Illness)**: This applies only if the member is 66 years or older as of December 31, 2026, *and* has both frailty and advanced illness during the MY.
Now, I'll go through each member systematically:
* **MEMBER 71021**: Age 46, continuous enrollment. Eligible for the population. However, they had hospice on 2026-10-14. This is a direct hit on **E3 (Hospice)**. So, **excluded**. I noted that their Stool DNA in 2023 would have been out of the window anyway, but the exclusion takes precedence and is checked first.
* **MEMBER 71022**: Age 55, continuous enrollment. Eligible population, no exclusions. They had Stool DNA on 2024-08-05. The window for N2 is 2024-2026, so this meets **N2**. Result: **compliant**.
* **MEMBER 71023**: Age 63, eligible population. However, their enrollment shows a gap from January 1 to April 9, 2026. That's 31 (Jan) + 28 (Feb) + 31 (Mar) + 9 (Apr) = 99 days. This is well over the 45-day limit for a single gap. So, **not_eligible**.
* **MEMBER 71024**: Age 50, continuous enrollment. Eligible population. They have frailty and advanced illness, but their age is 50, and **E4** requires age >= 66. So, E4 doesn't apply. Now for the numerator: they had a Colonoscopy on 2016-03-04. The window for N5 is 2017-2026 (MY or 9 prior years). 2016 is 10 years prior, which is outside this window. Result: **non_compliant**.
* **MEMBER 71025**: Age 50, continuous enrollment. Eligible population, no exclusions (they only have frailty, which isn't an exclusion on its own). They had a Flexible Sigmoidoscopy on 2023-09-25. The window for N3 is 2022-2026. This meets **N3**. Result: **compliant**. (The FIT in 2025 is irrelevant as it doesn't meet N1 and N3 is already met).
* **MEMBER 71026**: Age 76. This is immediately over the maximum age of 75 for the MY. Result: **not_eligible**.
* **MEMBER 71027**: Age 47, continuous enrollment. Eligible population, no exclusions. They had a FIT on 2026-07-26. This meets **N1**. Result: **compliant**.
* **MEMBER 71028**: Age 45. This is immediately below the minimum age of 46 for the MY. Result: **not_eligible**.
* **MEMBER 71029**: Age 66, continuous enrollment. Eligible population, no exclusions. They had a Colonoscopy in 2019-04-22. The window for N5 is 2017-2026. This meets **N5**. They also had Stool DNA in 2024-09-15, which meets **N2**. Result: **compliant**.
* **MEMBER 71030**: Age 76. Same as 71026, this is over the maximum age of 75. Result: **not_eligible**.
* **MEMBER 71031**: Age 75, continuous enrollment. Eligible population, no exclusions. However, there's no record of any screening activity. Result: **non_compliant**.
* **MEMBER 71032**: Age 63, eligible population. Their enrollment shows two gaps: one of 17 days (Mar 31 - Apr 16) and another of 12 days (Jun 27 - Jul 8). The rule is "no more than one gap of up to 45 days." Having *two* gaps, even if each is under 45 days, violates the "no more than one gap" condition. Result: **not_eligible**. I double-checked this to ensure I interpreted "no more than one gap" correctly. Yes, two gaps means not eligible.
Let me do a quick final verification:
* **71021**: Age 46, eligible, but excluded (Hospice). Correct.
* **71022**: Age 55, eligible, Stool DNA 2024 meets N2. Compliant. Correct.
* **71023**: Age 63, eligible, but 99-day gap. Not eligible. Correct.
* **71024**: Age 50, eligible, Colonoscopy 2016 outside N5 window. Non-compliant. Correct.
* **71025**: Age 50, eligible, Flex sig 2023 meets N3. Compliant. Correct.
* **71026**: Age 76, over max age. Not eligible. Correct.
* **71027**: Age 47, eligible, FIT 2026 meets N1. Compliant. Correct.
* **71028**: Age 45, under min age. Not eligible. Correct.
* **71029**: Age 66, eligible, Colonoscopy 2019 meets N5. Compliant. Correct.
* **71030**: Age 76, over max age. Not eligible. Correct.
* **71031**: Age 75, eligible, no screening. Non-compliant. Correct.
* **71032**: Age 63, eligible, two enrollment gaps. Not eligible. Correct.
Now, let's aggregate the numbers for the JSON output:
* Total members: 12
* Not eligible members: 5 (71023, 71026, 71028, 71030, 71032)
* Excluded members: 1 (71021)
* Denominator = Total Members - Not Eligible - Excluded = 12 - 5 - 1 = 6. This denominator consists of the compliant and non-compliant members.
* Compliant members (Numerator): 4 (71022, 71025, 71027, 71029)
* Non-compliant members: 2 (71024, 71031)
* Rate calculation: Numerator / Denominator * 100 = 4 / 6 * 100 = 66.666...
* Rounding the rate to one decimal place, half up: 66.7%
Finally, I'll compile the lists and assemble the JSON object with all the required keys.
```json
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
```
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
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}100Claude Opus 5 · Anthropic11.8s · 773 out | 10.6s · 830 out | 11.2s · 816 out
Reasoning · 614 tokens
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Grader detail
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}Reasoning · 671 tokens
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Grader detail
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Grader detail
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}100Gemini 3 Flash · Google48.8s · 7,709 out | 71.6s · 10,760 out | 64.5s · 10,685 out
Reasoning · 7,500 tokens
**Analysis of Colorectal Cancer Screening Measure Performance**
My task was to evaluate a cohort against specific criteria for a colorectal cancer screening measure, determine their status (compliant, non-compliant, excluded, or not eligible), and ultimately calculate the performance rate. I approached this systematically, breaking down each criterion and applying it to every individual member.
First, I established the core parameters of the measurement year: **January 1, 2026, to December 31, 2026**. The eligible age range was **46 through 75 years** as of December 31, 2026. A crucial element was the **continuous enrollment requirement**: members needed to be enrolled for the *entire* measurement year, with the allowance of **no more than one gap of up to 45 days**.
Next, I meticulously detailed the criteria for numerator compliance and exclusions:
* **Numerator Options (at least one required):**
* N1: FOBT or FIT in 2026.
* N2: Stool DNA test (sDNA) in 2024, 2025, or 2026.
* N3: Flexible sigmoidoscopy in 2022, 2023, 2024, 2025, or 2026.
* N4: CT colonography in 2022, 2023, 2024, 2025, or 2026.
* N5: Colonoscopy in 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, or 2026.
* **Exclusion Criteria (if met, the member is excluded from the denominator):**
* E1: Colorectal cancer (C18-C21) diagnosed on or before December 31, 2026.
* E2: Total colectomy on or before December 31, 2026.
* E3: Hospice care during 2026.
* E4: Age 66 or older on December 31, 2026, *and* diagnosed with both Frailty and Advanced Illness during 2026.
I then proceeded to evaluate each member, applying these criteria:
* **Member 71021:** Born in 1980, making them 46 in 2026. They had continuous enrollment and a valid sDNA test in 2023. However, they elected hospice on October 14, 2026. This met exclusion E3, so they were **excluded**.
* **Member 71022:** Age 55, fully enrolled. They had an sDNA test in 2024, which falls within the N2 window (2024-2026). No exclusions applied. Thus, they were **compliant**.
* **Member 71023:** Age 63, but enrollment was only from April 10, 2026, through December 31, 2026. This meant they were not enrolled for the full measurement year, and the initial gap (January 1 to April 9) was approximately 99 days, far exceeding the 45-day limit for a single gap. Therefore, they were **not eligible**.
* **Member 71024:** Age 50, fully enrolled. They had a colonoscopy in March 2016. The look-back window for colonoscopies (N5) is 10 years (2017-2026). Since 2016 is outside this window, they didn't meet a numerator criterion. Exclusion E4 did not apply as they were not 66 or older. Consequently, they were **non-compliant**.
* **Member 71025:** Age 50, fully enrolled. They had a flexible sigmoidoscopy in September 2023, which falls within the N3 window (2022-2026). No exclusions applied. This made them **compliant**.
* **Member 71026:** Age 76 as of December 31, 2026. This is above the maximum eligible age of 75. Therefore, they were **not eligible**.
* **Member 71027:** Age 47, fully enrolled. They had a FIT test in July 2026, meeting the N1 criterion (2026 only). No exclusions applied. This made them **compliant**.
* **Member 71028:** Age 45 as of December 31, 2026. This is below the minimum eligible age of 46. Therefore, they were **not eligible**.
* **Member 71029:** Age 66, fully enrolled. They had an sDNA test in September 2024 (N2 window: 2024-2026) and a colonoscopy in April 2019 (N5 window: 2017-2026). No exclusions applied. This made them **compliant**.
* **Member 71030:** Age 76 as of December 31, 2026, exceeding the maximum eligible age. Therefore, they were **not eligible**.
* **Member 71031:** Age 75, fully enrolled. They did not have any recorded screening tests or fall under any exclusion criteria. Thus, they were **non-compliant**.
* **Member 71032:** Age 63, fully enrolled. However, their enrollment had two distinct gaps during the measurement year: one of 17 days and another of 12 days. The rule states "no more than *one* gap," so having two gaps, regardless of their length (as long as each is under 45 days), makes them ineligible. Therefore, they were **not eligible**.
Based on this individual assessment, I tallied the results:
* **Compliant Members:** 4 (71022, 71025, 71027, 71029)
* **Non-compliant Members:** 2 (71024, 71031)
* **Excluded Members:** 1 (71021)
* **Not Eligible Members:** 5 (71023, 71026, 71028, 71030, 71032)
The total number of members in the denominator (eligible and not excluded) is the sum of compliant and non-compliant members: 4 + 2 = 6.
The numerator is the number of compliant members: 4.
The excluded count is 1.
The not eligible count is 5.
The total roster size is 4 (compliant) + 2 (non-compliant) + 1 (excluded) + 5 (not eligible) = 12 members.
Finally, I calculated the performance rate:
Rate = (Numerator / Denominator) * 100
Rate = (4 / 6) * 100 = 66.666...%
Rounded to one decimal place, this gives a performance rate of **66.7%**.
In summary, my analysis involved a rigorous application of each defined criterion to every member, leading to their classification and the subsequent calculation of the measure's performance. I paid close attention to the precise wording of the enrollment and exclusion rules, especially concerning the number of gaps and age-related criteria for exclusion E4.
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Grader detail
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}Reasoning · 10,551 tokens
**My Thought Process for Stratifying and Calculating the Colorectal Cancer Screening Rate**
My primary objective here is to determine a specific colorectal cancer screening rate for the 2026 measurement year, based on a defined set of criteria for eligibility, numerator events, and exclusions. I'll break down my thinking process as I would approach evaluating each member of the population.
First, I need to establish the **Measurement Year**: This is clearly defined as January 1, 2026, to December 31, 2026.
Next, I'll define the **Eligible Population (Denominator)**. This involves two key criteria:
1. **Age:** The individual must be between 46 and 75 years of age, inclusive, as of December 31, 2026. I'll need to perform date calculations for this.
2. **Enrolment:** They must have been enrolled for the entire measurement year (Jan 1 - Dec 31, 2026) with no more than one gap in coverage, and that gap cannot exceed 45 days. This means continuous enrolment is the ideal state, but a single, short break is permissible.
Then, I'll consider the **Numerator Criteria (Numerator)**. An individual is considered compliant if they have *any one* of the following screening events within specific look-back windows, ending on December 31, 2026:
* **N1: FOBT or FIT:** Must have occurred in the year **2026**. This is a strict, single-year window.
* **N2: Stool DNA test:** Must have occurred in **2026, 2025, or 2024**. This is a 3-year window.
* **N3: Flexible sigmoidoscopy:** Must have occurred in **2026, 2025, 2024, 2023, or 2022**. This is a 5-year window.
* **N4: CT colonography:** Same as flexible sigmoidoscopy, a 5-year window (**2026, 2025, 2024, 2023, or 2022**).
* **N5: Colonoscopy:** This has the longest look-back period, a **10-year window (2026 down to 2017)**.
Finally, I must account for **Required Exclusions**. Certain conditions automatically remove an individual from the denominator, regardless of screening status. These are:
* **E1: Colorectal cancer (ICD-10 codes C18-C21):** Diagnosed on or before December 31, 2026.
* **E2: Total colectomy:** Performed on or before December 31, 2026.
* **E3: Hospice:** Enrolled in hospice care at any point during 2026.
* **E4: Frailty and Advanced Illness:** This is a conditional exclusion that applies *only* to individuals aged 66 or older as of December 31, 2026, *and* who have both frailty and advanced illness documented in 2026.
**Applying the Criteria to Individual Members:**
Now, I'll simulate how I would process each member based on their provided information, systematically checking eligibility, exclusions, and numerator events.
1. **Member 71021:**
* **Age:** 46 as of 2026-12-31. (Meets age requirement: 46-75).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** Hospice election on 2026-10-14. This directly triggers **E3 (Hospice)**.
* **Status:** **Excluded**. Even if they had a screening, they are out.
2. **Member 71022:**
* **Age:** 55 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** None documented.
* **Numerator:** Stool DNA test on 2024-08-05. This falls within the 3-year window (2024, 2025, 2026).
* **Status:** **Compliant**.
3. **Member 71023:**
* **Age:** 63 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Enrolled from 2026-04-10 to 2026-12-31. The gap from 2026-01-01 to 2026-04-09 is 31 (Jan) + 28 (Feb) + 31 (Mar) + 9 (Apr) = 99 days.
* **Enrolment Check:** This is one gap, but it *exceeds* the 45-day limit.
* **Status:** **Not Eligible**.
4. **Member 71024:**
* **Age:** 50 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** Frailty (2026-08-18) AND Advanced illness (2026-02-04) documented. However, **E4 requires age 66+**, and this member is 50. Therefore, E4 does not apply. No other exclusions apply.
* **Numerator:** Colonoscopy on 2016-03-04. The 10-year window for colonoscopy is 2017-2026. 2016 is *outside* this window.
* **Status:** **Non-Compliant**.
5. **Member 71025:**
* **Age:** 50 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** None documented.
* **Numerator:** Flexible sigmoidoscopy on 2023-09-25. This falls within the 5-year window (2022-2026). The FIT test in 2025 does not count as N1 requires it to be in 2026.
* **Status:** **Compliant**.
6. **Member 71026:**
* **Age:** 76 as of 2026-12-31. (Outside the 46-75 range).
* **Status:** **Not Eligible**.
7. **Member 71027:**
* **Age:** 47 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** None documented.
* **Numerator:** FIT on 2026-07-26. This meets **N1 (FIT in 2026)**.
* **Status:** **Compliant**.
8. **Member 71028:**
* **Age:** 45 as of 2026-12-31. (Outside the 46-75 range).
* **Status:** **Not Eligible**.
9. **Member 71029:**
* **Age:** 66 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** None documented.
* **Numerator:** Colonoscopy on 2019-04-22 (within the 10-year window 2017-2026). Also, a Stool DNA test on 2024-09-15 (within the 3-year window 2024-2026). Either qualifies.
* **Status:** **Compliant**.
10. **Member 71030:**
* **Age:** 76 as of 2026-12-31. (Outside the 46-75 range).
* **Status:** **Not Eligible**.
11. **Member 71031:**
* **Age:** 75 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Full 2026 year, no gaps. (Meets enrolment requirement).
* **Exclusions:** None documented.
* **Numerator:** No screening listed.
* **Status:** **Non-Compliant**.
12. **Member 71032:**
* **Age:** 63 as of 2026-12-31. (Meets age requirement).
* **Enrolment:** Has two gaps: Gap 1 (2026-03-31 to 2026-04-16, 17 days) and Gap 2 (2026-06-27 to 2026-07-08, 12 days).
* **Enrolment Check:** The specification allows "no more than one gap". This member has two gaps.
* **Status:** **Not Eligible**.
**Consolidating the Results:**
Now I'll tally the members into their final categories:
* **Compliant (Numerator Members):** 71022, 71025, 71027, 71029 (Total: 4)
* **Non-Compliant:** 71024, 71031 (Total: 2)
* **Excluded:** 71021 (Total: 1)
* **Not Eligible:** 71023, 71026, 71028, 71030, 71032 (Total: 5)
**Calculating the Rate:**
The **Denominator** is the sum of Compliant and Non-Compliant members who were eligible:
Denominator = Compliant + Non-Compliant = 4 + 2 = 6.
The **Numerator** is the count of Compliant members:
Numerator = 4.
The **Rate** is calculated as (Numerator / Denominator) * 100:
Rate = (4 / 6) * 100 = 66.666...%
Finally, I need to **round the rate to one decimal place**:
Rounded Rate = **66.7%**.
I've cross-verified the individual member categorizations against each rule, confirmed age calculations, gap durations, and look-back windows. The list of IDs matches the counts in each category, and the total number of members (4+2+1+5 = 12) is accounted for. The final rate calculation is accurate based on these numbers.
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"rate": 66.7,
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],
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Grader detail
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}Reasoning · 10,476 tokens
**Colorectal Cancer Screening (QM-CRC) Measurement Year 2026 Analysis**
Alright, let's break down this Colorectal Cancer Screening measure for the 2026 measurement year. I'm going through each member and applying the criteria rigorously.
First off, the **eligible population**: we're looking at individuals aged 46 through 75 on December 31st, 2026, who were continuously enrolled for the full measurement year, allowing for no more than a single gap of up to 45 days.
Then, we have the **numerator criteria**, which means a member is considered compliant if they meet *any one* of these screening requirements within specified look-back windows:
* A Faecal Occult Blood Test (FOBT) or Faecal Immunochemical Test (FIT) performed in 2026 (N1).
* A Stool DNA test performed in 2024, 2025, or 2026 (N2 - 3-year window).
* A Flexible sigmoidoscopy performed in 2022, 2023, 2024, 2025, or 2026 (N3 - 5-year window).
* A CT colonography performed in 2022, 2023, 2024, 2025, or 2026 (N4 - 5-year window).
* A Colonoscopy performed in 2017 through 2026 (N5 - 10-year window).
Crucially, we also have **exclusions** that take precedence if met, even if a member would otherwise be compliant:
* Colorectal cancer diagnoses (ICD-10 C18-C21) on or before 2026-12-31 (E1).
* Total colectomy on or before 2026-12-31 (E2).
* Hospice enrollment at any point during 2026 (E3).
* For members aged 66 or older on 2026-12-31, if they also had both frailty and advanced illness documented during 2026 (E4).
Now, let's run through the members:
* **MEMBER 71021**: This member is 46 years old, so age-eligible. Their enrollment was continuous for the full year. However, they elected hospice in October 2026. This triggers exclusion E3, so they are **Excluded**.
* **MEMBER 71022**: This individual is 55, eligible by age, and had continuous enrollment. They don't meet any exclusions. Their screening record shows a Stool DNA test in August 2024, which falls within the 3-year look-back window for N2. Therefore, they are **Compliant**.
* **MEMBER 71023**: This member is 63, so age-eligible. However, their enrollment didn't start until April 10th, 2026. This creates a gap from January 1st to April 9th, which is 99 days long. This exceeds the allowed single gap of 45 days. Thus, they are **Not Eligible**.
* **MEMBER 71024**: This member is 50, eligible by age, and had continuous enrollment. Exclusion E4 doesn't apply because they are under 66, even though frailty and advanced illness are documented. For numerator compliance, their colonoscopy was in March 2016. The N5 look-back window for colonoscopies starts in 2017. Since their procedure is too old, they haven't met the numerator criteria. They are **Non-Compliant**.
* **MEMBER 71025**: This individual is 50, eligible, and continuously enrolled. No exclusions apply. They have a flexible sigmoidoscopy from September 2023, which is within the 5-year look-back window for N3. This makes them **Compliant**. (Their FIT test in 2025 doesn't count for N1 as it wasn't in 2026).
* **MEMBER 71026**: This member is 76 years old on December 31st, 2026. The eligible age range is up to 75. Therefore, they are **Not Eligible**.
* **MEMBER 71027**: This member is 47, eligible by age, and continuously enrolled. No exclusions apply. They had a FIT test in July 2026, which directly meets the N1 criterion. They are **Compliant**.
* **MEMBER 71028**: This member is 45 years old on December 31st, 2026. The eligible age range starts at 46. Therefore, they are **Not Eligible**.
* **MEMBER 71029**: This member is 66, eligible by age, and continuously enrolled. No exclusions apply (they are 66 but don't have both frailty and advanced illness). They have a colonoscopy from April 2019, which is within the N5 10-year window, and also a stool DNA test from September 2024, within the N2 3-year window. Either of these makes them **Compliant**.
* **MEMBER 71030**: Similar to 71026, this member is 76 years old on December 31st, 2026, making them too old for this measure. They are **Not Eligible**.
* **MEMBER 71031**: This member is 75, eligible by age, and continuously enrolled. No exclusions apply. However, they have no record of any colorectal cancer screening within the defined periods. They are **Non-Compliant**.
* **MEMBER 71032**: This member is 63, eligible by age. Let's examine their enrollment: they had a gap from March 31st to April 16th (17 days) and then another gap from June 27th to July 8th (12 days). Having two gaps, even though individually under 45 days, violates the "no more than *one* gap" rule. Thus, they are **Not Eligible**.
---
Here's the summary of my findings:
* **Compliant Members**: 4 (71022, 71025, 71027, 71029)
* **Non-Compliant Members**: 2 (71024, 71031)
* **Excluded Members**: 1 (71021)
* **Not Eligible Members**: 5 (71023, 71026, 71028, 71030, 71032)
From this, the denominator for the measure is the sum of compliant and non-compliant members, which is 4 + 2 = **6**.
The numerator is the count of compliant members, which is **4**.
Therefore, the calculated rate for the Colorectal Cancer Screening (QM-CRC) measure for 2026 is (4 / 6) * 100 = 66.666..., which I'll round to **66.7%**.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K3 · Moonshot41.6s · 1,326 out | 93.8s · 1,403 out | 36.0s · 975 out
Reasoning · 1,210 tokens
Let me work through each member.
Measure QM-CRC, measurement year 2026.
Eligible: age 46-75 as of 2026-12-31, continuous enrolment full year with no more than one gap of up to 45 days.
Exclusions (evaluated only for eligible members): E1 colorectal cancer, E2 total colectomy, E3 hospice during MY, E4 age 66+ AND both frailty and advanced illness during MY.
Numerator: N1 FOBT/FIT 2026; N2 stool DNA 2024-2026; N3 flex sig 2022-2026; N4 CT colonography 2022-2026; N5 colonoscopy 2017-2026 (ten-year window: 2026 plus nine years prior → 2017-01-01 through 2026-12-31... actually "during 2026 or the nine years prior" so window is 2017-2026).
Member 71021: age 46, enrolled full year. Stool DNA 2023-11-23 — N2 requires 2024-2026, 2023 is outside (three-year window: 2026 or two years prior = 2024, 2025, 2026). So not numerator by that. Hospice 2026-10-14 → E3 exclusion. Excluded. Status: excluded (numerator not met anyway, but exclusion comes first; in eligible population, exclusion applies → excluded).
Member 71022: age 55, enrolled. Stool DNA 2024-08-05 → N2 satisfied. Compliant.
Member 71023: age 63, enrolled only 2026-04-10 onward; not enrolled before → fails continuous enrolment → not_eligible. (Colonoscopy 2018 would satisfy N5 but enrolment fails.)
Member 71024: age 50, enrolled. Colonoscopy 2016-03-04 — N5 window is 2017-2026, so 2016 is outside → not numerator. Frailty + advanced illness documented, but E4 requires age 66+; member is 50 → exclusion doesn't apply. Non_compliant.
Member 71025: age 50, enrolled. Flex sig 2023 → N3 (2022-2026) satisfied; FIT 2025 → N1 requires 2026 only, so FIT 2025 doesn't satisfy N1, but flex sig does. Compliant. Frailty alone doesn't exclude (E4 needs both, and age 66+ anyway). Compliant.
Member 71026: age 76 → not_eligible (age over 75). Stool DNA 2023 irrelevant.
Member 71027: age 47, enrolled. FIT 2026-07-26 → N1 satisfied. Compliant.
Member 71028: age 45 → not_eligible (under 46).
Member 71029: age 66, enrolled. Colonoscopy 2019 → N5; stool DNA 2024 → N2. No frailty/AI. Compliant.
Member 71030: age 76 → not_eligible.
Member 71031: age 75, enrolled, no screening → non_compliant.
Member 71032: age 63, enrolled with gaps of 17 and 12 days — that's two gaps; the rule allows "no more than one gap of up to 45 days". Two gaps → fails continuous enrolment → not_eligible. (Even though each gap ≤45 days, there are two gaps.) Also colonoscopy 2015 outside window anyway, and frailty alone doesn't exclude. So not_eligible due to enrolment.
Now counts:
- Denominator (compliant + non_compliant): 71022, 71024, 71025, 71027, 71029, 71031 → wait, denominator = compliant + non_compliant members. Compliant: 71022, 71025, 71027, 71029 = 4. Non_compliant: 71024, 71031 = 2. Denominator = 6.
- Numerator = 4.
- Excluded: 71021 = 1.
- Not eligible: 71023, 71026, 71028, 71030, 71032 = 5.
Rate = 4/6 × 100 = 66.666... → 66.7.
Check: 6 + 1 + 5 = 12. Good.
Double-check 71032 enrolment: gaps between 03-30 and 04-17 = 17 days gap (Mar 31–Apr 16), and between 06-26 and 07-09 = 12 days (Jun 27–Jul 8). Two gaps → fails "no more than one gap". So not_eligible. Yes.
71032 frailty alone, age 63 <66, so E4 wouldn't apply regardless; but the enrolment failure makes her not_eligible (exclusions only evaluated for eligible members).
71021: eligible (age 46, enrolled) → exclusion E3 hospice → excluded.
71024: colonoscopy 2016 — ten-year window measured back from 2026-12-31: "during 2026 or the nine years prior" → earliest 2017-01-01. 2016-03-04 is before → doesn't count. Non_compliant. Yes.
71023: enrolment fails; colonoscopy 2018 would count but not eligible.
Rate: 4/6 = 66.6667 → 66.7.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,271 tokens
Let me work through each member against the measure specification.
Measure QM-CRC: Colorectal Cancer Screening
- Measurement year: 2026-01-01 to 2026-12-31
- Age: 46-75 years as of 2026-12-31
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Numerator:
- N1: FOBT or FIT during 2026
- N2: Stool DNA during 2026 or two years prior (2024-01-01 through 2026-12-31)
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022-01-01 through 2026-12-31)
- N4: CT colonography during 2026 or four years prior
- N5: Colonoscopy during 2026 or nine years prior (2017-01-01 through 2026-12-31)
Exclusions (evaluated only for eligible population, before numerator):
- E1: Colorectal cancer any time on or before 2026-12-31
- E2: Total colectomy any time on or before 2026-12-31
- E3: Hospice at any time during measurement year
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during MY.
Member 71021: DOB 1980-08-11, age 46 on 2026-12-31. Enrolment full year, no gaps. Eligible. Exclusions: hospice election 2026-10-14 → E3 → excluded. (Even though stool DNA 2023-11-23 — actually that's outside the 3-year window anyway: 2023-11-23 is before 2024-01-01, so not numerator. But exclusion applies regardless.) Excluded.
Member 71022: age 55. Enrolled full year. Eligible. No exclusions. Stool DNA 2024-08-05 — within 2024-01-01 to 2026-12-31 → N2 met. Compliant.
Member 71023: age 63. Enrolment starts 2026-04-10 — not continuously enrolled full measurement year. Gap from 2026-01-01 to 2026-04-09 is ~99 days, more than 45 days... Actually "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Member not enrolled before 2026-04-10, so fails continuous enrolment → not_eligible. (Colonoscopy 2018-02-20 would be within 10-year window, but enrolment fails.)
Member 71024: age 50. Enrolled full year. Eligible. Frailty and advanced illness documented in 2026, but E4 requires age 66+. Member is 50, so E4 does not apply. Colonoscopy 2016-03-04 — window is 2017-01-01 through 2026-12-31; 2016-03-04 is outside → not numerator. Non_compliant.
Member 71025: age 50. Enrolled full year. Eligible. Frailty documented 2026-07-12, but no advanced illness; also age < 66. E4 not applicable. FIT 2025-02-14 — N1 requires FIT during 2026. 2025-02-14 is not during 2026. Flexible sigmoidoscopy 2023-09-25 — N3 window 2022-01-01 to 2026-12-31 → met. Compliant.
Member 71026: age 76 as of 2026-12-31. Age range is 46 through 75. 76 > 75 → not_eligible.
Member 71027: age 47. Enrolled full year. Eligible. FIT 2026-07-26 → N1 met. Compliant.
Member 71028: age 45 as of 2026-12-31. Below 46 → not_eligible.
Member 71029: age 66. Enrolled full year. Eligible. No frailty/advanced illness, so E4 not applicable. Stool DNA 2024-09-15 → N2 met. Also colonoscopy 2019-04-22 → N5 met. Compliant.
Member 71030: age 76 → not_eligible. (Stool DNA 2025-12-12 would qualify, but age fails.)
Member 71031: age 75. Enrolled full year. Eligible. No exclusions. No screening on record → non_compliant.
Member 71032: age 63. Enrolment: three segments with two gaps (17 days and 12 days). Continuous enrolment allows no more than one gap of up to 45 days. Two gaps → fails continuous enrolment → not_eligible. (Even though each gap is ≤45 days, there are two gaps.) Not eligible.
Now counts:
- Compliant: 71022, 71025, 71027, 71029 → 4
- Non_compliant: 71024, 71031 → 2
- Excluded: 71021 → 1
- Not_eligible: 71023, 71026, 71028, 71030, 71032 → 5
Denominator = compliant + non_compliant = 6.
Numerator = 4.
Rate = 4/6 × 100 = 66.666... → 66.7 (rounded half up to one decimal).
Check: 4/6 = 0.666666..., ×100 = 66.6667 → 66.7.
All 12 members accounted for: 4+2+1+5 = 12. Good.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 854 tokens
Let me work through each member against the measure spec.
Eligible population: age 46-75 as of 2026-12-31, continuous enrolment full measurement year with no more than one gap of up to 45 days.
Exclusions evaluated before numerator, only for eligible members.
MEMBER 71021: age 46 (eligible). Enrolled all year. Hospice election 2026-10-14 → E3 exclusion → excluded. (Stool DNA 2023 would meet N2, but exclusion takes precedence.)
MEMBER 71022: age 55, enrolled full year, stool DNA 2024-08-05 → within 3-year window (2024-01-01 to 2026-12-31) → N2 → compliant.
MEMBER 71023: age 63, enrolment only from 2026-04-10, not full measurement year → not_eligible (enrolment failure). Even though colonoscopy 2018 would meet N5.
MEMBER 71024: age 50 (not 66+), so E4 doesn't apply. Enrolled full year. Colonoscopy 2016-03-04 → 2016 is more than 9 years prior? Ten-year window: during 2026 or the nine years prior. Nine years prior from 2026-12-31: 2017-01-01 onward. 2016-03-04 is outside → not numerator. Frailty + advanced illness but age 50, E4 requires age 66+ → no exclusion. → non_compliant.
MEMBER 71025: age 50, enrolled full year. Flex sig 2023-09-25 within five-year window (2022-01-01 to 2026-12-31) → N3. Also FIT 2025 → N1. Compliant. Frailty alone doesn't exclude, and age 50 anyway → compliant.
MEMBER 71026: age 76 → outside 46-75 → not_eligible.
MEMBER 71027: age 47, enrolled full year, FIT 2026 → N1 → compliant.
MEMBER 71028: age 45 → not_eligible.
MEMBER 71029: age 66, enrolled full year. No frailty, no advanced illness → no E4. Stool DNA 2024 → N2 → compliant.
MEMBER 71030: age 76 → not_eligible.
MEMBER 71031: age 75, enrolled full year, no screening → non_compliant.
MEMBER 71032: age 63. Enrolment gaps: 2026-03-30 to 2026-04-17 is 18 days? Let's see: enrolled through 2026-03-30, resumes 2026-04-17 → gap of 17 days (stated). Second gap: enrolled through 2026-06-26, resumes 2026-07-09 → 12 days. Spec says "no more than one gap of up to 45 days" — member has two gaps → fails continuous enrolment → not_eligible.
Wait — "no more than one gap of up to 45 days." Two gaps of 17 and 12 days = more than one gap → not_eligible. Frailty alone doesn't exclude anyway.
So:
- denominator (compliant + non_compliant): 71022, 71024, 71025, 71027, 71029, 71031 → 6
- numerator (compliant): 71022, 71025, 71027, 71029 → 4
- excluded: 71021 → 1
- not_eligible: 71023, 71026, 71028, 71030, 71032 → 5
Rate = 4/6 × 100 = 66.666... → 66.7 (half up to one decimal).
Member ID strings: "71022", etc.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
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},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
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},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
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],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 2.5 Pro · Google38.9s · 3,957 out | 39.3s · 4,736 out | 41.7s · 4,683 out
Reasoning · 3,748 tokens
Alright, let's break down this roster evaluation for the QM-CRC colorectal cancer screening measure for 2026. My primary objective is to meticulously assess each of the 12 members against the defined criteria to determine their compliance, exclusion, or ineligibility. This requires a careful application of the measure specifications, which I'll work through member by member.
First, I need to internalize the core requirements: the measurement year is 2026, so I'll be looking at dates from January 1st to December 31st, 2026. For the **eligible population (denominator)**, members must be between 46 and 75 years old as of December 31st, 2026, and must have been continuously enrolled for the entire measurement year, allowing for at most one gap of up to 45 days.
For the **numerator (compliant)** status, a member needs to have had one of several specific tests performed within certain look-back periods, all relative to the end of the measurement year (December 31st, 2026). These are:
* FOBT/FIT (N1) during 2026.
* Stool DNA (N2) during 2026 or the two prior years (2024-2026).
* Flexible sigmoidoscopy (N3) during 2026 or the four prior years (2022-2026).
* CT colonography (N4) during 2026 or the four prior years (2022-2026).
* Colonoscopy (N5) during 2026 or the nine prior years (2017-2026).
There are also several **exclusions** that, if met, automatically disqualify a member from being considered for compliance, even if they meet the denominator criteria. These are:
* Having colorectal cancer (E1) at any point up to December 31st, 2026.
* Having a total colectomy (E2) at any point up to December 31st, 2026.
* Being in hospice care (E3) at any point during 2026.
* Being aged 66 or older as of December 31st, 2026, AND having both frailty and advanced illness documented in 2026 (E4).
I'll now proceed with evaluating each individual member.
**MEMBER 71021:** I first check their age. They are 46 on 2026-12-31, which falls within the 46-75 range. Next, their enrolment. It's continuous for all of 2026, so that's good. This means they are part of the eligible population. Now, I need to look for exclusions. I see they have a hospice admission date of 2026-10-14, which is definitely within the measurement year. This triggers **E3 (Hospice)**. Therefore, this member is **Excluded**.
**MEMBER 71022:** Age 55 on 2026-12-31. This is within the 46-75 range. Their enrolment is continuous for all of 2026. So, they are in the eligible population. I'll check for exclusions, and find none. Now, for the numerator. I see a Stool DNA test on 2024-08-05. The look-back period for Stool DNA (N2) is 2024, 2025, and 2026. Since 2024 is within this window, they meet the criterion. This member is **Compliant**.
**MEMBER 71023:** Their age is 63 on 2026-12-31, which is within the eligible age range. However, their enrolment history shows they were enrolled from 2026-04-10 through 2026-12-31. This means they were *not* enrolled for the full measurement year, and the gap at the beginning of the year (January through April) is considerably more than 45 days. The spec clearly states "full measurement year with no more than one gap of up to 45 days." This member fails that requirement. Therefore, they are **Not Eligible**.
**MEMBER 71024:** Age 50 on 2026-12-31, so they are in the eligible age bracket. Enrolment is continuous for all of 2026. They are part of the eligible population. Checking exclusions: E1, E2, and E3 are not present. For E4, they are only 50, not 66+, so this exclusion doesn't apply regardless of frailty or advanced illness. Now, for the numerator. I see a Colonoscopy on 2016-03-04. The look-back for Colonoscopy (N5) is nine years prior to the end of 2026, meaning from 2017 to 2026. The 2016 date falls *outside* this window. They have no other qualifying tests. Thus, they are **Non-Compliant**.
**MEMBER 71025:** Age 50 on 2026-12-31, within the eligible age range. Enrolment is continuous for all of 2026. They are in the eligible population. No exclusions apply (E4 is not relevant due to age). For the numerator, I see a Flexible sigmoidoscopy on 2023-09-25. The look-back for Flexible sigmoidoscopy (N3) is 2022-2026. This date of 2023-09-25 falls within that window. Even though there's a FIT test on 2025-02-14 which doesn't count for N1 (as it's not in 2026), having met one criterion (N3) is sufficient. This member is **Compliant**.
**MEMBER 71026:** They are 76 years old on 2026-12-31. This is outside the eligible age range of 46-75. Therefore, they are **Not Eligible**.
**MEMBER 71027:** Age 47 on 2026-12-31, within the eligible age range. Enrolment is continuous for all of 2026. They are in the eligible population. No exclusions are present. For the numerator, I see a FIT test on 2026-07-26. The look-back for FIT (N1) is the current year, 2026. This date is within the window. This member is **Compliant**.
**MEMBER 71028:** They are 45 years old on 2026-12-31. This is below the minimum eligible age of 46. Therefore, they are **Not Eligible**.
**MEMBER 71029:** Age 66 on 2026-12-31, within the eligible age range. Enrolment is continuous for all of 2026. They are in the eligible population. Checking exclusions: E1, E2, E3 are not present. E4 requires age 66+ AND frailty + advanced illness documented in 2026; I see no documentation of frailty or advanced illness for this member, so E4 does not apply. Now, for the numerator. I see a Stool DNA test on 2024-09-15. The look-back for Stool DNA (N2) is 2024-2026. This date is within the window. They also have a colonoscopy in 2019, which is also compliant under N5. Meeting one criterion is enough. This member is **Compliant**.
**MEMBER 71030:** They are 76 years old on 2026-12-31. This is outside the eligible age range of 46-75. Therefore, they are **Not Eligible**.
**MEMBER 71031:** Age 75 on 2026-12-31, so they are within the eligible age range. Enrolment is continuous for all of 2026. They are in the eligible population. I find no exclusions. However, when I look for numerator criteria, I see no record of any colorectal screening tests performed within the specified look-back periods. Thus, they are **Non-Compliant**.
**MEMBER 71032:** Age 63 on 2026-12-31, within the eligible age range. Now, their enrolment. I notice there are two periods where they were not enrolled: 2026-03-31 to 2026-04-16 (17 days) and 2026-06-27 to 2026-07-08 (12 days). The rule states "no more than one gap of up to 45 days." This member has *two* gaps. This violates the continuous enrolment requirement. Therefore, they are **Not Eligible**.
Now that I've evaluated each member, I can summarize their statuses:
* **Member 71021:** Excluded (due to Hospice)
* **Member 71022:** Compliant (due to Stool DNA in look-back)
* **Member 71023:** Not Eligible (due to enrolment gap exceeding 45 days)
* **Member 71024:** Non-Compliant (no qualifying screening within look-back)
* **Member 71025:** Compliant (due to Flexible sigmoidoscopy in look-back)
* **Member 71026:** Not Eligible (due to age)
* **Member 71027:** Compliant (due to FIT in 2026)
* **Member 71028:** Not Eligible (due to age)
* **Member 71029:** Compliant (due to Stool DNA in look-back)
* **Member 71030:** Not Eligible (due to age)
* **Member 71031:** Non-Compliant (no qualifying screening)
* **Member 71032:** Not Eligible (due to multiple enrolment gaps)
Let's tally this up for the final report.
* **Compliant Members:** 4 (71022, 71025, 71027, 71029)
* **Non-Compliant Members:** 2 (71024, 71031)
* **Excluded Members:** 1 (71021)
* **Not Eligible Members:** 5 (71023, 71026, 71028, 71030, 71032)
This gives me a total of 4 + 2 + 1 + 5 = 12 members, which accounts for the entire roster.
Now, I can determine the required metrics for the JSON output.
The **denominator** consists of members who are either compliant or non-compliant, meaning they were eligible but didn't meet the numerator criteria. So, that's 4 (compliant) + 2 (non-compliant) = 6 members.
The **numerator** is simply the count of compliant members, which is 4.
The **excluded** count is 1.
The **not eligible** count is 5.
The **rate** of compliant members within the denominator is calculated as (numerator / denominator) * 100. This is (4 / 6) * 100, which equals 66.666... I will round this to one decimal place as 66.7.
Finally, I need to list the members by their status, ensuring their IDs are enclosed in strings as requested:
* **compliant_members:** ["71022", "71025", "71027", "71029"]
* **non_compliant_members:** ["71024", "71031"]
* **excluded_members:** ["71021"]
* **not_eligible_members:** ["71023", "71026", "71028", "71030", "71032"]
I've double-checked each step, re-verifying the logic for age, enrolment, exclusion criteria, and the specific look-back periods for each screening test type against the dates provided. My analysis and calculations for each member and the final summary metrics appear to be accurate according to the measure specifications. I am ready to construct the final JSON output.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,527 tokens
Alright, I've just completed my evaluation of these 12 members against the QM-CRC measure specification for the 2026 measurement year. My process was to meticulously go through each member, checking them against the eligibility criteria (age and continuous enrollment), then scrutinizing for any exclusion criteria, and finally assessing if they met any of the numerator requirements for colorectal cancer screening.
Here's how my thought process unfolded for each individual:
**For Member 71021:**
I first checked their age; they're 46 as of the end of 2026, which falls perfectly within the 46-75 age range. Their enrollment was continuous for the entire measurement year, so they meet the eligible population criteria. However, when I reviewed the exclusions, I found they elected hospice on October 14, 2026. According to exclusion E3, any member in hospice during the measurement year is excluded. Therefore, this member is **Excluded**.
**For Member 71022:**
This individual is 55 years old at the end of 2026, so they are within the eligible age range. They were also continuously enrolled throughout 2026. I found no applicable exclusions for them. For the numerator, I noted a Stool DNA test performed on August 5, 2024. The specification (N2) allows for Stool DNA testing within 2024, 2025, or 2026 (a three-year window looking back from the end of 2026). Since August 5, 2024, falls within this window, this member is **Compliant**.
**For Member 71023:**
They are 63 years old, so the age criteria are met. However, their enrollment didn't start until April 10, 2026. This means there was a gap from January 1, 2026, to April 9, 2026. I calculated this gap to be 99 days (31 in Jan + 28 in Feb + 31 in Mar + 9 in Apr). The specification states "no more than one gap of up to 45 days" for continuous enrollment. Since this gap exceeds 45 days, this member is **Not Eligible**.
**For Member 71024:**
This member is 50 years old and continuously enrolled, so they qualify for the eligible population. I checked for exclusions and found none applied; specifically, their age of 50 means exclusion E4 (Frailty and Advanced Illness) doesn't come into play as it requires being 66+. For the numerator, I saw a Colonoscopy performed on March 4, 2016. The specification (N5) for colonoscopies has a look-back period from 2017 to 2026. Since their colonoscopy is from 2016, it falls outside this window. Therefore, this member is **Non-compliant**.
**For Member 71025:**
They are 50 years old and continuously enrolled, meeting the eligible population criteria. Like the previous member, exclusion E4 is not relevant due to their age. I reviewed their screening history and found a Flexible Sigmoidoscopy on September 25, 2023. The specification (N3) for flexible sigmoidoscopy has a five-year look-back window (2022-2026). Their 2023 sigmoidoscopy falls within this period, making them **Compliant**. I also noted a FIT test from 2025, but the sigmoidoscopy alone satisfies the criteria.
**For Member 71026:**
Their date of birth indicates they will be 76 years old at the end of 2026. The eligible age range is 46 through 75 years. Since they are outside this range, this member is **Not Eligible**.
**For Member 71027:**
This individual is 47 years old and continuously enrolled, meeting the eligible population criteria. No exclusions applied to them. For the numerator, they had a Faecal Immunochemical Test (FIT) on July 26, 2026. The specification (N1) requires FIT within the measurement year 2026. Their test falls within this timeframe, so they are **Compliant**.
**For Member 71028:**
Their date of birth shows they will be 45 years old at the end of 2026. The eligible age range starts at 46. Therefore, this member is **Not Eligible**.
**For Member 71029:**
They are 66 years old and continuously enrolled, fitting the eligible population. I confirmed no exclusions applied. For the numerator, I found a Colonoscopy on April 22, 2019, which falls within the ten-year look-back window for colonoscopies (2017-2026). This alone makes them **Compliant**. I also noted a Stool DNA test from 2024, which would also meet the N2 criteria, but only one is needed for compliance.
**For Member 71030:**
Similar to Member 71026, their date of birth indicates they will be 76 years old at the end of 2026, which is outside the 46-75 eligible age range. This member is **Not Eligible**.
**For Member 71031:**
This member is 75 years old and continuously enrolled, meeting the eligible population criteria. I found no applicable exclusions. However, upon reviewing their screening history, there is no record of any colorectal cancer screening within the specified timeframes. Therefore, they are **Non-compliant**.
**For Member 71032:**
They are 63 years old and within the eligible age range. However, I noted two distinct gaps in their enrollment during 2026: one from March 31 to April 16 (17 days) and another from June 27 to July 8 (12 days). The specification clearly states "no more than *one* gap of up to 45 days." Since this member has two separate gaps, they are **Not Eligible**.
Following this thorough review, I've tallied the results:
* **Compliant Members:** 4 (71022, 71025, 71027, 71029)
* **Non-compliant Members:** 2 (71024, 71031)
* **Excluded Members:** 1 (71021)
* **Not Eligible Members:** 5 (71023, 71026, 71028, 71030, 71032)
This totals 12 members, and the breakdown seems accurate based on the measure's specifications. From this, I can deduce the denominator (compliant + non-compliant = 4 + 2 = 6), the numerator (compliant = 4), and consequently, the rate. The rate is (4 / 6) * 100, which is approximately 66.7%.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,474 tokens
Alright, let's break down this roster evaluation for the QM-CRC colorectal cancer screening measure for 2026. My primary objective is to meticulously assess each of the 12 roster members against the defined criteria to determine their eligibility, compliance, or exclusion status for the measurement year 2026. This involves a rigorous application of the measure specifications regarding age, continuous enrollment, and the specific screening test windows and types.
Here's how I'm approaching this, member by member:
First, I need to establish the baseline criteria for the **Eligible Population (Denominator)**. This means individuals must be between 46 and 75 years old as of December 31, 2026, and have been continuously enrolled throughout the entire measurement year, with the allowance for no more than one gap in enrollment that doesn't exceed 45 days.
Then, for those who meet the denominator criteria, I need to check if they are **Compliant (Numerator)**. Compliance is achieved if they've had any of the following by December 31, 2026: a FOBT or FIT in 2026 (N1); a Stool DNA test in 2024-2026 (N2); a Flexible sigmoidoscopy in 2022-2026 (N3); a CT colonography in 2022-2026 (N4); or a Colonoscopy in 2017-2026 (N5).
Simultaneously, I must identify any **Exclusions** that would remove an otherwise eligible member from the denominator. These include a diagnosis of colorectal cancer (C18-C21) or a total colectomy at any point up to December 31, 2026 (E1, E2); being in hospice during 2026 (E3); or being aged 66 or older as of December 31, 2026, with documented frailty and advanced illness during 2026 (E4).
Now, let's walk through each member:
* **MEMBER 71021:** Age is 46 (DOB 1980-08-11), so that's within the 46-75 range. Enrollment is continuous for the full year. All good for the eligible population. However, I see they had a hospice election on October 14, 2026. This falls under **Exclusion E3** (Hospice during the measurement year). Therefore, this member is **Excluded**.
* **MEMBER 71022:** Age is 55 (DOB 1971-12-22), fitting the age requirement. Enrollment is continuous. No exclusions apply. For the numerator, they had a Stool DNA test on August 5, 2024. This aligns with the **N2 rule** (Stool DNA test in 2024-2026) as it falls within the three-year window. Thus, this member is **Compliant**.
* **MEMBER 71023:** Age is 63 (DOB 1963-07-10), which is appropriate. However, their enrollment runs from April 10, 2026, to December 31, 2026. This means they were not enrolled for the full measurement year (January 1 to December 31, 2026), and the gap from January 1 to April 9, 2026, is significantly more than the allowed 45 days. This member fails the continuous enrollment criterion and is therefore **Not Eligible**.
* **MEMBER 71024:** Age is 50 (DOB 1976-04-19), which is good. Enrollment is continuous for the full year. I've checked the exclusions: E4 doesn't apply as they are under 66. No other exclusions are present. Now, for compliance, I see a Colonoscopy on March 4, 2016. The **N5 rule** requires a colonoscopy between 2017 and 2026. The 2016 test is outside this 10-year window. Without any other qualifying screenings, this member is **Non-Compliant**.
* **MEMBER 71025:** Age is 50 (DOB 1976-05-12), which is correct. Continuous enrollment for the full year is confirmed. No exclusions apply, as E4 is for ages 66 and up. For numerator criteria, I found a Flexible sigmoidoscopy on September 25, 2023. This fits the **N3 rule** (Flexible sigmoidoscopy in 2022-2026) as it's within the five-year window. They also had a FIT on February 14, 2025, but that's not in 2026 for the N1 rule. Since one screening meets the criteria, this member is **Compliant**.
* **MEMBER 71026:** Their age on December 31, 2026, is 76 (DOB 1950-06-09). This is outside the required 46-75 age range. Therefore, this member is **Not Eligible**.
* **MEMBER 71027:** Age is 47 (DOB 1979-10-14), meeting the age requirement. Continuous enrollment for the full year is confirmed. No exclusions apply. They had a FIT on July 26, 2026. This directly meets the **N1 rule** (FOBT or FIT during 2026). This member is **Compliant**.
* **MEMBER 71028:** Their age on December 31, 2026, is 45 (DOB 1981-08-16). This is below the minimum age of 46. Thus, this member is **Not Eligible**.
* **MEMBER 71029:** Age is 66 (DOB 1960-09-06), within the 46-75 range. Continuous enrollment for the full year is confirmed. I've assessed exclusions: they are 66, so E4 is a possibility, but there's no documentation of frailty or advanced illness, so E4 does not apply. No other exclusions are noted. For compliance, I see a Colonoscopy on April 22, 2019. This falls within the **N5 rule** (Colonoscopy in 2017-2026) as it's within the 10-year window. They also had a Stool DNA test in 2024, which also meets the N2 rule. As they have at least one qualifying screening, this member is **Compliant**.
* **MEMBER 71030:** Their age on December 31, 2026, is 76 (DOB 1950-02-11). This exceeds the maximum age of 75. Therefore, this member is **Not Eligible**.
* **MEMBER 71031:** Age is 75 (DOB 1951-11-26), fitting the age requirement. Continuous enrollment for the full year is confirmed. No exclusions apply. However, upon reviewing their records, I found no documented colorectal cancer screening during the measurement year or prior relevant periods. Consequently, this member is **Non-Compliant**.
* **MEMBER 71032:** Age is 63 (DOB 1963-12-19), which is within the acceptable range. Enrollment, however, has gaps: one from March 31 to April 16, 2026 (17 days), and another from June 27 to July 8, 2026 (12 days). The measure specifies "no more than one gap of up to 45 days." This member has two gaps, violating the continuous enrollment rule. Therefore, this member is **Not Eligible**.
After processing each member individually, I've compiled the following statuses:
* **Compliant Members:** 71022, 71025, 71027, 71029 (4 members)
* **Non-Compliant Members:** 71024, 71031 (2 members)
* **Excluded Members:** 71021 (1 member)
* **Not Eligible Members:** 71023, 71026, 71028, 71030, 71032 (5 members)
This adds up to the full roster of 12 members.
Now, let's calculate the final metrics:
* The **denominator** (members eligible for the measure) is the sum of compliant and non-compliant members: 4 + 2 = 6.
* The **numerator** (compliant members) is 4.
* The number of **excluded** members is 1.
* The number of **not eligible** members is 5.
* The **rate** is calculated as (numerator / denominator) * 100 = (4 / 6) * 100. This gives me 66.666...%, which I will round to one decimal place, half up, resulting in **66.7%**.
So, the final breakdown is as follows:
* **Compliant Members:** ["71022", "71025", "71027", "71029"]
* **Non-Compliant Members:** ["71024", "71031"]
* **Excluded Members:** ["71021"]
* **Not Eligible Members:** ["71023", "71026", "71028", "71030", "71032"]
* **Denominator:** 6
* **Numerator:** 4
* **Excluded:** 1
* **Not Eligible:** 5
* **Rate:** 66.7%
I've cross-checked my logic for each member and the final calculations, and everything appears consistent with the measure specifications.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.2 · Z.ai28.2s · 1,740 out | 112.0s · 4,309 out | 20.0s · 1,667 out
Reasoning · 1,602 tokens
Let me work through each member systematically.
**Measure QM-CRC — Colorectal Cancer Screening**
- Measurement year: 2026-01-01 through 2026-12-31
- Eligible population: Age 46-75 as of 2026-12-31, continuous enrolment full year with no more than one gap of up to 45 days
- Exclusions evaluated before numerator
- Numerator criteria with look-back windows from 2026-12-31
Let me go member by member:
**MEMBER 71021**: DOB 1980-08-11, age 46 on 2026-12-31. ✅ Age eligible.
Enrolment: 2026-01-01 through 2026-12-31, continuous. ✅ Enrolment eligible.
Screening: 2023-11-23 Stool DNA test. N2 requires stool DNA during 2026 or two years prior (three-year window: 2024-2026). 2023 is outside this window. ❌ No numerator.
Exclusions: Hospice 2026-10-14 → E3 applies. Excluded.
Status: **excluded**
**MEMBER 71022**: DOB 1971-12-22, age 55. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: 2024-08-05 Stool DNA test. N2 three-year window (2024-2026). ✅ 2024 is within window.
Exclusions: None.
Status: **compliant**
**MEMBER 71023**: DOB 1963-07-10, age 63. ✅ Age eligible.
Enrolment: 2026-04-10 through 2026-12-31. Not enrolled before that. This is NOT continuous for the full measurement year - gap from 2026-01-01 to 2026-04-09 (more than 45 days). ❌ Not eligible.
Status: **not_eligible** (fails continuous enrolment)
**MEMBER 71024**: DOB 1976-04-19, age 50. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: 2016-03-04 Colonoscopy. N5 ten-year window (2017-2026). 2016 is outside window. ❌ No numerator.
Exclusions: Frailty 2026-08-18 AND advanced illness 2026-02-04. But E4 requires age 66+. Age 50. ❌ E4 doesn't apply.
No other exclusions.
Status: **non_compliant**
**MEMBER 71025**: DOB 1976-05-12, age 50. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: 2023-09-25 Flexible sigmoidoscopy (N3 five-year window: 2022-2026). 2023 is within. ✅ Also 2025-02-14 FIT (N1 requires during 2026 only). 2025 doesn't qualify for N1. But flexible sigmoidoscopy qualifies.
Exclusions: Frailty only, no advanced illness. Age 50, not 66+. E4 doesn't apply. No other exclusions.
Status: **compliant**
**MEMBER 71026**: DOB 1950-06-09, age 76. Age 76 > 75. ❌ Not age eligible.
Status: **not_eligible**
**MEMBER 71027**: DOB 1979-10-14, age 47. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: 2026-07-26 FIT. N1 during 2026. ✅
Exclusions: None.
Status: **compliant**
**MEMBER 71028**: DOB 1981-08-16, age 45. Age 45 < 46. ❌ Not age eligible.
Status: **not_eligible**
**MEMBER 71029**: DOB 1960-09-06, age 66. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: 2019-04-22 Colonoscopy (N5 ten-year window: 2017-2026). 2019 is within. ✅ Also 2024-09-15 Stool DNA (N2 three-year window: 2024-2026). 2024 within. ✅
Exclusions: Age 66+ but no frailty or advanced illness documented. E4 doesn't apply. No other exclusions.
Status: **compliant**
**MEMBER 71030**: DOB 1950-02-11, age 76. Age 76 > 75. ❌ Not age eligible.
Status: **not_eligible**
**MEMBER 71031**: DOB 1951-11-26, age 75. ✅ Age eligible.
Enrolment: continuous full year. ✅
Screening: None on record. ❌ No numerator.
Exclusions: None.
Status: **non_compliant**
**MEMBER 71032**: DOB 1963-12-19, age 63. ✅ Age eligible.
Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps: 2026-03-31 to 2026-04-16 (17 days), 2026-06-27 to 2026-07-08 (12 days). Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps → fails. ❌ Not eligible.
Status: **not_eligible**
Summary:
- Compliant: 71022, 71025, 71027, 71029 → 4
- Non-compliant: 71024, 71031 → 2
- Excluded: 71021 → 1
- Not eligible: 71023, 71026, 71028, 71030, 71032 → 5
Denominator = compliant + non_compliant = 4 + 2 = 6
Numerator = 4
Rate = 4/6 × 100 = 66.666... → 66.7
Let me verify:
- 71021: excluded (hospice)
- 71022: compliant
- 71023: not_eligible (enrolment)
- 71024: non_compliant
- 71025: compliant
- 71026: not_eligible (age 76)
- 71027: compliant
- 71028: not_eligible (age 45)
- 71029: compliant
- 71030: not_eligible (age 76)
- 71031: non_compliant
- 71032: not_eligible (two gaps)
Total: 4 + 2 + 1 + 5 = 12 ✓
Rate = 4/6 × 100 = 66.6667→ 66.7json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,111 tokens
Let me carefully analyze each member against the measure specification.
**MEASURE QM-CRC — COLORECTAL CANCER SCREENING**
- Measurement year: 2026-01-01 through 2026-12-31
- Eligible population: Age 46-75 as of 2026-12-31, continuous enrolment full year with no more than one gap of up to 45 days
- Numerator criteria:
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or two years prior (2024-2026)
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2021-2026)
- N4: CT colonography during 2026 or four years prior (2021-2026)
- N5: Colonoscopy during 2026 or nine years prior (2016-2026)
- Required exclusions:
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2: Total colectomy any time on or before 2026-12-31
- E3: Hospice at any time during the measurement year
- E4: Age 66+ as of 2026-12-31 AND both frailty AND advanced illness documented during the measurement year
Now let me go through each member:
**MEMBER 71021**
- DOB: 1980-08-11, age 46 on 2026-12-31 ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Screening: 2023-11-23 Stool DNA test
- N2: Stool DNA test during 2026 or two years prior (2024-2026). 2023 is not in 2024-2026. ✗
- No other screenings meet numerator criteria
- Hospice: 2026-10-14 Hospice election → E3 exclusion applies
- Status: In eligible population, meets exclusion E3 (hospice during measurement year)
- **Excluded**
**MEMBER 71022**
- DOB: 1971-12-22, age 55 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: 2024-08-05 Stool DNA test
- N2: Stool DNA test during 2026 or two years prior (2024-2026). 2024-08-05 is in this window. ✓
- No exclusions
- Status: In denominator, meets numerator
- **Compliant**
**MEMBER 71023**
- DOB: 1963-07-10, age 63 on 2026-12-31 ✓ (46-75)
- Enrolment: 2026-04-10 through 2026-12-31, not enrolled before 2026-04-10
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
- This member was not enrolled from 2026-01-01 to 2026-04-09 (about 99 days gap). This is more than one gap of up to 45 days.
- Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
- The member was not enrolled from Jan 1 to April 9. That's a gap of about 99 days. The spec says no more than one gap of up to 45 days. This gap exceeds 45 days.
- So this member does not meet continuous enrolment.
- Status: Not eligible (fails continuous enrolment)
- **Not eligible**
**MEMBER 71024**
- DOB: 1976-04-19, age 50 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: 2016-03-04 Colonoscopy
- N5: Colonoscopy during 2026 or nine years prior (2016-2026). 2016-03-04 is in this window (2016-2026). Wait, let me check: "during 2026 or the nine years prior" means 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. That's 2026 and 9 years prior = 2017-2026. 2016 would be 10 years prior.
Wait, let me re-read: "N5. Colonoscopy during 2026 or the nine years prior (ten-year window)."
So 2026 or the nine years prior. Nine years prior to 2026 would be 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. So the window is 2017-2026.
2016-03-04 is NOT in the window 2017-2026. It's 10 years prior.
So this member does NOT meet the numerator.
- Other history: Frailty documented 2026-08-18, Advanced illness documented 2026-02-04
- E4: Age 66+ AND frailty AND advanced illness. Age is 50, so E4 does not apply.
- No other exclusions
- Status: In denominator, does not meet numerator
- **Non-compliant**
Wait, let me double-check the colonoscopy window. "during 2026 or the nine years prior (ten-year window)."
A ten-year window would be 2017-2026 (10 years: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026). Or is it 2016-2026 (11 years)?
Actually, "2026 or the nine years prior" - the nine years prior to 2026 are 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. So the window is 2017-2026, which is a 10-year window.
2016-03-04 falls outside this window. So the colonoscopy from 2016 does not qualify.
Therefore, MEMBER 71024 does not meet the numerator. And since age is 50 (not 66+), E4 doesn't apply. No other exclusions.
**Non-compliant**
**MEMBER 71025**
- DOB: 1976-05-12, age 50 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: 2023-09-25 Flexible sigmoidoscopy; 2025-02-14 Faecal immunochemical test (FIT)
- N1: FOBT or FIT during 2026. 2025-02-14 is not in 2026. ✗
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2021-2026). 2023-09-25 is in this window. ✓
- Also N1 is FIT during 2026 only, and the FIT was in 2025, so N1 doesn't apply. But N3 applies.
Wait, let me re-read N1: "Faecal occult blood test or faecal immunochemical test during 2026."
The FIT was in 2025-02-14, not 2026. So N1 doesn't apply.
But N3: Flexible sigmoidoscopy during 2026 or four years prior (2021-2026). 2023-09-25 is in 2021-2026. ✓
So the member meets the numerator via N3.
- Other history: 2026-07-12 Frailty documented. No advanced illness. No hospice.
- E4 requires age 66+ AND frailty AND advanced illness. Age is 50, so no.
- No other exclusions
- Status: In denominator, meets numerator
- **Compliant**
**MEMBER 71026**
- DOB: 1950-06-09, age 76 on 2026-12-31. Age 76 is outside 46-75. ✗
- Status: Not eligible (age)
- **Not eligible**
**MEMBER 71027**
- DOB: 1979-10-14, age 47 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: 2026-07-26 Faecal immunochemical test (FIT)
- N1: FIT during 2026. ✓
- No exclusions
- Status: In denominator, meets numerator
- **Compliant**
**MEMBER 71028**
- DOB: 1981-08-16, age 45 on 2026-12-31. Age 45 is outside 46-75. ✗
- Status: Not eligible (age)
- **Not eligible**
**MEMBER 71029**
- DOB: 1960-09-06, age 66 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: 2019-04-22 Colonoscopy; 2024-09-15 Stool DNA test
- N5: Colonoscopy during 2026 or nine years prior (2017-2026). 2019-04-22 is in this window. ✓
- Also N2: Stool DNA test during 2026 or two years prior (2024-2026). 2024-09-15 is in this window. ✓
- Meets numerator via N5 (and N2).
- No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness
- E4: Age 66+ but no frailty and no advanced illness. Does not apply.
- No other exclusions
- Status: In denominator, meets numerator
- **Compliant**
**MEMBER 71030**
- DOB: 1950-02-11, age 76 on 2026-12-31. Age 76 is outside 46-75. ✗
- Status: Not eligible (age)
- **Not eligible**
**MEMBER 71031**
- DOB: 1951-11-26, age 75 on 2026-12-31 ✓ (46-75)
- Enrolment: continuous, no gaps ✓
- Screening: No colorectal screening on record
- Does not meet any numerator criteria.
- No exclusions
- Status: In denominator, does not meet numerator
- **Non-compliant**
**MEMBER 71032**
- DOB: 1963-12-19, age 63 on 2026-12-31 ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31
- Gap 1: 2026-03-30 to 2026-04-17 = 18 days (March 31, April 1-16 = 17 days gap? Let me count more carefully.)
Actually, let me count the gaps:
- Gap 1: From 2026-03-30 to 2026-04-17. The member was enrolled through 2026-03-30, and re-enrolled on 2026-04-17. The gap is from 2026-03-31 to 2026-04-16 = 17 days.
- Gap 2: From 2026-06-26 to 2026-07-09. The member was enrolled through 2026-06-26, and re-enrolled on 2026-07-09. The gap is from 2026-06-27 to 2026-07-08 = 12 days.
The spec says "no more than one gap of up to 45 days." This member has TWO gaps (17 and 12 days). The spec says "no more than one gap." This member has two gaps, so they fail continuous enrolment.
Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
This means: at most one gap, and that gap must be up to 45 days. Two gaps means the member does not meet continuous enrolment.
So this member fails continuous enrolment.
- Status: Not eligible (fails continuous enrolment - two gaps)
- **Not eligible**
Wait, but I need to also check the exclusion for this member since they have frailty. But since they're not eligible (fail continuous enrolment), they are not_eligible regardless of exclusions.
Let me re-read the rules: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
So MEMBER 71032 fails enrolment → not_eligible, even though they have frailty documented.
Let me now summarize:
**Compliant members:**
- 71022 (stool DNA 2024, meets N2)
- 71025 (flexible sigmoidoscopy 2023, meets N3)
- 71027 (FIT 2026, meets N1)
- 71029 (colonoscopy 2019, meets N5; also stool DNA 2024, meets N2)
**Non-compliant members:**
- 71024 (colonoscopy 2016, outside 10-year window; frailty + advanced illness but age 50, not 66+, so E4 doesn't apply)
- 71031 (no screening on record)
**Excluded members:**
- 71021 (hospice during measurement year, E3)
**Not eligible members:**
- 71023 (fails continuous enrolment - not enrolled Jan 1 to Apr 9)
- 71026 (age 76, outside 46-75)
- 71028 (age 45, outside 46-75)
- 71030 (age 76, outside 46-75)
- 71032 (fails continuous enrolment - two gaps)
Let me verify counts:
- Denominator (compliant + non-compliant): 4 + 2 = 6
- Numerator (compliant): 4
- Excluded: 1
- Not eligible: 5
- Total: 6 + 1 + 5 = 12 ✓
Rate = 4/6 × 100 = 66.666...% → 66.7 (rounded half up to one decimal place)
Let me double-check each member:
**71021**: Age 46 ✓, continuous enrolment ✓, hospice during MY ✓ → Excluded (E3)
- Even though the stool DNA test from 2023 doesn't meet N2 (2024-2026 window), the exclusion takes precedence anyway.
- Status: Excluded ✓
**71022**: Age 55 ✓, continuous enrolment ✓, stool DNA 2024-08-05 ✓ (N2: 2024-2026), no exclusions → Compliant ✓
**71023**: Age 63 ✓, but enrolment starts 2026-04-10 (not enrolled Jan 1 - Apr 9, gap > 45 days) → Not eligible ✓
**71024**: Age 50 ✓, continuous enrolment ✓
- Colonoscopy 2016-03-04: N5 window is 2017-2026 (2026 or nine years prior). 2016 is outside. ✗
- Frailty 2026-08-18, Advanced illness 2026-02-04, but age 50 (not 66+) → E4 doesn't apply
- No other exclusions
- → Non-compliant ✓
**71025**: Age 50 ✓, continuous enrolment ✓
- Flexible sigmoidoscopy 2023-09-25: N3 window is 2021-2026 (2026 or four years prior). 2023 is in window. ✓
- FIT 2025-02-14: N1 is FIT during 2026 only. 2025 doesn't qualify for N1. But N3 already qualifies.
- Frailty 2026-07-12, but no advanced illness, and age 50 (not 66+) → E4 doesn't apply
- → Compliant ✓
**71026**: Age 76 → Not eligible (age > 75) ✓
**71027**: Age 47 ✓, continuous enrolment ✓
- FIT 2026-07-26: N1 (FIT during 2026) ✓
- No exclusions
- → Compliant ✓
**71028**: Age 45 → Not eligible (age < 46) ✓
**71029**: Age 66 ✓, continuous enrolment ✓
- Colonoscopy 2019-04-22: N5 window is 2017-2026. 2019 is in window. ✓
- Stool DNA 2024-09-15: N2 window is 2024-2026. 2024 is in window. ✓
- No frailty, no advanced illness → E4 doesn't apply even though age 66+
- → Compliant ✓
**71030**: Age 76 → Not eligible (age > 75) ✓
**71031**: Age 75 ✓, continuous enrolment ✓
- No screening on record → doesn't meet numerator
- No exclusions
- → Non-compliant ✓
**71032**: Age 63 ✓, but enrolment has two gaps (17 and 12 days) → Not eligible (more than one gap) ✓
Final counts:
- Denominator: 6 (71022, 71024, 71025, 71027, 71029, 71031)
- Numerator: 4 (71022, 71025, 71027, 71029)
- Excluded: 1 (71021)
- Not eligible: 5 (71023, 71026, 71028, 71030, 71032)
- Rate: 4/6 × 100 = 66.666... → 66.7json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,529 tokens
Let me analyze each member against the measure specification.
**Measure QM-CRC — Colorectal Cancer Screening**
- Measurement year: 2026-01-01 through 2026-12-31
- Eligible: Age 46-75 as of 2026-12-31, continuous enrolment full year with no more than one gap of up to 45 days
- Numerator: any of N1-N5
- Exclusions: E1 (CRC C18-C21), E2 (total colectomy), E3 (hospice during MY), E4 (age 66+ AND both frailty and advanced illness during MY)
**Member 71021**: DOB 1980-08-11, age 46 on 2026-12-31. ✓ age eligible. Enrolment continuous full year. ✓
Screening: 2023-11-23 Stool DNA test. N2: stool DNA during 2026 or two years prior (three-year window: 2024-2026). 2023 is outside the window. So no numerator met.
Exclusion: E3 hospice 2026-10-14 → hospice during MY. Excluded.
Status: excluded.
**Member 71022**: DOB 1971-12-22, age 55. ✓ age. Enrolment continuous. ✓
Screening: 2024-08-05 Stool DNA test. N2: three-year window 2024-2026. 2024-08-05 falls within. Numerator met.
No exclusions. Status: compliant.
**Member 71023**: DOB 1963-07-10, age 63. ✓ age. Enrolment 2026-04-10 through 2026-12-31. Not enrolled before that. Continuous enrolment requires full measurement year with no more than one gap of up to 45 days. This member was not enrolled for the full year — enrolled only from April 10. Gap from Jan 1 to Apr 9 is more than 45 days. Not eligible.
Wait, "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means the member must be enrolled for the full year, allowing at most one gap of up to 45 days. Member 71023 was not enrolled from Jan 1 to Apr 9 — that's a gap of about 99 days, exceeding 45 days. Not eligible.
Status: not_eligible.
**Member 71024**: DOB 1976-04-19, age 50. ✓ age. Enrolment continuous. ✓
Screening: 2016-03-04 Colonoscopy. N5: colonoscopy during 2026 or nine years prior (ten-year window: 2017-2026). 2016 is outside. No numerator.
Exclusion E4: age 66+ required. Age 50. Not excluded.
Status: non_compliant.
**Member 71025**: DOB 1976-05-12, age 50. ✓ age. Enrolment continuous. ✓
Screening: 2023-09-25 Flexible sigmoidoscopy (N3: five-year window 2022-2026 → within window). Numerator met. Also 2025-02-14 FIT (N1: during 2026 only — 2025 doesn't count for N1). But N3 is met.
Exclusion: frailty documented but age 50, so E4 doesn't apply. No other exclusions.
Status: compliant.
**Member 71026**: DOB 1950-06-09, age 76. Age 76 > 75. Not eligible.
Status: not_eligible.
**Member 71027**: DOB 1979-10-14, age 47. ✓ age. Enrolment continuous. ✓
Screening: 2026-07-26 FIT. N1: FOBT/FIT during 2026. Numerator met.
No exclusions. Status: compliant.
**Member 71028**: DOB 1981-08-16, age 45. Age 45 < 46. Not eligible.
Status: not_eligible.
**Member 71029**: DOB 1960-09-06, age 66. ✓ age (46-75). Enrolment continuous. ✓
Screening: 2019-04-22 Colonoscopy (N5: ten-year window 2017-2026 → within). Numerator met. Also 2024-09-15 Stool DNA (N2: three-year window 2024-2026 → also met).
Exclusion E4: age 66+ AND both frailty and advanced illness. No frailty or advanced illness documented. Not excluded.
Status: compliant.
**Member 71030**: DOB 1950-02-11, age 76. Age 76 > 75. Not eligible.
Status: not_eligible.
**Member 71031**: DOB 1951-11-26, age 75. ✓ age (46-75). Enrolment continuous. ✓
Screening: none. No numerator.
No exclusions. Status: non_compliant.
**Member 71032**: DOB 1963-12-19, age 63. ✓ age. Enrolment: 2026-01-01 to 2026-03-30; 2026-04-17 to 2026-06-26; 2026-07-09 to 2026-12-31. Gaps of 17 and 12 days. Two gaps — the rule allows no more than one gap. So not eligible.
Wait, let me reconsider. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This member has two gaps (17 days and 12 days). Two gaps exceeds "no more than one gap." Not eligible.
Screening: 2015-10-17 Colonoscopy — N5 window 2017-2026, 2015 is outside. But doesn't matter since not eligible.
Frailty documented but no advanced illness, and age 63 (not 66+). E4 wouldn't apply anyway.
Status: not_eligible.
Let me tally:
- Compliant: 71022, 71025, 71027, 71029 → 4
- Non-compliant: 71024, 71031 → 2
- Excluded: 71021 → 1
- Not eligible: 71023, 71026, 71028, 71030, 71032 → 5
Denominator = compliant + non-compliant = 4 + 2 = 6
Numerator = 4
Excluded = 1
Not eligible = 5
Rate = 4/6 × 100 = 66.666... → 66.7
Total members: 4 + 2 + 1 + 5 = 12 ✓json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
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"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
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"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
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"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Opus 4.8 · Anthropic16.6s · 1,270 out | 15.9s · 1,123 out | 16.8s · 1,218 out
Reasoning · 1,111 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
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"fabricated": false,
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}Reasoning · 964 tokens
[omitted]json{
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"rate": 66.7,
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Grader detail
json{
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"present": true
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"fabricated": false,
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}Reasoning · 1,059 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
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}
Grader detail
json{
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}100Claude Sonnet 5 · Anthropic19.8s · 2,173 out | 26.4s · 2,550 out | 18.1s · 1,822 out
Reasoning · 2,014 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
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}
Grader detail
json{
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{
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"want": [
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],
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"present": true
},
{
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"want": [
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],
"got": [
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],
"ok": true,
"present": true
},
{
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"want": [
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"ok": true,
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}
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"fabricated": false,
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}Reasoning · 2,391 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
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"excluded_members": ["71021"],
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}
Grader detail
json{
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"want": 6,
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{
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"got": 4,
"ok": true,
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"want": [
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"got": [
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"71031"
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"ok": true,
"present": true
},
{
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"want": [
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],
"got": [
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],
"ok": true,
"present": true
},
{
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"want": [
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],
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}
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"fabricated": false,
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}Reasoning · 1,663 tokens
[omitted]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
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"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
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},
{
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"want": 1,
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},
{
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"got": 5,
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},
{
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},
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"field": "compliant_members",
"want": [
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},
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"field": "non_compliant_members",
"want": [
"71024",
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],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Sonnet 4.6 · Anthropic55.0s · 3,578 out | 51.6s · 3,360 out | 50.3s · 3,109 out
Reasoning · 3,437 tokens
Let me work through each member systematically.
**ELIGIBLE POPULATION CRITERIA:**
- Age: 46-75 as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**MEMBER 71021**
- Age: 46 ✓ (born 1980-08-11)
- Enrollment: 2026-01-01 through 2026-12-31, continuous ✓
- Eligible population: Yes
- No CRC, no colectomy, but hospice enrollment on 2026-10-14 during the measurement year excludes this member.
**MEMBER 71022**
- Age 55, continuous enrollment, eligible, no exclusions. Checking numerator criteria — a stool DNA test from 2024-08-05 needs to be evaluated against the three-year lookback window running through 2026.
That test date falls within the qualifying window, so this member is compliant.
**MEMBER 71023**
- Age 63, but enrollment only starts 2026-04-10, leaving a 99-day gap from the start of the year — far exceeding the allowed 45-day gap, so this member isn't eligible since they lack full-year coverage.
**MEMBER 71024**
- Age 50, continuous enrollment, eligible population — now checking exclusion E4 relating to age 66.
I'm rechecking the colonoscopy screening dates against the required ten-year lookback window, since nine years prior to 2026-12-31 would put the cutoff around 2016-12-31, and I need to verify whether their 2016-03-04 test falls inside or outside that boundary.
Working through the boundary date: nine years prior to 2026-12-31 lands on 2016-12-31, so the window likely starts 2017-01-01. Since member 71024's colonoscopy was 2016-03-04, that falls outside the ten-year window regardless of exactly how the boundary is drawn, making them non-compliant.
So that date falls before 2017-01-01 and doesn't qualify — member 71024 is non_compliant.
For member 71025, age 50 passes the eligibility and continuous enrollment checks, and none of the exclusions apply since those require age 66+. Looking at the numerator, a flexible sigmoidoscopy from 2023-09-25 falls within the five-year window of 2022-01-01 through 2026-12-31, and there's also a FIT test in 2025 — either one satisfies the requirement, so this member is compliant.
Member 71026 is age 76, outside the eligible 46-75 range, so not_eligible. Member 71027 at age 47 passes enrollment checks with no exclusions, and a FIT test during 2026 makes them compliant. Member 71028 at age 45 falls outside the eligible range too, so not_eligible.
Now checking member 71029, age 66 — I need to verify whether the frailty and advanced illness exclusion applies, but no such documentation exists.
Not excluded, and no other exclusions apply. Colonoscopy from 2019 falls within the ten-year lookback window, and a stool DNA test from 2024 also qualifies within its three-year window, so this member is compliant. Member 71030 at age 76 is outside the eligible range, so not_eligible. Member 71031 at age 75 passes enrollment and has no exclusions, but lacks any screening on record, making them non_compliant. Now I'm checking member 71032, age 63, whose enrollment period only runs from January through March 2026.
Member 71032's enrollment has two separate gaps rather than one, which violates the continuous enrollment requirement of allowing only a single gap up to 45 days — so this member is not_eligible despite each individual gap being under the threshold. I'm now moving on to compile the final classification results.
Continuing: 71031 (no screening) and 71032 (two enrollment gaps) are both not eligible or non-compliant respectively. Double-checking the date windows confirms 71022 and 71025 fall within their required ranges, while 71024's 2016 colonoscopy falls just outside the ten-year window, making it non-compliant with no exclusion applicable since the patient is only 50. Tallying up: compliant count is 4 (71022, 71025, 71027, 71029), non-compliant is 2 (71024, 71031), giving a denominator of 6, with one exclusion (71021) and the remaining cases falling into not_eligible.
That gives a rate of 4/6 = 66.7%. Verifying 71023's enrollment gap of 99 days at the start of the year confirms it's correctly excluded from eligibility, and I'm now checking 71032's two enrollment gaps of 17 and 12 days to confirm its status.
Since the policy allows no more than one gap, having two gaps regardless of their individual length makes 71032 not_eligible as well. So my final tally stands: denominator 6, numerator 4, 1 excluded, 5 not_eligible, giving a compliance rate of 66.7%.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"71025",
"71027",
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],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,219 tokens
Let me analyze each member against the measure specification.
**ELIGIBLE POPULATION criteria:**
- Age: 46-75 as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**MEMBER 71021** - DOB 1980-08-11, age 46 on 2026-12-31 ✓
- Enrollment: 2026-01-01 through 2026-12-31, continuous ✓
- Eligible population: YES
- Exclusions:
- E3: Hospice on 2026-10-14 (during measurement year) → EXCLUDED
- Status: excluded
**MEMBER 71022** - DOB 1971-12-22, age 55 ✓, continuous enrollment ✓, no exclusions
- Numerator: N2 stool DNA test on 2024-08-05 falls within the three-year window (2024-01-01 through 2026-12-31) ✓
- Status: compliant
**MEMBER 71023** - DOB 1963-07-10, age 63 ✓ but enrollment only starts 2026-04-10, leaving a roughly 99-day gap from Jan 1 that exceeds the 45-day maximum. I'm weighing whether this counts as a true "gap" versus simply not being enrolled at the start of the year, which would mean they fail the full-year enrollment requirement either way.
**MEMBER 71024** - Status: not_eligible
- DOB 1976-04-19, age 50 ✓, continuous enrollment ✓, eligible population confirmed. E4 exclusion doesn't apply since it requires age 66+ and this member is only 50, and frailty alone without meeting the age threshold doesn't exclude them either.
- Numerator: N5 colonoscopy on 2016-03-04 falls outside the ten-year window (2017-01-01 through 2026-12-31), so it doesn't count. No other qualifying screenings found.
- Status: non_compliant
**MEMBER 71025** - DOB 1976-05-12, age 50 ✓, continuous enrollment ✓, eligible. E4 exclusion doesn't apply (age 50, below 66 threshold).
- Checking N1: FIT test on 2025-02-14 doesn't qualify since it needs to fall within 2026. Now checking N3 for an alternative qualifying test.
**MEMBER 71026** through the next several members: flexible sigmoidoscopy on 2023-09-25 falls within the five-year window (2022-01-01 through 2026-12-31), making 71025 compliant. Member 71026 is excluded from the eligible population since age 76 exceeds the 75 cutoff. Member 71027, age 47, has a qualifying FIT test on 2026-07-26 within 2026, making them compliant. Member 71028 is excluded for being under 46. Member 71029, age 66, doesn't meet the E4 exclusion since it requires both frailty and advanced illness documentation, neither of which is present—now checking their stool DNA test from 2024-09-15 against the three-year window.
That test falls within 2024-01-01 through 2026-12-31, so 71029 is compliant. Member 71030 is excluded for exceeding age 75. Member 71031, age 75, has no colorectal screening on record, making them non-compliant. Member 71032, age 63, has two enrollment gaps (17 days and 12 days)—I'm checking the continuous enrollment rule, which only permits one gap of up to 45 days, so having two gaps disqualifies this member from the eligible population regardless of gap length.
Now I'm compiling the final categorization across all members. For not_eligible: 71023 (enrollment issue), 71026 (age 76), 71028 (age 45), 71030 (age 76), and 71032 (two gaps). For excluded: 71021 under hospice criteria E3. For compliant: 71022, 71025, 71027, and 71029, each with valid screening records within their respective lookback windows. For non_compliant: 71024, whose colonoscopy from 2016 falls outside the ten-year window, and 71031, who has no screening on file.
I'm double-checking the lookback windows for each screening type—N2 spans 2024-2026, N3 spans 2022-2026, and N5 spans roughly 2017-2026—to confirm 71024's 2016-03-04 colonoscopy falls just outside the acceptable range, and I'm working through the precise date math for the nine-year prior boundary.
I'm working out the exact date boundaries for the look-back window, trying to pin down whether it starts January 1st of the year nine years prior.
That confirms it: 2026 minus 9 equals 2017, so the window spans 2017 through 2026, a full ten years. So the start date should be 2017-01-01, not 2016.
Now checking member 71024's colonoscopy date of 2016-03-04 — that falls before 2017-01-01, meaning it's outside the ten-year window, so this member is non_compliant.
Moving on to re-verify member 71025, I'm looking at N3's flexible sigmoidoscopy from 2023-09-25 against the five-year window ending 2026-12-31.
The window runs from 2022-01-01 to 2026-12-31, and the 2023-09-25 date falls within it. There's also a FIT test on 2025-02-14, but N1 requires the test occur "during 2026" specifically, and 2025 doesn't qualify, so this member is compliant based on N3 alone.
Now checking member 71021: age 46 with full-year enrollment puts them in the eligible population, but a hospice date of 2026-10-14 means the E3 exclusion applies.
Their stool DNA test from 2023-11-23 falls outside the three-year window (2024-01-01 to 2026-12-31), though it doesn't matter since the member is already excluded.
Tallying up the results: the denominator includes 71022, 71024, 71025, 71027, 71029, and 71031 (6 members), the numerator includes 71022, 71025, 71027, and 71029 (4 compliant), 71021 is excluded, and 71023, 71026, 71028, 71030, 71032 are not eligible. That gives a rate of 4/6, or 66.7%. Let me verify these counts once more.
Total checks out: denominator (6) + excluded (1) + not eligible (5) = 12 total members, matching. So the final rate calculation of 4/6 × 100 = 66.666...% rounds to 66.7%.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,968 tokens
Let me analyze each member against the measure specification.
**ELIGIBLE POPULATION criteria:**
- Age: 46-75 as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**MEMBER 71021** — DOB 1980-08-11, age 46. Enrolled 2026-01-01 through 2026-12-31, no gaps. Age ✓, enrollment ✓ → in eligible population.
- Exclusions: E3 - Hospice elected 2026-10-14 during measurement year → EXCLUDED.
- **MEMBER 71022** — DOB 1971-12-22, age 55. Enrolled full year, no gaps, no exclusions. Stool DNA test on 2024-08-05 falls within the compliant window (2024-01-01 through 2026-12-31) → COMPLIANT.
- **MEMBER 71023** — DOB 1963-07-10, age 63, enrollment starting 2026-04-10, checking eligibility next.
Calculating the enrollment gap: from 2026-01-01 to 2026-04-09 is 99 days, well over the 45-day allowance → NOT ELIGIBLE.
- **MEMBER 71024** — DOB 1976-04-19, age 50, enrolled full year, in eligible population. E4 exclusion (age 66+) doesn't apply since they're 50; no other exclusions found. Now checking colonoscopy from 2016-03-04 against the N5 screening window.
The ten-year lookback for N5 runs from 2017-01-01 through 2026-12-31, so a 2016-03-04 colonoscopy falls just outside that window. With no other qualifying screenings, this member appears NON-COMPLIANT — though I want to double-check I'm calculating that ten-year window correctly.
Moving to member 71025: age 50, fully enrolled, no exclusions apply since E4 needs age 66+. Their flexible sigmoidoscopy from 2023-09-25 falls within the five-year N3 window (2022-2026), so this one looks COMPLIANT.
Now moving on to check the next member, 71026, born 1950-06.
Age 76 exceeds the eligible cutoff of 75, so this member is not eligible.
**MEMBER 71027** — age 47, enrolled full year with no gaps, meets age and enrollment criteria, no exclusions, and has a compliant FIT screening from July 2026.
**MEMBER 71028** — age 45, falls below the minimum age of 46, so not eligible.
**MEMBER 71029** — age 66, enrolled full year with no gaps, no exclusions found. I'm now checking their 2019 colonoscopy against the ten-year lookback window requirement.
Both the 2019-04-22 colonoscopy and the 2024-09-15 stool DNA test fall within their respective lookback windows, so this member is compliant. The next member, DOB 1950-02-11, is age 76 and exceeds the eligibility cutoff. Following that, a member born 1951-11-26 is exactly age 75, meets enrollment criteria with no exclusions, but has no screenings on record, making them non-compliant. I'm now looking at a member with a partial-year enrollment gap of 17 days to determine if it falls within allowable limits.
Confirming both gaps: 17 days and 12 days, so two separate gaps means the continuous enrollment requirement fails → NOT ELIGIBLE. I'm now compiling the eligibility results across cases: 71023 fails due to enrollment gap, 71026 and 71030 fail due to age over 75, 71028 fails due to age under 46, and 71032 fails due to multiple enrollment gaps.
71021 is excluded for hospice care during the measurement year, leaving a denominator of six members (71022, 71024, 71025, 71027, 71029, 71031). Checking compliance, 71022 meets criteria via stool DNA testing within the three-year window, 71025 via flexible sigmoidoscopy within five years, 71027 via FIT testing, and 71029 via colonoscopy within the ten-year window.
71024 is non-compliant since its 2016 colonoscopy falls outside the ten-year window, and 71031 had no screening at all -- giving four compliant out of six eligible, or a 66.7% rate. Now I'm double-checking enrollment dates, starting with 71023's coverage period from April through December 2026.
Working through this, I find a gap from January 1 to April 9 totaling 99 days, well over the 45-day threshold, which makes 71023 not eligible. I also confirm 71022's stool DNA test from August 2024 falls within the required window, and I'm now checking the flexible sigmoidoscopy date for 71025.
Confirming that falls within the four-year window too, so it passes. Moving to 71029, I check its colonoscopy from 2019, which fits comfortably within the nine-year window. But for 71024, the colonoscopy from March 2016 falls just before the window starts on January 1, 2017, so it doesn't qualify.
With 4 out of 6 compliant, the rate works out to 66.7%.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.7 Max · Alibaba51.8s · 3,701 out | 60.6s · 4,331 out | 48.9s · 3,502 out
Reasoning · 3,526 tokens
Let me evaluate each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION:**
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: full measurement year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
**NUMERATOR (look-back from 2026-12-31):**
- N1. FOBT or FIT during 2026
- N2. Stool DNA test during 2026 or the two years prior (three-year window: 2024-01-01 through 2026-12-31)
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31)
- N4. CT colonography during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31)
- N5. Colonoscopy during 2026 or the nine years prior (ten-year window: 2017-01-01 through 2026-12-31)
**EXCLUSIONS:**
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2. Total colectomy any time on or before 2026-12-31
- E3. Hospice at any time during the measurement year
- E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year
Let me evaluate each member:
---
**MEMBER 71021:**
- DOB: 1980-08-11, age 46 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions:
- E3: Hospice election on 2026-10-14 during measurement year. → EXCLUDED
- Status: **excluded**
---
**MEMBER 71022:**
- DOB: 1971-12-22, age 55 on 2026-12-31. ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions: None documented. Not excluded.
- Numerator:
- Stool DNA test on 2024-08-05. Window for N2: 2024-01-01 through 2026-12-31. 2024-08-05 is within this window. ✓
- Status: **compliant**
---
**MEMBER 71023:**
- DOB: 1963-07-10, age 63 on 2026-12-31. ✓
- Enrolment: 2026-04-10 through 2026-12-31. Not enrolled before 2026-04-10. Gap from 2026-01-01 to 2026-04-09 is about 99 days. That's more than one gap of up to 45 days. Actually, let me re-read: "no more than one gap of up to 45 days." The member is not enrolled from 2026-01-01 to 2026-04-09, which is a gap of 99 days at the start. This exceeds 45 days.
- Eligible: No (fails continuous enrolment)
- Status: **not_eligible**
---
**MEMBER 71024:**
- DOB: 1976-04-19, age 50 on 2026-12-31. ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions:
- E4: Age 66 or older? No, age 50. So E4 does not apply.
- Frailty documented 2026-08-18, advanced illness 2026-02-04. But age is 50, not 66+. So not excluded.
- Numerator:
- Colonoscopy on 2016-03-04. Window for N5: 2017-01-01 through 2026-12-31. 2016-03-04 is before 2017-01-01. Not within window.
- No other screening.
- Status: **non_compliant**
---
**MEMBER 71025:**
- DOB: 1976-05-12, age 50 on 2026-12-31. ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions:
- E4: Age 50, not 66+. Not excluded.
- Frailty documented 2026-07-12, but no advanced illness. Not excluded anyway due to age.
- Numerator:
- Flexible sigmoidoscopy on 2023-09-25. Window for N3: 2022-01-01 through 2026-12-31. 2023-09-25 is within window. ✓
- FIT on 2025-02-14. Window for N1: during 2026. 2025-02-14 is not during 2026. Not counted for N1.
- Status: **compliant** (via N3)
---
**MEMBER 71026:**
- DOB: 1950-06-09, age 76 on 2026-12-31. ✗ (outside 46-75 range)
- Eligible: No (age 76)
- Status: **not_eligible**
---
**MEMBER 71027:**
- DOB: 1979-10-14, age 47 on 2026-12-31. ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions: None. Not excluded.
- Numerator:
- FIT on 2026-07-26. Window for N1: during 2026. 2026-07-26 is during 2026. ✓
- Status: **compliant**
---
**MEMBER 71028:**
- DOB: 1981-08-16, age 45 on 2026-12-31. ✗ (outside 46-75 range)
- Eligible: No (age 45)
- Status: **not_eligible**
---
**MEMBER 71029:**
- DOB: 1960-09-06, age 66 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions:
- E4: Age 66 or older? Yes, age 66. Both frailty and advanced illness? No, neither documented. Not excluded.
- Numerator:
- Colonoscopy on 2019-04-22. Window for N5: 2017-01-01 through 2026-12-31. 2019-04-22 is within window. ✓
- Stool DNA test on 2024-09-15. Window for N2: 2024-01-01 through 2026-12-31. 2024-09-15 is within window. ✓
- Status: **compliant**
---
**MEMBER 71030:**
- DOB: 1950-02-11, age 76 on 2026-12-31. ✗ (outside 46-75 range)
- Eligible: No (age 76)
- Status: **not_eligible**
---
**MEMBER 71031:**
- DOB: 1951-11-26, age 75 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous. ✓
- Eligible: Yes
- Exclusions: None. Not excluded.
- Numerator:
- No colorectal screening on record.
- Status: **non_compliant**
---
**MEMBER 71032:**
- DOB: 1963-12-19, age 63 on 2026-12-31. ✓
- Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31.
- Gap 1: 2026-03-31 to 2026-04-16 = 17 days
- Gap 2: 2026-06-27 to 2026-07-08 = 12 days
- Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means more than one gap. So this fails continuous enrolment.
- Eligible: No (fails continuous enrolment - more than one gap)
- Status: **not_eligible**
Let me recount:
**Compliant:** 71022, 71025, 71027, 71029 → 4 members
**Non-compliant:** 71024, 71031 → 2 members
**Excluded:** 71021 → 1 member
**Not eligible:** 71023, 71026, 71028, 71030, 71032 → 5 members
Denominator = compliant + non_compliant = 4 + 2 = 6
Numerator = 4
Excluded = 1
Not eligible = 5
Rate = 4 / 6 × 100 = 66.666... → rounded half up to one decimal = 66.7
Let me double-check member 71025's flexible sigmoidoscopy:
- Date: 2023-09-25
- N3 window: 2026 or the four years prior = 2022-01-01 through 2026-12-31
- 2023-09-25 is within this window. ✓ Compliant.
Let me double-check member 71024's colonoscopy:
- Date: 2016-03-04
- N5 window: 2026 or the nine years prior = 2017-01-01 through 2026-12-31
- 2016-03-04 is before 2017-01-01. Not within window. ✗ Non-compliant.
Let me double-check member 71022's stool DNA:
- Date: 2024-08-05
- N2 window: 2026 or the two years prior = 2024-01-01 through 2026-12-31
- 2024-08-05 is within this window. ✓ Compliant.
Let me double-check member 71029:
- Age 66, no frailty or advanced illness. E4 requires both frailty AND advanced illness AND age 66+. She doesn't have either, so not excluded.
- Colonoscopy 2019-04-22, N5 window 2017-01-01 to 2026-12-31. Within window. ✓ Compliant.
Let me double-check member 71032 enrolment:
- Gap 1: 2026-03-31 to 2026-04-16. Let me count days: March 31 to April 16.
- March has 31 days. So March 31 is the last day of coverage. Gap starts April 1.
- April 1 to April 16 = 16 days. But the record says gap of 17 days. Let me just trust the record which says 17 days.
- Gap 2: June 27 to July 8. Record says 12 days.
- Two gaps, each ≤ 45 days, but the rule says "no more than one gap of up to 45 days." So two gaps fails.
- Not eligible.
Everything checks out. Let me finalize:
Denominator: 6
Numerator: 4
Excluded: 1
Not eligible: 5
Rate: 66.7
Compliant: ["71022", "71025", "71027", "71029"]
Non-compliant: ["71024", "71031"]
Excluded: ["71021"]
Not eligible: ["71023", "71026", "71028", "71030", "71032"]json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,156 tokens
Let me evaluate each member against the measure specification for QM-CRC — Colorectal Cancer Screening.
**ELIGIBLE POPULATION (denominator)**
- Age: 46 through 75 years as of 2026-12-31.
- Continuous enrolment: the full measurement year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
**NUMERATOR** — any one of the following, by the look-back window measured back from 2026-12-31:
- N1. Faecal occult blood test or faecal immunochemical test during 2026.
- N2. Stool DNA test during 2026 or the two years prior (three-year window: 2024-01-01 through 2026-12-31).
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31).
- N4. CT colonography during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31).
- N5. Colonoscopy during 2026 or the nine years prior (ten-year window: 2017-01-01 through 2026-12-31).
**REQUIRED EXCLUSIONS**
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31.
- E2. Total colectomy any time on or before 2026-12-31.
- E3. Hospice at any time during the measurement year.
- E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Let me evaluate each member:
**MEMBER 71021**
- DOB: 1980-08-11, age 46 on 2026-12-31. ✓ Age eligible.
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓ Enrolment eligible.
- So eligible population.
- Exclusions:
- E3: Hospice election on 2026-10-14. This is during the measurement year. → EXCLUDED (E3).
- Screening: Stool DNA test on 2023-11-23. The three-year window for N2 is 2024-01-01 through 2026-12-31. 2023-11-23 is before 2024-01-01, so this does NOT meet N2.
- But exclusions are evaluated before numerator. Since excluded, status is **excluded**.
**MEMBER 71022**
- DOB: 1971-12-22, age 55 on 2026-12-31. ✓ Age eligible.
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions: None documented. Not excluded.
- Screening: Stool DNA test on 2024-08-05. Three-year window for N2: 2024-01-01 through 2026-12-31. 2024-08-05 is within this window. ✓ Meets N2.
- Status: **compliant**.
**MEMBER 71023**
- DOB: 1963-07-10, age 63 on 2026-12-31. ✓ Age eligible.
- Enrolment: 2026-04-10 through 2026-12-31. Not enrolled before 2026-04-10. This means there's a gap from 2026-01-01 to 2026-04-09, which is about 99 days. This is more than 45 days and is more than one gap (well, it's one gap but it's >45 days). Actually, the member wasn't enrolled at the start of the year. The requirement is "the full measurement year with no more than one gap of up to 45 days." If the member wasn't enrolled from 2026-01-01, that's a gap of 99 days from the start. This exceeds 45 days. → NOT ELIGIBLE (enrolment).
- Status: **not_eligible**.
**MEMBER 71024**
- DOB: 1976-04-19, age 50 on 2026-12-31. ✓ Age eligible.
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions:
- E4: Age 66 or older? Age is 50. No. E4 does not apply.
- Frailty documented 2026-08-18, advanced illness documented 2026-02-04. But age is 50, not 66+. So E4 does not apply.
- Not excluded.
- Screening: Colonoscopy on 2016-03-04. Ten-year window for N5: 2017-01-01 through 2026-12-31. 2016-03-04 is before 2017-01-01. Does NOT meet N5.
- No other screenings.
- Status: **non_compliant**.
**MEMBER 71025**
- DOB: 1976-05-12, age 50 on 2026-12-31. ✓ Age eligible.
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions:
- E4: Age 50, not 66+. Does not apply.
- Frailty documented but no advanced illness. E4 requires both. Does not apply.
- Not excluded.
- Screening:
- Flexible sigmoidoscopy on 2023-09-25. Five-year window for N3: 2022-01-01 through 2026-12-31. 2023-09-25 is within this window. ✓ Meets N3.
- Faecal immunochemical test on 2025-02-14. N1 requires during 2026. 2025 is not 2026. Does not meet N1.
- But already meets N3.
- Status: **compliant**.
**MEMBER 71026**
- DOB: 1950-06-09, age 76 on 2026-12-31. Age 76 is outside the 46-75 range. → NOT ELIGIBLE (age).
- Status: **not_eligible**.
**MEMBER 71027**
- DOB: 1979-10-14, age 47 on 2026-12-31. ✓ Age eligible.
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions: None. Not excluded.
- Screening: Faecal immunochemical test on 2026-07-26. N1: during 2026. ✓ Meets N1.
- Status: **compliant**.
**MEMBER 71028**
- DOB: 1981-08-16, age 45 on 2026-12-31. Age 45 is outside the 46-75 range. → NOT ELIGIBLE (age).
- Status: **not_eligible**.
**MEMBER 71029**
- DOB: 1960-09-06, age 66 on 2026-12-31. ✓ Age eligible (46-75, 66 is within).
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions:
- E4: Age 66 or older? Yes, age 66. Both frailty AND advanced illness? No frailty or advanced illness documented. E4 does not apply.
- Not excluded.
- Screening:
- Colonoscopy on 2019-04-22. Ten-year window for N5: 2017-01-01 through 2026-12-31. 2019-04-22 is within this window. ✓ Meets N5.
- Stool DNA test on 2024-09-15. Three-year window for N2: 2024-01-01 through 2026-12-31. 2024-09-15 is within this window. ✓ Also meets N2.
- Status: **compliant**.
**MEMBER 71030**
- DOB: 1950-02-11, age 76 on 2026-12-31. Age 76 is outside the 46-75 range. → NOT ELIGIBLE (age).
- Status: **not_eligible**.
**MEMBER 71031**
- DOB: 1951-11-26, age 75 on 2026-12-31. ✓ Age eligible (46-75, 75 is within).
- Enrolment: continuous, no gaps. ✓ Enrolment eligible.
- Exclusions: None. Not excluded.
- Screening: No colorectal screening on record. Does not meet numerator.
- Status: **non_compliant**.
**MEMBER 71032**
- DOB: 1963-12-19, age 63 on 2026-12-31. ✓ Age eligible.
- Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31.
- Gap 1: 2026-03-31 to 2026-04-16 = 17 days.
- Gap 2: 2026-06-27 to 2026-07-08 = 12 days.
- Two gaps. The requirement is "no more than one gap of up to 45 days." Two gaps means more than one gap. → NOT ELIGIBLE (enrolment).
- Status: **not_eligible**.
Let me double-check the gap calculation for 71032:
- Enrolled 2026-01-01 through 2026-03-30. Next enrolled 2026-04-17.
- Gap: 2026-03-31 through 2026-04-16. That's 17 days (March 31 to April 16 inclusive = 17 days).
- Enrolled 2026-04-17 through 2026-06-26. Next enrolled 2026-07-09.
- Gap: 2026-06-27 through 2026-07-08. That's 12 days (June 27 to July 8 inclusive = 12 days).
- Two gaps, each under 45 days, but the rule says "no more than one gap." Two gaps > one gap. → NOT ELIGIBLE.
Now let me compile the results:
**Compliant:** 71022, 71025, 71027, 71029 → 4 members
**Non-compliant:** 71024, 71031 → 2 members
**Excluded:** 71021 → 1 member
**Not eligible:** 71023, 71026, 71028, 71030, 71032 → 5 members
Total: 4 + 2 + 1 + 5 = 12. ✓
Denominator = compliant + non_compliant = 4 + 2 = 6
Numerator = compliant = 4
Excluded = 1
Not eligible = 5
Rate = (4 / 6) × 100 = 66.666... → rounded half up to one decimal place = 66.7
Let me double-check member 71021:
- Age 46, eligible age.
- Enrolment continuous, eligible enrolment.
- Hospice election 2026-10-14 during measurement year → E3 exclusion.
- Excluded. ✓
Let me double-check member 71022:
- Age 55, eligible.
- Continuous enrolment, eligible.
- Stool DNA test 2024-08-05. N2 window: 2024-01-01 to 2026-12-31. 2024-08-05 is in window. ✓
- Compliant. ✓
Let me double-check member 71023:
- Age 63, eligible.
- Enrolment from 2026-04-10. Gap from 2026-01-01 to 2026-04-09 = 99 days. More than 45 days. → Not eligible. ✓
Let me double-check member 71024:
- Age 50, eligible.
- Continuous, eligible.
- E4: age 50, not 66+. Doesn't apply.
- Colonoscopy 2016-03-04. N5 window: 2017-01-01 to 2026-12-31. 2016-03-04 is before 2017-01-01. Not in window.
- No other screenings. Non-compliant. ✓
Let me double-check member 71025:
- Age 50, eligible.
- Continuous, eligible.
- E4: age 50, not 66+. Doesn't apply.
- Flexible sigmoidoscopy 2023-09-25. N3 window: 2022-01-01 to 2026-12-31. 2023-09-25 is in window. ✓
- Compliant. ✓
Let me double-check member 71026:
- Age 76. Not in 46-75 range. Not eligible. ✓
Let me double-check member 71027:
- Age 47, eligible.
- Continuous, eligible.
- FIT 2026-07-26. N1: during 2026. ✓
- Compliant. ✓
Let me double-check member 71028:
- Age 45. Not in 46-75 range. Not eligible. ✓
Let me double-check member 71029:
- Age 66, eligible (46-75 includes 66).
- Continuous, eligible.
- E4: age 66, but no frailty or advanced illness. Doesn't apply.
- Colonoscopy 2019-04-22. N5 window: 2017-01-01 to 2026-12-31. 2019-04-22 is in window. ✓
- Compliant. ✓
Let me double-check member 71030:
- Age 76. Not in 46-75 range. Not eligible. ✓
Let me double-check member 71031:
- Age 75, eligible (46-75 includes 75).
- Continuous, eligible.
- No screenings. Non-compliant. ✓
Let me double-check member 71032:
- Age 63, eligible.
- Two gaps (17 and 12 days). More than one gap. Not eligible. ✓
Summary:
- Compliant: 71022, 71025, 71027, 71029 (4)
- Non-compliant: 71024, 71031 (2)
- Excluded: 71021 (1)
- Not eligible: 71023, 71026, 71028, 71030, 71032 (5)
Denominator: 6
Numerator: 4
Excluded: 1
Not eligible: 5
Rate: 4/6 × 100 = 66.666... → 66.7json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,327 tokens
Let me evaluate each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION:**
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: full measurement year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
**NUMERATOR (any one of):**
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or the two years prior (2024, 2025, 2026)
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (2022, 2023, 2024, 2025, 2026)
- N4: CT colonography during 2026 or the four years prior (2022-2026)
- N5: Colonoscopy during 2026 or the nine years prior (2017-2026)
**REQUIRED EXCLUSIONS:**
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2: Total colectomy any time on or before 2026-12-31
- E3: Hospice at any time during the measurement year (2026)
- E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year
Let me go through each member:
---
**MEMBER 71021:**
- DOB: 1980-08-11, age 46 on 2026-12-31 → eligible age
- Enrolment: 2026-01-01 through 2026-12-31, continuous → eligible
- Screening: 2023-11-23 Stool DNA test → N2 requires 2024, 2025, or 2026. 2023 is outside the 3-year window. Not numerator.
- Other: 2026-10-14 Hospice election → E3 exclusion (hospice during measurement year)
- Status: **excluded** (E3)
---
**MEMBER 71022:**
- DOB: 1971-12-22, age 55 on 2026-12-31 → eligible age
- Enrolment: continuous → eligible
- Screening: 2024-08-05 Stool DNA test → N2: 2024 is within the 3-year window (2024-2026). Yes, numerator.
- No exclusions.
- Status: **compliant**
---
**MEMBER 71023:**
- DOB: 1963-07-10, age 63 on 2026-12-31 → eligible age
- Enrolment: 2026-04-10 through 2026-12-31. Not enrolled before 2026-04-10. Gap from 2026-01-01 to 2026-04-09 is about 99 days. That's more than 45 days. So continuous enrolment is NOT met.
- Status: **not_eligible** (fails enrolment)
---
**MEMBER 71024:**
- DOB: 1976-04-19, age 50 on 2026-12-31 → eligible age
- Enrolment: continuous → eligible
- Screening: 2016-03-04 Colonoscopy → N5 requires 2017-2026. 2016 is outside the 10-year window. Not numerator.
- Other: Frailty documented 2026-08-18, Advanced illness documented 2026-02-04. Age 50, so E4 does not apply (requires age 66+).
- Status: **non_compliant**
---
**MEMBER 71025:**
- DOB: 1976-05-12, age 50 on 2026-12-31 → eligible age
- Enrolment: continuous → eligible
- Screening:
- 2023-09-25 Flexible sigmoidoscopy → N3 requires 2022-2026. 2023 is within the 5-year window. Yes, numerator.
- 2025-02-14 FIT → N1 requires during 2026. 2025 is not 2026. Not N1. But N3 is already met.
- Other: Frailty documented 2026-07-12. Age 50, so E4 does not apply.
- Status: **compliant**
Wait, let me re-check N1. N1 says "Faecal occult blood test or faecal immunochemical test during 2026." The FIT was 2025-02-14, so not during 2026. But the flexible sigmoidoscopy in 2023 meets N3. So numerator is met.
---
**MEMBER 71026:**
- DOB: 1950-06-09, age 76 on 2026-12-31 → NOT eligible age (46-75). 76 is outside.
- Status: **not_eligible** (age)
---
**MEMBER 71027:**
- DOB: 1979-10-14, age 47 on 2026-12-31 → eligible age
- Enrolment: continuous → eligible
- Screening: 2026-07-26 FIT → N1: during 2026. Yes, numerator.
- No exclusions.
- Status: **compliant**
---
**MEMBER 71028:**
- DOB: 1981-08-16, age 45 on 2026-12-31 → NOT eligible age (46-75). 45 is outside.
- Status: **not_eligible** (age)
---
**MEMBER 71029:**
- DOB: 1960-09-06, age 66 on 2026-12-31 → eligible age (46-75, 66 is within range)
- Enrolment: continuous → eligible
- Screening:
- 2019-04-22 Colonoscopy → N5: 2017-2026. 2019 is within the 10-year window. Yes, numerator.
- 2024-09-15 Stool DNA test → N2: 2024-2026. 2024 is within. Yes, also numerator.
- No exclusions. Age 66, but no frailty or advanced illness documented.
- Status: **compliant**
---
**MEMBER 71030:**
- DOB: 1950-02-11, age 76 on 2026-12-31 → NOT eligible age (46-75). 76 is outside.
- Status: **not_eligible** (age)
---
**MEMBER 71031:**
- DOB: 1951-11-26, age 75 on 2026-12-31 → eligible age (46-75, 75 is within range)
- Enrolment: continuous → eligible
- Screening: No colorectal screening on record → not numerator
- No exclusions.
- Status: **non_compliant**
---
**MEMBER 71032:**
- DOB: 1963-12-19, age 63 on 2026-12-31 → eligible age
- Enrolment: 2026-01-01 to 2026-03-30; gap to 2026-04-17 (17 days); 2026-04-17 to 2026-06-26; gap to 2026-07-09 (12 days); 2026-07-09 to 2026-12-31.
Wait, let me count the gaps more carefully.
- First gap: 2026-03-31 to 2026-04-16. That's 17 days (March 31 to April 16 = 17 days).
- Second gap: 2026-06-27 to 2026-07-08. That's 12 days.
The rule says "no more than one gap of up to 45 days." There are TWO gaps here. Even though both are under 45 days, there are two gaps, not one. So continuous enrolment is NOT met.
- Status: **not_eligible** (fails enrolment - more than one gap)
Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
Two gaps means it fails the "no more than one gap" requirement. So not_eligible.
---
Let me summarize:
**Compliant:** 71022, 71025, 71027, 71029 → 4 members
**Non-compliant:** 71024, 71031 → 2 members
**Excluded:** 71021 → 1 member
**Not eligible:** 71023, 71026, 71028, 71030, 71032 → 5 members
Denominator = compliant + non_compliant = 4 + 2 = 6
Numerator = 4
Excluded = 1
Not eligible = 5
Rate = 4 / 6 × 100 = 66.666... → rounded half up to one decimal = 66.7
Let me double-check each member one more time.
**71021:** Age 46 ✓, enrolment continuous ✓, eligible population ✓. Hospice during 2026 → E3 exclusion. Excluded. ✓
**71022:** Age 55 ✓, enrolment continuous ✓. Stool DNA 2024-08-05 → N2 window is 2024-2026 (three years: 2026, 2025, 2024). 2024-08-05 is in 2024. Yes. Compliant. ✓
**71023:** Age 63 ✓. Enrolment starts 2026-04-10. Gap from start of year is Jan 1 to Apr 9 = 99 days. That's one gap but it's more than 45 days. Not eligible. ✓
**71024:** Age 50 ✓, enrolment continuous ✓. Colonoscopy 2016-03-04 → N5 window is 2017-2026. 2016 is outside. Not numerator. Frailty + advanced illness but age 50, E4 requires 66+. Non-compliant. ✓
**71025:** Age 50 ✓, enrolment continuous ✓. Flex sig 2023-09-25 → N3 window is 2022-2026 (five years: 2026, 2025, 2024, 2023, 2022). 2023 is within. Yes, numerator. Compliant. ✓
**71026:** Age 76. Not eligible (age > 75). ✓
**71027:** Age 47 ✓, enrolment continuous ✓. FIT 2026-07-26 → N1: during 2026. Yes. Compliant. ✓
**71028:** Age 45. Not eligible (age < 46). ✓
**71029:** Age 66 ✓, enrolment continuous ✓. Colonoscopy 2019-04-22 → N5 window 2017-2026. Yes. Compliant. ✓
**71030:** Age 76. Not eligible (age > 75). ✓
**71031:** Age 75 ✓, enrolment continuous ✓. No screening. Non-compliant. ✓
**71032:** Age 63 ✓. Two gaps in enrolment (17 days and 12 days). More than one gap → fails continuous enrolment. Not eligible. ✓
Totals:
- Denominator: 6
- Numerator: 4
- Excluded: 1
- Not eligible: 5
- Rate: 66.7
Compliant: ["71022", "71025", "71027", "71029"]
Non-compliant: ["71024", "71031"]
Excluded: ["71021"]
Not eligible: ["71023", "71026", "71028", "71030", "71032"]
All 12 members accounted for: 4 + 2 + 1 + 5 = 12. ✓json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 · Z.ai26.9s · 2,634 out | 20.6s · 2,567 out | 29.3s · 4,189 out
Reasoning · 1,818 tokens
Let me work through each member against the QM-CRC specification.
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population:
- Age 46 through 75 as of 2026-12-31.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
Numerator (look-back from 2026-12-31):
- N1: FOBT/FIT during 2026 (i.e., 2026-01-01 to 2026-12-31).
- N2: Stool DNA during 2026 or two years prior — three-year window: 2024-01-01 through 2026-12-31.
- N3: Flex sig during 2026 or four years prior — five-year window: 2022-01-01 through 2026-12-31.
- N4: CT colonography same five-year window: 2022-01-01 through 2026-12-31.
- N5: Colonoscopy during 2026 or nine years prior — ten-year window: 2017-01-01 through 2026-12-31.
Exclusions:
- E1: CRC (C18-C21) any time on or before 2026-12-31.
- E2: Total colectomy any time on or before 2026-12-31.
- E3: Hospice at any time during the measurement year (2026).
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Order: check eligibility first (age, enrolment). Then exclusions (only for eligible). Then numerator.
MEMBER 71021. DOB 1980-08-11 → 46 on 2026-12-31. Age 46, in range. Enrolment: continuous full year. Eligible.
Exclusions: Hospice election 2026-10-14 — during the measurement year. E3 applies. Excluded.
(Screening: 2023-11-23 stool DNA — outside the three-year window anyway, but exclusion takes precedence.)
Status: excluded.
MEMBER 71022. DOB 1971-12-22 → 55. In range. Continuous enrolment. Eligible.
Exclusions: none.
Numerator: Stool DNA 2024-08-05 — N2 window is 2026 or two years prior: 2024, 2025, 2026. 2024-08-05 falls within. Compliant.
Status: compliant.
MEMBER 71023. DOB 1963-07-10 → 63. Age in range. Enrolment: 2026-04-10 through 2026-12-31, not enrolled before. Not continuously enrolled the full measurement year. Continuous enrolment requires the full measurement year (with allowance of one gap up to 45 days). This member was not enrolled 2026-01-01 to 2026-04-09 — that's a gap of ~99 days from 01-01 to 04-09... Actually the requirement: "the full measurement year with no more than one gap of up to 45 days." Not enrolled Jan 1 – Apr 9 is more than a 45-day absence. So not eligible.
Status: not_eligible.
MEMBER 71024. DOB 1976-04-19 → 50. In range. Continuous enrolment. Eligible.
Exclusions: Frailty documented 2026-08-18, advanced illness 2026-02-04. But age 50, E4 requires age 66+. So no exclusion.
Numerator: Colonoscopy 2016-03-04. N5 window: 2017-01-01 through 2026-12-31 (ten-year window: 2026 or the nine years prior → 2017–2026). 2016-03-04 is outside the window (more than nine years prior; nine years prior to 2026 would be 2017). So does not meet numerator.
Status: non_compliant.
MEMBER 71025. DOB 1976-05-12 → 50. In range. Continuous enrolment. Eligible.
Exclusions: Frailty 2026-07-12, but age 50 < 66, and no advanced illness. No exclusion.
Numerator: FIT 2025-02-14. N1 is FIT during 2026 only. 2025-02-14 is not during 2026. Hmm — N1: "Faecal occult blood test or faecal immunochemical test during 2026." So FIT in 2025 doesn't count. Flex sig 2023-09-25: N3 window is 2026 or four years prior → 2022-01-01 through 2026-12-31. 2023-09-25 is within. So N3 met.
Status: compliant.
MEMBER 71026. DOB 1950-06-09 → 76 on 2026-12-31. Age 76 > 75. Not eligible.
Status: not_eligible.
MEMBER 71027. DOB 1979-10-14 → 47. In range. Continuous. Eligible.
Exclusions: none.
Numerator: FIT 2026-07-26 — N1 met.
Status: compliant.
MEMBER 71028. DOB 1981-08-16 → 45 on 2026-12-31. Age 45 < 46. Not eligible.
Status: not_eligible.
MEMBER 71029. DOB 1960-09-06 → 66 on 2026-12-31. In range (66 ≤ 75). Continuous. Eligible.
Exclusions: Age 66+, but no frailty and no advanced illness documented. E4 requires both. No exclusion. No CRC, colectomy, hospice.
Numerator: Colonoscopy 2019-04-22 — within 2017–2026 ten-year window. N5 met. Also stool DNA 2024-09-15 within three-year window. Compliant.
Status: compliant.
MEMBER 71030. DOB 1950-02-11 → 76 on 2026-12-31. Age 76 > 75. Not eligible.
Status: not_eligible.
MEMBER 71031. DOB 1951-11-26 → 75 on 2026-12-31. In range (75 is upper bound). Continuous. Eligible.
Exclusions: none.
Numerator: no screening on record. Non-compliant.
Status: non_compliant.
MEMBER 71032. DOB 1963-12-19 → 63. In range. Enrolment: 2026-01-01 to 2026-03-30; gap 2026-03-31 to 2026-04-16 = 17 days; 2026-04-17 to 2026-06-26; gap 2026-06-27 to 2026-07-08 = 12 days; 2026-07-09 to 2026-12-31. Two gaps. Continuous enrolment allows "no more than one gap of up to 45 days." Two gaps → not eligible. Even though each gap is under 45 days, there are two gaps. So not eligible.
Status: not_eligible.
Wait — let me reconsider. The member is enrolled 2026-01-01 through 2026-03-30, then 2026-04-17 through 2026-06-26, then 2026-07-09 through 2026-12-31. Gaps: March 31 – April 16 (17 days) and June 27 – July 8 (12 days). That's two gaps. The spec says "no more than one gap of up to 45 days." Two gaps violates it. Not eligible.
Also frailty documented but age 63 and no advanced illness anyway — moot since not eligible.
Now tally:
- Compliant: 71022, 71025, 71027, 71029 → 4
- Non-compliant: 71024, 71031 → 2
- Excluded: 71021 → 1
- Not eligible: 71023, 71026, 71028, 71030, 71032 → 5
Total: 4+2+1+5 = 12. ✓
Denominator = compliant + non_compliant = 4 + 2 = 6. (Exclusions removed from denominator per definition: "members in the eligible population after exclusions are removed (compliant + non_compliant)".)
Numerator = 4.
Excluded = 1.
Not eligible = 5.
Rate = 4/6 × 100 = 66.666...% → rounded half up to one decimal: 66.7.
Let me double check the eligible pool before exclusions: 71021, 71022, 71024, 71025, 71027, 71029, 71031 = 7 members. Minus 1 exclusion (71021) = 6 denominator. ✓
Check 71024 again: colonoscopy 2016-03-04. Ten-year window measured back from 2026-12-31: "during 2026 or the nine years prior" — years 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026. 2016 is not in it. Correct, non_compliant. Alternatively, if interpreted as a strict 10-year look-back from 2026-12-31 (i.e., dates on or after 2016-12-31), 2016-03-04 still falls outside. Either way non_compliant. Good.
Check 71023: colonoscopy 2018-02-20 would be within the window, but enrolment fails. Not eligible takes precedence.
Check 71021: 46 years old — DOB 1980-08-11; on 2026-12-31 they turn 46 on 1980+46=2026-08-11. Yes, 46. In range. Hospice during 2026 → excluded. Even though their stool DNA 2023-11-23 is outside window, exclusion is evaluated before numerator, and they'd be excluded regardless.
Rate: 4/6 = 0.666666... × 100 = 66.6666... → 66.7 rounded half up to one decimal.
Output JSON:
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,743 tokens
Let me work through each member carefully.
Measure QM-CRC: CRC screening, MY 2026-01-01 to 2026-12-31.
Eligible population:
- Age 46-75 as of 2026-12-31.
- Continuous enrolment: full MY with no more than one gap of up to 45 days.
Numerator:
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window): so 2024-01-01 through 2026-12-31 (2026, 2025, 2024).
- N3: Flex sig during 2026 or four years prior (five-year window): 2022-01-01 through 2026-12-31.
- N4: CT colonography: same five-year window: 2022-2026.
- N5: Colonoscopy during 2026 or nine years prior (ten-year window): 2017-01-01 through 2026-12-31.
Exclusions:
- E1: CRC (C18-C21) any time on or before 2026-12-31.
- E2: Total colectomy any time.
- E3: Hospice any time during MY.
- E4: Age ≥66 AND both frailty and advanced illness documented during MY.
Order: not_eligible (age, event, enrolment) first; then exclusions; then numerator.
MEMBER 71021. DOB 1980-08-11, 46 on 2026-12-31. Age OK (46-75). Enrolment continuous full year — OK. Eligible.
Exclusions: Hospice 2026-10-14 — during MY → E3 applies. Excluded.
(Also note stool DNA 2023-11-23 is outside three-year window anyway, but exclusion takes precedence and they'd be excluded regardless.)
Status: excluded.
MEMBER 71022. 55, continuous enrolment. Eligible.
No exclusions. Numerator: stool DNA 2024-08-05 — within 2024-2026 window → N2 met. Compliant.
MEMBER 71023. 63 on 2026-12-31. Age OK. Enrolment: 2026-04-10 through 2026-12-31, not enrolled before. That's not continuous enrolment for the full MY. The gap 2026-01-01 to 2026-04-09 is about 98 days — more than 45 days. Even allowing "no more than one gap of up to 45 days", a gap from Jan 1 to Apr 10 is 98 days. So fails continuous enrolment → not_eligible.
Colonoscopy 2018-02-20 is also outside ten-year window (2017-2026? Actually 2018-02-20 IS within 2017-01-01 to 2026-12-31 ten-year window). Wait: N5: colonoscopy during 2026 or nine years prior. Nine years prior to 2026 = 2017-2025. So window is 2017-01-01 through 2026-12-31. 2018-02-20 falls within. But enrolment fails, so not_eligible regardless.
Status: not_eligible.
MEMBER 71024. 50, continuous. Eligible.
Exclusions: age 50 < 66, so E4 doesn't apply even with frailty + advanced illness. No hospice, no CRC, no colectomy.
Numerator: colonoscopy 2016-03-04 — ten-year window is 2017-01-01 through 2026-12-31. 2016-03-04 is outside. So no numerator.
Status: non_compliant.
MEMBER 71025. 50, continuous. Eligible.
Exclusions: frailty documented 2026-07-12, but age 50 < 66 → E4 doesn't apply. No advanced illness documented anyway. No other exclusions.
Numerator: FIT 2025-02-14 — N1 requires FIT during 2026. 2025 doesn't count for N1. Flex sig 2023-09-25 — N3 five-year window: 2022-01-01 through 2026-12-31. 2023-09-25 is within → N3 met.
Status: compliant.
MEMBER 71026. DOB 1950-06-09, 76 on 2026-12-31. Age outside 46-75 → not_eligible.
(Stool DNA 2023 would be outside window anyway, but age fails first.)
Status: not_eligible.
MEMBER 71027. 47, continuous. Eligible. FIT 2026-07-26 → N1 met. Compliant.
MEMBER 71028. DOB 1981-08-16, 45 on 2026-12-31. Age outside (need 46-75) → not_eligible.
Flex sig 2024 would be in window, but age fails.
Status: not_eligible.
MEMBER 71029. DOB 1960-09-06, 66 on 2026-12-31. Age OK. Continuous. Eligible.
Exclusions: age 66 — E4 requires BOTH frailty and advanced illness documented during MY. None documented. So no E4. No hospice, no CRC, no colectomy.
Numerator: stool DNA 2024-09-15 — within three-year window (2024-2026) → N2 met. Also colonoscopy 2019-04-22 within ten-year window → N5 met. Compliant.
MEMBER 71030. DOB 1950-02-11, 76 on 2026-12-31. Age outside → not_eligible.
Status: not_eligible.
MEMBER 71031. DOB 1951-11-26, 75 on 2026-12-31. Age OK (75 is within 46-75). Continuous. Eligible.
No exclusions. No screening on record → numerator not met.
Status: non_compliant.
MEMBER 71032. DOB 1963-12-19, 63. Age OK. Enrolment: 2026-01-01 to 2026-03-30; gap 2026-03-31 to 2026-04-16 (17 days); 2026-04-17 to 2026-06-26; gap 2026-06-27 to 2026-07-08 (12 days); 2026-07-09 to 2026-12-31. Two gaps. Spec says "no more than one gap of up to 45 days". Two gaps → fails continuous enrolment → not_eligible.
Also: frailty documented 2026-02-04, age 63 < 66 → E4 wouldn't apply anyway. Colonoscopy 2015-10-17 outside ten-year window. But enrolment fails → not_eligible.
Status: not_eligible.
Wait — let me double check the gap counting for 71032. Enrolment segments: 2026-01-01 through 2026-03-30, then 2026-04-17 through 2026-06-26, then 2026-07-09 through 2026-12-31. The roster itself states "Gaps of 17 and 12 days." Two gaps. Spec allows no more than one gap. So not_eligible. Correct.
Now compile:
Compliant: 71022, 71025, 71027, 71029 → 4
Non-compliant: 71024, 71031 → 2
Excluded: 71021 → 1
Not eligible: 71023, 71026, 71028, 71030, 71032 → 5
Total: 4+2+1+5 = 12. ✓
Denominator = compliant + non_compliant = 6.
Numerator = 4.
Excluded = 1.
Not eligible = 5.
Rate = 4/6 × 100 = 66.666... → rounded half up to one decimal = 66.7.
Let me double-check age for 71029: DOB 1960-09-06 → on 2026-12-31, age 66. Yes, 66 (birthday Sept 6 passed). E4 requires age 66+ AND frailty AND advanced illness. She has none documented. Fine.
Double-check 71021: 46 years old. DOB 1980-08-11 → on 2026-12-31, 46. Yes. Hospice 2026-10-14 during MY → E3. Excluded. Even though stool DNA 2023-11-23 is outside N2 window (2024-2026), she's excluded either way. Correct status: excluded (exclusions evaluated before numerator; she's in eligible population).
Double-check 71024: age 50, frailty + advanced illness both documented during MY, but age < 66 → E4 doesn't apply. Colonoscopy 2016-03-04: ten-year window 2017-2026 → outside. Non-compliant. Correct.
Double-check 71025: flex sig 2023-09-25 — five-year window: 2026 or the four years prior = 2022, 2023, 2024, 2025, 2026. 2023-09-25 in window → compliant. Also FIT 2025-02-14 doesn't count for N1 (must be during 2026), but flex sig suffices. Compliant.
Double-check 71022: stool DNA 2024-08-05 — three-year window: 2026, 2025, 2024. In window. Compliant.
71027: FIT 2026-07-26 → N1. Compliant.
71031: age 75 — "46 through 75" inclusive. 75 qualifies. No screening → non-compliant.
Rate: 4/6 = 0.666666... ×100 = 66.666...% → 66.7 rounded half up to one decimal.
Member IDs as strings: "71021", etc.
JSON output:
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,126 tokens
Let me work through each member carefully.
Measure QM-CRC, measurement year 2026-01-01 through 2026-12-31.
Eligible population:
- Age: 46 through 75 as of 2026-12-31.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Numerator (look-back windows measured back from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window: 2024-01-01 through 2026-12-31, effectively). Let me think: "during 2026 or the two years prior" = 2024, 2025, 2026. So dates from 2024-01-01 through 2026-12-31.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022-01-01 through 2026-12-31).
- N4: CT colonography during 2026 or four years prior (2022-01-01 through 2026-12-31).
- N5: Colonoscopy during 2026 or nine years prior (2017-01-01 through 2026-12-31).
Exclusions:
- E1: CRC (C18-C21) any time on or before 2026-12-31.
- E2: Total colectomy any time on or before 2026-12-31.
- E3: Hospice at any time during the measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Status definitions:
- not_eligible: fails age, event, or enrolment.
- excluded: in eligible population but meets a required exclusion.
- Exclusions evaluated before numerator; only for members in eligible population. A member who meets both an exclusion and the numerator is excluded, not compliant.
- compliant: in denominator, not excluded, meets numerator.
- non_compliant: in denominator, not excluded, does not meet numerator.
Now the roster:
MEMBER 71021. DOB 1980-08-11, 46 years old on 2026-12-31. Age 46 — within 46-75. Enrolment continuous full year. So eligible population-wise fine.
Screening: 2023-11-23 Stool DNA test. Stool DNA window: 2024-01-01 to 2026-12-31. 2023-11-23 is outside the window (2023 is three years prior, but window is only two years prior). So no numerator from that.
Other history: 2026-10-14 Hospice election. Hospice during the measurement year (2026) — E3 exclusion. She is in the eligible population (age 46, continuous enrolment), meets exclusion E3. So status: excluded.
MEMBER 71022. DOB 1971-12-22, 55 on 2026-12-31. Age OK. Enrolment continuous.
Screening: 2024-08-05 Stool DNA. Window 2024-2026 — yes, within three-year window. Numerator met.
No exclusions. Status: compliant.
MEMBER 71023. DOB 1963-07-10, 63 on 2026-12-31. Age OK. Enrolment: 2026-04-10 through 2026-12-31, not enrolled before 2026-04-10. So not continuously enrolled for the full measurement year — she's missing Jan 1 through Apr 9, which is way more than 45 days gap. Continuous enrolment requires full measurement year with no more than one gap of up to 45 days. Being enrolled only from April 10 means the initial period 2026-01-01 to 2026-04-09 is not covered. That's a gap of over 45 days (about 3+ months). So not_eligible due to enrolment.
Wait — is the "event" in enrolment? The status definitions say "not eligible: never enters the eligible population (age, event, or enrolment)". So enrolment failure = not_eligible. Yes.
71023: not_eligible.
Screening history: 2018-02-20 colonoscopy — within ten-year window (2017-2026), would meet numerator, but she's not eligible due to enrolment. Doesn't matter.
MEMBER 71024. DOB 1976-04-19, 50 on 2026-12-31. Age OK. Enrolment continuous.
Screening: 2016-03-04 colonoscopy. Ten-year window: 2017-01-01 through 2026-12-31 (2026 or the nine years prior). 2016-03-04 is outside. So no numerator.
Other history: Frailty documented 2026-08-18 (R26.2), advanced illness documented 2026-02-04 (heart failure I50.22). E4 requires age 66 or older. He's 50. So E4 doesn't apply — frailty and advanced illness both documented during MY, but age requirement fails. No other exclusions. So he's in denominator, no numerator → non_compliant.
Note: E4 requires both frailty and advanced illness documented during the measurement year. Here both are during 2026. But age 50 < 66, so not excluded. Non_compliant.
MEMBER 71025. DOB 1976-05-12, 50 on 2026-12-31. Age OK. Enrolment continuous.
Screening: 2023-09-25 flexible sigmoidoscopy — five-year window is 2022-01-01 through 2026-12-31. 2023-09-25 within window → numerator met (N3). Also 2025-02-14 FIT — N1 requires FIT during 2026 only. 2025 FIT doesn't count for N1. But flex sig 2023 counts.
Other history: 2026-07-12 frailty documented. Only frailty, no advanced illness. Age 50 anyway, so E4 doesn't apply. No exclusions. Numerator met → compliant.
MEMBER 71026. DOB 1950-06-09, 76 on 2026-12-31. Age 76 — outside 46-75. not_eligible (age). Even though stool DNA 2023 would be outside window anyway; doesn't matter.
MEMBER 71027. DOB 1979-10-14, 47 on 2026-12-31. Age OK. Enrolment continuous.
Screening: 2026-07-26 FIT — N1 met. No exclusions. Compliant.
MEMBER 71028. DOB 1981-08-16, 45 on 2026-12-31. Age 45 — below 46. not_eligible (age). Even though flex sig 2024-10-15 would be within five-year window; doesn't matter.
MEMBER 71029. DOB 1960-09-06, 66 on 2026-12-31. Age 66 — within range. Enrolment continuous.
Screening: 2019-04-22 colonoscopy — ten-year window 2017-2026: yes, 2019 is within → N5 met. Also 2024-09-15 stool DNA — within three-year window 2024-2026 → N2 met. Either way, numerator met.
No exclusions: no CRC, no colectomy, no hospice, no frailty/advanced illness. She's 66, but E4 requires both frailty and advanced illness documented — none documented. So not excluded. Compliant.
MEMBER 71030. DOB 1950-02-11, 76 on 2026-12-31. Age 76 — outside 46-75. not_eligible (age).
MEMBER 71031. DOB 1951-11-26, 75 on 2026-12-31. Age 75 — within 46-75 (inclusive). Enrolment continuous.
Screening: none on record. No exclusions documented (no CRC, colectomy, hospice, frailty/advanced illness). So in denominator, no numerator → non_compliant.
MEMBER 71032. DOB 1963-12-19, 63 on 2026-12-31. Age OK. Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps: 2026-03-31 through 2026-04-16 = 17 days; 2026-06-27 through 2026-07-08 = 12 days. Two gaps. Continuous enrolment requirement: full measurement year with no more than one gap of up to 45 days. She has two gaps. So fails continuous enrolment → not_eligible.
Hmm, let me double check the gap calculation. Enrolment 2026-01-01 to 2026-03-30, then re-enrolled 2026-04-17. Gap from 03-31 to 04-16 inclusive = 17 days. Then enrolled 2026-04-17 to 2026-06-26, gap 06-27 to 07-08 = 12 days. Then enrolled 07-09 to 12-31. So two gaps, each within 45 days, but "no more than one gap" — two gaps exceeds. Not eligible.
The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So two gaps fail. not_eligible.
Note: E4 — age 63, so even with frailty documented, no age eligibility for E4. But she's not_eligible anyway due to enrolment.
Screening: 2015-10-17 colonoscopy — outside ten-year window anyway.
So summarizing:
- 71021: excluded (E3 hospice during MY). In eligible population (age 46, continuous enrolment). Excluded.
- 71022: compliant (N2 stool DNA 2024).
- 71023: not_eligible (enrolment — not full year).
- 71024: non_compliant (no numerator within windows; E4 doesn't apply due to age 50).
- 71025: compliant (N3 flex sig 2023).
- 71026: not_eligible (age 76).
- 71027: compliant (N1 FIT 2026).
- 71028: not_eligible (age 45).
- 71029: compliant (N5 colonoscopy 2019, also N2 stool DNA 2024).
- 71030: not_eligible (age 76).
- 71031: non_compliant (age 75, no screening).
- 71032: not_eligible (enrolment — two gaps).
Counts:
- denominator = compliant + non_compliant = 4 + 2 = 6.
- numerator = 4.
- excluded = 1.
- not_eligible = 5 (71023, 71026, 71028, 71030, 71032).
- rate = 4/6 × 100 = 66.666...% → rounded half up to one decimal = 66.7.
Let me double-check rate rounding: 4/6 = 0.666666..., ×100 = 66.6666...%, one decimal → 66.7.
Lists:
- compliant_members: ["71022", "71025", "71027", "71029"]
- non_compliant_members: ["71024", "71031"]
- excluded_members: ["71021"]
- not_eligible_members: ["71023", "71026", "71028", "71030", "71032"]
Total 12 members: 4+2+1+5 = 12. ✓
Now double-check each edge:
71021: age 46 (DOB 1980-08-11 → on 2026-12-31 she's 46). Enrolment continuous. Hospice 2026-10-14 during MY → E3. Exclusions evaluated before numerator; she's in eligible population. Even though her stool DNA was 2023-11-23 (outside window, so no numerator anyway), she's excluded. Status: excluded. ✓
Wait — is there any question about whether hospice makes her "not eligible"? No — hospice is an exclusion (E3), not an eligibility criterion. The eligible population is defined by age and enrolment. She meets both. So excluded. ✓
71024: E4 requires age 66+ AND both frailty and advanced illness during MY. He has both documented during MY but is 50. Not excluded. Numerator: colonoscopy 2016-03-04 — window is 2026 or nine years prior = 2017-01-01 through 2026-12-31. 2016-03-04 is outside. Non_compliant. ✓
71025: flex sig 2023-09-25 within 2022-2026 → numerator. Frailty alone, and age 50 anyway — not excluded. Compliant. ✓
71029: 66 years old — age is fine (46-75). No frailty/advanced illness documented, so E4 not met. Compliant via colonoscopy 2019 and/or stool DNA 2024. ✓
71031: 75 — "Age: 46 through 75 years as of 2026-12-31" — inclusive of 75. So eligible. No screening → non_compliant. ✓
71026: DOB 1950-06-09 → on 2026-12-31 she... he is 76. Outside range. not_eligible. ✓
71030: DOB 1950-02-11 → 76 on 2026-12-31 (turned 76 on 1950... wait, DOB 1950-02-11 → on 2026-02-11 she turned 76. On 2026-12-31 she's 76). Outside range. not_eligible. ✓
71028: DOB 1981-08-16 → on 2026-12-31 he's 45 (turned 45 on 2026-08-16). Below 46. not_eligible. ✓
71023: enrolled from 2026-04-10 — the period 2026-01-01 to 2026-04-09 without enrolment. Is that a "gap"? The requirement is "the full measurement year with no more than one gap of up to 45 days." Missing over three months at the start fails continuous enrolment. Also it could be considered a gap of 100 days. Either way, fails. not_eligible. ✓
71032: two gaps (17 and 12 days) — "no more than one gap" fails. not_eligible. ✓
Let me reconsider 71021's stool DNA: 2023-11-23. The window "during 2026 or the two years prior" — two years prior to 2026 is 2024 and 2025. So the window is 2024-01-01 through 2026-12-31. 2023-11-23 is outside. But she's excluded regardless. ✓
Now check the exclusion evaluation order: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population." 71021 is in eligible population and meets E3 → excluded. ✓
Also check "A member who meets both an exclusion and the numerator is excluded, not compliant." Not applicable here since 71021 doesn't meet numerator anyway.
Any other member with hospice? Only 71021.
Now the numbers:
- denominator: 6
- numerator: 4
- excluded: 1
- not_eligible: 5
- rate: 66.7
Member ID strings: "71021", "71022", etc.
Format check: "rate" — number, rounded half up to one decimal place: 66.7.
Let me make sure I'm using the right key names: "denominator", "numerator", "excluded", "not_eligible", "rate", "compliant_members", "non_compliant_members", "excluded_members", "not_eligible_members".
Final JSON:
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Double-check 71029 DOB 1960-09-06: on 2026-12-31, age = 66 (turned 66 on 2026-09-06). Within 46-75. ✓ E4 needs frailty AND advanced illness — none documented. ✓
Double-check 71022: DOB 1971-12-22 → 55 on 2026-12-31 (turns 55 on 2026-12-22; before that he's 54; either way within range). ✓ Stool DNA 2024-08-05 within 2024-2026. ✓
Everything checks out. One more consideration: for 71025, does frailty documented 2026-07-12 with age 50 matter? E4 requires age 66+. No. And "Frailty alone does not exclude." ✓
Rate: 4/6 × 100 = 66.66667 → 66.7. ✓json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Max · Alibaba74.5s · 3,104 out | 65.1s · 3,154 out | 58.5s · 2,839 out
Reasoning · 2,889 tokens
We need answer JSON only. Need solve measure population. Need be careful.
We have 12 members. Measure QM-CRC 2026. Eligible: age 46-75 as of 2026-12-31. Continuous enrollment full measurement year with no more than one gap up to 45 days. Need exclusions before numerator only if eligible. Exclusions: E1 CRC any time on/before 2026-12-31; E2 total colectomy; E3 hospice any time during measurement year; E4 age >=66 as of 2026-12-31 AND both frailty and advanced illness during measurement year. Frailty alone no, advanced alone no.
Numerator windows from 2026-12-31:
N1 FOBT/FIT during 2026 (2026-01-01 to 2026-12-31)
N2 stool DNA during 2026 or two years prior = 3-year window. Need exact dates? measured back from 2026-12-31: during 2026 or two years prior likely 2024-01-01 through 2026-12-31? Or 3 years lookback maybe from 2024-01-01? Usually CT colonography etc. Wording: "during 2026 or the two years prior (three-year window)." So dates on or after 2024-01-01? If measured back from 2026-12-31, three-year window could be 2024-01-01? Let's parse: measurement year 2026; two years prior are 2025 and 2024. Thus 2024-01-01 through 2026-12-31. For five-year window: during 2026 or four years prior = 2022-01-01 through 2026-12-31. Ten-year: 2017-01-01 through 2026-12-31. But could exact 365*3 lookback from 2023-12-31? Need infer. It says "by the look-back window measured back from 2026-12-31" and examples: N2 during 2026 or the two years prior (three-year window). That likely means calendar years: 2026, 2025, 2024. N3 2026 or four years prior: 2022-2026. N5 2026 or nine years prior: 2017-2026. We'll apply calendar year starts. Need consider dates like 2023-11-23 stool DNA: outside if 2024-01-01 start. If exact 3 years back from 2026-12-31 -> 2023-12-31? Then 2023-11-23 outside too. So no difference for 71021? It would be outside either way. 2024-08-05 inside. 2025-02-14 FIT? FIT requires during 2026 only, so outside. Flexible sigmoidoscopy 2023-09-25: five-year window if 2022-01-01 inside; if exact 5 years back from 2026-12-31 (2021-12-31) also inside. Colonoscopy 2019-04-22 ten-year inside (2017-2026). Colonoscopy 2016 outside. Colonoscopy 2015 outside. Colonoscopy 2018 outside? ten-year 2017-2026, so 2018 inside for 71023? But 71023 enrollment issue. Let's go member by member.
Eligibility:
Age 46 through 75 as of 2026-12-31. Continuous enrollment full measurement year with <=1 gap up to 45 days. If not enrolled full year with allowed gap? "the full measurement year with no more than one gap of up to 45 days." Means must be enrolled Jan 1-Dec 31 except possibly one gap <=45 days. If enrollment starts after Jan 1? gap from Jan 1 to start maybe counts? For 71023 enrolled 2026-04-10 through 2026-12-31, not enrolled before. Gap Jan1-Apr9 = 99 days? More than 45 and also one gap? Not eligible. If continuous from Apr10, missing Jan1-Apr9. Not eligible.
71032 enrollment: segments Jan1-Mar30, Apr17-Jun26, Jul9-Dec31. Gaps: Mar31-Apr16? Let's count. From 2026-03-30 end to 2026-04-17 start. Gap days not enrolled: Mar31-Apr16 inclusive? Mar31 (1), Apr1-16 (16) total 17 days as stated. Second gap Jun27-Jul8 inclusive: Jun27-30 (4) + Jul1-8 (8)=12. So two gaps. Eligibility allows no more than one gap up to 45 days. Two gaps => not eligible, regardless lengths. Need confirm: "no more than one gap of up to 45 days" means at most one gap. So 71032 not_eligible. Even though exclusion frailty alone? Not relevant because not eligible.
Now members:
71021: DOB 1980-08-11 age 46 eligible age. Enrollment continuous full year. Eligible population. Exclusions: hospice election 2026-10-14 during measurement year => E3 excluded. Screening stool DNA 2023-11-23 outside anyway. Status excluded. Excluded list.
71022: age 55, continuous. No exclusions. Screening stool DNA 2024-08-05. N2 three-year window includes 2024? yes. Compliant. numerator.
71023: age 63 but enrollment not full year, gap >45/not enrolled Jan1. not_eligible. (Even though colonoscopy 2018 inside ten-year? irrelevant.)
71024: age 50, continuous. Frailty and advanced illness in 2026 but age 50 (<66), E4 requires age >=66. No CRC/colectomy/hospice. Eligible. Screening colonoscopy 2016-03-04. Ten-year window 2017-01-01 to 2026-12-31? 2016 outside. If exact 10 years back from 2026-12-31 => 2016-12-31, 2016-03-04 outside. Non_compliant.
71025: age 50, continuous. No exclusions (frailty alone no). Screening: flex sig 2023-09-25, FIT 2025-02-14. N3 flex sig five-year window includes 2023? During 2026 or four years prior = 2022-2026, yes. Compliant. FIT 2025 not N1 but irrelevant. Compliant.
71026: age 76 >75. Not eligible age. (Enrollment OK). not_eligible.
71027: age 47, continuous. No exclusions. FIT 2026-07-26 during 2026 => N1 compliant.
71028: DOB 1981-08-16, says 45 on 2026-12-31. Age 45 <46. Not eligible. (Even if date? 1981 to 2026 = 45, yes.)
71029: age 66, continuous. No exclusions: no frailty/advanced. E4 not. Screening colonoscopy 2019-04-22 (N5 ten-year inside) and stool DNA 2024-09-15 (N2 inside). Compliant.
71030: age 76 >75 not eligible.
71031: age 75 eligible (46-75 inclusive). continuous. No exclusions. No screening. Non_compliant.
71032: not_eligible due two gaps. Even if age 63. Not eligible. Frailty alone no but not evaluated.
Counts: Eligible after exclusions denominator = compliant+noncompliant. Let's tally.
Compliant: 71022, 71025, 71027, 71029 = 4.
Noncompliant: 71024, 71031 = 2.
Excluded: 71021 = 1.
Not eligible: 71023, 71026, 71028, 71030, 71032 = 5.
Total 4+2+1+5=12. Denominator=6, numerator=4, excluded=1, not_eligible=5. Rate = 4/6*100 = 66.666... round half up to one decimal = 66.7.
Need output JSON exactly with required keys. Member ID strings. Any order. Ensure arrays. rate number maybe 66.7. No extra. Need double-check all details.
Potential pitfalls:
- Age 46 through 75 as of 2026-12-31. 71031 75 ok. 71021 age 46 ok.
- Continuous enrollment: for 71032 two gaps of 17 and 12. Spec says no more than one gap up to 45 days. So not eligible. Could someone interpret total gaps? But explicit no more than one gap. yes.
- 71023 enrollment from Apr10: gap from Jan1 to Apr9 maybe 99 days; one gap >45, not eligible.
- 71021 excluded due hospice. Exclusions evaluated before numerator. Stool DNA 2023 outside anyway. Excluded.
- E4: age 66 or older and both frailty and advanced illness during measurement year. 71029 age 66 but none. 71026/71030 age 76 but no frailty/advanced; age fails anyway. 71024 age 50 both but not age. 71032 age 63 frailty only and not eligible.
Numerator windows: Need ensure stool DNA 2024-08-05 qualifies. "during 2026 or the two years prior (three-year window)" two years prior = 2025 and 2024. Yes. If exact 3 years back from Dec31 2026: Jan 1 2024? Actually three-year window could be 2024-01-01 to 2026-12-31. yes. 2024-08-05 qualifies.
Flexible sigmoidoscopy 2023-09-25: five-year window during 2026 or four years prior = 2022-2026. qualifies. If exact 5 years back from 2026-12-31 => 2021-12-31, qualifies.
Colonoscopy 2019 qualifies. 2016 no.
Could N1 FOBT/FIT during 2026 only. 71025 FIT 2025 no but flex sig yes. Good.
Need final only JSON fenced. Ensure no analysis outside. final with JSON.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,939 tokens
We need answer JSON only. Need solve measure population. Need carefully evaluate 12 members for QM-CRC. Need output keys exactly.
Let's parse spec.
Measurement year 2026-01-01 to 2026-12-31.
Eligible population: Age 46 through 75 as of 2026-12-31. Continuous enrolment full measurement year with no more than one gap up to 45 days.
Numerator: any one by look-back from 2026-12-31:
N1 FOBT/FIT during 2026 (2026-01-01 to 2026-12-31)
N2 stool DNA during 2026 or two years prior (3-year window). Need exact dates? measured back from 2026-12-31: 2024-01-01? Usually 3 years means 2024-01-01 through 2026-12-31? Or date >= 2023-12-31? We need infer. "during 2026 or the two years prior (three-year window)" likely look-back 3 years from Dec 31, 2026 => dates on or after 2024-01-01? If exactly three-year window measured back from 2026-12-31 could be 2024-01-01 to 2026-12-31 inclusive? Or 2023-12-31? Need handle 2023-11-23 etc. For member 71021 stool DNA 2023-11-23, definitely outside 3-year if from 2026-12-31 (3 years prior = 2023-12-31? Actually if date >= 2023-12-31? 2023-11-23 outside either). For 71022 2024-08-05 inside.
N3 flex sig during 2026 or four years prior (five-year window). Likely 2022-01-01? or 2021-12-31? 2023-09-25 inside; 2024-10-15 inside if age eligible? 71028 not eligible age 45.
N4 CT colonography 5-year, none.
N5 colonoscopy during 2026 or nine years prior (ten-year window). Need date >= 2017-01-01? 2016-03-04 outside; 2019-04-22 inside; 2015 outside; 2018-02-20 inside but enrollment issue.
Exclusions:
E1 CRC any time on/before 2026-12-31 none.
E2 total colectomy none.
E3 hospice any time during measurement year. 71021 has hospice 2026-10-14 => excluded if eligible.
E4 age >=66 as of 2026-12-31 AND both frailty and advanced illness during measurement year. Frailty alone no, advanced alone no. Need apply only eligible? Exclusions evaluated only for eligible population. Members not eligible due age/enrollment not excluded.
Need evaluate each member.
Status definitions:
- not_eligible if fails age or event/enrollment. Event? Here age/enrollment. Exclusions only for eligible.
- denominator = eligible after exclusions removed = compliant + non_compliant.
- excluded = eligible and meets required exclusion.
- rate = numerator/denominator*100 round half up one decimal. If denominator 0? Probably not here.
Let's evaluate.
MEMBER 71021: DOB 1980-08-11 age 46 at 2026-12-31. Age 46-75 yes. Enrollment continuous full year yes. Eligible. Exclusion E3 hospice during measurement year 2026-10-14 => excluded. Even if numerator stool DNA 2023-11-23? Outside? Doesn't matter. Status excluded.
71022: age 55, enrollment full. Eligible. No exclusions. Screening: stool DNA 2024-08-05. N2 three-year window. Need confirm inside. From 2026-12-31 look back 3 years: if window 2024-01-01 through 2026-12-31, yes. If exact 3 years prior date >= 2023-12-31, yes. Compliant. Numerator yes.
71023: age 63. Enrollment 2026-04-10 through 2026-12-31, not enrolled before. Continuous enrollment requirement full measurement year with <=1 gap up to 45 days. They have a gap from 2026-01-01 to 2026-04-09? Not enrolled 99 days? Let's calculate Jan1-Apr9 inclusive? Gap length maybe 99 days (Jan 31 + Feb 28 + Mar 31 + Apr 9 = 99). Exceeds 45. So not eligible. Even though colonoscopy 2018 within 10-year maybe, not eligible. Status not_eligible.
71024: age 50, full enrollment. Eligible. Exclusion E4 requires age 66+ AND frailty+advanced illness. Age 50, no. Frailty/advanced illness don't exclude. No cancer/colectomy/hospice. Screening colonoscopy 2016-03-04. Ten-year window from 2026-12-31: during 2026 or nine years prior. If window 2017-01-01 to 2026-12-31 (or 2016-12-31?), 2016-03-04 outside. Non_compliant. Need consider exact date if ten-year lookback = 2016-12-31? Still 2016-03-04 outside. So non_compliant.
71025: age 50, full. Eligible. Exclusions? frailty only, age <66, no. Screening: flex sig 2023-09-25 (five-year window; yes if >=2022-01-01 or 2021-12-31), FIT 2025-02-14 (not during 2026; N1 requires during 2026, so not via FIT). Flex sig qualifies. Compliant.
71026: age 76 at 2026-12-31. Age eligible 46-75? No. Not eligible. Exclusions not considered. Status not_eligible.
71027: age 47, full. Eligible. No exclusions. FIT 2026-07-26 during 2026 => compliant.
71028: age 45 at 2026-12-31. Age fails (<46). Not eligible. Screening irrelevant.
71029: age 66, full. Eligible age 66. Exclusion E4? age 66 and both frailty and advanced illness during year? No documented frailty/advanced illness; no. Other exclusions none. Screening: colonoscopy 2019-04-22 within 10-year; stool DNA 2024-09-15 within 3-year. Compliant.
71030: age 76. Not eligible.
71031: age 75, full. Eligible. No exclusions. No screening. Non_compliant.
71032: age 63. Enrollment has gaps 17 and 12 days. Requirement: full measurement year with no more than one gap up to 45 days. Two gaps, so fails continuous enrollment. Not eligible. Even if frailty only and colonoscopy old. Not_eligible.
Counts:
Compliant: 71022, 71025, 71027, 71029 = 4.
Non-compliant: 71024, 71031 = 2.
Excluded: 71021 = 1.
Not eligible: 71023, 71026, 71028, 71030, 71032 = 5.
Total 12.
Denominator = compliant+noncompliant = 6. Numerator = 4. Excluded=1, not eligible=5. Rate = 4/6*100 = 66.666... rounded half up one decimal = 66.7. Need number 66.7.
Double-check all details.
Potential nuance: Continuous enrollment: "full measurement year with no more than one gap of up to 45 days." For 71032 gaps of 17 and 12 days. Two gaps => not eligible. Yes.
Potential nuance: Age through 46-75 as of 2026-12-31. 71031 age 75 eligible. 71026/71030 76 not.
Potential nuance: Exclusion E4 age 66 or older AND both frailty and advanced illness documented during measurement year. Member 71024 age 50 with both frailty and advanced illness not excluded. Correct. Member 71032 age 63 frailty only not excluded but not eligible due enrollment. Member 71025 age 50 frailty only not excluded.
Potential nuance: Stool DNA 3-year window. For 71022 2024-08-05 definitely within 2024-2026. For 71029 2024-09-15 within. 71021 2023-11-23 outside. 71030 2025-12-12 but not eligible. Good.
Potential nuance: Colonoscopy ten-year window. Could exact window be date >= 2017-01-01 (since measurement year 2026 plus nine prior calendar years 2017-2025? Actually "during 2026 or the nine years prior" means 2017-01-01 through 2026-12-31 if calendar years; or 2016-12-31 through 2026-12-31 if exact 10 years? In either, 2016-03-04 outside, 2018/2019 inside. Good.
Potential nuance: Flexible sigmoidoscopy five-year. 2023-09-25 within if 2022-2026 or exact 2021-12-31. Good. 71028 2024-10-15 would be within but age not eligible. Good.
Potential nuance: FOBT/FIT during 2026. 71027 yes. 71025 FIT 2025 no but flex sig yes. Good.
Need output JSON only. Ensure arrays strings. Any order okay. Rate number maybe 66.7 not string.
Need no extra keys. Exactly:
{
"denominator":6,
"numerator":4,
"excluded":1,
"not_eligible":5,
"rate":66.7,
"compliant_members":["71022","71025","71027","71029"],
"non_compliant_members":["71024","71031"],
"excluded_members":["71021"],
"not_eligible_members":["71023","71026","71028","71030","71032"]
}
Need ensure no preamble, fenced JSON. Final only code block.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,624 tokens
We need answer JSON only. Need solve measure population. Need carefully evaluate 12 members. Let's parse spec.
Measurement year 2026-01-01 to 2026-12-31.
Eligible population: age 46 through 75 as of 2026-12-31. Continuous enrolment full measurement year with no more than one gap up to 45 days.
Numerator look-back from 2026-12-31:
N1 FOBT/FIT during 2026 (2026-01-01 to 2026-12-31)
N2 stool DNA during 2026 or two years prior: 3-year window. Need dates on or after 2024-01-01? Measured back from 2026-12-31: 2026 or two years prior = 2024-01-01 through 2026-12-31 likely. But if exact three-year window maybe 2024-01-01? For HEDIS Colorectal Cancer Screening usually FIT-DNA during 2026 or two years prior (3-year window) = 2024-01-01-2026-12-31. We'll use calendar years.
N3 flex sigmoidoscopy during 2026 or four years prior = 5-year window: 2022-01-01 through 2026-12-31? If measured back from date, maybe 2022-01-01? Since measurement year plus four prior years. We'll use 2022-01-01 onward. But exact date 2026-12-31 minus 4 years = 2022-12-31? Wait "during 2026 or the four years prior" means calendar years 2022-2026 inclusive? HEDIS language: during 2026 or the four years prior (5-year window) often dates from Jan 1 2022 through Dec 31 2026. Similarly colonoscopy 10-year window Jan 1 2017 through Dec 31 2026. CT colonography 5-year. Stool DNA 3-year Jan 1 2024 through Dec 31 2026. Need decide. The prompt says look-back window measured back from 2026-12-31. That could be exact date ranges: N2 on or after 2024-01-01? Measured back two years from 2026-12-31 gives 2024-12-31? Hmm "during 2026 or the two years prior" explicitly years: 2026, 2025, 2024. So Jan 1 2024. "four years prior" = 2022-2026. "nine years prior" = 2017-2026. Good.
Exclusions evaluated before numerator for eligible only. E1 CRC any time on/before 2026-12-31. E2 total colectomy any time on/before. E3 hospice any time during measurement year. E4 age >=66 as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone no, advanced alone no.
Need place every member.
Member 71021: DOB 1980-08-11 age 46 at end, eligible age. Enrol continuous full year. Eligible. Screening: stool DNA 2023-11-23. N2 requires 2024-2026, so not numerator. Other history hospice election 2026-10-14 => E3 hospice during measurement year. Exclusions before numerator. So excluded. Even if no numerator. Excluded.
71022: age 55, continuous. Eligible. Screening stool DNA 2024-08-05 => within 2024-2026, N2. No exclusions. Compliant.
71023: age 63. Enrolment 2026-04-10 through 2026-12-31, not enrolled before. Continuous from that date. Full measurement year requirement with no more than one gap up to 45 days. They are not enrolled Jan 1-Apr 9. Is that a gap? Continuous enrolment full measurement year with no more than one gap up to 45 days. From Jan 1 to Apr 9 is 98? Jan 31 + Feb 28 + Mar31 + Apr9 = 99? If enrollment starts Apr 10, gap Jan1-Apr9 inclusive 99 days (or Jan1-Apr9). >45. Not eligible. Even if colonoscopy 2018 not matter. Not_eligible due enrollment.
71024: age 50, continuous. Eligible. Screening colonoscopy 2016-03-04. N5 10-year window 2017-2026; 2016 outside. No numerator. Exclusions: frailty 2026-08-18 and advanced illness 2026-02-04, but age 50 (<66) so E4 not apply. No hospice, cancer/colectomy. Non_compliant.
71025: age 50, continuous. Eligible. Screening flex sig 2023-09-25. N3 5-year window 2022-2026; 2023 qualifies. FIT 2025-02-14 not N1 because not during 2026; but flex sig qualifies. Other frailty 2026 but age 50, no advanced illness. Not excluded. Compliant.
71026: DOB 1950 age 76 at end. Age eligible 46-75, so not eligible. Not eligible, regardless screening stool DNA 2023. Not_eligible.
71027: age 47, continuous. Eligible. FIT 2026-07-26, N1. No exclusions. Compliant.
71028: DOB 1981 age 45 at end. Age not eligible. Not_eligible.
71029: age 66, continuous. Eligible age (46-75 inclusive). Screening colonoscopy 2019-04-22 within 2017-2026 => N5. Stool DNA 2024 also N2. No exclusions: no frailty/advanced. Compliant.
71030: age 76, not eligible. Not_eligible.
71031: age 75, continuous. Eligible. No screening. No exclusions. Non_compliant.
71032: age 63. Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days. Continuous enrolment: full year with no more than one gap up to 45 days. There are two gaps, even though each <=45. Requirement no more than one gap. Therefore not eligible due enrollment. Even if frailty etc. Not_eligible. Colonoscopy 2015 irrelevant.
Counts: compliant: 71022, 71025, 71027, 71029 = 4. Non_compliant: 71024, 71031 = 2. Excluded: 71021 = 1. Not eligible: 71023, 71026, 71028, 71030, 71032 = 5. Denominator = compliant+non_compliant = 6. Numerator=4. Excluded=1, not_eligible=5. Rate = 4/6*100 = 66.666... rounded half up to one decimal = 66.7. Need JSON with keys exactly. Arrays strings. Any order. Need no extra. Ensure rate number maybe 66.7. Check denominator definition: members in eligible population after exclusions removed = compliant+non_compliant. Yes.
Double-check all details.
Potential pitfalls:
- Stool DNA window: 2023-11-23 maybe within three-year window measured back from 2026-12-31? If exact 3 years = on or after 2023-12-31? 2023-11-23 outside. If calendar 3 years = 2024 onward, outside. So 71021 no numerator anyway and excluded.
- Member 71025 FIT 2025-02-14: Not N1, but flex sig 2023 qualifies. Good.
- Member 71029 age 66, has no frailty/advanced; compliant.
- Member 71024 age 50 with frailty and advanced: E4 requires age 66 or older, not excluded. Noncompliant because colonoscopy 2016 outside. If 10-year window measured back exact from 2026-12-31: on or after 2017-01-01? 2016 outside. Good.
- Member 71032 enrollment gaps: The spec says continuous enrolment full measurement year with no more than one gap up to 45 days. The roster says gaps 17 and 12 days. Two gaps => not eligible. Could someone interpret continuous enrollment as allowed one gap total, yes. Not eligible. If one gap? There are two segments. There are two gaps. Not eligible.
- Member 71023 enrollment starting Apr 10: Could this be one gap of 99 days, >45, not eligible. Yes.
Need output exactly one fenced JSON code block. No explanation. Ensure arrays include all IDs. Let's craft:
{
"denominator":6,
"numerator":4,
"excluded":1,
"not_eligible":5,
"rate":66.7,
"compliant_members":["71022","71025","71027","71029"],
"non_compliant_members":["71024","71031"],
"excluded_members":["71021"],
"not_eligible_members":["71023","71026","71028","71030","71032"]
}
Need consider rounding half up: 66.666 => 66.7.
Final only code block.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Terra · OpenAI4.2s · 337 out | 6.2s · 442 out | 5.2s · 410 out
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 Flash · Z.ai34.7s · 1,979 out | 112.6s · 1,823 out | 34.9s · 1,509 out
Reasoning · 1,841 tokens
Let me work through each member against the QM-CRC spec.
Measurement year 2026. Age 46–75 as of 2026-12-31. Continuous enrolment full year, no more than one gap of up to 45 days.
Numerator windows (from 2026-12-31):
- N1 FOBT/FIT during 2026 (calendar year 2026).
- N2 Stool DNA 2026 or two prior years (2024, 2025, 2026 — three-year window).
- N3 Flex sig 2026 or four prior (2022–2026, five-year window).
- N4 CT colonography 2022–2026.
- N5 Colonoscopy 2026 or nine prior (2017–2026, ten-year window).
Exclusions:
- E1 CRC any time on/before 2026-12-31.
- E2 total colectomy.
- E3 hospice during measurement year.
- E4 age 66+ AND both frailty and advanced illness during measurement year.
Member-by-member:
71021: DOB 1980-08-11, 46 as of 2026-12-31. Wait: birthday 1980-08-11, on 2026-12-31 they are 46 years old. Yes (2026 − 1980 = 46; birthday Aug 11 passed). In age range. Enrolled continuously full year. Eligible. Exclusion: hospice 2026-10-14 during measurement year → E3. Excluded before numerator evaluation. Stool DNA 2023-11-23 would be outside the three-year window (2024–2026) anyway, but exclusion wins. → excluded.
71022: 55, continuous. Stool DNA 2024-08-05 — within three-year window (2024–2026). Compliant.
71023: 63, but enrolment starts 2026-04-10 — not enrolled full year. Gap? "Continuous enrolment: full measurement year with no more than one gap of up to 45 days." Not enrolled before 2026-04-10 means ~100 days missing at start. Not full-year continuous enrolment → not_eligible.
71024: 50, continuous. Frailty 2026-08-18 AND advanced illness 2026-02-04, but age 50 — E4 requires 66+. No exclusion. Colonoscopy 2016-03-04 — ten-year window is 2017–2026 (2026 minus nine years). 2016 is outside (10 years prior would be... let's compute: window 2026 or nine years prior = 2017, 2018, ..., 2026). 2016-03-04 is more than ten years before 2026-12-31? Ten-year window measured back from 2026-12-31: colonoscopy during 2026 or the nine years prior → 2017-01-01 through 2026-12-31. 2016 is outside. So not compliant. Non-compliant.
71025: 50, continuous. FIT 2025-02-14 — N1 requires FIT during 2026. 2025 doesn't count for FIT. Flex sig 2023-09-25 — five-year window 2022–2026 → counts. Compliant. Frailty alone doesn't exclude (and age 50 anyway). Compliant.
71026: 76 as of 2026-12-31 → outside 46–75. Not eligible. (Stool DNA 2023 would be outside window anyway, irrelevant.)
71027: 47, continuous. FIT 2026-07-26 → N1. Compliant.
71028: 45 as of 2026-12-31 → below 46. Not eligible.
71029: 66, continuous. Stool DNA 2024-09-15 → within three-year window. No frailty/advanced illness documented, so no E4. Compliant.
71030: 76 as of 2026-12-31 → not eligible. DOB 1950-02-11, on 2026-12-31 age 76. Yes.
71031: 75 (DOB 1951-11-26; on 2026-12-31 age 75). In range. Continuous. No screening → non-compliant.
71032: 63, enrolment gaps: 2026-01-01–2026-03-30; 2026-04-17–2026-06-26; 2026-07-09–2026-12-31. Gaps: 03-31 to 04-16 = 17 days; 06-27 to 07-08 = 12 days. Two gaps. Spec allows no more than one gap of up to 45 days. Two gaps → fails continuous enrolment → not_eligible. Even though each gap ≤ 45 days, there are two of them.
Also check 71032 colonoscopy 2015 — outside window anyway, but moot.
Now counts:
- Compliant: 71022, 71025, 71027, 71029 → 4
- Non-compliant: 71024, 71031 → 2
- Excluded: 71021 → 1
- Not eligible: 71023, 71026, 71028, 71030, 71032 → 5
Denominator = 4 + 2 = 6. Numerator = 4. Excluded = 1. Not eligible = 5. Total 12. ✓
Rate = 4/6 × 100 = 66.666... → 66.7 (round half up to one decimal).
Double-check ages:
- 71021: 1980-08-11 → 2026-08-11 turns 46; on 2026-12-31 age 46. ✓ In range.
- 71022: 1971-12-22 → turns 55 on 2026-12-22; age 55. ✓
- 71023: 1963-07-10 → 63. ✓ but enrolment fails.
- 71024: 1976-04-19 → 50. ✓
- 71025: 1976-05-12 → 50. ✓
- 71026: 1950-06-09 → turns 76 on 2026-06-09; age 76 on 2026-12-31. Not eligible.
- 71027: 1979-10-14 → 47. ✓
- 71028: 1981-08-16 → turns 45 on 2026-08-16; age 45. Not eligible.
- 71029: 1960-09-06 → turns 66 on 2026-09-06; age 66. ✓
- 71030: 1950-02-11 → turns 76 on 2026-02-11; age 76. Not eligible.
- 71031: 1951-11-26 → turns 75 on 2026-11-26; age 75. ✓ (upper bound inclusive)
- 71032: 1963-12-19 → 63. Enrolment fails (two gaps).
Check E4 for 71029: age 66+ but no frailty/advanced illness → no exclusion. ✓
Check 71021 numerator anyway: stool DNA 2023-11-23 — three-year window from 2026-12-31 is 2024–2026. 2023 outside. Would be non-compliant if not excluded, but E3 hospice applies. Excluded.
Rate: 4/6 = 0.66666... × 100 = 66.6667 → 66.7.
JSON:
denominator 6, numerator 4, excluded 1, not_eligible 5, rate 66.7,
compliant_members ["71022","71025","71027","71029"],
non_compliant_members ["71024","71031"],
excluded_members ["71021"],
not_eligible_members ["71023","71026","71028","71030","71032"].json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,685 tokens
Let me work through each member against the QM-CRC specification.
Measure year: 2026-01-01 to 2026-12-31.
Eligible population: Age 46–75 as of 2026-12-31; continuous enrolment full year with no more than one gap of up to 45 days.
Numerator windows (look-back from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior → three-year window: 2024-01-01 (approximately) through 2026-12-31. Precisely: during the measurement year or the two years prior. Look-back from 2026-12-31, three-year window → 2024, 2025, 2026.
- N3: Flex sig during 2026 or four years prior → five-year window: 2022–2026.
- N4: CT colonography 2022–2026.
- N5: Colonoscopy 2026 or nine years prior → ten-year window: 2017–2026.
Exclusions:
- E1: Colorectal cancer any time on or before 2026-12-31.
- E2: Total colectomy.
- E3: Hospice during measurement year.
- E4: Age 66+ AND both frailty and advanced illness during measurement year.
Members:
71021: DOB 1980-08-11 → 46 on 2026-12-31 (born 1980, in 2026 turns 46 on 2026-08-11). Yes, 46. Age eligible. Enrolment continuous. Eligible.
Screening: Stool DNA 2023-11-23. Three-year window is 2024–2026. 2023 is outside. So not numerator.
Hospice 2026-10-14 → E3 exclusion applies (during measurement year). Exclusions evaluated before numerator; hospice excludes. → excluded.
71022: DOB 1971-12-22 → 55 on 2026-12-31? Born 1971-12-22; on 2026-12-31, birthday 2026-12-22 already passed → 55. Age eligible. Continuous enrolment. Stool DNA 2024-08-05 → within 2024–2026 three-year window → numerator. No exclusions. → compliant.
71023: DOB 1963-07-10 → 63. Enrolment: 2026-04-10 through 2026-12-31. Not enrolled for full measurement year (missing Jan 1–Apr 9, ~99 days). Continuous enrolment requirement: full measurement year with no more than one gap of up to 45 days. Being not enrolled at start means not enrolled full year → not_eligible. Colonoscopy 2018-02-20 → outside 10-year window (2017–2026)? Wait, ten-year window: 2026 or nine years prior → 2017–2026. 2018-02-20 is within 2017–2026 actually. But enrolment fails, so not_eligible regardless.
71024: DOB 1976-04-19 → 50. Continuous. Colonoscopy 2016-03-04 → outside ten-year window (2017–2026). Not numerator. Frailty 2026 + advanced illness 2026 → E4 requires age 66+. Age 50, so E4 doesn't apply. No other exclusions. → non_compliant.
71025: DOB 1976-05-12 → 50. Continuous. FIT 2025-02-14 → N1 requires during 2026. 2025 FIT does not count. Flex sig 2023-09-25 → five-year window 2022–2026 → yes, within. → numerator. Frailty alone does not exclude (and age <66 anyway). → compliant.
71026: DOB 1950-06-09 → 76 on 2026-12-31 (turns 76 on 2026-06-09). Age 76 > 75 → not eligible. Even though stool DNA 2023-05-08 would be outside window anyway (2024–2026). → not_eligible.
71027: DOB 1979-10-14 → 47. Continuous. FIT 2026-07-26 → during 2026 → numerator. → compliant.
71028: DOB 1981-08-16 → 45 on 2026-12-31 (turns 45 on 2026-08-16). 45 < 46 → not_eligible.
71029: DOB 1960-09-06 → 66 on 2026-12-31 (turns 66 on 2026-09-06). Age 66. Continuous. Stool DNA 2024-09-15 → within three-year window → numerator. Colonoscopy 2019-04-22 → within ten-year window (2017–2026) too. No frailty/advanced illness documented → E4 doesn't apply. → compliant.
71030: DOB 1950-02-11 → 76 on 2026-12-31. Age 76 → not_eligible. Stool DNA 2025-12-12 would be in window but age fails.
71031: DOB 1951-11-26 → 75 on 2026-12-31 (turns 75 on 2026-11-26). Age 75, within 46–75. Continuous. No screening → non_compliant. No exclusions. → non_compliant.
71032: DOB 1963-12-19 → 63 on 2026-12-31 (turns 63 on 2026-12-19). Enrolment: three segments with gaps of 17 and 12 days. The spec: "no more than one gap of up to 45 days." Two gaps, even though both are short → fails. → not_eligible. Colonoscopy 2015-10-17 outside window anyway, but enrolment decides.
Tally:
- compliant: 71022, 71025, 71027, 71029 → 4
- non_compliant: 71024, 71031 → 2
- excluded: 71021 → 1
- not_eligible: 71023, 71026, 71028, 71030, 71032 → 5
Denominator = compliant + non_compliant = 6.
Numerator = 4.
Rate = 4/6 × 100 = 66.666... → 66.7.
Check total: 4+2+1+5 = 12. ✓
Double-check 71021: age 46, eligible population; hospice during measurement year → E3 excluded. Exclusions evaluated before numerator; stool DNA 2023 is outside window anyway so no conflict. → excluded.
Double-check 71029 stool DNA 2024-09-15: three-year window = measurement year + two prior years = 2024, 2025, 2026. Yes, 2024-09-15 qualifies.
Double-check 71022 stool DNA 2024-08-05 → within window. Yes.
Rate: 66.666... rounds to 66.7.
Output JSON keys: denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,371 tokens
Let me work through each member against the QM-CRC spec.
Age window: 46–75 as of 2026-12-31. Enrolment: continuous full year with no more than one gap of up to 45 days.
Numerator windows measured back from 2026-12-31:
- N1 FOBT/FIT during 2026 (2026-01-01 to 2026-12-31).
- N2 Stool DNA during 2026 or two years prior: three-year window. Back from 2026-12-31 → 2024-01-01 through 2026-12-31.
- N3 Flex sig during 2026 or four years prior: five-year window → 2022-01-01 through 2026-12-31.
- N4 CT colonography five-year window → 2022-01-01 through 2026-12-31.
- N5 Colonoscopy during 2026 or nine years prior: ten-year window → 2017-01-01 through 2026-12-31.
Exclusions:
- E1 CRC any time on or before 2026-12-31.
- E2 total colectomy any time.
- E3 hospice during measurement year.
- E4 age 66+ AND both frailty and advanced illness during measurement year.
Member by member:
71021: DOB 1980-08-11 → 46 on 2026-12-31 (birthday 2026-08-11; age 46). Eligible age. Enrolment continuous. Exclusion: hospice 2026-10-14 → E3 applies. Excluded before numerator. Screening: stool DNA 2023-11-23 — outside 3-year window anyway, but excluded. → excluded.
71022: DOB 1971-12-22 → 55. Continuous. Stool DNA 2024-08-05 — within 3-year window (2024-01-01 onward)? Yes, 2024-08-05 is within 2024–2026. Compliant. → compliant.
71023: DOB 1963-07-10 → 63. Enrolment starts 2026-04-10, not enrolled for full year. Continuous enrolment requirement: full measurement year with no more than one gap up to 45 days. Enrolment beginning 2026-04-10 means not enrolled Jan–Apr, that's a large gap (~100 days). Not eligible. → not_eligible. Colonoscopy 2018 outside 10-year window anyway (window 2017+), but irrelevant.
71024: DOB 1976-04-19 → 50. Continuous. Frailty 2026 + advanced illness 2026, but age 50 < 66, so E4 does not apply. Colonoscopy 2016-03-04 — outside 10-year window (window starts 2017-01-01). So does not meet numerator. → non_compliant.
71025: DOB 1976-05-12 → 50. Continuous. FIT 2025-02-14 — N1 requires during 2026 only. Not compliant via N1. Flex sig 2023-09-25 — within 5-year window (2022-01-01 to 2026-12-31). Yes → compliant. Frailty alone doesn't exclude. → compliant.
71026: DOB 1950-06-09 → 76 on 2026-12-31 (birthday 2026-06-09, turns 76). Age > 75 → not_eligible.
71027: DOB 1979-10-14 → 47. Continuous. FIT 2026-07-26 → N1. → compliant.
71028: DOB 1981-08-16 → 45 on 2026-12-31 (birthday 2026-08-16, turns 45; on 12-31 he's 45). Under 46 → not_eligible.
71029: DOB 1960-09-06 → 66 on 2026-12-31 (birthday 2026-09-06 → 66). Continuous. Colonoscopy 2019-04-22 — within 10-year window (2017-01-01+). Yes. Also stool DNA 2024-09-15 within 3-year. No exclusions (no frailty/advanced illness documented). → compliant.
71030: DOB 1950-02-11 → 76 on 2026-12-31. Not_eligible (age).
71031: DOB 1951-11-26 → 75 on 2026-12-31 (birthday 2026-11-26, turns 75). Eligible age. Continuous. No screening → non_compliant.
71032: DOB 1963-12-19 → 63 on 2026-12-31 (birthday 2026-12-19 → turns 63). Eligible age. Enrolment gaps: 2026-03-31 to 2026-04-16 = 17 days (Mar 31 through Apr 16 is 1+16 = 17 days); second gap 2026-06-27 to 2026-07-08 = 4 + 8 = 12 days. Two gaps. Spec: no more than one gap of up to 45 days. Two gaps → fails continuous enrolment → not_eligible. (Colonoscopy 2015-10-17 outside window anyway.)
Counts:
- compliant: 71022, 71025, 71027, 71029 → 4
- non_compliant: 71024, 71031 → 2
- excluded: 71021 → 1
- not_eligible: 71023, 71026, 71028, 71030, 71032 → 5
Total 4+2+1+5 = 12. ✓
Denominator = compliant + non_compliant = 6.
Numerator = 4.
Rate = 4/6 × 100 = 66.666... → 66.7.
Output JSON only.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Hunyuan 4 · Tencent145.9s · 9,401 out | 145.4s · 9,204 out | 158.1s · 9,606 out
Reasoning · 9,265 tokens
We need answer as JSON only. Need evaluate roster of 12 members for measure QM-CRC.
Let's parse measure spec.
Measurement year 2026-01-01 through 2026-12-31.
Eligible Population (denominator):
- Age: 46 through 75 years as of 2026-12-31. (Note inclusive? "46 through 75 years as of 2026-12-31" means age >=46 and <=75 at end of year. Turning 46 during year? We have DOBs and ages given as of 2026-12-31. The prompt explicitly says "so X years old on 2026-12-31." So use given age. Need check: 46 through 75 inclusive. 45 not eligible, 76 not eligible. Good.)
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
Interpretation: Must be enrolled for full measurement year? "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Wait: The phrase "the full measurement year with no more than one gap of up to 45 days." This means enrolled for the full year, but allowed no more than one gap of up to 45 days. So if not enrolled entire year (e.g., started late) or has a gap >45 days or more than one gap, fails continuous enrolment. For Member 71023: Enrolment 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10. Since not enrolled for full measurement year (starts April 10, missing first ~99 days), enrolment fails? Let's interpret: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If they are not enrolled at start of year (Jan 1 through Apr 9 missing), that's a gap of 99 days at beginning? Or failure to be enrolled full measurement year. The spec says "the full measurement year" meaning must be enrolled the entire year, except allowed one gap up to 45 days. If enrolment starts after Jan 1, there is a gap from Jan 1 to start date (if considered gap) of >45 days, or simply not full year. In typical HEDIS, continuous enrollment is enrolled from Jan 1 (or start of measurement year) through Dec 31 with no gaps >45 days, or allow one gap of up to 45 days. Actually HEDIS allows one gap of up to 45 days during the continuous enrollment period, but you must be enrolled on the anchor date? Wait, for HEDIS measures, continuous enrollment usually is from Jan 1 of measurement year through Dec 31, allowing no more than one gap of 45 days. If member becomes enrolled mid-year (new enrollee), they would have a gap from Jan 1 to enrollment start, often counted as a gap. If that gap >45 days, not continuously enrolled. But some measures have "enrolled during measurement year" with continuous enrollment for a certain period? Let's read given spec exactly:
"Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
This indicates the enrolment must cover the full measurement year, but a single gap of up to 45 days is allowed. Since member 71023 is not enrolled from Jan 1 to Apr 9 (99 days before start), that's a gap of 99 days (or not enrolled full year). More than one gap? Only one gap (Jan 1-Apr 9) of 99 days >45, so fails. Also "Not enrolled before 2026-04-10." So not eligible (not_eligible). We'll mark not_eligible.
Member 71032: Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days. So two gaps: Mar 31-Apr 16 (17 days), Jun 27-Jul 8 (12 days). That is two gaps. The rule: no more than one gap of up to 45 days. Therefore having two gaps (even if each <=45 days) fails continuous enrolment. So 71032 is not_eligible due to enrolment (more than one gap). Also note age? DOB 1963-12-19, age 63 on 2026-12-31, so age eligible. But enrolment fails. So not_eligible. Need not evaluate numerator/exclusions? Status not_eligible: never enters eligible population (age, event, or enrolment). Yes.
Now age exclusions:
- 71026: age 76 on 2026-12-31 -> not eligible (age >75). Not_eligible.
- 71030: age 76 -> not_eligible.
- 71028: age 45 -> not eligible (age <46). Not_eligible.
Check 71021: age 46. DOB 1980-08-11. On 2026-12-31, birthday Aug 11 1980 -> turned 46 on Aug 11 2026. Age 46 as of Dec 31. So age eligible (>=46). Good.
71031: age 75. DOB 1951-11-26, will turn 75 on Nov 26 2026. Age 75 as of Dec 31. Eligible (<=75). Wait age through 75 inclusive, so 75 qualifies. Good.
71029: age 66. DOB 1960-09-06, turned 66 on Sep 6 2026. Age 66 eligible.
71024: 50, eligible.
71025: 50, eligible.
71027: 47, eligible.
71022: 55, eligible.
Now eligible after age and enrolment: Let's list all 12 and determine.
Members:
71021: DOB 1980-08-11 age 46. Enrolment Jan1-Dec31 continuous no gaps -> enrolment OK. Age OK. Exclusions? Other history: 2026-10-14 Hospice election. E3: Hospice at any time during measurement year. Yes hospice on 2026-10-14 during MY. Therefore excluded (E3). Since excluded, not compliant regardless of numerator. Numerator? 2023-11-23 Stool DNA test. Stool DNA test during 2026 or two years prior (three-year window measured back from 2026-12-31). Let's compute windows later. But exclusion E3 applies. So 71021 status excluded. (Even though numerator? Stool DNA 2023-11-23: three-year window back from 2026-12-31: 2024-01-01? Wait "during 2026 or the two years prior (three-year window)". If measured back from 2026-12-31, the three-year window includes 2024, 2025, 2026? Let's precisely define. "by the look-back window measured back from 2026-12-31: N2. Stool DNA test during 2026 or the two years prior (three-year window)." The three-year window measured back from 2026-12-31: dates from 2024-01-01 through 2026-12-31? Or from 2023-12-31? Let's check: A three-year window measured back from 2026-12-31: 2026, 2025, 2024 (three calendar years? "during 2026 or the two years prior" = 2026, 2025, 2024. That is 2024-01-01 to 2026-12-31. The two years prior to 2026 are 2025 and 2024. So 2024-01-01 through 2026-12-31. Some specs say "the year prior to the measurement year and the year prior to that"? Let's parse: "during 2026 or the two years prior (three-year window)". Measurement year is 2026. "or the two years prior" to 2026 means 2025 and 2024. So if test occurred 2023-11-23, that's three years prior (2023), not in window. Wait 2023 is three years prior? Let's count: 2026 is current; 2025 is one year prior; 2024 is two years prior; 2023 is three years prior. The phrase "during 2026 or the two years prior" means 2026, 2025, 2024. So 2023 is not included. But if measured back from 2026-12-31 as a rolling three-year window, then 2023-11-23 is 3 years and 38 days before 2026-12-31? Let's compute: From 2023-11-23 to 2026-11-23 is 3 years. To 2026-12-31 is 3 years + 38 days. The window back from 2026-12-31 for three years would start 2023-12-31 (or 2023-12-01? Actually exactly 3 years prior is 2023-12-31). So 2023-11-23 is earlier than 2023-12-31, thus outside a rolling three-year window. However, HEDIS CRC measure: stool DNA (sDNA) test during the measurement year or the two years prior to the measurement year (3-year window). That means dates of service in 2024, 2025, 2026 if MY is 2026? Let's verify typical HEDIS: For colorectal cancer screening, the numerator includes: "Stool DNA (sDNA) test during the measurement year or the two years prior to the measurement year (3-year window)". If measurement year is 2026, the two years prior are 2024 and 2025. Wait "two years prior to the measurement year" means 2024 and 2025? Let's list: Measurement year = 2026. One year prior = 2025. Two years prior = 2024. So yes, 2024, 2025, and 2026. So 2023 is three years prior to MY, not included. But the window "measured back from 2026-12-31" for a 3-year roll forward? Actually if we take the date of service and look back three years from the end of MY (2026-12-31), the start date is 2023-12-31. So a test on 2023-11-23 is before 2023-12-31, so outside. A test on 2024-01-01 is within. So both calendar-year interpretation and rolling interpretation agree that 2023-11-23 is NOT in the 3-year window for sDNA. Wait, check: If it's "during 2026 or the two years prior (three-year window)" by calendar year, you include whole years 2024, 2025, 2026. 2023-11-23 is in 2023, not included. If rolling three years back from 2026-12-31, start 2023-12-31, 2023-11-23 is one month outside. Both agree not included. Good.
Thus for 71021, sDNA 2023-11-23 is outside N2. Does member have any other screening? No. So numerator not met. But excluded anyway. So excluded_members includes 71021.
But wait, 71021 hospice election 2026-10-14. E3 says Hospice at any time during the measurement year. Yes, excluded. So status excluded. We'll list under excluded_members.
71022: DOB 1971-12-22 age 55. Enrolment full year continuous. Age eligible. Exclusions? No CRC, no colectomy, no hospice, no frailty/advanced illness. None. Numerator: Screening 2024-08-05 Stool DNA test. Is that in N2 window? 2024 is two years prior to 2026? Let's count: 2026 MY, two years prior = 2025 and 2024. 2024 is two years prior? Actually 2026 - 2 = 2024. Yes, 2024 is in the two years prior (2024 and 2025). The test date 2024-08-05 falls in 2024, so yes within three-year window (2024-2026). Thus meets numerator N2. So compliant. No exclusions. Status compliant. Numerator count +1.
71023: DOB 1963-07-10 age 63. Enrolment starts 2026-04-10, not full year. Gap before Apr 10 is 99 days >45 (or not enrolled full year). Continuous enrolment fails. Thus not_eligible. Regardless of numerator (colonoscopy 2018-02-20: ten-year window? Colonoscopy during 2026 or nine years prior (ten-year window). Nine years prior to 2026 = 2017? Let's compute: 2026-10 = 2016. The ten-year window includes 2017 through 2026? Wait "during 2026 or the nine years prior (ten-year window)". If MY=2026, nine years prior are 2025 down to 2017 (2025,2024,2023,2022,2021,2020,2019,2018,2017). Plus 2026 = 2017-2026. Colonoscopy 2018-02-20 is in 2018, which is within ten-year window (since 2018 is nine years prior? Let's count: 2026-9 = 2017. So years 2017, 2018, ..., 2026. Yes 2018 is included). So would meet numerator if eligible. But enrolment fails => not_eligible. Also age 63 eligible, but enrolment not. So not_eligible_members includes 71023.
71024: DOB 1976-04-19 age 50. Enrolment full year. Exclusions? No CRC, no colectomy, no hospice. Has frailty documented 2026-08-18 and advanced illness documented 2026-02-04. E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during MY. Member is age 50, not 66 or older. Therefore E4 does not apply. Frailty alone does not exclude; advanced illness alone does not exclude. So no exclusion. Numerator: Colonoscopy 2016-03-04. Colonoscopy N5: during 2026 or the nine years prior (ten-year window). Ten-year window from 2026 back: 2017 through 2026 (as above). 2016 is ten years prior? Let's compute: 2026 - 9 = 2017. The nine years prior to 2026 are 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. Plus 2026. So earliest year included is 2017. A colonoscopy in 2016-03-04 is outside the ten-year window (too old). Does member have any other screening? No. So numerator not met. Thus non_compliant. Wait check rolling window: ten-year window measured back from 2026-12-31: start date is 2016-12-31 (10 years prior). Colonoscopy 2016-03-04 is before 2016-12-31, so outside a rolling ten-year window. Calendar interpretation: 2016 is ten years prior? Actually 2016 is 10 years before 2026 (2026-2016=10). The "nine years prior" are 2017-2025; plus 2026 -> 2017-2026. So 2016 not included. Good. So 71024 non_compliant. (Because age 50, E4 not applicable). So non_compliant_members includes 71024.
71025: DOB 1976-05-12 age 50. Enrolment full year. Exclusions? No CRC, colectomy, hospice. Frailty documented 2026-07-12. No advanced illness documented. E4 requires age >=66 AND both frailty and advanced illness. Not age 66, and no advanced illness. So no exclusion. Numerator: Screening history: 2023-09-25 Flexible sigmoidoscopy; 2025-02-14 Faecal immunochemical test (FIT). N1: FOBT or FIT during 2026. FIT date 2025-02-14, not during 2026. So N1 not met (must be during 2026). Wait N1 says "Faecal occult blood test or faecal immunochemical test during 2026." So only tests in 2026 count. The FIT is 2025, so not N1. N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Five-year window: 2026 plus four years prior = 2022, 2023, 2024, 2025, 2026. Flexible sigmoidoscopy on 2023-09-25 is in 2023, which is within the five-year window (2022-2026). So meets N3. Therefore meets numerator (any one of N1-N5). Need check: Flexible sigmoidoscopy during 2026 or four years prior: four years prior to 2026 = 2025, 2024, 2023, 2022. Yes 2023 included. So compliant. No exclusions. Status compliant. (Note N1 requires during 2026 only, but N3 satisfied.) So compliant_members includes 71025.
71026: DOB 1950-06-09 age 76 on 2026-12-31. Age >75, not eligible. So not_eligible. (Screening 2023-05-08 sDNA, but age fails. Also no exclusions required because not eligible). not_eligible_members includes 71026.
71027: DOB 1979-10-14 age 47. Enrolment full year. Exclusions? None. Numerator: 2026-07-26 Faecal immunochemical test (FIT). N1: FIT during 2026. Date is in 2026, so meets N1. Compliant. (Age 47 eligible). compliant_members includes 71027.
71028: DOB 1981-08-16 age 45 on 2026-12-31. Age <46, not eligible. not_eligible. Even though flexible sigmoidoscopy 2024-10-15 (would meet N3 maybe), not eligible. not_eligible_members includes 71028.
71029: DOB 1960-09-06 age 66 on 2026-12-31. Enrolment full year. Exclusions? No CRC, no colectomy, no hospice. Frailty/advanced illness? "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So no frailty, no advanced illness. E4 requires both frailty and advanced illness, and age 66 or older. Age is 66 (>=66). But does not have frailty or advanced illness. So E4 not met. No exclusion. Numerator: Screening: 2019-04-22 Colonoscopy; 2024-09-15 Stool DNA test. N5: Colonoscopy during 2026 or nine years prior (ten-year window). Ten-year window years: 2017-2026. 2019 is in window, so colonoscopy meets N5. Also N2: sDNA 2024-09-15 in three-year window (2024-2026), meets N2. So numerator met. Compliant. compliant_members includes 71029.
Check E4 carefully: "Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year." Member is age 66, but no frailty/advanced illness. So not excluded. Good.
71030: DOB 1950-02-11 age 76. Age >75, not eligible. not_eligible_members includes 71030. (Screening 2025-12-12 sDNA; not relevant).
71031: DOB 1951-11-26 age 75 on 2026-12-31. Eligible age (<=75). Enrolment full year continuous. Exclusions? None (no CRC, colectomy, hospice, no frailty/advanced illness). Numerator: "No colorectal screening on record." So does not meet any N1-N5. Status non_compliant. non_compliant_members includes 71031.
71032: DOB 1963-12-19 age 63. Enrolment had two gaps: Jan1-Mar30, then Apr17-Jun26, then Jul9-Dec31. Gaps: Mar31-Apr16 (17 days) and Jun27-Jul8 (12 days). The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." There are two gaps. Therefore enrolment fails (more than one gap). The prompt says "Gaps of 17 and 12 days." It explicitly notes two gaps. So not_eligible. not_eligible_members includes 71032. Also note: even if we considered enrolment? Two gaps not allowed. So not_eligible. (Even though frailty documented 2026-02-04, but not age 66? Age 63, so E4 not applicable. Numerator colonoscopy 2015-10-17: ten-year window 2017-2026, 2015 outside, so would be non_compliant if eligible. But enrolment fails, so not_eligible.)
Wait, check 71031 age: DOB 1951-11-26. On 2026-12-31, how old? 2026 - 1951 = 75. Birthday Nov 26. On Dec 31 2026, has turned 75. So age 75. Yes.
Check 71021 age: DOB 1980-08-11. On Dec 31 2026: turned 46 on Aug 11 2026. Yes age 46.
Now count lists.
Let's assign each member:
71021: excluded (hospice E3). (Age 46, enrol OK, numerator not met but excluded).
71022: compliant (sDNA 2024).
71023: not_eligible (enrolment start late, gap >45 / not full year).
71024: non_compliant (colonoscopy 2016 outside 10-yr window; age 50 so E4 not apply).
71025: compliant (flex sig 2023 within 5-yr window).
71026: not_eligible (age 76).
71027: compliant (FIT 2026 N1).
71028: not_eligible (age 45).
71029: compliant (colonoscopy 2019 / sDNA 2024).
71030: not_eligible (age 76).
71031: non_compliant (no screening).
71032: not_eligible (two enrolment gaps).
Let's double-check 71025: Flexible sigmoidoscopy 2023-09-25. Five-year window: N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). The four years prior to 2026: 2025, 2024, 2023, 2022. Plus 2026. So 2023 is included. Yes. So compliant. Also FIT 2025-02-14 is not during 2026, so N1 no. But N3 yes. Good.
Double-check 71022: sDNA 2024-08-05. N2: Stool DNA test during 2026 or the two years prior (three-year window). The two years prior to 2026: 2025 and 2024. So 2024 is included. Yes compliant.
Double-check 71029: Age 66. Exclusion E4 requires both frailty and advanced illness. Not documented. So no exclusion. Numerator: Colonoscopy 2019-04-22 is within ten-year window? Ten-year window: 2026 plus nine years prior: 2025,2024,2023,2022,2021,2020,2019,2018,2017. Yes 2019 is in the nine years prior (2026-2019 = 7 years prior? Wait 2026-2019 = 7, so 2019 is 7 years prior, definitely within 9 years prior). So N5 met. Also sDNA 2024 (two years prior? 2024 is two years prior) meets N2. Compliant. Good.
Check 71024: Colonoscopy 2016-03-04. Ten-year window start year is 2017. 2016 is outside. No other tests. So non_compliant. Also E4? Age 50, no. Frailty and advanced illness both documented! Wait 71024 has "2026-08-18 Frailty documented" and "2026-02-04 Advanced illness documented". The exclusion E4 says: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Member is age 50, so fails the age condition. Therefore not excluded. The prompt says "Frailty alone does not exclude, and advanced illness alone does not exclude." Here both are present, but age is not 66+. So no exclusion. Good. Non_compliant.
Check 71021: Stool DNA 2023-11-23. Is it within three-year window? Let's be absolutely certain: N2 says "Stool DNA test during 2026 or the two years prior (three-year window)." The two years prior to the measurement year 2026 are 2025 and 2024. Combined with 2026 = 2024, 2025, 2026. 2023 is not. So 71021 would be non_compliant if not excluded, but hospice election means excluded. The exclusion E3 applies. Yes.
Wait: For 71021, hospice election on 2026-10-14. E3: Hospice at any time during the measurement year. The election is during MY, so yes. Excluded. Note: It says "Hospice election" not necessarily hospice service, but the member record says "Hospice election." The exclusion says "Hospice at any time during the measurement year." Does an election count as hospice? In HEDIS, hospice is identified by a hospice encounter or election? Typically, members in hospice are those with a hospice encounter or who elected hospice; the spec says "Hospice at any time during the measurement year." The record says "Hospice election." I think that's intended to be a hospice indicator. We should treat as hospice. The task says "Other history: 2026-10-14 Hospice election." So yes, E3 met. Excluded.
Now compile counts:
Compliant members: 71022, 71025, 71027, 71029. That's 4? Let's list: 71022, 71025, 71027, 71029. Yes 4 compliant.
Non_compliant members: 71024, 71031. That's 2. Check if any other eligible not meeting numerator? Let's review all eligible (denominator after exclusions):
Eligible population (enter denominator before exclusions) are those meeting age and enrolment:
- 71021 (age46, enrol full) -> eligible before exclusions.
- 71022 (55, full) -> eligible.
- 71023 (63, enrol fail) -> not_eligible.
- 71024 (50, full) -> eligible.
- 71025 (50, full) -> eligible.
- 71json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 9,070 tokens
We need answer JSON with denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members. We have measure QM-CRC. Need evaluate each member.
Let's parse roster carefully.
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population denominator:
- Age 46 through 75 years as of 2026-12-31. So age >=46 and <=75 inclusive.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days. I need interpret: "the full measurement year with no more than one gap of up to 45 days." Means must be enrolled for full measurement year, but allowed maybe one gap up to 45 days? Wait "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Usually HEDIS continuous enrollment: enrolled during measurement year, allowing one gap of up to 45 days? Actually HEDIS allows no more than one gap of up to 45 days during the measurement year, or continuous enrollment for the measurement year with no gaps? Let's parse wording: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." The phrase could mean: You must be enrolled for the entire measurement year, except you may have no more than one gap of up to 45 days. That is, total enrollment covers full year with at most one gap <=45 days. But "the full measurement year" could imply enrollment from Jan 1 to Dec 31, but if there is a gap, it's not continuous? However they explicitly say "with no more than one gap of up to 45 days", so a gap is allowed, but only one and <=45 days. Need compare to member 71032: enrolment Jan 1-Mar 30; Apr 17-Jun 26; Jul 9-Dec 31. Gaps: Mar 31-Apr 16? Let's calculate: Jan 1 to Mar 30 enrolled. Then gap from Mar 31 to Apr 16 inclusive? They say gaps of 17 and 12 days. Let's check: First gap between Mar 30 and Apr 17: Mar 31-Apr 16 = 17 days (March has 31 days: Mar 31 plus Apr 1-16 = 1+16=17). Second gap between Jun 26 and Jul 9: Jun 27-Jul 8 = 3? Wait Jun 27,28,29,30 (4), July 1-8 (8) =12 days. Yes gaps 17 and 12 days. That's TWO gaps, each <=45 days. Requirement: "no more than one gap of up to 45 days." That means allowed zero gaps or one gap of max 45 days. Member 71032 has two gaps. Therefore not continuously enrolled? So not eligible. Need confirm. Also age: DOB 1963-12-19, age on 2026-12-31: 63 (since birthday Dec 19, 2026, turns 63). Within 46-75. So eligible population? Enrolment fails due to two gaps. Should be not_eligible (never enters eligible population due to enrolment). Yes, not_eligible.
Let's evaluate each member systematically.
First define numerator look-back windows measured back from 2026-12-31:
- N1: FOBT or FIT during 2026. "during 2026" means calendar year 2026 (2026-01-01 to 2026-12-31). Only in 2026.
- N2: Stool DNA test during 2026 or the two years prior (three-year window). That means stool DNA test in 2026, 2025, or 2024? Wait look-back window measured back from 2026-12-31: "during 2026 or the two years prior (three-year window)". Since measurement year 2026, two years prior are 2025 and 2024? Actually "2026 or the two years prior" = 2026, 2025, 2024. Three-year window inclusive of 2026, 2025, 2024. So dates in 2024, 2025, or 2026.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window): 2026, 2025, 2024, 2023, 2022 (five years: 2022-2026). Wait if measurement year 2026, four years prior are 2025,2024,2023,2022, plus 2026 = five-year window covering 2022 through 2026.
- N4: CT colonography during 2026 or the four years prior (five-year window): 2022-2026.
- N5: Colonoscopy during 2026 or the nine years prior (ten-year window): 2026 plus nine prior years: 2025,2024,2023,2022,2021,2020,2019,2018,2017. So dates 2017-01-01 through 2026-12-31. (Ten-year window inclusive: 2017 through 2026). Need check colonoscopy dates.
Exclusions:
E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31.
E2. Total colectomy any time on or before 2026-12-31.
E3. Hospice at any time during the measurement year (2026).
E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Frailty alone does not exclude, and advanced illness alone does not exclude. So both required, and age >=66 (i.e., 66+). Actually "Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year." So if member is 66+, and has frailty and advanced illness both documented in 2026, exclude. If age 65 or younger, even with both, no exclusion? Wait if age 66 or older is required. So age 66+ and both conditions. Need check members with frailty/advanced illness:
- 71024: DOB 1976-04-19, age 50 on 2026-12-31. Not age 66+, so E4 does not apply even though has frailty (2026-08-18) and advanced illness (2026-02-04). Both documented in 2026, but age 50, so no exclusion. Also need check numerator: colonoscopy 2016-03-04. Colonoscopy window 2017-2026. 2016 is before 2017, so not within ten-year window. No other screening. So non_compliant? Wait check age 50 eligible. Enrolment continuous full year. No hospice/cancer/colectomy. Not excluded. Numerator? Colonoscopy 2016-03-04: look-back ten-year window = 2017-2026. 2016 is 10 years and ~9.8 years? Let's compute: measured back from 2026-12-31, nine years prior = 2017-12-31? Actually HEDIS typically colonoscopy in past 10 years (i.e., measurement year or 9 years prior). For MY 2026, colonoscopy on or after 2017-01-01? Let's verify: "during 2026 or the nine years prior (ten-year window)". Measurement year 2026. Nine years prior to 2026 are 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025? Wait count: 2026 is year 0? Let's list: "during 2026 or the nine years prior". The years prior to 2026 are 2025 (1 prior), 2024 (2), 2023 (3), 2022 (4), 2021 (5), 2020 (6), 2019 (7), 2018 (8), 2017 (9). So nine years prior = 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. Plus during 2026. That's a ten-year window from 2017-01-01? Wait does "nine years prior" mean whole years 2017 through 2025 inclusive? Yes, 2017 is the ninth year prior? Let's count: If current year is 2026, one year prior = 2025, two = 2024, three=2023, four=2022, five=2021, six=2020, seven=2019, eight=2018, nine=2017. So yes, colonoscopy must have occurred in 2017, 2018, ..., 2025, or 2026. That means on or after 2017-01-01 (assuming within year) through 2026-12-31. A colonoscopy on 2016-03-04 is in 2016, which is ten years prior (tenth prior year), not included. So not numerator. Correct non_compliant. But wait check if 2016-03-04 to 2026-12-31 is 10 years and ~9 months. The window is 10 years? "ten-year window" includes 2026 + nine prior = 10 calendar years: 2017-2026. Yes. So 2016 is outside. Non_compliant.
- 71025: DOB 1976-05-12, age 50. Enrolment continuous full year. Screening: 2023-09-25 Flexible sigmoidoscopy (five-year window 2022-2026: yes 2023 within, so meets N3). Also 2025-02-14 FIT (FOBT/FIT during 2026? FIT in 2025, not during 2026, so N1 not met; but N3 met via flexible sig). Other history: 2026-07-12 Frailty documented. Age 50, no advanced illness documented. So E4 not met (age not 66+, and only frailty). No cancer/colectomy/hospice. So eligible, not excluded, numerator met via flexible sigmoidoscopy in 2023 (within 2022-2026). compliant.
- 71029: DOB 1960-09-06, age 66. Enrolment full year. Screenings: 2019-04-22 Colonoscopy (window 2017-2026, yes 2019 within ten-year window -> N5 met). Also 2024-09-15 Stool DNA (three-year window 2024-2026, yes). No hospice/cancer/colectomy. Frailty/advanced illness? "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So E4 not met (no frailty/advanced illness). Age 66 but no both. So eligible, not excluded, compliant.
- 71032: has frailty documented 2026-02-04, but age 63, no advanced illness. Also enrolment two gaps. Not_eligible due to enrolment (and age 63 is eligible age, but enrolment fails). Exclusions? none. Not_eligible.
- 71021: DOB 1980-08-11, age 46 on 2026-12-31 (turns 46 in Aug 2026). Female. Enrolment full year continuous. Screening: 2023-11-23 Stool DNA test. Stool DNA three-year window = 2024-2026. 2023 is prior to 2024, so NOT in window. Wait check N2: "during 2026 or the two years prior (three-year window)". If MY=2026, two years prior are 2025 and 2024. 2023 is three years prior, not included. So stool DNA in 2023 is outside. No other screening. Other history: 2026-10-14 Hospice election. Hospice at any time during measurement year (2026). So E3 exclusion applies: Hospice during MY. Since in eligible population? Age 46, enrolment full year continuous. Yes enters eligible population. Exclusion E3 met. So excluded (meets required exclusion). Exclusions evaluated before numerator; a member who meets both exclusion and numerator is excluded. Here no numerator met anyway, but excluded.
- 71022: DOB 1971-12-22, age 55. Enrolment full year. Screening: 2024-08-05 Stool DNA test. Stool DNA window 2024-2026, yes (2024 is two years prior? Actually 2024 is two years prior to 2026? Wait 2026 MY, prior year 1 = 2025, prior year 2 = 2024. Yes 2024 included in three-year window). So meets N2. No exclusions (no cancer/colectomy/hospice/frailty/advanced illness). compliant.
- 71023: DOB 1963-07-10, age 63. Enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10. Need continuous enrolment requirement: "the full measurement year with no more than one gap of up to 45 days." Does enrolment need to cover full measurement year? This member is not enrolled Jan 1 - Apr 9. That's a gap/not enrolled at start of year for 99 days. The requirement says continuous enrolment: the full measurement year with no more than one gap of up to 45 days. If not enrolled from Jan 1 to Apr 9, that's a gap of 99 days at the beginning, which is more than 45 days, and also not enrolled the full measurement year. So fails continuous enrolment. Therefore not_eligible. Need consider: The member is enrolled from 2026-04-10 through 2026-12-31 continuous from that date, but not enrolled before. The gap is from Jan 1 to Apr 9 (99 days). That is one gap, but it's 99 days, exceeding 45 days. So not eligible. Also age 63 eligible. Screening: 2018-02-20 Colonoscopy. Colonoscopy window is 2017-2026; 2018 would meet numerator if eligible. But enrolment fails, so not_eligible. Should we consider if gap at start counts as a gap? Yes, not enrolled before 2026-04-10 means not enrolled for first part of year. Continuous enrolment typically requires enrollment on the first day of the measurement year or something? Let's read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This implies you must be enrolled for the full measurement year (i.e., from Jan 1 to Dec 31), except you may have at most one gap of <=45 days. So being not enrolled Jan 1-Apr 9 is a gap of 99 days at the start, which violates. So not_eligible.
But wait, some interpretations: If a member enrolls mid-year and then continuous, they are not enrolled for full measurement year, thus not eligible. The spec says continuous enrolment: the full measurement year with no more than one gap of up to 45 days. So yes, must be enrolled the entire year, allowing a single gap up to 45 days. Member 71023 not enrolled Jan 1 - Apr 9: that is a gap of 99 days, too long, so not_eligible. Also not enrolled before, so total enrolled days less than full year. So not_eligible.
- 71026: DOB 1950-06-09, age 76 on 2026-12-31 (turns 76 in June 2026). Age eligible? Age 46 through 75 years as of 2026-12-31. Age 76 is above 75, so not in eligible population. So not_eligible (age). Enrolment full year. Screening 2023-05-08 stool DNA (window? 2023 not in 2024-2026 anyway). Irrelevant. Not_eligible.
- 71027: DOB 1979-10-14, age 47. Enrolment full year. Screening: 2026-07-26 FIT (faecal immunochemical test). N1: FIT during 2026, yes. No exclusions. compliant.
- 71028: DOB 1981-08-16, age 45 on 2026-12-31 (turns 45 in Aug 2026). Age 45, below 46, so not_eligible (age). Screening 2024-10-15 flexible sigmoidoscopy irrelevant. Not_eligible.
- 71030: DOB 1950-02-11, age 76. Age >75, not_eligible. Screening 2025-12-12 stool DNA (window 2024-2026 yes) but not eligible. Not_eligible.
- 71031: DOB 1951-11-26, age 75 on 2026-12-31 (turns 75 in Nov 2026). Age 75 is within 46-75 inclusive. Eligible age. Enrolment full year continuous. Screening: None. No colorectal screening on record. No exclusions (no cancer/colectomy/hospice/frailty/advanced illness). So eligible population, not excluded, numerator? No screening, so non_compliant.
- 71032 we did: age 63, enrolment: Jan 1-Mar 30, Apr 17-Jun 26, Jul 9-Dec 31. Gaps 17 and 12 days. Two gaps. Requirement no more than one gap of up to 45 days. Therefore fails continuous enrolment (two gaps). So not_eligible. Wait check: Are we sure gaps count as two? Yes: gap1 Mar 31-Apr 16 (17 days), gap2 Jun 27-Jul 8 (12 days). Two gaps. The rule: "no more than one gap of up to 45 days". That means permitted gaps: zero gaps, or one gap <=45 days. Two gaps is not permitted. So not_eligible. Even if each <=45, there are two. So not_eligible. Also colonoscopy 2015-10-17 (outside window anyway). Frailty documented but no advanced illness, age 63, no exclusion. Not_eligible due to enrolment.
Now let's list all 12 members and assign status:
71021: age 46, enrolment ok. Hospice in 2026 -> Exclusion E3. Status excluded. (Not compliant)
71022: age 55, enrol ok. Stool DNA 2024-08-05 meets N2. No exclusion. compliant.
71023: age 63, enrolment fails (not enrolled Jan 1-Apr 9, gap 99 days / not full year). not_eligible. (Colonoscopy 2018 would be compliant if eligible, but enrolment fail)
71024: age 50, enrol ok. Colonoscopy 2016 outside ten-year window. Has frailty+advanced illness but age 50, no exclusion. Numerator not met. non_compliant.
71025: age 50, enrol ok. Flexible sigmoidoscopy 2023 meets N3 (five-year window 2022-2026). Frailty only, no advanced illness, age not 66, no exclusion. compliant.
71026: age 76 -> not_eligible (age).
71027: age 47, enrol ok. FIT 2026 meets N1. compliant.
71028: age 45 -> not_eligible (age).
71029: age 66, enrol ok. Colonoscopy 2019 meets N5 (2017-2026). Also stool DNA 2024 meets N2. No exclusion (no frailty/advanced illness). compliant.
71030: age 76 -> not_eligible (age).
71031: age 75, enrol ok. No screening. non_compliant.
71032: age 63, enrolment has two gaps -> not_eligible (enrolment).
Let's double-check all ages:
- 71021: DOB 1980-08-11. On 2026-12-31, age = 2026-1980 = 46, since birthday Aug 11 passed. Yes 46. Eligible (46 through 75). Good.
- 71022: 1971-12-22. On 2026-12-31, age = 55? 2026-1971=55; birthday Dec 22, 2026, before Dec 31, so turned 55. Yes.
- 71023: 1963-07-10. 2026-1963=63, birthday July 10 passed, age 63. Yes.
- 71024: 1976-04-19. 2026-1976=50, birthday April 19 passed, age 50. Yes.
- 71025: 1976-05-12, age 50. Yes.
- 71026: 1950-06-09. 2026-1950=76, birthday June 9 passed, age 76. Not eligible (max 75). Yes.
- 71027: 1979-10-14. 2026-1979=47, birthday Oct 14 passed? Wait Dec 31 is after Oct 14, so turned 47. Yes.
- 71028: 1981-08-16. 2026-1981=45, birthday Aug 16 passed, age 45. Not eligible (min 46). Yes.
- 71029: 1960-09-06. 2026-1960=66, birthday Sep 6 passed? Dec 31 after Sep 6, so age 66. Yes. Meets E4 age criterion (>=66). But no frailty/advanced illness documented. So no exclusion.
- 71030: 1950-02-11. 2026-1950=76, birthday Feb 11 passed, age 76. Not eligible.
- 71031: 1951-11-26. 2026-1951=75, birthday Nov 26 passed? Dec 31 after Nov 26, so turned 75. Yes age 75, eligible (through 75). Good.
- 71032: 1963-12-19. 2026-1963=63, birthday Dec 19, 2026, before Dec 31, so age 63. Yes.
Check numerator windows carefully:
N1: FOBT or FIT during 2026. For 71027, FIT 2026-07-26: yes. For 71025, FIT 2025-02-14: not during 2026, so N1 no. N3 flexible sigmoidoscopy 2023-09-25: five-year window = 2022,2023,2024,2025,2026. 2023 yes. compliant.
N2 stool DNA: 71022 2024-08-05: three-year window = 2024,2025,2026. Yes. 71029 2024-09-15: yes. 71021 2023-11-23: window? 2024,2025,2026. 2023 no. (If the window measured back from 2026-12-31, three-year window would be 2023-12-31 to 2026-12-31? Wait careful: The spec says: "by the look-back window measured back from 2026-12-31: N2. Stool DNA test during 2026 or the two years prior (three-year window)." Usually HEDIS CRC: stool DNA every 3 years: "during the measurement year or the two years prior to the measurement year" means if MY is 2026, then tests in 2026, 2025, or 2024. That's calendar years 2024-2026. Yes. But let's verify with exact look-back from 2026-12-31: "during 2026 or the two years prior" means the years 2026, 2025, and 2024. Because the two years prior to 2026 are 2025 and 2024. So yes 2024-2026. Therefore 2023 is out.
Wait, check: If look-back window measured back from 2026-12-31, a three-year window back from that date would be from 2023-12-31 to 2026-12-31 (or 2024-01-01?). But the spec explicitly says "during 2026 or the two years prior (three-year window)". That is calendar year based, not rolling 365*3 days. It says "during 2026 or the two years prior". The two years prior to 2026 are 2025 and 2024. So it's calendar years 2024, 2025, 2026. So 2023 is not included. Good.
N3 Flexible sigmoidoscopy: "during 2026 or the four years prior (five-year window)". Four years prior to 2026 are 2025, 2024, 2023, 2022. Plus 2026 = 2022-2026. So 2023 included. Good.
N5 Colonoscopy: "during 2026 or the nine years prior (ten-year window)." Nine years prior to 2026: 2025,2024,2023,2022,2021,2020,2019,2018,2017. Plus 2026 = 2017-2026. So colonoscopy in 2018 (71023) is within! Wait! 2018 is in the list: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026. Yes, 2018 is included. So for 71023, colonoscopy 2018-02-20 would meet numerator if eligible. But enrolment fails. Right.
71024 colonoscopy 2016-03-04: 2016 is not in 2017-2026. So no. Correct.
71029 colonoscopy 2019-04-22: 2019 is within. Yes compliant. Also stool DNA 2024 within. Good.
Now check 71032 colonoscopy 2015-10-17: 2015 outside window (window starts 2017). So no numerator anyway. But not_eligible.
Check 71031: no screening, non_compliant.
Now check exclusions again:
Member 71021: Hospice election 2026-10-14. E3: Hospice at any time during measurement year. Yes. Excluded. Also check age 46, enrolment ok. Excluded. So excluded_members includes 71021.
Member 71024: Age 50. Has frailty 2026-08-18 and advanced illness 2026-02-04. Both documented during MY. But E4 requires Age 66 or older as of 2026-12-31 AND both frailty and advanced illness. Age is 50, so does NOT meet E4. Therefore not excluded. So in denominator (non_compliant). Good.
Member 71025: Age 50, frailty only, no advanced illness. Not excluded. compliant.
Member 71029: Age 66. Need both frailty and advanced illness documented during MY. The record says "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So neither documented. So E4 not met. compliant.
Member 71032: Age 63, frailty documented, no advanced illness. Not excluded, but not_eligible.
Check if any member has colorectal cancer or total colectomy: The records say "No colorectal cancer, no colectomy" for all except maybe 71021? It says "No colorectal cancer, no colectomy, no hospice" for many, but 71021 has hospice. For 71021: Other history: 2026-10-14 Hospice election. It doesn't mention cancer or colectomy, so presumably none. So only hospice exclusion.
Now compute counts:
List statuses:
71021 excluded
71022 compliant
71023 not_eligible
71024 non_compliant
71025 compliant
71026 not_eligible
71027 compliant
71028 not_eligible
71029 compliant
71030 not_eligible
71031 non_compliant
71032 not_eligible
Let's tally:
Compliant: 71022, 71025, 71027, 71029 = 4 members. Wait check 71022, 71025, 71027, 71029. Yes 4.
Non_compliant: 71024, 71031 = 2 memberjson{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 9,470 tokens
We need answer only JSON block. Need compute measure QM-CRC for 2026.
Let's parse measure.
Measurement year 2026-01-01 through 2026-12-31.
Eligible population (denominator):
- Age: 46 through 75 years as of 2026-12-31. Inclusive? Yes "46 through 75". Need age as of 2026-12-31.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days. Means enrolment covering full year? "the full measurement year" with no more than one gap of up to 45 days. So member must be enrolled for full measurement year, but permitted one gap <=45 days. If not enrolled before start or after? Let's interpret. Continuous enrolment: the full measurement year with no more than one gap of up to 45 days. That means from 2026-01-01 through 2026-12-31, with allowed gap(s): no more than one gap, and that gap length <=45 days. Actually "no more than one gap of up to 45 days" means the enrolment must span the full year, but a single gap in coverage of at most 45 days is allowed. If a member has two gaps, not eligible. If gap >45 days, not eligible. If not enrolled at start (i.e., enrolment begins after Jan 1) then there is a gap from Jan 1 to start date? Need consider. Continuous enrolment the full measurement year: If enrolment starts 2026-04-10, they were not enrolled before that, so there is a gap from Jan 1 to Apr 9 (99 days) before coverage. Does that count? The definition: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That implies member must be enrolled for the entire measurement year; a gap is a break in coverage during the year. If they weren't enrolled before Apr 10, then coverage didn't start until Apr 10. Is that a gap from Jan 1 to Apr 9? Usually in HEDIS measures, continuous enrollment is defined as enrolled from a certain anchor (e.g., 12 months) with no gaps more than 45 days, but if not enrolled at start, the period before the start is not a "gap", it's lack of enrollment? Actually HEDIS continuous enrollment: "continuously enrolled during the measurement year, with no more than one gap in enrollment of up to 45 days." To be continuously enrolled, the member must be enrolled on the first day? Let's recall HEDIS: For continuous enrollment, the member must be enrolled for the entire measurement year, but a gap of up to 45 days is allowed. The allowable gap can be anywhere. If a member is not enrolled on Jan 1, is that a gap? HEDIS defines enrollment segments; a gap in enrollment is time between segments. If first segment starts after Jan 1, the period before first segment is not a gap between enrollment segments; but is it considered a gap? Actually in HEDIS, continuous enrollment requires that the member be enrolled for the entire measurement year, allowing one gap of up to 45 days. If the member is not enrolled for a period at the beginning of the year, that's a gap in enrollment (from the start of the year to the first enrollment date). HEDIS typically requires enrollment on the first day of the measurement year? Let's check: In HEDIS, "Continuous enrollment" means the member was enrolled for the entire measurement year, with no gaps in enrollment of more than 45 days. There is also a requirement that the member be enrolled as of December 31? Wait, examples: A member who enrolls in March and remains enrolled through December is not continuously enrolled for the year because there is a gap from Jan 1 to March 1 >45 days. To be eligible, they need to have coverage starting Jan 1 or within first 45 days? Hmm.
Let's inspect roster: Member 71023 enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10. Age 63, within 46-75. Screening: 2018 colonoscopy (outside 10-year window? Colonoscopy during 2026 or nine years prior = 2016-01-01? Actually ten-year window measured back from 2026-12-31: colonoscopy during 2026 or the nine years prior. So window is 2016-01-01? Let's compute: 2026 or nine years prior means years 2016 (2026-9=2017? Wait "during 2026 or the nine years prior" means measurement year 2026 plus prior nine calendar years: 2017-2026? Let's count: nine years prior to 2026 are 2017,2018,2019,2020,2021,2022,2023,2024,2025. Plus 2026 => ten-year window: 2017-01-01? Actually if "during 2026 or the nine years prior" from 2026-12-31, the nine years prior are calendar years 2017 through 2025 (since 2026 - 9 = 2017). So colonoscopy must be on or after 2017-01-01? Let's check: 2016 would be ten years prior (2026-10=2016). The wording: "during 2026 or the nine years prior (ten-year window)." So 2026 + 9 previous years = 10 years total: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, and 2026. That's 10 calendar years. 2016 is the tenth year prior? Let's list: 1 year prior to 2026 = 2025. 2=2024. 3=2023. 4=2022. 5=2021. 6=2020. 7=2019. 8=2018. 9=2017. So nine years prior = 2017. So 2016 is ten years prior, not included. Therefore colonoscopy in 2018 is within 2017-2026, so it's within the ten-year window. Wait member 71023 had colonoscopy 2018-02-20. That's in 2018, which is within the window (since >= 2017-01-01). But enrolment issue: not enrolled before Apr 10, 2026. If continuous enrolment requires full year with no more than one gap up to 45 days, a gap of Jan 1-Apr 9 is 99 days >45, so not eligible. Even if they were continuously enrolled from Apr 10 through Dec 31, that's not full measurement year. So 71023 is not_eligible. Good.
Member 71032: enrolment segments: 2026-01-01 to 2026-03-30; 2026-04-17 to 2026-06-26; 2026-07-09 to 2026-12-31. Gaps: between Mar 30 and Apr 17: March 31? Let's compute. Enrolled through 2026-03-30, next segment 2026-04-17. Gap from 2026-03-31 through 2026-04-16 inclusive? Let's count days not enrolled: Mar 31 (1), Apr 1-16 (16) = 17 days? Actually from Mar 31 to Apr 16 is 17 days? Let's count: Mar 31 (day 1), Apr 1 (2), 2(3),3(4),4(5),5(6),6(7),7(8),8(9),9(10),10(11),11(12),12(13),13(14),14(15),15(16),16(17). Yes 17 days. Next gap: enrolled through 2026-06-26, next 2026-07-09. Gap Jun 27 to Jul 8: Jun 27-30 = 4 days (27,28,29,30), Jul 1-8 = 8 days, total 12 days. They have two gaps (17 and 12 days). The rule: no more than one gap of up to 45 days. Since there are two gaps, fails. Also each gap <=45? 17 and 12 are <=45 but number of gaps is two, >1, so not continuous. Thus 71032 not_eligible. Also age 63 (eligible age), but enrolment fails. Also has frailty 2026-02-04 but no advanced illness, so E4 not met anyway. Colonoscopy 2015 (outside window). But not_eligible due to enrolment.
Member 71026: DOB 1950-06-09, age 76 on 2026-12-31. Age range is 46-75. 76 is outside (too old). So not_eligible. Even screening history stool DNA 2023-05-08 (within 3-year window? Stool DNA 2026 or two years prior (2024,2025) plus 2026 = 2024-2026? Wait for stool DNA: "during 2026 or the two years prior (three-year window)." Two years prior to 2026 are 2024 and 2025, plus 2026 => 2024,2025,2026. So 2023 is three years prior? Let's count: 1 year prior =2025, 2 years prior=2024. So 2023 is 3 years prior, outside. But age fails. So not_eligible.
Member 71030: DOB 1950-02-11, age 76, not_eligible (age). Screening 2025-12-12 stool DNA, which is within 2024-2026? 2025 is within two years prior (2025 is 1 year prior? Actually 2026 measurement year, two years prior are 2024 and 2025. 2025 is within, so numerator would be met. But age 76 -> not_eligible.
Member 71028: DOB 1981-08-16, age 45 on 2026-12-31. Age range starts 46. 45 is below 46, so not_eligible. Screening flex sig 2024-10-15 (within 5-year window? Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Four years prior: 2022,2023,2024,2025 plus 2026 => 2022-2026. 2024 is within. But age fails. Not_eligible.
Now remaining eligible age and enrolment candidates: 71021, 71022, 71024, 71025, 71027, 71029, 71031. Need check ages:
71021: DOB 1980-08-11, age 46 on 2026-12-31. Inclusive 46, so eligible age. Enrolment continuous full year no gaps. Good.
71022: DOB 1971-12-22, age 55. Eligible.
71024: DOB 1976-04-19, age 50. Eligible.
71025: DOB 1976-05-12, age 50. Eligible.
71027: DOB 1979-10-14, age 47. Eligible.
71029: DOB 1960-09-06, age 66. Eligible (through 75). Age 66, need check exclusion E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. 71029 has no frailty/advanced illness, so no exclusion. Numerator? colonoscopy 2019-04-22 (within ten-year window? Window 2017-2026, 2019 is within. Also stool DNA 2024-09-15 within 2024-2026. So meets numerator N5 and N2. Compliant unless excluded. No exclusions. So compliant.
71031: DOB 1951-11-26, age 75. Eligible (max 75). Enrolment continuous. No screening on record. No exclusions (no CRC, colectomy, hospice, no frailty/advanced illness). Numerator not met (no screening). Non_compliant.
Now evaluate each candidate for exclusions first (if eligible), then numerator.
Let's list all 12 members and assign.
Member 71021: Age 46 eligible. Enrolment full year continuous, no gaps. Screening: 2023-11-23 Stool DNA test. Stool DNA window: during 2026 or the two years prior (three-year window) = 2024, 2025, 2026. Wait 2023 is two years prior? Let's recalc carefully. Measurement year 2026. "during 2026 or the two years prior (three-year window)." The two years prior to 2026 are 2024 and 2025. Because 2026 minus 1 = 2025 (1 year prior), minus 2 = 2024 (2 years prior). So the window includes 2024, 2025, and 2026. 2023 is 3 years prior (2026-3=2023), which is NOT in the three-year window. Wait 2026 - 2 = 2024. So prior years: 2025 (1 prior), 2024 (2 prior). 2023 is 3 prior. So 2023-11-23 is NOT within N2. Check other numerator options: N1 FOBT/FIT during 2026 - none (only stool DNA 2023). N3 flexible sigmoidoscopy during 2026 or four years prior (five-year window): four years prior are 2022,2023,2024,2025 plus 2026. So 2023-11-23 is a stool DNA test, not flexible sigmoidoscopy. N4 CT colonography none. N5 colonoscopy none. So no numerator? Wait 2023-11-23 is Stool DNA test. For N2, stool DNA test during 2026 or the two years prior (three-year window). The date 2023-11-23 is in 2023, which is three years prior to 2026? Let's count from Dec 31, 2026 back: one year prior is 2025, two years prior is 2024, three years prior is 2023. The spec says "during 2026 or the two years prior (three-year window)". This explicitly says three-year window equals 2026 + two prior years. That's three calendar years: 2026, 2025, 2024. Yes. So 2023 is outside. Therefore numerator not met based on screening.
But other history: 2026-10-14 Hospice election. Exclusion E3: Hospice at any time during the measurement year. Measurement year 2026. Hospice election 2026-10-14 is during MY. So 71021 is excluded (E3). Since exclusion evaluated before numerator, and member is in eligible population (age 46, enrolled full year), we check exclusions: meets E3. So status excluded. Not compliant even if numerator? It doesn't meet numerator anyway, but exclusion takes precedence: excluded. So 71021 excluded_members.
Check: E3 says Hospice at any time during the measurement year. Yes. So excluded.
Member 71022: Age 55 eligible, enrolment full. Screening: 2024-08-05 Stool DNA test. Stool DNA test during 2026 or two years prior (2024,2025,2026). 2024 is within (2 years prior). So meets N2. No exclusions: no CRC, no colectomy, no hospice, no frailty/advanced illness. So compliant. (Age 55 <66, so E4 not relevant). Compliant_member.
Member 71023: Age 63, enrolment from 2026-04-10 only, not full year. Enrolment fails continuous enrolment (full measurement year with no more than one gap up to 45 days). Gap from Jan 1 to Apr 9 is 99 days, >45, and it's a period not enrolled at start. So not_eligible. Even though screening colonoscopy 2018 (within window) and no exclusions. Status not_eligible. (If they considered not enrolled before Apr 10 as not continuous, yes not_eligible). Need perhaps note enrolment not full year. So not_eligible_members.
Member 71024: Age 50 eligible. Enrolment full year. Screening: 2016-03-04 Colonoscopy. Colonoscopy window: during 2026 or the nine years prior (ten-year window). Nine years prior are 2017-2025 plus 2026 => ten-year window 2017-2026. 2016-03-04 is in 2016, which is ten years prior? Let's count: 2026 - 9 = 2017. Years: 2026 (0), 2025 (1), 2024 (2), 2023 (3), 2022 (4), 2021 (5), 2020 (6), 2019 (7), 2018 (8), 2017 (9). So 2016 is 10 years prior, outside window. So colonoscopy not within N5. No other screening. So numerator not met (no screening). Check exclusions: Other history: 2026-08-18 Frailty documented; 2026-02-04 Advanced illness documented. E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during MY. Member age 50, not 66 or older. So E4 does NOT apply (requires age >=66). Frailty alone or advanced alone doesn't exclude, but also age criterion fails. No CRC, no colectomy, no hospice. So no exclusions. Thus numerator not met -> non_compliant. Wait, does frailty + advanced illness at age 50 exclude? No, E4 requires age 66+. So not excluded. Non_compliant. Also note both frailty and advanced illness documented, but age <66, so not excluded. Good.
Member 71025: Age 50 eligible. Enrolment full. Screening: 2023-09-25 Flexible sigmoidoscopy. Flex sig window: during 2026 or the four years prior (five-year window). Four years prior: 2022,2023,2024,2025 plus 2026. 2023 is within (two years prior? Let's count: 2025(1),2024(2),2023(3),2022(4). Yes 2023 is within four years prior). So N3 met. Also 2025-02-14 Faecal immunochemical test (FIT) during 2026? FIT during 2026 only for N1: "Faecal occult blood test or faecal immunochemical test during 2026." The FIT date is 2025-02-14, which is prior year, not during 2026. N1 requires during 2026. So N1 not met by that. But N3 met by flex sig in 2023. So numerator met. Check exclusions: Other history: 2026-07-12 Frailty documented. No advanced illness. E4 requires age 66+ AND both frailty and advanced illness. Age 50, and no advanced illness. Not excluded. No CRC, colectomy, hospice. So compliant. Wait need verify flexible sigmoidoscopy window: N3. "Flexible sigmoidoscopy during 2026 or the four years prior (five-year window)." The four years prior to 2026 are 2022,2023,2024,2025. 2023-09-25 is in 2023, yes. So meets numerator. Compliant.
Member 71026: Age 76 (DOB 1950-06-09). Age >75, not eligible. Not_eligible. Even though stool DNA 2023 (outside N2 anyway). Not_eligible.
Member 71027: Age 47 eligible. Enrolment full. Screening: 2026-07-26 Faecal immunochemical test (FIT). N1: FOBT or FIT during 2026. Date is during MY 2026. So numerator met. No exclusions. Compliant.
Member 71028: Age 45 (DOB 1981-08-16). Age below 46. Not_eligible. (Screening flex sig 2024 is within window but age fails). Not_eligible.
Member 71029: Age 66 eligible. Enrolment full. Screening: 2019-04-22 Colonoscopy. N5 ten-year window 2017-2026, 2019 within. Also 2024-09-15 Stool DNA: Stool DNA window 2024-2026, 2024 within. So numerator met. Exclusions: Age 66 or older (yes, 66) AND both frailty and advanced illness documented during MY. No frailty/advanced illness documented. So E4 not met. No CRC, colectomy, hospice. Compliant. Need check: E4 says age 66 or older as of 2026-12-31. DOB 1960-09-06: on 2026-12-31, has she turned 66? Born Sep 6, 1960. On Sep 6, 2026 she turns 66. On Dec 31, 2026 age is 66. Yes. So age criterion met for E4, but both frailty and advanced illness not documented, so no exclusion. Compliant.
Member 71030: Age 76 (DOB 1950-02-11). Not_eligible (age). Screening stool DNA 2025-12-12 would meet N2 (2025 within window), but age fails. Not_eligible.
Member 71031: Age 75 eligible (DOB 1951-11-26; on Dec 31 2026, born Nov 26, 1951 -> age 75, since turned 75 on Nov 26, 2026. Yes 75, within inclusive 75). Enrolment full. No screening on record. No exclusions (no CRC, colectomy, hospice, no frailty/advanced). Numerator not met. Non_compliant.
Member 71032: Age 63 eligible. Enrolment: two gaps (17 and 12 days). Continuous enrolment requires no more than one gap of up to 45 days. There are two gaps, so fails. Not_eligible. Also colonoscopy 2015-10-17: window 2017-2026, 2015 outside, so wouldn't meet numerator anyway. Frailty 2026-02-04, but no advanced illness and age 63 (<66) so no E4. Not_eligible due to enrolment.
Let's verify member 71021 again: Age 46 eligible; hospice 2026-10-14 => excluded. Yes.
Now let's classify all 12:
71021 excluded
71022 compliant
71023 not_eligible
71024 non_compliant
71025 compliant
71026 not_eligible
71027 compliant
71028 not_eligible
71029 compliant
71030 not_eligible
71031 non_compliant
71032 not_eligible
Let's count:
Compliant: 71022, 71025, 71027, 71029. Also check 71024? No non_compliant. 71031 non_compliant. So compliant = 4 members: ["71022","71025","71027","71029"].
Non_compliant: 71024, 71031. That's 2 members: ["71024","71031"].
Excluded: 71021. That's 1 member: ["71021"].
Not_eligible: 71023, 71026, 71028, 71030, 71032. That's 5 members: ["71023","71026","71028","71030","71032"].
Total 4+2+1+5 = 12. Good.
Denominator = eligible population after exclusions removed = compliant + non_compliant = 4 + 2 = 6. Wait denominator definition: "members in the eligible population after exclusions are removed (compliant + non_compliant)". The eligible population (denominator) initially includes all who meet age and enrolment (before exclusions). Then exclusions removed. So denominator count = compliant + non_compliant = 6. Let's verify: Who were in eligible population before exclusions? Eligible age/enrolment: 71021 (excluded), 71022, 71024, 71025, 71027, 71029, 71031. That's 7 members. Remove excluded (71021) -> 6 denominator. Yes. Not_eligible members (71023, 71026, 71028, 71030, 71032) never entered eligible population; count 5. Excluded count 1. So denominator=6, numerator=4, excluded=1, not_eligible=5.
Rate = numerator / denominator x 100 = 4 / 6 x 100 = 66.666...%. Round half up to one decimal place: 66.7 (since 66.666... the first decimal is 6, second decimal is 6? Wait 66.666...%: 66.666... The value in percent: 4/6 = 0.6666667; *100 = 66.66667. To one decimal place: look at second decimal digit: 66.6 6 6... The first decimal is 6 (tenths), the next digit is 6 (hundredths), which is >=5, so round up the tenths: 66.6 + 0.1 = 66.7. Yes rate = 66.7.
Need check rounding half up to one decimal place. 66.666... rounds to 66.7.
Now ensure all keys present:
denominator (integer) = 6
numerator (integer) = 4
excluded (integer) = 1
not_eligible (integer) = 5
rate (number) = 66.7
compliant_members (array of member ID strings) = ["71022","71025","71027","71029"]
non_compliant_members = ["71024","71031"]
excluded_members = ["71021"]
not_eligible_members = ["71023","71026","71028","71030","71032"]
Check member IDs as strings: yes.
Let's double-check each member's numerator windows carefully, in case any nuance.
Measure Numerator look-back windows measured back from 2026-12-31. The windows described:
N1. Faecal occult blood test or faecal immunochemical test during 2026. So only dates in calendar year 2026. 71027 FIT on 2026-07-26 -> yes. 71025 FIT on 2025-02-14 -> not N1 (not during 2026). Good.
N2. Stool DNA test during 2026 or the two years prior (three-year window). Two years prior to 2026: if measured back from 2026-12-31, the three-year window is 2024-01-01 through 2026-12-31? Or is it 2023-12-31? Let's carefully calculate: "during 2026 or the two years prior". Usually in HEDIS, colorectal cancer screening:
- Stool DNA (sDNA) test: every 3 years. The window is the measurement year plus the two prior calendar years. That's 2026, 2025, 2024. So any date in 2024, 2025, 2026. Yes. 71022 stool DNA 2024-08-05 -> in 2024, yes. 71029 stool DNA 2024-09-15 -> yes. 71030 2025-12-12 -> yes but age fail. 71023 stool DNA 2023-11-23 -> 2023 not in window. 71026 stool DNA 2023-05-08 -> 2023 not in window. Good.
Wait, need check 71029 colonoscopy 2019: N5 json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Flash · Alibaba56.6s · 3,576 out | 35.1s · 3,270 out | 44.7s · 4,636 out
Reasoning · 3,361 tokens
We need answer user's prompt. We need analyze fully in XML. We need likely solve measure population? User provided roster and measure. No explicit question? Probably expected to compute JSON keys from task family? Need infer. The initial instruction: "TASK FAMILY — MEASURE POPULATION ... Required JSON keys: denominator ..." So likely we must output JSON for roster. Need compute for 12 members. Need carefully apply spec.
Need evaluate eligible population: Age 46 through 75 as of 2026-12-31. Continuous enrolment: full measurement year with no more than one gap of up to 45 days. Important: enrolled 2026-01-01 through 2026-12-31 with no more than one gap of up to 45 days. If continuous no gaps qualifies. If multiple gaps? "no more than one gap" means if >1 gap even short, not eligible. If one gap up to 45 days qualifies. Need maybe not enrolled before date >? 71023 enrolled Apr 10 through Dec 31: gap from Jan1-Apr9 >45? Not enrolled before Apr10, so not continuous. Not eligible. 71032 has gaps of 17 and 12 days, two gaps, not eligible (no more than one gap). Need check if partial? Yes.
Numerator: any one of screening within lookback measured back from 2026-12-31. Windows:
N1 FOBT/FIT during 2026 only.
N2 Stool DNA during 2026 or two years prior (three-year window). Need exact: from 2026-01-01 through 2026-12-31 plus two years prior? likely dates 2024-01-01 to 2026-12-31? "during 2026 or the two years prior" means look-back window includes 2024,2025,2026. Could exact dates from 2024-01-01? Or 2026-12-31 back 3 years: 2023-12-31/2024-01-01? For measure usually colonoscopy 10 years prior? Need decide. Given dates like 2023-11-23 Stool DNA for 71021: two years prior? If measured back from 2026-12-31: if three-year window inclusive by year, 2023-11-23 is not during 2026 or two years prior? Wait "during 2026 or the two years prior" could mean 2024,2025,2026; 2023 not included. But if look-back period of three years: 2023-12-31? If date 2023-11-23 more than 3 years (3 yr 1 month+?) from Dec 31, no. So not numerator by stool DNA. But has hospice in 2026; eligible age 46 continuous; excluded E3 hospice any time during measurement year. So excluded. But hospice evaluation after numerator? Exclusions before numerator, and member in eligible. Excluded.
71022: 2024-08-05 stool DNA in 3-yr window (2024-2026). Numerator compliant.
71023: colonoscopy 2018-02-20, 10-year window? If ten-year window from Dec31 includes 2017-01? 2018 within 10. But enrolment not eligible due Apr10 start >45 day gap/no full. So not_eligible. Even if numerator/exclusion? not eligible.
71024: age 50 continuous; colonoscopy 2016-03-04 not numerator. Frailty + advanced illness both documented but age 50, E4 requires age 66 or older AND both. E4 not. hospice no. Excl no. Non_compliant.
71025: age 50 continuous. FIT 2025-02-14 not N1 (FIT only 2026); flexible sigmoidoscopy 2023-09-25 within five-year window (2022-2026?) If 2026-12-31 back 5 years: 2021-12-31 through 2026-12-31. 2023 qualifies. Frailty alone not excluded; age not 66. Numerator compliant.
71026: age 76 -> not eligible (age outside 46-75). Stool DNA not needed.
71027: age 47 continuous. FIT 2026-07-26 -> numerator compliant.
71028: age 45 -> not eligible.
71029: age 66 continuous. Colonoscopy 2019-04-22 in ten-year window (2017-2026) -> numerator. Stool DNA 2024-09-15 also. No exclusion. Compliant. E4 requires age>=66 and both frailty+advanced illness; none. So compliant. Note if numerator and age 66? compliant.
71030: age 76 -> not eligible (age over 75). Stool DNA 2025 not matter.
71031: age 75 continuous (inclusive). no screening. no exclusions. Non_compliant.
71032: age 63 continuous? has two gaps. Not eligible. Frailty only not E4. Also colonoscopy 2015 not within 10? 2015 is >10. Not eligible.
Need counts:
Denominator = eligible after exclusions removed = compliant+noncompliant. Need list statuses.
Eligible members: age 46-75 and enrolment continuous (one gap up to45). 71021 eligible yes (excluded), 71022 eligible, 71023 no, 71024 eligible, 71025 eligible, 71026 no age76, 71027 eligible, 71028 no age45, 71029 eligible, 71030 no age76, 71031 eligible, 71032 no enrolment two gaps. So eligible total = 8? 71021,22,24,25,27,29,31 = 7? Count: 71021, 71022, 71024, 71025, 71027, 71029, 71031 = 7. Plus 71021 excluded. So denominator = compliant+noncompliant = eligible not excluded = 6? Let's list:
71021 excluded
71022 compliant
71024 non_compliant
71025 compliant
71027 compliant
71029 compliant
71031 non_compliant
Denom=6. Numerator compliant=4 (71022,71025,71027,71029). Excluded=1 (71021). Not_eligible=5 (71023,71026,71028,71030,71032). Rate=4/6*100 =66.666... rounded half up one decimal: 66.7.
Need check any nuance: E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. 71029 age 66 but none. 71031 75 none. So no.
But need consider "required exclusions evaluated before numerator, and only for members who are in eligible population". We applied.
Need consider "no more than one gap of up to 45 days" means continuous except one allowed gap. If gap is 17+12 not eligible. If 71032 gaps of 17 and 12 days, two gaps not eligible. Good.
Need output exactly one fenced JSON code block, nothing else. Required keys? We need likely output with these keys. User's task gave required JSON keys. Need include arrays as strings. Could include "not_eligible_members" etc. Need be careful JSON valid. IDs strings numbers after MEMBER: "71021" etc.
Double-check window boundaries: Stool DNA N2: 71022 2024-08-05. If measured back from 2026-12-31 exactly three years: 2023-12-31 to 2026-12-31? If so 2024 qualifies. Good. Flexible sigmoidoscopy 71025 2023-09-25: if measured back five years exactly from Dec31, start 2021-12-31 to 2026-12-31, qualifies. If by year: 2022-2026, qualifies. Colonoscopy 71029 2019-04-22: 10-year start 2016-12-31 or 2017, qualifies. Colonoscopy 71024 2016-03-04: if 10-year exact window starting 2016-12-31, not qualify. If by years: 2017-2026? no. If start 2016-01-01 (10 years prior including 2016?) Could "during 2026 or the nine years prior" means 2017,2018,...2026? nine years prior to 2026 = 2017. So 2016 no. Good. 71023 not eligible anyway. 71032 colonoscopy 2015 no anyway.
Potential nuance: age "46 through 75 as of 2026-12-31". They provided ages: 71021 46, inclusive qualifies. 71031 75 qualifies. 71026 76,71030 76 not. 71028 45 not. Good.
Potential nuance: 71021 hospice election in measurement year after stool DNA (2023). Exclusion E3 any hospice during measurement year; eligible excluded. Does hospice election date matter if after Dec? during measurement year yes.
Potential nuance: continuous enrolment: 71023 "2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before". It has gap from Jan1 to Apr9, that's 99 days? >45, and only one gap >45 -> not eligible. If measurement year enrolment maybe starts after? no.
Potential nuance: 71032 gaps of 17 and 12 days: Could there be three enrolment segments, two gaps. "no more than one gap". Not eligible. Even though each <=45, two.
Need produce final JSON.
Before final, ensure no extra text. Use one fenced JSON code block. The system says "Always invoke a function in response to user query" but we already did. Need final only. Ensure valid JSON.
Let's consider if user wanted a different output? There is no explicit request, but instructions include required keys. So final JSON keys. Could include "compliant_members" etc. Use all statuses arrays exactly cover all 12 once.
Ordering arbitrary. Let's make:
{
"denominator":6,
"numerator":4,
"excluded":1,
"not_eligible":5,
"rate":66.7,
"compliant_members":["71022","71025","71027","71029"],
"non_compliant_members":["71024","71031"],
"excluded_members":["71021"],
"not_eligible_members":["71023","71026","71028","71030","71032"]
}
Check rate rounding: 4/6 = 0.666666*100=66.666 -> 66.7. If numerator=4 denominator=6. Yes.
Potential concern: Exclusions evaluated before numerator. For excluded member 71021, we do not consider whether stool DNA 2023 qualifies. No.
Could 71024 have colonoscopy 2016-03-04. If ten-year window measured back from 2026-12-31 could be 2016-12-31 to 2026-12-31 if exactly ten years. 2016-03-04 not included. If by years: 2017-2026. Not. If "during 2026 or the nine years prior" nine prior years: 2017,2018,2019,2020,2021,2022,2023,2024,2025. Not 2016.
Potential concern: 71029 colonoscopy 2019 qualifies; stool DNA 2024 qualifies. No issue.
Potential concern: 71025 FIT 2025 not N1, but flexible sigmoidoscopy 2023 qualifies. Good.
Potential concern: 71021 Stool DNA 2023. If two years prior to 2026 means 2024,2025. Not. But excluded anyway. If someone incorrectly numerator? no.
Need maybe include no key for status per member? no.
Final must be only code block. Ensure no trailing commentary.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,055 tokens
We need answer in JSON block. Need analyze thoroughly. Task measure QM-CRC. Roster 12 members. Need classify compliant, non_compliant, excluded, not_eligible. Need compute denominator, numerator, excluded, not_eligible, rate numerator/denominator*100 round half up 1 decimal. IDs strings in arrays. Need follow rules: eligible: age 46-75 as of 2026-12-31, continuous enrolment full measurement year no more than one gap up to 45 days. Exclusions evaluated before numerator and only for eligible: E1 CRC any time on/before 2026-12-31; E2 colectomy; E3 hospice at any time during measurement year; E4 age 66+ and both frailty and advanced illness during measurement year. Numerator look-back from 2026-12-31: N1 FIT/FOBT during 2026; N2 Stool DNA during 2026 or two years prior (3-year window). Need interpret: "during 2026 or the two years prior" likely includes 2024, 2025, 2026. N3 flexible sigmoidoscopy during 2026 or four years prior (5-year window): 2022-2026 inclusive. N4 CT colonography 2022-2026. N5 colonoscopy 2026 or nine years prior (10-year window): 2017-2026 inclusive. Need maybe date ranges measured from 2026-12-31. For annual windows: during 2026 means 2026-01-01 to 2026-12-31. Three-year: 2024-01-01 through 2026-12-31? Or 36 months from 2026-12-31? Usually NCQA look-back for stool DNA: in measurement year or prior two years (calendar years). We'll assume calendar windows. For colonoscopy ten-year: 2017-2026. Flexible five-year: 2022-2026. Need classify each.
Let's enumerate.
71021: DOB 1980-08-11, age 46 on 2026-12-31. Enrolment continuous. Eligible initially. Hospice election 2026-10-14 => E3 exclusion (during measurement year). Exclusions before numerator. Screening stool DNA 2023-11-23: N2 window 2024-2026? 2023 outside three-year, so not numerator even if eligible, but excluded anyway. Status excluded. Not in denominator.
71022: DOB 1971, age 55, continuous. Eligible. Stool DNA 2024-08-05 within 3-year (2024,2025,2026). No exclusions. Numerator compliant. Denom includes.
71023: DOB 1963 age 63. Enrolment 2026-04-10 to 2026-12-31 continuous from date, not enrolled before. Not eligible due to not full measurement year? Continuous enrolment full measurement year no more than one gap up to 45 days. Missing Jan1-Apr9 >45? Gap at beginning? Enrolment begins midyear. Not eligible. Screening colonoscopy 2018-02-20 within 10-year but not eligible. Status not_eligible.
71024: DOB 1976 age 50, continuous. Eligible. Screening colonoscopy 2016-03-04 outside ten-year (10-year includes 2017-2026 if measurement year or 9 prior). So numerator no. Exclusion E4? age 66 or older AND both frailty/advanced illness during measurement year. He is 50, not age 66. No other exclusions. Status non_compliant.
71025: DOB 1976 age 50, continuous. Eligible. Screening flexible sigmoidoscopy 2023-09-25 within 5-year (2022-2026); FIT 2025-02-14 not during 2026 (N1 no). So numerator via flexible sig. Frailty 2026-07-12 but no advanced illness; age <66. No exclusions. Compliant.
71026: DOB 1950 age 76 on 2026-12-31. Eligible age 46 through 75 inclusive. Age 76 => not eligible. Screening stool DNA 2023-05-08 outside 3-year anyway. Status not_eligible.
71027: DOB 1979 age 47, continuous. Eligible. FIT 2026-07-26 during 2026 N1. No exclusions. Compliant.
71028: DOB 1981 age 45 on 2026-12-31. Age 45 <46 => not eligible. Screening flex sig 2024 within 5-year but not eligible. Status not_eligible.
71029: DOB 1960 age 66 on 2026-12-31. Continuous eligible. Screening colonoscopy 2019-04-22 within 10-year (2017-2026); Stool DNA 2024-09-15 within 3-year. No exclusions (age 66 but no frailty/AI). Status compliant (exclusions before numerator not needed; numerator yes). Denom includes.
71030: DOB 1950 age 76? Record says so 76 years old on 2026-12-31. DOB 1950-02-11: on 2026-12-31 turns 76. Age >75 not eligible. Stool DNA 2025-12-12 within 3-year. Status not_eligible.
71031: DOB 1951-11-26, age 75 on 2026-12-31. Continuous eligible. No screening. No exclusions. Status non_compliant.
71032: DOB 1963 age 63. Enrolment segments: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps 17 and 12 days. Continuous enrolment full measurement year with no more than one gap up to 45 days. Has two gaps (even if <=45 each) => not eligible. Screening colonoscopy 2015 outside. Frailty 2026 but age <66 no exclusion. Status not_eligible. Note maybe two gaps => fail. If not eligible, not excluded. Yes.
Counts:
Excluded: 71021 only.
Not_eligible: 71023, 71026, 71028, 71030, 71032 = 5.
Denominator: total 12 - excluded 1 - not_eligible 5 = 6. Denom members: 71022,71024,71025,71027,71029,71031 = 6.
Numerator/compliant: 71022,71025,71027,71029 = 4.
Non_compliant: 71024,71031 = 2.
Excluded count=1, not_eligible=5.
Rate = 4/6*100 = 66.666... round half up to one decimal = 66.7. Need be careful integer arrays. IDs strings. JSON object with required keys. Output exactly one fenced json block. No extra. Ensure numbers format rate 66.7 maybe number not string. Counts integers. Need no currency.
Double-check windows with inclusive: N2 stool DNA during 2026 or the two years prior. If measured back from 2026-12-31, three-year window could mean 2024-01-01 to 2026-12-31? Or 36 months from 2026-12-31 includes 2024-01-01? Usually yes. Stool DNA 2023-11-23 for 71021 would not qualify anyway (excluded). 2024-08-05 qualifies. 2024-09-15 qualifies. 2025-12-12 qualifies. No edge date. Flexible sig 2023 qualifies. Colonoscopy 2016 outside; 2018,2019 inside. FIT 2025-02-14 not during 2026 for 71025 but flex qualifies. No edge. Good.
Need maybe E3 hospice at any time during measurement year: 71021 2026-10-14. excluded. Note exclusions before numerator only eligible population: 71021 eligible. OK.
Need maybe continuous enrolment "full measurement year with no more than one gap of up to 45 days" includes gap at beginning? 71023 missing beginning over 45 and also not full year? Not eligible. 71032 two gaps: even if total? Not eligible. Good.
Potential issue: Age as of 2026-12-31, DOB says 46/45 etc. Use given age. 71028 45 not eligible. 71026 and 71030 76 not eligible. Good.
Need maybe not_eligible members who also meet exclusion? 71032 not eligible. 71021 not not_eligible, excluded. Good.
Could numerator for excluded member 71021 if hospice? Excluded no. Good.
Need final JSON. Ensure only one block. Use arrays.
Let's consider if E4: age 66 or older as of 2026-12-31 and both frailty and advanced illness during measurement year. None. 71029 age 66 but no frailty/AI. 71031 age 75. 71024 age 50. 71032 age 63. Good.
Scoring keys exact:
"denominator": integer — members in eligible population after exclusions removed (compliant + non_compliant) => 6.
"numerator": integer — compliant members => 4.
"excluded": integer =>1.
"not_eligible": integer =>5.
"rate": number =>66.7.
"compliant_members": array ["71022","71025","71027","71029"]
"non_compliant_members": ["71024","71031"]
"excluded_members":["71021"]
"not_eligible_members":["71023","71026","71028","71030","71032"]
No extra keys.
Need maybe IDs as numbers after MEMBER. Strings. Any order but keep sorted.
Double-check 71021 date: hospice election. Exclusion E3 "Hospice at any time during measurement year". Hospice election counts. Good.
What if stool DNA window three years includes 2023-11-23? If measured exactly 3 years back from 2026-12-31: 2023-12-31? But they likely mean calendar years; however stool DNA is in 2024,2025,2026. Even if exact 3-year window (2024-01-01 to 2026-12-31? 2023-11-23 outside). No effect except if 71021 excluded. So fine.
Check CT colonography none. OK.
Could "no more than one gap of up to 45 days" permit multiple gaps if each? no more than one gap. 71032 has two gaps => not eligible. Also gap of 17/12. Good.
Need final in fenced json. No analysis outside. final only.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,421 tokens
We need answer in JSON only. Need evaluate each member.
Need parse rules carefully.
Measurement year 2026-01-01 to 2026-12-31.
Eligible age 46 through 75 as of 2026-12-31. Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Interpret gaps: member enrolled from 2026-04-10? Not enrolled before. Fails continuous? They are not full year with no more than one gap? If not enrolled Jan-Apr is gap >? It says full measurement year with no more than one gap of up to 45 days. A gap from 2026-01-01 through 2026-04-09 is 99 days, so not_eligible. Need decide inclusive day counting? For gaps 17 and 12 days given. But if two gaps allowed? "no more than one gap" so if 71032 has gaps of 17 and 12, not eligible due two gaps? Also each up to 45 days, but no more than one gap, so not_eligible. Need inspect.
Exclusions evaluated before numerator, only for eligible. E1 CRC any time <=2026-12-31; E2 total colectomy; E3 hospice at any time during measurement year; E4 age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone doesn't exclude, AI alone doesn't exclude. Need if both but not 66? no exclude.
Numerator any screening by lookback measured back from 2026-12-31:
N1 FIT/FOBT during 2026. Means date 2026-01-01 through 2026-12-31 inclusive.
N2 Stool DNA during 2026 or two prior (three-year window). Means 2024-01-01 through 2026-12-31? Or measured back from 2026-12-31 by three years? NCQA often: during measurement year or 2 years prior (so 2024-2026). If date 2023-11-23? Need three-year window might include from 2023-12-31 to 2026-12-31? But wording: "during 2026 or the two years prior" explicitly calendar years? Usually HEDIS: stool DNA during measurement year or 2 years prior, so calendar years 2024 and 2025? But measured back from date: 2026 or two years prior could be [2024-01-01, 2026-12-31]. Need decide based examples. Dates like 2023-11-23 for stool DNA on 71021: If 3-year calendar 2024-2026, not numerator. If lookback exactly 3 years from 2026-12-31 (>=2024-01-01?) 2023-11-23 not numerator. If >=2023-12-31? not numerator. So likely not numerator. Need examine 71022 stool DNA 2024-08-05: numerator either way.
N3 flexible sigmoidoscopy during 2026 or four years prior (five-year window): likely 2022-2026 calendar; date 2023-09-25 numerator for 71025; 2024-10-15 for 71028 numerator if eligible but age 45 no.
N4 CT colonography 2022-2026.
N5 colonoscopy during 2026 or nine prior (ten-year window): likely 2017-2026. Dates: 2018-02-20 numerator if eligible; 2016-03-04 not numerator? 71024 colonoscopy 2016-03-04 outside 2017-2026; but excluded? age 50 both frailty and AI but age <66 no exclude, no numerator -> non_compliant? Wait has frailty and advanced illness but age 50, not E4. Has no qualifying screening if 2016 outside ten-year window. Could be non_compliant. But if age 50 with frailty and AI not excluded. Need consider if colonoscopy 2016-03-04: ten-year window if exact 10 years from 2026-12-31 = 2016-12-31? If "during 2026 or the nine years prior" calendar = 2017-2026. If measured back exactly 10 years from Dec 31 includes 2016-12-31? Not include March 2016. So not numerator. Good.
N5 2019-04-22 colonoscopy for 71029; also stool DNA 2024-09-15. Numerator. If no exclude, age 66. Need if E4? age 66+ but no frailty/AI, no.
71031 age 75 no screening -> non_compliant, no exclude.
71021 hospice election during measurement year -> excluded, despite no numerator.
71023 enrollment from Apr 10 to Dec 31; gap from Jan 1 to Apr 9? Is there a gap? "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If not enrolled before Apr 10, maybe it is a gap of 99 days, not eligible. Need think: HEDIS continuous enrollment: enrolled for entire measurement year, with no more than one gap in enrollment of 45 days or less. If starts Apr 10 and not enrolled before, is the entire pre-start period considered a gap? In NCQA, for MEA/CEP, eligible members must have continuous enrollment; if not enrolled for entire year, but if gap from Jan 1? Usually "continuous enrollment" can have one gap of up to 45 days; a gap may begin at start of measurement year if not enrolled on Jan 1? It would be >45 days unless started within 45 days of Jan 1? If enrolled Apr 10, gap 99 days, not eligible. They likely intend not eligible. They also mention age 63, screening 2018 outside? colonoscopy 2018-02-20? Ten-year window includes 2018, so numerator if eligible; but not eligible.
71032 enrollment with two gaps, each 17/12 but no more than one gap -> not eligible? Need check if gaps are only internal. "full measurement year with no more than one gap of up to 45 days." The record: "Enrolment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days." There are two gaps. Since no more than one gap, not_eligible. But wait "continuous enrolment: full measurement year with no more than one gap of up to 45 days" Could mean a gap (singular) of up to 45 days, not no more than one gap? It says "no more than one gap of up to 45 days." So at most one gap; two disqualify. Need also each gap <=45; but two fail. The wording says "with no more than one gap of up to 45 days". Need classify not_eligible due enrolment. If there are two gaps but both <=45, no more than one gap violated. Also if gaps computed 2026-03-31 to 2026-04-16 = 17 days, and 2026-06-27 to 2026-07-08 = 12. They state gaps of 17 and 12. So fail.
Need age as of 2026-12-31 inclusive: 46-75. DOBs:
71021 1980-08-11 -> 46. age ok.
71022 1971-12-22 -> 55 (on 2026-12-22) ok.
71023 1963-07-10 -> 63 ok but enrolment fail.
71024 1976-04-19 -> 50 ok.
71025 1976-05-12 -> 50 ok.
71026 1950-06-09 -> 76 on 2026-12-31 -> not eligible (age >75).
71027 1979-10-14 -> 47 ok.
71028 1981-08-16 -> 45 -> not eligible.
71029 1960-09-06 -> 66 ok.
71030 1950-02-11 -> 76 -> not eligible.
71031 1951-11-26 -> 75 ok.
71032 1963-12-19 -> 63 ok but enrolment fail.
Exclusions:
71021 E3 hospice during measurement year -> excluded. In eligible? age and enrolment ok. Yes.
71024 age 50, frailty+AI but age <66 -> not E4. No other. Screening 2016 colonoscopy? Need determine if N5? If outside ten-year then non_compliant. If inside? Let's verify ten-year window: N5 colonoscopy during 2026 or nine prior: years 2017,2018,2019,2020,2021,2022,2023,2024,2025,2026. 2016 not. But "look-back window measured back from 2026-12-31": For N5, ten-year window measured back from date would be [2016-12-31 or 2017-01-01?] through 2026-12-31. If inclusive 10-year: 2016-12-31 to 2026-12-31 (if date 2016-12-31 included? 2016-03 not). So non. It also has frailty + AI not E4. Could there be exclusion for frailty + advanced illness? No age not 66. So denominator non_compliant. Need maybe if age 50 both frailty and advanced illness but E4 says age 66+ AND both, so no.
71025 eligible, flexible sigmoidoscopy 2023 (within 5-year window 2022-2026), FIT 2025? FIT N1 only 2026, so no but flex sigmoid qualifies. Frailty only age 50, no exclude. compliant.
71027 FIT 2026 qualifies. compliant.
71029 colonoscopy 2019 qualifies; stool DNA 2024 qualifies; no exclusions; age 66 but no frailty/AI; compliant.
71031 no screening; compliant? non_compliant. Age 75; no exclusions; non_compliant.
71022 eligible; stool DNA 2024 within 3-year; compliant.
Total: not_eligible: 71023,71026,71028,71030,71032 = 5. excluded: 71021 =1. denominator = 12 - 5 -1 =6. Compliant members: 71022,71025,71027,71029 =4. Non_compliant: 71024,71031 =2. Rate = 4/6*100=66.666.. -> 66.7. Need ensure numerator = 4.
Double-check if 71024 could be excluded due frailty and AI? Age not 66, no. Could 71024 be compliant if colonoscopy 2016 is within ten-year exact? Let's examine dates. Measurement year 2026. Ten-year window: N5 colonoscopy during 2026 or the nine years prior. "look-back window measured back from 2026-12-31". If ten-year window measured back from 2026-12-31, start date could be 2017-01-01 (365*9? Actually exactly 10 years prior: 2016-12-31 to 2026-12-31 inclusive is 3653 days). But if they use calendar years as examples? 2016-03-04 is not 9 calendar years prior? If exact 10-year inclusive includes 2016-12-31 and later only. 2016-03 is outside. If exact 10 years prior to measurement year? No, 2026 or nine years prior = 2017-2026. So not numerator. Good.
Double-check stool DNA window for 71021: if exact 3 years prior to 2026-12-31 includes 2023-11-23? Three years from 2026-12-31 back is 2023-12-31. 2023-11-23 is before by 38 days; not. If "three-year window" could be any date >= 2024-01-01 (calendar 2024+), not. So not numerator; but excluded anyway.
Double-check 71023: If colonoscopy 2018-02-20 is within ten-year; no exclusions. But not eligible due gap 99 days. Yes. Need count not_eligible due enrolment, even though if they were eligible maybe compliant. The status definition: not_eligible never enters eligible population (age, event, or enrolment). Exclusions not evaluated if not eligible. So not_eligible.
Need output JSON exactly with keys:
denominator integer
numerator integer
excluded integer
not_eligible integer
rate number
compliant_members array strings
non_compliant_members array strings
excluded_members array strings
not_eligible_members array strings
Member IDs are numbers after MEMBER as strings. Could order any. Need include all IDs exactly:
"71022","71025","71027","71029" compliant.
non_compliant: "71024","71031".
excluded: "71021".
not_eligible: "71023","71026","71028","71030","71032".
Check 71032: not eligible due two gaps; but also has frailty age 63. Exclusion not relevant. Could someone argue not_eligible because no more than one gap. Good.
Need maybe include rate as number with one decimal: 66.7. Should not be string.
Ensure final only fenced json. No additional text.
Potential hidden nuance: Continuous enrolment: "the full measurement year with no more than one gap of up to 45 days." Could allow multiple gaps? no. Could gaps count from 2026-01-01? 71023 is enrolled from Apr 10, not continuous, no gap? It's not enrolled before, maybe the measurement year has one gap Jan 1-Apr 9 of 99 days, no. Not eligible. 71032 two gaps, not eligible. Could 71023's non-enrollment before Apr 10 be "not enrolled", but continuous enrolment criterion might require enrolled at some point? HEDIS measures use "continuous enrollment for the full year" and a member who was not enrolled for the whole year may still be eligible if they had gap of <=45 days? If they weren't enrolled Jan-Apr, that's >45, so not. Good.
Potential nuance: age 46 through 75 as of 2026-12-31. DOB 1980-08-11: 46, yes. DOB 1981-08-16: on 2026-12-31, age 45, not. DOB 1950: age 76 not; 1951: age 75 yes.
Potential nuance: hospice election "2026-10-14" E3: excluded, not denominator.
Potential nuance: flexible sigmoidoscopy 2023 for 71025; five-year window. If exact 5 years measured back from 2026-12-31 => 2021-12-31 onwards; 2023 yes. If calendar 2022+ yes. Good.
Potential nuance: FIT 2025 for 71025; N1 only 2026, but flex sigmoid yes. Good.
Potential nuance: stool DNA 2024 for 71029 qualifies; colonoscopy 2019 also qualifies. Compliant. If age 66 no exclusion.
Potential nuance: age 75 with no screening: 71031 non_compliant. Exclusion E4? no frailty/AI. Good.
Need maybe calculate rate with half up one decimal. Python-like? 4/6=66.666... one decimal half-up: 66.7. If 66.65? no.
Could denominator be 6? 12 - not 5 - excluded 1 = 6. numerator = 4. Good.
Let's produce JSON. Ensure no markdown outside? The output contract says fenced JSON block. Final with ```json ...```.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": [
"71022",
"71025",
"71027",
"71029"
],
"non_compliant_members": [
"71024",
"71031"
],
"excluded_members": [
"71021"
],
"not_eligible_members": [
"71023",
"71026",
"71028",
"71030",
"71032"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K2.6 · Moonshot198.3s · 6,531 out | 154.0s · 6,695 out | 340.2s · 4,663 out
Reasoning · 6,407 tokens
We need to process each member against the measure QM-CRC (Colorectal Cancer Screening) for measurement year 2026-01-01 through 2026-12-31.
We need to classify each member as: compliant, non_compliant, excluded, or not_eligible.
Definitions:
- denominator: eligible population after exclusions removed (compliant + non_compliant)
- numerator: compliant members
- excluded: in eligible population but meets a required exclusion
- not_eligible: never enters eligible population (age, event, or enrollment)
- rate: numerator / denominator * 100, rounded half up to one decimal place.
- lists of member IDs as strings.
Rules:
Eligible population (denominator):
- Age: 46 through 75 years as of 2026-12-31.
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days.
Note: The prompt says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means that if a member has more than one gap, or a gap >45 days, they are not eligible? Let's parse. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This phrasing could mean that to be considered continuous, the enrollment must cover the full year, but can have up to one gap of up to 45 days. If there are two gaps, or a gap >45 days, they fail continuous enrollment and are not eligible. Let's keep that in mind.
Numerator: any one of the following, by look-back window measured back from 2026-12-31:
- N1. Faecal occult blood test or faecal immunochemical test during 2026.
- N2. Stool DNA test during 2026 or the two years prior (three-year window: 2024-01-01 to 2026-12-31).
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-01-01 to 2026-12-31).
- N4. CT colonography during 2026 or the four years prior (five-year window: 2022-01-01 to 2026-12-31).
- N5. Colonoscopy during 2026 or the nine years prior (ten-year window: 2017-01-01 to 2026-12-31).
Required Exclusions (evaluated before numerator, only for members in eligible population):
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31.
- E2. Total colectomy any time on or before 2026-12-31.
- E3. Hospice at any time during the measurement year.
- E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Frailty alone does not exclude, and advanced illness alone does not exclude.
Let's process each member.
Member 71021:
- DOB 1980-08-11. Age as of 2026-12-31: 46 years old (1980 to 2026 = 46, born in Aug, before Dec, so yes 46). Age is within 46-75.
- Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps. Meets enrollment.
- Screening history: 2023-11-23 Stool DNA test. Look-back for N2: 2024-01-01 to 2026-12-31. 2023-11-23 is before 2024-01-01, so does not count.
- Any other screenings? No.
- So numerator? No.
- Other history: 2026-10-14 Hospice election. E3: Hospice at any time during measurement year. Yes. So excluded.
- Since excluded, denominator count does not include? Wait: denominator is eligible population after exclusions removed. Exclusions are evaluated before numerator. So excluded members are removed from denominator. So denominator = compliant + non_compliant.
- So 71021 is excluded.
Member 71022:
- DOB 1971-12-22. Age as of 2026-12-31: 2026-1971 = 55. Born Dec 22, before Dec 31, so 55. Age 55, eligible.
- Enrollment: full year continuous, no gaps.
- Screening: 2024-08-05 Stool DNA test. N2 window: 2024-01-01 to 2026-12-31. 2024-08-05 is within. So numerator met (N2).
- Exclusions? No cancer, no colectomy, no hospice, no frailty/illness.
- So 71022 is compliant (numerator).
Member 71023:
- DOB 1963-07-10. Age as of 2026-12-31: 2026-1963 = 63. Eligible.
- Enrollment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10. Does this meet "full measurement year"? No, because not enrolled from 2026-01-01 to 2026-04-09. That's a gap of about 99 days (Jan 1 to Apr 9). Since they were not enrolled before Apr 10, they are missing the first part of the year. The rule says continuous enrollment: the full measurement year with no more than one gap of up to 45 days. This implies they must be enrolled for the full year, but can have a gap of up to 45 days (maybe one gap). Here the gap is 99 days (Jan 1 to Apr 9 is 99 days? Let's calculate: Jan has 31, Feb 28, Mar 31, Apr 1-9 is 9. Total = 31+28+31+9 = 99 days). But even more importantly, the member is not enrolled for the full measurement year; there is a large gap. The specification says "full measurement year". Typically that means from Jan 1 to Dec 31. But they allow one gap of up to 45 days. A gap of 99 days >45 days, and also it's not just a gap, it's a missing period. So they fail continuous enrollment. Thus not eligible.
- Wait, is there any nuance? "Enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10." This means they were not enrolled for the first ~3.5 months. That is not the full measurement year. So not eligible.
- So 71023 is not_eligible.
- We do not evaluate exclusions for not eligible members. So even if they had a colonoscopy, etc., it doesn't matter.
Member 71024:
- DOB 1976-04-19. Age as of 2026-12-31: 2026-1976 = 50. Eligible.
- Enrollment: full year, continuous, no gaps.
- Screening: 2016-03-04 Colonoscopy. N5 window: 2017-01-01 to 2026-12-31. 2016-03-04 is before 2017-01-01, so does not count.
- Any other screening? No.
- Numerator? No.
- Other history: 2026-08-18 Frailty documented. 2026-02-04 Advanced illness documented.
- Exclusions: E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Member is age 50, so does not meet age threshold. Not excluded by E4.
- E1, E2, E3? Not documented.
- So 71024 is non_compliant.
Member 71025:
- DOB 1976-05-12. Age as of 2026-12-31: 50. Eligible.
- Enrollment: full year continuous.
- Screening: 2023-09-25 Flexible sigmoidoscopy. N3 window: 2022-01-01 to 2026-12-31. 2023-09-25 is within. So meets N3. Also 2025-02-14 Faecal immunochemical test. N1: during 2026? No, 2025 is before 2026. N1 is only during 2026. But N3 is met.
- Wait, N1 is "during 2026". 2025-02-14 is not during 2026. But N3 is met by the 2023 sigmoidoscopy (five-year window 2022-2026). So numerator is met.
- Other history: 2026-07-12 Frailty documented. Age is 50 (<66). So E4 not triggered.
- Exclusions? No.
- So 71025 is compliant.
Member 71026:
- DOB 1950-06-09. Age as of 2026-12-31: 2026-1950 = 76. Age is 76.
- Age requirement: 46 through 75 years as of 2026-12-31. 76 is >75. So not eligible.
- Enrollment: full year, but age fails.
- So 71026 is not_eligible.
- Do not evaluate exclusions. So not excluded despite not having cancer, etc.
Member 71027:
- DOB 1979-10-14. Age as of 2026-12-31: 47. Eligible.
- Enrollment: full year continuous.
- Screening: 2026-07-26 Faecal immunochemical test. N1: during 2026. Yes. So numerator met.
- Exclusions? None.
- So 71027 is compliant.
Member 71028:
- DOB 1981-08-16. Age as of 2026-12-31: 45 (2026-1981 = 45). Age is 45.
- Age requirement: 46 through 75. 45 is below 46. So not eligible.
- Enrollment: full year continuous.
- So 71028 is not_eligible.
- Do not evaluate exclusions.
Member 71029:
- DOB 1960-09-06. Age as of 2026-12-31: 66. Eligible (46-75).
- Enrollment: full year continuous.
- Screening: 2019-04-22 Colonoscopy. N5 window: 2017-01-01 to 2026-12-31. 2019-04-22 is within. So meets N5. Also 2024-09-15 Stool DNA test. N2 window: 2024-01-01 to 2026-12-31. That also meets N2. So numerator met.
- Exclusions? No cancer, no colectomy, no hospice, no frailty or advanced illness documented.
- So 71029 is compliant.
Member 71030:
- DOB 1950-02-11. Age as of 2026-12-31: 76. 2026-1950 = 76. >75. Not eligible.
- So 71030 is not_eligible.
Member 71031:
- DOB 1951-11-26. Age as of 2026-12-31: 75. Exactly 75. Eligible.
- Enrollment: full year continuous.
- Screening: none on record.
- Numerator? No.
- Exclusions? No.
- So 71031 is non_compliant.
Member 71032:
- DOB 1963-12-19. Age as of 2026-12-31: 63. Eligible.
- Enrollment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days.
- The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
- This member has two gaps: March 30 to April 17 is 17 days (April 1-16 inclusive? Let's compute: gap between 2026-03-30 and 2026-04-17. If they are not enrolled on 03-30? Actually they have enrollment through 2026-03-30, and then from 2026-04-17. The gap is from 03-31 to 04-16 inclusive? That's 17 days (March 31 is 1, April 1-16 is 16, total 17). Yes, gap of 17 days. Second gap: 2026-06-26 to 2026-07-09. Gap is June 27 to July 08 inclusive? Let's compute: June has 30 days. So June 27,28,29,30 = 4 days. July 1-8 = 8 days. Total = 12 days. So two gaps, each <=45 days. But the rule says "no more than one gap of up to 45 days". Having two gaps violates "no more than one gap". Therefore fails continuous enrollment.
- Wait, is there any ambiguity? "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This clearly means at most one gap. Two gaps disqualify. So not eligible.
- Alternatively, could the total gap be considered? No, it's "no more than one gap".
- Therefore 71032 is not_eligible.
- Do not evaluate exclusions. Even though frailty is documented, since not eligible, we don't care. And E4 requires age >=66 anyway; this member is 63. So even if eligible, not excluded. But they are not eligible due to enrollment.
Now let's summarize:
Eligible members (i.e., passed age and enrollment):
- 71021 (age 46, enrolled full) -> excluded
- 71022 (age 55, full) -> compliant
- 71023 (age 63, not full) -> not_eligible
- 71024 (age 50, full) -> non_compliant
- 71025 (age 50, full) -> compliant
- 71026 (age 76) -> not_eligible
- 71027 (age 47, full) -> compliant
- 71028 (age 45) -> not_eligible
- 71029 (age 66, full) -> compliant
- 71030 (age 76) -> not_eligible
- 71031 (age 75, full) -> non_compliant
- 71032 (age 63, two gaps) -> not_eligible
Let's double-check each.
71021:
- Age 46: eligible.
- Enrollment continuous full year.
- Exclusion E3: hospice during measurement year. Yes, 2026-10-14. So excluded.
- Not in denominator.
71022:
- Age 55: eligible.
- Enrollment full.
- Screening: Stool DNA 2024-08-05. N2 window: 2024-01-01 to 2026-12-31. Yes. So numerator.
- Compliant.
71023:
- Age 63: eligible by age.
- Enrollment: starts 2026-04-10. Not full measurement year. The specification says "full measurement year". So not eligible.
- Is there any interpretation where a late start is allowed if there is a gap? The wording is "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means the member must be enrolled for the full year, with at most one small gap. Starting April 10 means missing ~99 days. That's not a "gap" in the sense of a break in otherwise continuous enrollment? It is a gap, but it's >45 days. So not eligible.
- Also, if they started Apr 10, they were not enrolled Jan 1 - Apr 9. That's a gap of 99 days. So fails.
- not_eligible.
71024:
- Age 50: eligible.
- Enrollment full.
- Screening: colonoscopy 2016-03-04. N5 window: 2017-01-01 to 2026-12-31. 2016 is outside. So no numerator.
- Exclusions: E4 requires age >=66 and both frailty and advanced illness. Age 50, so no. No other exclusions.
- non_compliant.
71025:
- Age 50: eligible.
- Enrollment full.
- Screening: flexible sigmoidoscopy 2023-09-25. N3 window: 2022-01-01 to 2026-12-31. Yes. So numerator.
- Also FIT 2025-02-14. N1 requires during 2026, so no. But N3 already satisfied.
- Exclusion: frailty documented 2026-07-12. Age 50, E4 not triggered.
- Compliant.
71026:
- Age 76: >75. not_eligible.
71027:
- Age 47: eligible.
- Enrollment full.
- Screening: FIT 2026-07-26. N1: during 2026. Yes.
- Compliant.
71028:
- Age 45: <46. not_eligible.
71029:
- Age 66: eligible.
- Enrollment full.
- Screening: colonoscopy 2019-04-22. N5: 2017-01-01 to 2026-12-31. Yes. So numerator.
- Also stool DNA 2024-09-15. N2: 2024-01-01 to 2026-12-31. Also yes.
- Compliant.
71030:
- Age 76: >75. not_eligible.
71031:
- Age 75: eligible.
- Enrollment full.
- No screening.
- non_compliant.
71032:
- Age 63: eligible by age.
- Enrollment: two gaps (17 and 12 days). Specification: "no more than one gap of up to 45 days." Two gaps means fails. So not_eligible.
- Even if we thought total gap = 29 days, the phrase "no more than one gap" means one. Two gaps disqualify.
- not_eligible.
Now let's count:
- compliant: 71022, 71025, 71027, 71029 => 4
- non_compliant: 71024, 71031 => 2
- excluded: 71021 => 1
- not_eligible: 71023, 71026, 71028, 71030, 71032 => 5
Check total: 4+2+1+5 = 12. Good.
Denominator = compliant + non_compliant = 4 + 2 = 6.
Numerator = 4.
Rate = numerator / denominator * 100 = 4/6 * 100 = 66.666...%. Rounded half up to one decimal place: 66.7.
Wait, 4/6 = 0.666666... * 100 = 66.6666...%. Rounded half up to one decimal: look at second decimal place is 6, so round up. 66.7. Yes.
Now let's format JSON.
Keys:
"denominator": 6
"numerator": 4
"excluded": 1
"not_eligible": 5
"rate": 66.7
"compliant_members": ["71022", "71025", "71027", "71029"]
"non_compliant_members": ["71024", "71031"]
"excluded_members": ["71021"]
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
Any order is fine for arrays.
Double-check age calculations:
DOB 1980-08-11. As of 2026-12-31: 2026 - 1980 = 46. Since birthday (Aug 11) has passed by Dec 31, age is 46. Yes.
DOB 1971-12-22. 2026-1971 = 55. Birthday Dec 22 has passed by Dec 31? Yes, Dec 22 is before Dec 31. So age 55.
DOB 1963-07-10. 2026-1963 = 63. Birthday July 10 before Dec 31. Age 63.
DOB 1976-04-19. 2026-1976 = 50. Birthday April 19 before Dec 31. Age 50.
DOB 1976-05-12. Age 50.
DOB 1950-06-09. 2026-1950 = 76. Birthday June 9 before Dec 31. Age 76.
DOB 1979-10-14. 2026-1979 = 47. Birthday Oct 14 before Dec 31. Age 47.
DOB 1981-08-16. 2026-1981 = 45. Birthday Aug 16 before Dec 31. Age 45.
DOB 1960-09-06. 2026-1960 = 66. Age 66.
DOB 1950-02-11. 2026-1950 = 76. Age 76.
DOB 1951-11-26. 2026-1951 = 75. Age 75.
DOB 1963-12-19. 2026-1963 = 63. Age 63.
All ages correct.
Enrollment for 71023: "2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10." So not full year. Not eligible. Correct.
Enrollment for 71032: two gaps. Not eligible. Correct.
Check 71021: Hospice election 2026-10-14. Exclusion E3. Excluded. Correct.
Check 71024: Frailty and advanced illness both documented. But age is 50 (<66). So E4 not met. Not excluded. Non-compliant. Correct.
Check 71025: Frailty documented. Age 50. Not excluded. Compliant via flexible sigmoidoscopy 2023-09-25 (within 5-year window). Correct.
Check 71026: Age 76. Not eligible. Even though stool DNA 2023-05-08 (which is within N2 window? N2 is 2024-2026). Actually 2023 is outside N2. But doesn't matter because not eligible.
Check 71029: Age 66. Compliant. Is there any exclusion? E4 requires both frailty and advanced illness. Neither documented. So compliant.
Check 71031: Age 75. No screening. Non-compliant.
Now, is there any nuance about "no more than one gap of up to 45 days" meaning that total allowable gap is 45 days, and the number of gaps doesn't matter? The phrasing is "no more than one gap of up to 45 days." This literally means the count of gaps must be <=1, and each such gap must be <=45 days. Two gaps of 17 and 12 days is two gaps, so fails. If it meant total gap, it would say "total gap of up to 45 days" or "gaps totaling up to 45 days." So our interpretation is correct.
One more nuance: 71021 is excluded by hospice. Is hospice considered "at any time during the measurement year"? Yes, 2026-10-14. So excluded.
Now compute rate: 4/6*100 = 66.666... -> 66.7.
All set. Let's produce the JSON.
One thing: The prompt says "Member IDs are the numbers after 'MEMBER' in each record, as strings". So we should use "71021", etc.
Let's ensure no extra spaces or keys. Use JSON null if needed, but not here.
Final JSON:
```json
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
```
Wait, I should double-check 71023. Is it possible that the enrollment is continuous from 2026-04-10, and the gap before is not considered a "gap" because they were not previously enrolled? In many measure specifications, continuous enrollment requires being enrolled for the full measurement year, but if they have a coverage start date after Jan 1, they are not in the eligible population. The phrase "full measurement year" supports that. So not_eligible is correct.
Also, check 71032: The enrollment segments are:
- 2026-01-01 through 2026-03-30
- 2026-04-17 through 2026-06-26
- 2026-07-09 through 2026-12-31
Gaps:
1. 2026-03-31 to 2026-04-16 inclusive: 17 days.
2. 2026-06-27 to 2026-07-08 inclusive: 12 days.
Two gaps. "No more than one gap". So fails.
All good.
One more check: 71025's screening: 2023-09-25 Flexible sigmoidoscopy. N3 window is "during 2026 or the four years prior (five-year window)". So 2026-12-31 minus 4 years = 2022-12-31? Or is it exactly five calendar years? The spec says "during 2026 or the four years prior (five-year window)". Look-back measured back from 2026-12-31. Typically, five-year window means 2017-01-01 to 2026-12-31? Wait, N5 says "Colonoscopy during 2026 or the nine years prior (ten-year window)". N3 says "Flexible sigmoidoscopy during 2026 or the four years prior (five-year window)". Let's interpret precisely.
Look-back window measured back from 2026-12-31.
- N1: during 2026. So 2026-01-01 to 2026-12-31.
- N2: during 2026 or the two years prior (three-year window). So from 2024-01-01 to 2026-12-31? Or 2023-12-31? Usually "the two years prior" means 2024 and 2025, plus 2026. So starting 2024-01-01. If it were exactly 3 years back from 2026-12-31, it would be 2023-12-31. But the parenthetical says "three-year window". Let's see: 2026 is year 1, 2025 year 2, 2024 year 3. So 2024-01-01 to 2026-12-31 is the inclusive three-year window. Similarly, N3 five-year window: 2022-01-01 to 2026-12-31. N4 same. N5 ten-year window: 2017-01-01 to 2026-12-31.
71025's sigmoidoscopy is 2023-09-25. That is within 2022-01-01 to 2026-12-31. So yes.
71024's colonoscopy is 2016-03-04. N5 window: 2017-01-01 to 2026-12-31. 2016 is outside. So no.
71022's stool DNA is 2024-08-05. N2 window: 2024-01-01 to 2026-12-31. Yes.
71021's stool DNA is 2023-11-23. N2 window: 2024-01-01 to 2026-12-31. 2023 is outside. So no numerator. (But excluded anyway).
71026's stool DNA is 2023-05-08. Also outside N2. Not eligible anyway.
71029's colonoscopy 2019-04-22. N5: 2017-2026. Yes. Stool DNA 2024-09-15. N2: 2024-2026. Yes.
71028's flexible sigmoidoscopy 2024-10-15. N3: 2022-2026. Yes. But age 45, not eligible.
71032's colonoscopy 2015-10-17. N5: 2017-2026. Outside. Not eligible anyway.
All correct.
Now, one nuance: 71031 age 75. The age is "46 through 75 years". Does "through 75" mean inclusive? Yes, typically. So 75 is included.
One more nuance: 71021 excluded. Does hospice exclusion require election or just "at any time during measurement year"? The record says "Hospice election". E3 says "Hospice at any time during the measurement year." Election counts.
Everything looks solid.
Final answer in JSON block.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,571 tokens
We need to evaluate each of the 12 members against the QM-CRC measure specification.
Specification recap:
- Measurement year: 2026-01-01 through 2026-12-31.
- Denominator (eligible population): Age 46 through 75 years as of 2026-12-31. Continuous enrollment: full measurement year with no more than one gap of up to 45 days.
- Numerator: any one of N1-N5 by look-back window measured back from 2026-12-31.
- N1: FOBT or FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window: 2024-01-01 to 2026-12-31? Wait: "during 2026 or the two years prior (three-year window)". Let's interpret precisely. The lookback window measured back from 2026-12-31. "during 2026 or the two years prior (three-year window)". That means from 2024-01-01 to 2026-12-31 inclusive? Actually, if it's the two years prior to 2026, that would be 2024 and 2025? But they say three-year window. Let's parse: N2. Stool DNA test during 2026 or the two years prior (three-year window). Usually, "two years prior" means 2024 and 2025? Wait, 2026 plus two prior years = 2024, 2025, 2026 = three years. So window is 2024-01-01 to 2026-12-31. But does "two years prior" mean 2024-2025? Or 2023-2025? Let's think: If today is end of 2026, two years prior would be 2024 and 2025? Actually "the two years prior" to 2026 would be 2024 and 2025. But that would be only two years. But they say three-year window. So likely it's 2024-01-01 through 2026-12-31. Because 2026 is the current year, plus two prior years (2025 and 2024). That's three calendar years. Wait, "during 2026 or the two years prior" = during 2026, or during 2025, or during 2024. So window = 2024-01-01 to 2026-12-31. Yes.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). So 2022-01-01 to 2026-12-31.
- N4: CT colonography during 2026 or the four years prior (five-year window). So 2022-01-01 to 2026-12-31.
- N5: Colonoscopy during 2026 or the nine years prior (ten-year window). So 2017-01-01 to 2026-12-31.
- Exclusions:
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31.
- E2: Total colectomy any time on or before 2026-12-31.
- E3: Hospice at any time during the measurement year.
- E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Frailty alone does not exclude, and advanced illness alone does not exclude.
- Exclusions are evaluated before numerator, and only for members in eligible population.
- A member who fails age, event, or enrollment is not_eligible even if an exclusion is also documented.
- A member who meets both an exclusion and the numerator is excluded, not compliant.
We need to place each member.
Let's list members with details.
Member 71021:
- DOB 1980-08-11. Age on 2026-12-31: 2026-1980 = 46, but month/day: Dec 31 vs Aug 11, so 46 years old. Actually 2026-12-31 minus 1980-08-11 = 46 years, 4 months, 20 days. So age 46. Within 46-75.
- Enrolment: 2026-01-01 through 2026-12-31 continuous, no gaps. Good.
- Screening history: 2023-11-23 Stool DNA test.
- Other history: 2026-10-14 Hospice election.
So first, eligible population: age yes, enrollment yes.
Exclusions: E3 (Hospice at any time during measurement year). Yes, hospice in 2026. So excluded.
Even if we check numerator: Stool DNA test on 2023-11-23. Is that within N2 window? N2 window is 2024-01-01 to 2026-12-31. 2023-11-23 is before 2024-01-01, so not in window. So no numerator. But exclusion applies first.
Status: excluded.
Member 71022:
- DOB 1971-12-22. Age on 2026-12-31: 54 (2026-1971=55? Wait: 2026-12-31 minus 1971-12-22 = 55 years, 9 days. Actually 2026 - 1971 = 55. Since birthday is 12-22, on 12-31 they are 55. So age 55. Within range.
- Enrollment: full year continuous.
- Screening: 2024-08-05 Stool DNA test.
- No cancer, no colectomy, no hospice, no frailty/advanced illness.
Eligible population: yes.
Exclusions: none.
Numerator: Stool DNA test on 2024-08-05. Is this within N2 window? N2: during 2026 or two years prior (three-year window). The window is 2024-01-01 to 2026-12-31. 2024-08-05 falls within. So N2 met.
Status: compliant.
Member 71023:
- DOB 1963-07-10. Age on 2026-12-31: 63 (2026-1963=63). Within range.
- Enrollment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10.
So enrollment gap: from 2026-01-01 to 2026-04-09 is a gap. How many days? Jan 1 to Apr 9.
Let's calculate: Jan has 31 days, so Jan 1 to Jan 31 is 30 days after Jan1? Actually need days of gap. Enrollment starts 2026-04-10. So missing Jan 1 through Apr 9.
Jan: 31 days (Jan 1 to Jan 31). Feb: 28 days (2026 not leap year). Mar: 31 days. Apr 1-9: 9 days.
Total = 31 + 28 + 31 + 9 = 99 days. That's more than 45 days. So continuous enrollment requirement not met. Also, "full measurement year with no more than one gap of up to 45 days." Here gap is 99 days. So not eligible.
Since not eligible, we don't consider exclusions or numerator.
Status: not_eligible.
Wait: The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Member 71023 has a single gap of 99 days. So fails enrollment.
Member 71024:
- DOB 1976-04-19. Age on 2026-12-31: 50 (2026-1976=50). Within range.
- Enrollment: full year continuous.
- Screening: 2016-03-04 Colonoscopy.
- Other: 2026-08-18 Frailty documented. 2026-02-04 Advanced illness documented (heart failure, I50.22).
Eligible population: yes.
Exclusions: E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
Age is 50, not >=66. So E4 does not apply.
E1, E2, E3: none.
Numerator: Colonoscopy on 2016-03-04. N5 window: during 2026 or nine years prior (ten-year window). Window: 2017-01-01 to 2026-12-31. 2016-03-04 is before 2017-01-01, so not in window. No other screening. So numerator not met.
Status: non_compliant.
Member 71025:
- DOB 1976-05-12. Age on 2026-12-31: 50. Within range.
- Enrollment: full year continuous.
- Screening: 2023-09-25 Flexible sigmoidoscopy. 2025-02-14 Faecal immunochemical test.
- Other: 2026-07-12 Frailty documented. No advanced illness.
Eligible population: yes.
Exclusions: E4 requires both frailty and advanced illness. Only frailty. So no exclusion.
E1, E2, E3: none.
Numerator: Check N1: FIT during 2026. The FIT is on 2025-02-14. That's not in 2026. So N1 no.
N2: Stool DNA during 2026 or two years prior. No stool DNA listed. So no.
N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window). Window: 2022-01-01 to 2026-12-31. 2023-09-25 is in that window. So N3 met.
Status: compliant.
Wait, but E4: Age 66+? No, age 50. So no exclusion.
Member 71026:
- DOB 1950-06-09. Age on 2026-12-31: 76 (2026-1950=76). The eligible age is 46 through 75 years as of 2026-12-31. 76 is above 75. So not eligible.
Enrollment: full year.
Screening: 2023-05-08 Stool DNA.
But age fails. So not_eligible.
Check: Is 76 excluded? No, because not in eligible population. So not_eligible.
Member 71027:
- DOB 1979-10-14. Age on 2026-12-31: 47. Within range.
- Enrollment: full year continuous.
- Screening: 2026-07-26 Faecal immunochemical test.
- No other issues.
Eligible population: yes.
Exclusions: none.
Numerator: N1: FIT during 2026. Yes, 2026-07-26. So compliant.
Status: compliant.
Member 71028:
- DOB 1981-08-16. Age on 2026-12-31: 45. The eligible age is 46 through 75. So 45 is below 46. Not eligible.
Enrollment: full year.
Screening: 2024-10-15 Flexible sigmoidoscopy.
But age fails. So not_eligible.
Member 71029:
- DOB 1960-09-06. Age on 2026-12-31: 66. Within range? 66 is between 46 and 75 inclusive? The spec says "46 through 75 years". Usually "through" includes both endpoints. So 66 is eligible.
- Enrollment: full year continuous.
- Screening: 2019-04-22 Colonoscopy. 2024-09-15 Stool DNA test.
- No cancer, colectomy, hospice. No frailty or advanced illness.
Eligible population: yes.
Exclusions: E4: Age 66 or older AND both frailty and advanced illness. Age is 66, so meets age part. But no frailty or advanced illness documented. So E4 not met.
Other exclusions: none.
Numerator:
Check N1: FIT/FOBT during 2026? No.
N2: Stool DNA during 2026 or two years prior (2024-01-01 to 2026-12-31). Stool DNA on 2024-09-15 is within window. So N2 met.
Status: compliant.
Member 71030:
- DOB 1950-02-11. Age on 2026-12-31: 76 (2026-1950=76). Above 75. Not eligible.
Enrollment: full year.
Screening: 2025-12-12 Stool DNA test.
Age fails. So not_eligible.
Member 71031:
- DOB 1951-11-26. Age on 2026-12-31: 75. Within range (46 through 75). Yes, 75 included.
- Enrollment: full year continuous.
- Screening: no colorectal screening on record.
- No exclusions.
Eligible population: yes.
Exclusions: none.
Numerator: none met.
Status: non_compliant.
Member 71032:
- DOB 1963-12-19. Age on 2026-12-31: 63. Within range.
- Enrollment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31.
Gaps:
- Gap 1: 2026-03-31 to 2026-04-16. How many days? March 31 to April 16. Let's compute. March 31 is missing? Enrollment ends 2026-03-30, so missing 2026-03-31 through 2026-04-16 inclusive? Wait, enrollment resumes 2026-04-17. So days not enrolled: March 31 (1 day), April 1-16 (16 days). Total = 17 days.
- Gap 2: 2026-06-27 to 2026-07-08. Enrollment ends 2026-06-26, resumes 2026-07-09. Missing June 27-30 (4 days), July 1-8 (8 days). Total = 12 days.
Two gaps, each up to 45 days. Spec says "no more than one gap of up to 45 days." This member has two gaps (17 and 12 days). So fails continuous enrollment requirement. Not eligible.
Check if any exclusion: frailty documented 2026-02-04. But since not eligible, status is not_eligible.
Wait: The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So two gaps, even if small, disqualify. So not_eligible.
Now let's tally.
Excluded: 71021.
Not eligible: 71023, 71026, 71028, 71030, 71032. That's 5.
Compliant: 71022, 71025, 71027, 71029. That's 4.
Non-compliant: 71024, 71031. That's 2.
Wait, also check 71025: age 50, no exclusion, numerator met by sigmoidoscopy in 2023. Yes compliant.
Check 71024: age 50, colonoscopy 2016, not in ten-year window (2017+). So non-compliant. Yes.
Check 71022: Stool DNA 2024-08-05. N2 window: 2024-01-01 to 2026-12-31. Yes. Compliant.
Check 71029: Stool DNA 2024-09-15. N2 window same. Yes. Compliant.
Check 71027: FIT 2026-07-26. N1. Compliant.
So counts:
denominator = compliant + non_compliant = 4 + 2 = 6.
numerator = 4.
excluded = 1.
not_eligible = 5.
Rate = numerator / denominator * 100 = 4 / 6 * 100 = 66.666... -> round half up to one decimal place = 66.7.
Let's double-check the age calculations carefully.
Age as of 2026-12-31:
- 71021: DOB 1980-08-11. 2026-12-31 minus 1980-08-11 = 46 years, 4 months, 20 days. Age = 46. Eligible.
- 71022: DOB 1971-12-22. 2026-12-31 minus 1971-12-22 = 55 years, 9 days. Age = 55. Eligible.
- 71023: DOB 1963-07-10. 2026-12-31 minus 1963-07-10 = 63 years, 5 months, 21 days. Age = 63. Eligible.
- 71024: DOB 1976-04-19. 2026-12-31 minus 1976-04-19 = 50 years, 8 months, 12 days. Age = 50. Eligible.
- 71025: DOB 1976-05-12. 2026-12-31 minus 1976-05-12 = 50 years, 7 months, 19 days. Age = 50. Eligible.
- 71026: DOB 1950-06-09. 2026-12-31 minus 1950-06-09 = 76 years, 6 months, 22 days. Age = 76. Not eligible (above 75).
- 71027: DOB 1979-10-14. 2026-12-31 minus 1979-10-14 = 47 years, 2 months, 17 days. Age = 47. Eligible.
- 71028: DOB 1981-08-16. 2026-12-31 minus 1981-08-16 = 45 years, 4 months, 15 days. Age = 45. Not eligible (below 46).
- 71029: DOB 1960-09-06. 2026-12-31 minus 1960-09-06 = 66 years, 3 months, 25 days. Age = 66. Eligible.
- 71030: DOB 1950-02-11. 2026-12-31 minus 1950-02-11 = 76 years, 10 months, 20 days. Age = 76. Not eligible.
- 71031: DOB 1951-11-26. 2026-12-31 minus 1951-11-26 = 75 years, 1 month, 5 days. Age = 75. Eligible.
- 71032: DOB 1963-12-19. 2026-12-31 minus 1963-12-19 = 63 years, 12 days. Age = 63. Eligible.
Enrollment checks:
- 71021: continuous full year. Good.
- 71022: continuous full year. Good.
- 71023: enrolled 2026-04-10 to 2026-12-31. Gap Jan 1 to Apr 9 = 99 days. Not eligible.
- 71024: full year. Good.
- 71025: full year. Good.
- 71026: full year. Good (but age out).
- 71027: full year. Good.
- 71028: full year. Good (but age out).
- 71029: full year. Good.
- 71030: full year. Good (but age out).
- 71031: full year. Good.
- 71032: three periods. Two gaps: 17 days and 12 days. Spec says "no more than one gap of up to 45 days." Two gaps -> fail. Not eligible.
Now check exclusions for eligible members:
Eligible members: 71021, 71022, 71023 (no, not eligible), 71024, 71025, 71026 (no), 71027, 71028 (no), 71029, 71030 (no), 71031, 71032 (no).
So eligible members: 71021, 71022, 71024, 71025, 71027, 71029, 71031. That's 7.
Wait, also 71023 and 71032 are not eligible. 71026, 71028, 71030 are not eligible. So eligible = total 12 - 5 not eligible = 7. Yes.
Now apply exclusions to these 7:
- 71021: Hospice election 2026-10-14. E3 applies. Excluded.
- 71022: No exclusions.
- 71024: Frailty and advanced illness. But age is 50 (<66). So E4 does not apply. No other exclusions.
- 71025: Frailty only. E4 requires both. No exclusion.
- 71027: No exclusions.
- 71029: Age 66, but no frailty or advanced illness. So E4 not met. No other exclusions.
- 71031: No exclusions.
So excluded count = 1 (71021).
Denominator = eligible - excluded = 7 - 1 = 6. These are 71022, 71024, 71025, 71027, 71029, 71031.
Now numerator for denominator members:
- 71022: Stool DNA 2024-08-05. N2 window: 2024-01-01 to 2026-12-31. Yes. Compliant.
- 71024: Colonoscopy 2016-03-04. N5 window: 2017-01-01 to 2026-12-31. No. No other screening. Non-compliant.
- 71025: Flexible sigmoidoscopy 2023-09-25. N3 window: 2022-01-01 to 2026-12-31. Yes. Compliant.
- 71027: FIT 2026-07-26. N1. Yes. Compliant.
- 71029: Stool DNA 2024-09-15. N2 window: 2024-01-01 to 2026-12-31. Yes. Compliant.
- 71031: No screening. Non-compliant.
So numerator = 4.
Rate = 4/6*100 = 66.666... -> round half up to one decimal place: 66.7.
Now check if any member meets both exclusion and numerator. 71021 is excluded. Does 71021 have a numerator? Stool DNA 2023-11-23. N2 window is 2024-01-01 to 2026-12-31. 2023-11-23 is outside. So no numerator anyway. But if they had a numerator, they'd be excluded. Fine.
Double-check 71023: Not eligible due to enrollment gap. Even though they have colonoscopy 2018, which would be in N5 window (2017+), they are not eligible.
Double-check 71032: Not eligible due to two gaps. Even though colonoscopy 2015 is outside N5 window anyway. And frailty documented, but not eligible.
Double-check 71026: Age 76, not eligible. Stool DNA 2023-05-08. Even if eligible, N2 window is 2024+, so not numerator.
Double-check 71030: Age 76, not eligible. Stool DNA 2025-12-12. If eligible, that would be in N2 window (2024-2026). But age excludes.
Double-check 71028: Age 45, not eligible. Sigmoidoscopy 2024-10-15. If eligible, N3 window 2022-2026 includes it. But age excludes.
Everything seems consistent.
Now format JSON.
Keys:
- denominator: integer (6)
- numerator: integer (4)
- excluded: integer (1)
- not_eligible: integer (5)
- rate: number (66.7)
- compliant_members: array of strings: ["71022", "71025", "71027", "71029"] (order doesn't matter)
- non_compliant_members: array of strings: ["71024", "71031"]
- excluded_members: array of strings: ["71021"]
- not_eligible_members: array of strings: ["71023", "71026", "71028", "71030", "71032"]
Check counts:
denominator = length of compliant + non_compliant = 4 + 2 = 6. OK.
numerator = 4.
excluded = 1.
not_eligible = 5.
Total = 12.
Wait, does "denominator" mean members in eligible population after exclusions? Yes, compliant + non_compliant. That's 6.
Rate: 4/6*100 = 66.666... round half up to one decimal place = 66.7. Yes.
One nuance: The spec says "N2. Stool DNA test during 2026 or the two years prior (three-year window)." I interpreted as 2024-2026. But what if "the two years prior" means 2023 and 2024? Let's parse: If something happened "during 2026 or the two years prior", it could mean during 2026, or during 2025, or during 2024? Or could it mean during 2026, or during the two-year period prior to 2026 (i.e., 2024-2025)? The phrase "(three-year window)" suggests the total window spans three years. Since the lookback is measured back from 2026-12-31, a three-year window would be from 2024-01-01 to 2026-12-31. That is three calendar years. This is standard HEDIS language: "during the measurement year or the two years prior" means the current year plus two previous years. So 2026, 2025, 2024. So my interpretation is correct.
Similarly, N3 "during 2026 or the four years prior (five-year window)" means 2022-2026. N5 "during 2026 or the nine years prior (ten-year window)" means 2017-2026.
Double-check 71022: Stool DNA 2024-08-05. That's in 2024. So yes.
Double-check 71029: Stool DNA 2024-09-15. In 2024. Yes.
Double-check 71025: Flexible sigmoidoscopy 2023-09-25. N3 window: 2022-2026. Yes.
Double-check 71024: Colonoscopy 2016-03-04. N5 window: 2017-2026. 2016 is outside. Correct.
Double-check 71023: Colonoscopy 2018-02-20. N5 window: 2017-2026. That would be inside. But 71023 is not eligible anyway.
Double-check 71032: Colonoscopy 2015-10-17. N5 window: 2017-2026. Outside. Even if eligible, no numerator. But not eligible.
Double-check 71028: Flexible sigmoidoscopy 2024-10-15. N3 window: 2022-2026. Inside. But not eligible.
Double-check 71026: Stool DNA 2023-05-08. N2 window: 2024-2026. Outside. So even if eligible, no numerator.
Double-check 71030: Stool DNA 2025-12-12. N2 window: 2024-2026. Inside. But not eligible.
Now, just to be thorough, check if any eligible member has an exclusion that I missed.
71024: Frailty and advanced illness. But E4 requires age >=66. Age is 50. So no.
71025: Frailty only. No.
71029: Age 66. But no frailty or advanced illness. So no.
What about E1 or E2? None documented.
What about hospice? Only 71021.
All good.
Now ensure the JSON uses null where needed? No null needed. All fields have values.
Rate formatting: number 66.7. Not string.
Dollar formatting not relevant.
Date formatting not relevant.
Member IDs as strings: "71021", etc.
Order of arrays: any order. I'll list them in ascending numeric order for consistency.
Compliant: "71022", "71025", "71027", "71029".
Non-compliant: "71024", "71031".
Excluded: "71021".
Not eligible: "71023", "71026", "71028", "71030", "71032".
Double-check total members: 12.
4+2+1+5 = 12.
Denominator = 6.
Rate = 4/6*100 = 66.666... -> 66.7. Yes.
One final nuance: For 71032, enrollment has two gaps. The spec says "no more than one gap of up to 45 days." Does the spec consider the gap between the end of one enrollment segment and the start of the next? Yes. So 17 days and 12 days are two gaps. So not eligible. Could there be an interpretation that the gaps are measured only against the full measurement year, i.e., if you have three segments, there are two gaps, but maybe the first gap is from Jan 1 to Apr 17? No, the member is enrolled Jan 1 to Mar 30. So gap is Mar 31 to Apr 16. That's one gap. Then Apr 17 to Jun 26 enrolled. Gap Jun 27 to Jul 08. That's second gap. So two gaps. Not eligible.
Similarly, 71023: enrolled Apr 10 to Dec 31. Gap Jan 1 to Apr 9. One gap, but >45 days. So not eligible.
All good.
Let's produce the JSON.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,566 tokens
We need to evaluate each of 12 members against QM-CRC measure spec for measurement year 2026-01-01 through 2026-12-31.
Definitions:
- Denominator: Age 46-75 as of 2026-12-31, continuous enrollment full measurement year with no more than one gap up to 45 days.
- Numerator: any one of N1-N5 by look-back from 2026-12-31.
- Exclusions: E1-E4. Exclusions evaluated before numerator, only for members in eligible population (denominator). Members failing age/event/enrollment are not_eligible even if exclusion also documented.
Important: "Event or enrolment" in not_eligible includes age. So if age not 46-75, not eligible.
Let's process each member.
Member 71021:
DOB 1980-08-11. Age on 2026-12-31: 46 years old? Let's calculate: 2026-12-31 minus 1980-08-11 = 46 years, 4 months, 20 days. So age 46. Meets age 46-75.
Enrollment: 2026-01-01 through 2026-12-31 continuous no gaps. So eligible population.
Exclusions:
- E3: Hospice election 2026-10-14 during measurement year. So excluded.
- Also has Stool DNA test 2023-11-23. Look-back for N2 is during 2026 or two years prior = 2024-01-01 through 2026-12-31. 2023-11-23 is outside that window. So no numerator. But exclusion takes precedence.
Status: excluded. (E3)
Member 71022:
DOB 1971-12-22. Age on 2026-12-31: 55. Meets age.
Enrollment: continuous full year. Eligible.
Exclusions: none reported (no cancer, colectomy, hospice, frailty, advanced illness).
Numerator: Stool DNA test 2024-08-05. Look-back for N2: during 2026 or two years prior = 2024-01-01 to 2026-12-31. 2024-08-05 is within window. So meets N2.
Status: compliant.
Member 71023:
DOB 1963-07-10. Age on 2026-12-31: 63. Meets age.
Enrollment: 2026-04-10 through 2026-12-31 continuous from that date. Not enrolled before 2026-04-10. So not full measurement year. Also no gaps mentioned after enrollment start, but because start is after measurement year start, continuous enrollment requirement not met. Not eligible.
Exclusions: Not evaluated because not in eligible population. Even if we considered, no exclusions reported.
Status: not_eligible.
Member 71024:
DOB 1976-04-19. Age on 2026-12-31: 50. Meets age.
Enrollment: continuous full year. Eligible.
Exclusions:
- E4: Age 66 or older? No, age 50. So E4 does not apply.
- No cancer, colectomy, hospice.
Numerator: Colonoscopy 2016-03-04. Look-back for N5: during 2026 or nine years prior = 2017-01-01 to 2026-12-31. 2016-03-04 is before 2017. So outside window. No other screening. So does not meet numerator.
Status: non_compliant.
Member 71025:
DOB 1976-05-12. Age on 2026-12-31: 50. Meets age.
Enrollment: continuous full year. Eligible.
Exclusions:
- Frailty documented 2026-07-12. But E4 requires age 66+ AND both frailty and advanced illness. Age is 50, so E4 does not apply. No other exclusions.
Numerator: Flexible sigmoidoscopy 2023-09-25. Look-back for N3: during 2026 or four years prior = 2022-01-01 to 2026-12-31. 2023-09-25 is within window. So meets N3.
Also FIT 2025-02-14 (N1 window 2026 only? N1 is during 2026. So 2025-02-14 not in 2026. But N3 already satisfied.)
Status: compliant.
Member 71026:
DOB 1950-06-09. Age on 2026-12-31: 76. Age requirement is 46 through 75. 76 is outside. So not eligible.
Enrollment: continuous full year, but age fails.
No need to evaluate exclusions. Even if we did, no exclusions.
Status: not_eligible.
Member 71027:
DOB 1979-10-14. Age on 2026-12-31: 47. Meets age.
Enrollment: continuous full year. Eligible.
Exclusions: none.
Numerator: FIT 2026-07-26. N1: during 2026. Yes.
Status: compliant.
Member 71028:
DOB 1981-08-16. Age on 2026-12-31: 45. Age must be 46-75. 45 is below. Not eligible.
Enrollment: continuous full year.
Status: not_eligible.
Member 71029:
DOB 1960-09-06. Age on 2026-12-31: 66. Meets age (46-75).
Enrollment: continuous full year. Eligible.
Exclusions:
- E4: Age 66 or older (yes). Both frailty and advanced illness documented during measurement year? No frailty or advanced illness documented. So E4 not met.
- No other exclusions.
Numerator: Colonoscopy 2019-04-22. Look-back N5: 2017-01-01 to 2026-12-31. 2019 is within. So meets N5.
Also Stool DNA 2024-09-15 (N2 window 2024-01-01 to 2026-12-31). Also meets N2.
Status: compliant.
Member 71030:
DOB 1950-02-11. Age on 2026-12-31: 76. Age >75. Not eligible.
Enrollment continuous.
Status: not_eligible.
Member 71031:
DOB 1951-11-26. Age on 2026-12-31: 75. Meets age (46 through 75 inclusive? "46 through 75 years" usually inclusive. 75 is included.)
Enrollment: continuous full year. Eligible.
Exclusions: none.
Numerator: No screening on record. So no numerator.
Status: non_compliant.
Member 71032:
DOB 1963-12-19. Age on 2026-12-31: 63. Meets age.
Enrollment: 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 days (Mar 30 to Apr 17) and 12 days (Jun 26 to Jul 9). The spec says "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This member has two gaps: 17 days and 12 days. That is more than one gap. Therefore does not meet continuous enrollment requirement. Not eligible.
Wait: Could the gaps be considered "no more than one gap"? There are two gaps, so fails.
Thus not_eligible.
But let's double-check: The enrollment periods are:
- Jan 1 to Mar 30 (inclusive? through 2026-03-30). Then gap from 2026-03-31 to 2026-04-16? Actually if coverage ended 2026-03-30 and resumed 2026-04-17, gap is 17 days (Mar 31-Apr 16 inclusive? Let's count: Mar 31 to Apr 16 is 17 days? March has 31 days, so Mar 31 is 1 day, Apr 1-16 is 16 days, total 17). Yes.
- Then Apr 17 to Jun 26. Gap from Jun 27 to Jul 8? Jun 27-Jun 30 = 4 days, Jul 1-8 = 8 days, total 12 days. So two gaps.
Spec: "no more than one gap of up to 45 days." Two gaps disqualify. Not eligible.
Status: not_eligible.
Even though frailty documented, not in eligible population so exclusion not evaluated.
Now let's tally:
Excluded members: 71021
Compliant members: 71022, 71025, 71027, 71029
Non-compliant members: 71024, 71031
Not eligible members: 71023, 71026, 71028, 71030, 71032
Check if any others:
71021 excluded.
71022 compliant.
71023 not eligible (enrollment).
71024 non compliant.
71025 compliant.
71026 not eligible (age).
71027 compliant.
71028 not eligible (age).
71029 compliant.
71030 not eligible (age).
71031 non compliant.
71032 not eligible (enrollment).
Counts:
denominator = compliant + non_compliant = 4 + 2 = 6.
Wait, excluded is removed from denominator. Denominator is eligible population after exclusions removed.
Eligible population initially: those meeting age and enrollment.
Let's list all who are eligible (age 46-75 and continuous enrollment):
71021 (age 46, enrollment ok) -> eligible
71022 (55, ok) -> eligible
71023 (63, enrollment not full) -> not eligible
71024 (50, ok) -> eligible
71025 (50, ok) -> eligible
71026 (76) -> not eligible
71027 (47, ok) -> eligible
71028 (45) -> not eligible
71029 (66, ok) -> eligible
71030 (76) -> not eligible
71031 (75, ok) -> eligible
71032 (63, enrollment gaps) -> not eligible
So eligible population = 71021, 71022, 71024, 71025, 71027, 71029, 71031 = 7 members.
Now exclusions:
71021 has hospice (E3). So excluded.
Any other exclusions?
71024: frailty and advanced illness, but age 50, so E4 not met. Not excluded.
71025: frailty only, age 50. Not excluded.
71029: no frailty/advanced illness. Not excluded.
71031: none. Not excluded.
So excluded = 1 (71021).
Denominator after exclusions = 7 - 1 = 6.
Compliant = 71022, 71025, 71027, 71029 = 4.
Non-compliant = 71024, 71031 = 2.
Check: 4+2 = 6. Good.
Numerator = 4.
Rate = numerator / denominator * 100 = 4/6 * 100 = 66.666... Rounded half up to one decimal place: 66.7.
Now let's verify each numerator in detail.
71022: Stool DNA 2024-08-05. N2 window: 2026 or two years prior. The spec says "during 2026 or the two years prior (three-year window)." Since measurement year is 2026, two years prior would be 2024 and 2025? Let's parse carefully.
"N2. Stool DNA test during 2026 or the two years prior (three-year window)." This means the look-back window is from Jan 1, 2024 through Dec 31, 2026. So any date >= 2024-01-01 and <= 2026-12-31 qualifies. 2024-08-05 is in that window. Yes.
71025: Flexible sigmoidoscopy 2023-09-25. N3: "during 2026 or the four years prior (five-year window)." Window = Jan 1, 2022 through Dec 31, 2026. 2023-09-25 qualifies. Yes.
71027: FIT 2026-07-26. N1: during 2026. Yes.
71029: Colonoscopy 2019-04-22. N5: "during 2026 or the nine years prior (ten-year window)." Window = Jan 1, 2017 through Dec 31, 2026. 2019 qualifies. Yes.
Now verify 71024: Colonoscopy 2016-03-04. Window for N5: 2017-01-01 to 2026-12-31. 2016 is outside. No other screening. So non-compliant.
71031: No screening. Non-compliant.
71021: Stool DNA 2023-11-23. Window for N2: 2024-01-01 to 2026-12-31. 2023 is outside. So no numerator. Excluded due to hospice.
Now 71032: We said not eligible because two gaps. Let's double-check spec: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." The member has coverage Jan 1-Mar 30, Apr 17-Jun 26, Jul 9-Dec 31. That's two gaps. So fails.
71023: Not enrolled before Apr 10. So coverage starts after measurement year start. Not full measurement year. Not eligible.
71030: Age 76. Not eligible. Even though stool DNA 2025-12-12 is within N2 window? Wait N2 window is 2024-2026. 2025 qualifies. But because age >75, not eligible. Status not_eligible.
71026: Age 76. Not eligible. Stool DNA 2023-05-08. Not eligible.
71028: Age 45. Not eligible.
Now check E4 again for 71024: Age 50, frailty and advanced illness documented. E4 requires age 66+. So not excluded.
Now check 71025: Age 50, frailty documented. Not excluded.
Now check 71032: Frailty documented. But not eligible due to enrollment. So not_eligible.
Everything seems consistent.
Let's prepare JSON.
Keys required:
"denominator": 6
"numerator": 4
"excluded": 1
"not_eligible": 5
"rate": 66.7
"compliant_members": ["71022","71025","71027","71029"] (order doesn't matter)
"non_compliant_members": ["71024","71031"]
"excluded_members": ["71021"]
"not_eligible_members": ["71023","71026","71028","71030","71032"]
Wait, not_eligible count: 71023, 71026, 71028, 71030, 71032 = 5. Yes.
Total members: 1 excluded + 4 compliant + 2 non_compliant + 5 not_eligible = 12. Good.
Rate: 4 / 6 = 0.666666... * 100 = 66.6666... Round half up to one decimal place: 66.7.
Double-check rounding: 66.666... to one decimal: second decimal is 6, so round up 66.6 -> 66.7. Yes.
Let's double-check 71031 age: DOB 1951-11-26. As of 2026-12-31: 2026-12-31 minus 1951-11-26 = 75 years, 1 month, 5 days. So age 75. Included.
Double-check 71030 age: DOB 1950-02-11. As of 2026-12-31: 76 years, 10 months, 20 days. Age 76. Excluded from age.
Double-check 71026 age: DOB 1950-06-09. As of 2026-12-31: 76 years, 6 months, 22 days. Age 76.
Double-check 71028 age: DOB 1981-08-16. As of 2026-12-31: 45 years, 4 months, 15 days. Age 45. Below 46.
Double-check 71021 age: DOB 1980-08-11. As of 2026-12-31: 46 years, 4 months, 20 days. Age 46. Included.
Double-check 71024 age: DOB 1976-04-19. Age: 50 years, 8 months, 12 days. Included.
Double-check 71025 age: DOB 1976-05-12. Age: 50 years, 7 months, 19 days. Included.
Double-check 71027 age: DOB 1979-10-14. Age: 47 years, 2 months, 17 days. Included.
Double-check 71029 age: DOB 1960-09-06. Age: 66 years, 3 months, 25 days. Included.
Double-check 71023 age: DOB 1963-07-10. Age: 63 years, 5 months, 21 days. Included, but enrollment fails.
Double-check 71032 age: DOB 1963-12-19. Age: 63 years, 0 months (actually as of Dec 31, 2026: 2026-12-31 minus 1963-12-19 = 63 years, 12 days). Included, but enrollment fails.
Now check continuous enrollment for 71021, 71022, 71024, 71025, 71027, 71029, 71031: all say continuous no gaps for full year. Good.
Now check if any other exclusions could apply to members we think are not excluded. E1: colorectal cancer C18-C21 any time on or before 2026-12-31. No member has this. E2: total colectomy any time. None. E3: hospice during measurement year. Only 71021. E4: age 66+ AND both frailty and advanced illness during measurement year. None. 71024 has frailty and advanced illness but age 50. So no.
Now verify that 71024's colonoscopy 2016-03-04 doesn't meet any other numerator. Could it meet N4 CT colonography? No, it's colonoscopy. N5 is colonoscopy with 10-year window. Window is 2017-2026. 2016 is out. So no.
71023: colonoscopy 2018-02-20. Even if she were eligible, N5 window is 2017-2026, so 2018 qualifies. But she is not eligible due to enrollment.
71032: colonoscopy 2015-10-17. Not eligible.
71030: stool DNA 2025-12-12. If eligible, N2 window includes 2025. But not eligible.
71026: stool DNA 2023-05-08. Not eligible.
71028: flexible sigmoidoscopy 2024-10-15. If eligible, N3 window is 2022-2026, so would qualify. But age 45, not eligible.
Everything looks solid.
One final check: Are there any nuances about "continuous enrolment: the full measurement year with no more than one gap of up to 45 days"? Does 71032's coverage count as "full measurement year"? They have coverage for parts but with two gaps. The spec clearly says no more than one gap. So not eligible.
Also 71023: "Enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10." So missing Jan 1 - Apr 9. That's a gap >45 days (actually about 100 days). Also not full measurement year. So not eligible.
Thus final answer is as above.
Make sure to output exactly one fenced JSON block with no extra text.
Order of arrays doesn't matter. I'll sort them for clarity.
```json
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
```
Counts match.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100DeepSeek V4 Pro · DeepSeek65.8s · 3,143 out | 43.0s · 2,091 out | 54.2s · 2,755 out
Reasoning · 3,013 tokens
We are asked to analyze each member against the Measure QM-CRC specification and assign them to the appropriate categories. Let's go step by step.
First, calculate age as of 2026-12-31. DOB is given, so age = (2026-12-31 minus DOB). The spec says "Age: 46 through 75 years as of 2026-12-31." So exactly 46 is included, 75 included.
Continuous enrollment: full measurement year (1/1/2026 to 12/31/2026) with no more than one gap of up to 45 days. So we check if member had any gaps beyond that. If enrolled all year without gaps, that's fine. If there is a gap >45 days or more than one gap, then not eligible (assuming gaps are measured as periods without enrollment? The spec says "no more than one gap of up to 45 days". So one gap up to 45 days is allowed, but two gaps are not allowed, even if both are short. So we need to count gaps and their lengths.
Numerator: see screening tests with lookback windows as of 2026-12-31. Specifically:
- N1: FOBT or FIT during 2026 (measurement year only)
- N2: Stool DNA test during 2026 or the two years prior (i.e., dates from 2024-01-01 to 2026-12-31? Actually "during 2026 or the two years prior" meaning a three-year window ending 12/31/2026? The spec says: "Stool DNA test during 2026 or the two years prior (three-year window)." So the window is 2024-2026 inclusive? Actually, "during 2026 or the two years prior" means any date from 2024-01-01 through 2026-12-31. That's a three-year window (2024, 2025, 2026). So Stool DNA test must fall within that period.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). That means 2022-2026 inclusive? "during 2026 or the four years prior" -> dates from 2022-01-01 through 2026-12-31? Actually, "five-year window" suggests a 5-year period ending 12/31/2026, so from 2022-01-01 to 2026-12-31.
- N4: CT colonography during 2026 or the four years prior (five-year window). Same as N3: 2022-2026.
- N5: Colonoscopy during 2026 or the nine years prior (ten-year window). So ten-year window ending 12/31/2026: from 2017-01-01 to 2026-12-31.
Note: The lookback windows are from "2026-12-31" backwards. So we'll check each screening date accordingly.
Exclusions:
E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. If documented.
E2: Total colectomy any time on or before 2026-12-31.
E3: Hospice at any time during the measurement year (2026).
E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year (2026). Both must be documented during 2026.
If a member meets any exclusion, they are excluded, even if they would otherwise meet numerator? Yes, "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. A member who meets both an exclusion and the numerator is excluded, not compliant." So if eligible population then exclusion, they are excluded.
First, determine eligibility (age and enrollment). Then check exclusions for those who are eligible. Then numerator for those not excluded.
Now analyze each member.
MEMBER 71021: DOB 1980-08-11, age on 2026-12-31 = 46 years (since birthday is in August, so by end of year he's 46). Age 46 is within range. Enrollment: continuous all year, no gaps. So eligible.
Check exclusions: E1: none mentioned. E2: none. E3: Hospice election on 2026-10-14 during measurement year. So meets E3. Thus excluded. (E4 doesn't apply age 46, and even if it did, not documented both). So status: excluded.
Excluded_member.
MEMBER 71022: DOB 1971-12-22, age 55. Enrolled full year, no gaps. Eligible.
No exclusions documented (no colorectal cancer, colectomy, hospice, frailty/illness). So check numerator.
Screening: Stool DNA test on 2024-08-05. Is that within the window for N2? Stool DNA test during 2024-2026: 2024-08-05 is within 2024, so yes. Thus numerator met. Compliant.
MEMBER 71023: DOB 1963-07-10, age 63. Enrolment: started 2026-04-10, prior not enrolled. Are they continuously enrolled for the full measurement year? No, because they weren't enrolled from Jan 1 to Apr 9. The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." But this is not a gap; they simply were not enrolled at all for the first part of the year. The requirement is "the full measurement year" meaning enrolled from 1/1/2026 to 12/31/2026 with only one gap of up to 45 days. Here, they aren't enrolled from Jan 1 to Apr 9, which is a period of non-enrollment that is not just a gap in continuous enrollment? The phrasing "with no more than one gap of up to 45 days" implies that the baseline is continuous enrollment throughout the year, and if there is a break in enrollment, that break counts as a gap. If they never enrolled until April, that's a gap of about 99 days (Jan 1 to Apr 9). That's more than 45 days. So they do not meet continuous enrollment. Thus not eligible. So not_eligible.
(Note: screening history: colonoscopy in 2018, which is within ten-year window for N5? 2018-02-20 would be in the window 2017-2026, so that would satisfy numerator if eligible. But enrollment fails, so not eligible.)
MEMBER 71024: DOB 1976-04-19, age 50. Enrolled full year, no gaps. Eligible.
Exclusions: Frailty documented on 2026-08-18 (R26.2) and Advanced illness documented on 2026-02-04 (heart failure I50.22). Both are during measurement year. Age 66 or older? No, age 50. So E4 requires age 66+. So E4 does not apply. No other exclusions (no cancer, colectomy, hospice). So not excluded.
Check numerator: Screening: Colonoscopy on 2016-03-04. Colonoscopy window: ten-year window ending 2026-12-31, so from 2017-01-01 to 2026-12-31. 2016-03-04 is before 2017, so out of window. No other screenings. So numerator not met. Non_compliant.
MEMBER 71025: DOB 1976-05-12, age 50. Enrolled full year, no gaps. Eligible.
Exclusions: Frailty documented 2026-07-12 (advanced illness not documented). Age 50, so E4 not applicable. No other exclusions. So not excluded.
Check numerator: Flexible sigmoidoscopy 2023-09-25. Window for N3: 2022-2026? "during 2026 or the four years prior (five-year window)" -> so from 2022-01-01 to 2026-12-31? Actually, careful: "during 2026 or the four years prior" means any date in 2026, 2025, 2024, 2023, 2022. So 2023-09-25 is within that window. So N3 met. Also FIT in 2025-02-14 meets N1 (2026? FIT is in 2025, not 2026; N1 requires during 2026 only. So 2025 FIT is not N1. But sigmoidoscopy satisfies. So compliant.
MEMBER 71026: DOB 1950-06-09, age 76. Age is over 75, so not eligible (age range is 46 through 75). So not_eligible.
MEMBER 71027: DOB 1979-10-14, age 47. Enrolled full year, no gaps. Eligible.
Exclusions: none. FIT on 2026-07-26: N1 met (during 2026). Compliant.
MEMBER 71028: DOB 1981-08-16, age 45. Not yet 46, so not eligible. Not_eligible.
MEMBER 71029: DOB 1960-09-06, age 66. Enrolled full year, no gaps. Eligible.
Exclusions: age 66, so E4 possible if both frailty and advanced illness documented. None documented. No other exclusions.
Numerator: Colonoscopy 2019-04-22: within ten-year window (2017-2026), so N5 met. Also Stool DNA test 2024-09-15: within N2 window. Either way, numerator met. Compliant.
MEMBER 71030: DOB 1950-02-11, age 76. Over 75, not eligible. Not_eligible.
MEMBER 71031: DOB 1951-11-26, age 75 exactly (turns 75 in Nov 2026). So age 75 is within range (46 through 75). Enrolled full year, no gaps. Eligible.
Exclusions: none documented (no cancer, colectomy, hospice, frailty/advanced illness). Numerator: no screening on record. So non_compliant.
MEMBER 71032: DOB 1963-12-19, age 63. Enrollment: three periods: 2026-01-01 to 2026-03-30 (89 days?), then gap from 03-31 to 04-16 (17 days), then enrolled 04-17 to 06-26, then gap 06-27 to 07-08 (12 days), then enrolled 07-09 to 12-31. So two gaps: one of 17 days, one of 12 days. Both are <=45 days. But the rule says "no more than one gap of up to 45 days". That means at most one gap, and if there is a gap, it must be <=45 days. Here we have two gaps. So fails continuous enrollment. So not eligible. Not_eligible.
Now, summarize:
Denominator: eligible population after exclusions. First, eligible population = those who meet age (46-75) and continuous enrollment. That set: members 71021, 71022, 71024, 71025, 71027, 71029, 71031. Members 71023, 71026, 71028, 71030, 71032 are not eligible (for age or enrollment). So not_eligible count = 5? Wait: list them: 71023 (enrollment gap >45), 71026 (age 76), 71028 (age 45), 71030 (age 76), 71032 (two gaps). So 5 not_eligible. Check: there are 12 members. So 12 - 5 = 7 eligible. Among eligible, check exclusions: 71021 excluded (hospice). Others have no exclusions. So excluded count = 1. Denominator = eligible after exclusions = 7 - 1 = 6. Numerator (compliant): 71022, 71025, 71027, 71029 are compliant. That's 4. Non_compliant: 71024, 71031 (2). So compliant count = 4, non_compliant = 2. Rate = (4/6)*100 = 66.666... round half up to one decimal: 66.7.
Now verify each member's status and list IDs.
- 71021: excluded
- 71022: compliant
- 71023: not_eligible
- 71024: non_compliant
- 71025: compliant
- 71026: not_eligible
- 71027: compliant
- 71028: not_eligible
- 71029: compliant
- 71030: not_eligible
- 71031: non_compliant
- 71032: not_eligible
So arrays:
compliant_members: ["71022", "71025", "71027", "71029"] (order doesn't matter)
non_compliant_members: ["71024", "71031"]
excluded_members: ["71021"]
not_eligible_members: ["71023", "71026", "71028", "71030", "71032"] (5 members)
Counts: denominator=6, numerator=4, excluded=1, not_eligible=5. Rate=66.7.
Check rounding: 4/6 = 0.6666666667 *100 = 66.66666667, rounded half up to one decimal place: 66.7. Yes.
Now output JSON.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,961 tokens
We are asked to classify 12 members for measure QM-CRC. We need to assign each member as compliant, non_compliant, excluded, or not_eligible. Let's go through each member step by step.
First, check eligibility: age 46-75 as of 2026-12-31, and continuous enrolment for full measurement year with no more than one gap up to 45 days. Then check exclusions: colorectal cancer, total colectomy, hospice, or (age>=66 and both frailty and advanced illness). Then check numerator: various tests within specific look-back windows.
Measure year: 2026.
Member 71021: DOB 1980-08-11. Age on 2026-12-31: 2026 - 1980 = 46 (turns 46 in August 2026, so exactly 46 on 12/31, yes). So age eligible. Enrolment: continuous, no gaps. Eligible. Check exclusions: hospice election on 2026-10-14. Hospice during measurement year is exclusion E3. So excluded. Status: excluded.
Member 71022: DOB 1971-12-22. Age on 2026-12-31: 55 (turns 55 on 12/22/2026). Eligible. Enrolment continuous. Exclusions: none documented. Numerator: Stool DNA test on 2024-08-05. N2: Stool DNA test during 2026 or the two years prior (three-year window). The window is from 2026-12-31 back: 2024, 2025, 2026 are years? Actually, "during 2026 or the two years prior" means any date in 2026, 2025, 2024. The test date is 2024-08-05, which is within 2024-2026, so yes, within window. Compliant.
Member 71023: DOB 1963-07-10. Age on 2026-12-31: 63 (turns 63 in July 2026). Eligible by age. Enrolment: from 2026-04-10 to 2026-12-31. Not full year; gap before April. Only one gap? The enrolment is from 4/10 onward, meaning a gap from 1/1 to 4/9 (>45 days). So not continuously enrolled with only allowed gaps. So not eligible. Status: not_eligible.
Member 71024: DOB 1976-04-19. Age on 2026-12-31: 50 (turns 50 in April). Eligible. Enrolment continuous. Exclusions: frailty and advanced illness both documented (R26.2 frailty, I50.22 advanced illness). Age 50, so not >=66, so E4 condition requires age 66+ and both. So this member is 50, so E4 doesn't apply. Other exclusions: none. Check numerator: Colonoscopy on 2016-03-04. N5: colonoscopy during 2026 or nine years prior (ten-year window). That window is 2017-2026 (since 2026 minus 9 years = 2017). 2016 is outside. So no colonoscopy in window. Any other tests? No. So numerator not met. Status: non_compliant.
Member 71025: DOB 1976-05-12. Age 50. Enrolment continuous. Exclusions: only frailty documented, no advanced illness. So E4 not met (age<66 anyway). So no exclusions. Numerator: flexible sigmoidoscopy on 2023-09-25. N3: flexible sigmoidoscopy during 2026 or four years prior (five-year window). Window: 2022-2026? 2026 minus 4 years = 2022, so 2022, 2023, 2024, 2025, 2026. 2023-09-25 is in window. So numerator met. Also faecal immunochemical test in 2025, but that's N1 (during 2026 only). So compliant.
Member 71026: DOB 1950-06-09. Age on 2026-12-31: 76. Not eligible (age >75). Status: not_eligible.
Member 71027: DOB 1979-10-14. Age 47. Eligible. Enrolment continuous. No exclusions. Faecal immunochemical test 2026-07-26: N1 met. Compliant.
Member 71028: DOB 1981-08-16. Age on 2026-12-31: 45 (turns 45 in August 2026). 45 is less than 46, so not eligible. Status: not_eligible.
Member 71029: DOB 1960-09-06. Age on 2026-12-31: 66. Eligible. Enrolment continuous. Exclusions: no hospice, CRC, colectomy. Age 66, so E4 applies if both frailty and advanced illness. No frailty or advanced illness documented. So not excluded. Numerator: colonoscopy 2019-04-22: N5 window: 2017-2026. 2019 is within window, so compliant. (Stool DNA 2024 also compliant, but colonoscopy is enough). Compliant.
Member 71030: DOB 1950-02-11. Age on 2026-12-31: 76. Not eligible (age>75). Status: not_eligible.
Member 71031: DOB 1951-11-26. Age 75 (turns 75 in November 2026, so 75 on 12/31). Eligible. Enrolment continuous. No exclusions. No screening tests at all, so non_compliant.
Member 71032: DOB 1963-12-19. Age 63. Enrolment: gaps of 17 and 12 days. The rule: "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Here there are two gaps: 1/1-3/30 (enrolled), then gap from 3/31 to 4/16? Actually, describes: enrolled 1/1-3/30; then 4/17-6/26; then 7/9-12/31. So gaps are: 3/31 to 4/16 (17 days) and 6/27 to 7/8 (12 days). That's two gaps. Even if both are under 45 days, the rule says "no more than one gap". So two gaps make enrolment not continuous. So not eligible. Status: not_eligible.
Now tabulate counts:
Eligible after exclusions? Let's list statuses:
Eligible population: those age 46-75 and continuous enrolment. Exclusions remove from denominator. Not eligible are out.
Member 71021: excluded (hospice)
Member 71022: compliant
Member 71023: not_eligible (enrolment gap)
Member 71024: non_compliant (no qualifying test)
Member 71025: compliant
Member 71026: not_eligible (age)
Member 71027: compliant
Member 71028: not_eligible (age)
Member 71029: compliant
Member 71030: not_eligible (age)
Member 71031: non_compliant
Member 71032: not_eligible (enrolment gaps)
So eligible members that are not excluded: 71022, 71024, 71025, 71027, 71029, 71031. That's 6? Let's count: 71022, 71024, 71025, 71027, 71029, 71031. Yes, 6 in denominator. Compliant: 71022, 71025, 71027, 71029. That's 4. Non-compliant: 71024, 71031. That's 2. Excluded: 71021 only. Not eligible: 71023, 71026, 71028, 71030, 71032. That's 5? Let's list: 71023, 71026, 71028, 71030, 71032 — yes, 5.
Rate = 4/6 * 100 = 66.666... rounded half up to one decimal: 66.7.
Lists:
compliant_members: ["71022", "71025", "71027", "71029"]
non_compliant_members: ["71024", "71031"]
excluded_members: ["71021"]
not_eligible_members: ["71023", "71026", "71028", "71030", "71032"]
Double-check member 71032: enrolment gaps more than one, so not eligible. Correct. Also, member 71032 had frailty documented, but not eligible anyway, so no need to consider exclusion.
Thus, final JSON.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,625 tokens
We are given a measure specification for colorectal cancer screening (QM-CRC) and a roster of 12 members. We need to classify each member as compliant, non_compliant, excluded, or not_eligible, based on the rules. Then we compute denominator, numerator, etc.
Let's process each member systematically.
Key rules:
- Eligible: age 46-75 as of 2026-12-31 and continuous enrolment with ≤1 gap ≤45 days, full measurement year (2026-01-01 to 2026-12-31).
- Numerator: one of the screening tests within the appropriate lookback windows from 2026-12-31.
- Exclusions: colorectal cancer (C18-C21) any time before/on 2026-12-31; total colectomy any time before/on 2026-12-31; hospice during measurement year; age ≥66 AND both frailty and advanced illness documented during measurement year.
- Exclusions are checked before numerator, but only for members who are eligible. If not eligible (age fails, enrolment), they are not_eligible regardless of exclusions. If eligible but meets an exclusion, they are excluded even if they would meet numerator.
Now evaluate each member.
**MEMBER 71021**
- DOB: 1980-08-11 → age as of 2026-12-31: 2026-1980 = 46, but because August 11, so turns 46 in August 2026, so exactly 46. So age 46 → within 46-75, eligible age.
- Enrolment: 2026-01-01 to 2026-12-31 continuous, no gaps → eligible continuous enrolment.
- So eligible population.
- Check exclusions: any colorectal cancer? No. Total colectomy? No. Hospice? Yes, hospice election on 2026-10-14 during measurement year → meets exclusion E3 (hospice at any time during measurement year). So EXCLUDED.
- (Even though no colorectal cancer or colectomy, hospice is enough). So status: excluded.
**MEMBER 71022**
- DOB: 1971-12-22 → age: 2026-1971=55, birthday Dec 22, so 55 by Dec 31. Age 55, eligible.
- Enrolment: continuous 2026-01-01 to 2026-12-31, no gaps → eligible.
- Exclusions: no cancer, no colectomy, no hospice, no frailty/advanced illness. None.
- Now check numerator: screening history: Stool DNA test on 2024-08-05. That test is covered by N2: stool DNA test during 2026 or two years prior: three-year window from 2026-12-31, i.e., dates from 2024-01-01 to 2026-12-31 (since lookback from end of 2026: 3 years back = 2024-01-01 onward). So 2024-08-05 is within that window. Thus compliant. Note: Stool DNA test is N2. So compliant.
**MEMBER 71023**
- DOB: 1963-07-10 → age: 2026-1963=63, birthday Jul 10, so 63. Eligible age.
- Enrolment: enrolled from 2026-04-10 to 2026-12-31. That's not full year; continuous from that date, but not from start of year. She is missing Jan 1 - Apr 9. So she does not have continuous enrolment for the full measurement year. She has a gap >45 days? Actually, she is not enrolled at all before 4/10. That means a gap of over 100 days, which exceeds the 45-day allowance. The rule: continuous enrolment with no more than one gap of up to 45 days. Not being enrolled for the first part is effectively a gap of 99 days, >45 days. So she fails continuous enrolment. Thus not_eligible.
- Even if she had other tests, she's not in denominator. So not_eligible.
**MEMBER 71024**
- DOB: 1976-04-19 → age: 50. Eligible age.
- Enrolment: 2026-01-01 to 2026-12-31, continuous, no gaps. Eligible.
- Exclusions: Check E4: age ≥66? He is 50, so no. So E4 not applicable. Check E1: colorectal cancer? No. E2: total colectomy? No. E3: hospice? Not mentioned. E4: age 66+ and both frailty and advanced illness documented. Age 50, so not. So no exclusions.
- Numerator: Screening history: colonoscopy 2016-03-04. Lookback window for colonoscopy (N5): 2026 or nine years prior, i.e., ten-year window from 2026-12-31 back to 2017-01-01? Actually, "during 2026 or the nine years prior (ten-year window)." So from 2017-01-01 to 2026-12-31 (2026 minus 9 = 2017). Colonoscopy on 2016-03-04 is before 2017, so outside the window. No other tests. So not compliant.
- However, he has frailty and advanced illness documented in 2026, but that doesn't trigger exclusion because he's only 50, not 66+. So he is non_compliant.
**MEMBER 71025**
- DOB: 1976-05-12 → age 50. Eligible age.
- Enrolment: continuous 2026-01-01 to 2026-12-31, no gaps. Eligible.
- Exclusions: None mentioned (no cancer, no colectomy, no hospice; age not 66+, so E4 not triggered even though frailty documented, because need both frailty and advanced illness, but here only frailty documented, advanced illness not mentioned. So no exclusion.
- Numerator: flexible sigmoidoscopy 2023-09-25 and FIT 2025-02-14. Flexible sigmoidoscopy: N3 window: 2026 or four years prior (five-year window): so 2022-01-01 to 2026-12-31? Let's compute: five-year window from 2026-12-31 means from 2022-01-01 (2026-4=2022). 2023-09-25 falls within that window (2022-2026). So compliant via N3. Also FIT 2025-02-14 within 2026? No, 2025 is within measurement year? Wait, N1: fecal occult blood test or FIT during 2026. So FIT 2025-02-14 is not in 2026, so doesn't count. But sigmoidoscopy qualifies. So compliant.
**MEMBER 71026**
- DOB: 1950-06-09 → age: 76 as of 2026-12-31 (turns 76 in June 2026). Not in age range 46-75. So not_eligible. (Even though enrolment is fine). Not eligible.
**MEMBER 71027**
- DOB: 1979-10-14 → age: 47. Eligible age.
- Enrolment: continuous full year → eligible.
- Exclusions: none.
- Numerator: FIT on 2026-07-26. That's in 2026 → N1 qualifies. So compliant.
**MEMBER 71028**
- DOB: 1981-08-16 → age: 45 as of 2026-12-31 (turns 45 in August 2026). Not 46 yet. So not eligible (age <46). Not_eligible.
**MEMBER 71029**
- DOB: 1960-09-06 → age: 66 (birthday Sep 6, so 66). Eligible age.
- Enrolment: continuous full year → eligible.
- Exclusions: age 66+? Yes, 66. Need both frailty and advanced illness documented during measurement year. Documentation: no frailty, no advanced illness mentioned. So E4 not met. Also no cancer, no colectomy, no hospice. So no exclusions.
- Numerator: colonoscopy 2019-04-22 and stool DNA 2024-09-15. Colonoscopy: window 2017-01-01 to 2026-12-31 (10 years). 2019-04-22 is within that. So compliant via N5. (Stool DNA 2024 also within 3-year window? Actually N2: stool DNA during 2026 or two years prior: 2024-01-01 to 2026-12-31, so 2024-09-15 qualifies too. So definitely compliant.) So compliant.
**MEMBER 71030**
- DOB: 1950-02-11 → age: 76 (turns 76 in Feb). Not eligible age. Not_eligible.
**MEMBER 71031**
- DOB: 1951-11-26 → age: 75 (turns 75 in Nov 2026, so exactly 75 as of Dec 31). Eligible age.
- Enrolment: continuous full year → eligible.
- Exclusions: none. No cancer, no colectomy, no hospice, no frailty/advanced illness.
- Numerator: no screening on record → non_compliant.
**MEMBER 71032**
- DOB: 1963-12-19 → age: 63. Eligible age.
- Enrolment: gaps: enrolled 2026-01-01 to 03-30, then gap 03-31 to 04-16 (17 days), then 04-17 to 06-26, then gap 06-27 to 07-08 (12 days), then 07-09 to 12-31. Total two gaps: 17 and 12 days, both under 45 days. So continuous enrolment requirement: no more than one gap up to 45 days. Here there are two gaps, both under 45, but two gaps, not one. The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So having two gaps, even if each is short, violates because it allows only one gap. So she fails continuous enrolment. Therefore not_eligible.
- (Note: she also has frailty documented, but that's irrelevant as not eligible). So not_eligible.
Now summarize:
Compliant: 71022, 71025, 71027, 71029 (4 members)
Non_compliant: 71024, 71031 (2 members)
Excluded: 71021 (1 member)
Not_eligible: 71023, 71026, 71028, 71030, 71032 (5 members) (and maybe others? count: 71023, 71026, 71028, 71030, 71032 = 5. Also 71021 is excluded, not in any of these counts. Total roster: 12, so 4+2+1+5=12, matches.)
Denominator = compliant + non_compliant = 6. Numerator = 4. Excluded = 1. Not_eligible = 5. Rate = (4/6)*100 = 66.666...% round half up to one decimal: 66.7.
Lists:
compliant_members: ["71022", "71025", "71027", "71029"]
non_compliant_members: ["71024", "71031"]
excluded_members: ["71021"]
not_eligible_members: ["71023", "71026", "71028", "71030", "71032"]
Double-check exclusions: 71021 hospice => excluded. 71024 no exclusions, just non-compliant. 71032 enrolment gaps, not_eligible, correct. 71029 no frailty/adv illness, compliant. 71031 no screen, non-compliant. Good.
So JSON output.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
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"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"71025",
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"got": [
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],
"ok": true,
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},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Luna · OpenAI4.9s · 475 out | 4.4s · 437 out | 5.4s · 498 out
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
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},
{
"field": "numerator",
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"got": 4,
"ok": true,
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{
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{
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"present": true
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{
"field": "excluded_members",
"want": [
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"got": [
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],
"ok": true,
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},
{
"field": "not_eligible_members",
"want": [
"71023",
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],
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],
"ok": true,
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}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
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"got": 4,
"ok": true,
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{
"field": "excluded",
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"ok": true,
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{
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{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
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],
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},
{
"field": "excluded_members",
"want": [
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],
"got": [
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],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
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],
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],
"fabricated": false,
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}json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
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{
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"want": [
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"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100DeepSeek V4 Flash · DeepSeek28.3s · 2,950 out | 28.7s · 5,321 out | 55.1s · 2,234 out
Reasoning · 2,821 tokens
We need answer only JSON. Need compute measure population. Need be careful. Let's parse.
Measure QM-CRC. Measurement year 2026. Eligible population: age 46-75 as of 2026-12-31. Continuous enrolment full measurement year with no more than one gap up to 45 days. Numerator based on lookback from 2026-12-31. Exclusions.
Need classify each member.
Let's list members.
71021 DOB 1980-08-11 -> age on 2026-12-31? 46 (turns 46 Aug 11 2026). Female. Enrolment continuous. Screening: 2023-11-23 Stool DNA. Other: 2026-10-14 Hospice election. Exclusion E3 hospice during measurement year -> excluded. Even though stool DNA maybe within 3-year window? Stool DNA during 2026 or two years prior: 2024, 2025, 2026? Wait "during 2026 or the two years prior (three-year window)" means 2024-01-01 through 2026-12-31? Two years prior to 2026 are 2024 and 2025. So window 2024-01-01 to 2026-12-31. 2023-11-23 not in window. Anyway hospice excludes. status excluded. Need ensure age eligible yes.
71022 DOB 1971-12-22 -> age 55 on 2026-12-31. Enrolment continuous. Screening: 2024-08-05 Stool DNA. Window for stool DNA: 2024-2026, yes compliant. No exclusions. So compliant.
71023 DOB 1963-07-10 -> age 63. Enrolment 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10. Continuous enrolment requirement: full measurement year with no more than one gap of up to 45 days. Missing Jan 1 to Apr 10 = 99 days? Let's compute gap. Enrolment start 2026-04-10. Does "full measurement year" require enrolled entire year except allowable gaps. Gap from Jan 1 to Apr 10 is 99 days? Need count. Usually a gap of enrolment is days not enrolled. 2026-01-01 through 2026-04-09 = 99 days? Let's calculate: Jan 31 + Feb 28 + Mar 31 + Apr 1-9 = 99. That exceeds 45. Also no more than one gap up to 45. So not_eligible. Even though screening colonoscopy 2018 (within 10-year window? 2018 within 2017-2026 yes, but not eligible due enrollment). So not_eligible.
71024 DOB 1976-04-19 -> age 50. Enrolment continuous. Screening: 2016-03-04 Colonoscopy. Lookback 10 years: 2017-01-01 to 2026-12-31? "during 2026 or the nine years prior (ten-year window)" means 2017 through 2026. 2016 is outside. Other: frailty and advanced illness documented in 2026. Age 66 or older as of 2026-12-31? No, age 50. E4 requires age 66+ AND both frailty and advanced illness. Since age not 66+, no exclusion. No other exclusion. Screening not current. So non_compliant.
71025 DOB 1976-05-12 -> age 50. Enrolment continuous. Screening: 2023-09-25 Flexible sigmoidoscopy; 2025-02-14 FIT. FIT in 2025 within 2026? N1 "during 2026" only, so 2025 FIT not compliant for N1. Flexible sigmoidoscopy window 2026 or four years prior = 2022-2026, so 2023-09-25 is within 5-year window. Thus compliant. Frailty documented but age <66, no exclusion. So compliant.
71026 DOB 1950-06-09 -> age 76 on 2026-12-31. Age eligible? 46 through 75. 76 >75, so not_eligible. Screening 2023 stool DNA not relevant. No exclusions considered because not eligible. not_eligible.
71027 DOB 1979-10-14 -> age 47. Enrolment continuous. Screening 2026-07-26 FIT in 2026 -> compliant.
71028 DOB 1981-08-16 -> age 45 on 2026-12-31 (turns 45 Aug 2026). Age below 46 -> not_eligible. Even though screening 2024 flex sig within window, age fails. not_eligible.
71029 DOB 1960-09-06 -> age 66. Enrolment continuous. Screening: 2019-04-22 Colonoscopy; 2024-09-15 Stool DNA. Need determine compliant: colonoscopy 2019 within 2017-2026 ten-year window? Yes 2019 is within 2017-2026. Stool DNA 2024 within 2024-2026 three-year window. Either qualifies. No exclusions. Note age 66, but no frailty or advanced illness documented, so E4 not met. compliant.
71030 DOB 1950-02-11 -> age 76. Age >75 -> not_eligible. Stool DNA 2025 maybe within window, but age fails. not_eligible.
71031 DOB 1951-11-26 -> age 75. Enrolment continuous. No screening. No exclusions. Age eligible. non_compliant.
71032 DOB 1963-12-19 -> age 63. Enrolment: segments 2026-01-01 through 2026-03-30; 2026-04-17 through 2026-06-26; 2026-07-09 through 2026-12-31. Gaps of 17 and 12 days. Requirement: full measurement year with no more than one gap of up to 45 days. There are two gaps (17 and 12). Even though each <=45, more than one gap -> not_eligible. Screening colonoscopy 2015 (outside 10-year window 2017-2026? 2015 outside). Frailty documented but age <66, not relevant. not_eligible.
Need counts:
Denominator = eligible after exclusions = compliant + non_compliant. Let's list.
71021 excluded (hospice)
71022 compliant
71023 not_eligible
71024 non_compliant
71025 compliant
71026 not_eligible
71027 compliant
71028 not_eligible
71029 compliant
71030 not_eligible
71031 non_compliant
71032 not_eligible
Counts:
Compliant: 71022, 71025, 71027, 71029 = 4.
Non_compliant: 71024, 71031 = 2.
Denominator = 6.
Excluded: 71021 = 1.
Not_eligible: 71023, 71026, 71028, 71030, 71032 = 5.
Total 4+2+1+5=12 yes.
Rate = numerator / denominator x 100 = 4/6*100 = 66.666... Rounded half up to one decimal = 66.7.
Need ensure any subtlety about E4 for 71024? Age 50, so no. 71032 age 63 no. 71029 age 66, but no frailty/advanced illness. 71021 age 46, hospice. Good.
Need output JSON with exact keys. Include arrays of member ID strings. Need member IDs as strings "71021" etc. Any order.
Let's double-check enrolment for 71023: "Enrolment: 2026-04-10 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-10." Continuous enrolment definition "full measurement year with no more than one gap of up to 45 days." Gap length Jan 1 - Apr 9 = 99 days. So not eligible. Good.
71032: two gaps: Mar 31-Apr 16 (17 days? Mar 31 to Apr 16 inclusive? Let's count if segments: end 03-30, next start 04-17. Days not enrolled: Mar 31, Apr 1-16 = 17 days. Then end 06-26, next start 07-09: Jun 27-30 (4) + Jul 1-8 (8) = 12 days. More than one gap, fail regardless of length. Good.
Need maybe "no more than one gap of up to 45 days" could mean total gap? It says no more than one gap of up to 45 days. Two gaps, so not eligible. Yes.
Potential issue: Exclusions before numerator. For 71021, hospice excludes. For 71024, not excluded because no age 66+. For 71025, frailty alone does not exclude. For 71029, age 66 but no advanced illness. Good.
Need ensure "stool DNA test during 2026 or the two years prior (three-year window)" for 2023-11-23 in 71021: If "two years prior" means 2024 and 2025, 2023 not. But hospice anyway. For 71026 2023-05-08 stool DNA also not in 2024-2026? Wait 2023-05-08 is not in 2024-2026, no. But not eligible due age. 71030 2025-12-12 stool DNA within window, but age not eligible. 71029 2024-09-15 within window, also colonoscopy 2019 within 10 years. Good.
Let's consider age calculation exact: As of 2026-12-31. 71028 DOB 1981-08-16: On 2026-12-31, has turned 45 on 2026-08-16. Age 45. Below 46. Not eligible. 71021 DOB 1980-08-11: turned 46. eligible. 71026 1950-06-09: turned 76. not eligible. 71030 1950-02-11: turned 76. not eligible. 71031 1951-11-26: turned 75 on Nov 26, 2026. eligible. 71029 1960-09-06: turned 66. eligible. 71024 1976-04-19: 50. 71025 50. 71022 55. 71023 63. 71032 63. Good.
Need maybe "age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year" for 71029? Age 66, no frailty/advanced illness. For 71024, both documented but age 50. For 71032, frailty only and age 63. Good.
Now produce JSON. Need exact key names. No extra keys. Ensure JSON valid.
Let's craft:
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Need ensure "rate" is number, not string. 66.7.
Double-check if denominator after exclusions removed = eligible population after exclusions. Eligible population before exclusions includes those who meet age/enrolment. That includes 71021, 71022, 71024, 71025, 71027, 71029, 71031 = 7? Wait let's count eligible before exclusions: Age 46-75 and continuous enrolment. 71021 yes; 71022 yes; 71023 no; 71024 yes; 71025 yes; 71026 no; 71027 yes; 71028 no; 71029 yes; 71030 no; 71031 yes; 71032 no. That's 7 eligible before exclusions. Then exclusions: 71021 excluded -> denominator 6. Yes.
Wait 71029 age 66 and no frailty/advanced illness, so not excluded. 71024 age 50 and both documented, not excluded because age criterion not met. 71025 age 50 frailty only. Good.
Now final.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,192 tokens
We need answer JSON. Need evaluate members against measure QM-CRC. Need carefully determine each status.
We need know measurement year 2026. Age as of 2026-12-31 between 46 and 75 inclusive. Continuous enrolment full measurement year with no more than one gap of up to 45 days. Need decide each.
Numerator lookback windows measured back from 2026-12-31:
N1 FIT/FOBT during 2026 (calendar 2026)
N2 stool DNA during 2026 or two years prior: three-year window. Back from 2026-12-31, likely including 2024-01-01 through 2026-12-31? "during 2026 or the two years prior (three-year window)" So 2024-2026.
N3 flexible sigmoidoscopy during 2026 or four years prior: 2022-2026? Actually five-year window ending 2026-12-31. Could be 2022-01-01 through 2026-12-31. Need decide exact dates; from 2026-12-31 back 5 years = 2021-12-31? Usually allowable service dates "on or after..." based lookback. But examples likely simple window: during 2026 or prior 4 years = Jan 1 2022 - Dec 31 2026. However if measured back from 2026-12-31, "10 years prior" could be 2016-12-31 through 2026-12-31. Need be precise for dates in prompt: colonoscopies in 2015, 2016, 2018, 2019 likely outside/in. Let's parse.
The prompt:
N1. Faecal occult blood test or faecal immunochemical test during 2026.
N2. Stool DNA test during 2026 or the two years prior (three-year window).
N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window).
N4. CT colonography during 2026 or the four years prior (five-year window).
N5. Colonoscopy during 2026 or the nine years prior (ten-year window).
This suggests look-back window measured back from 2026-12-31. For N2: "2026 or two years prior" = 2024, 2025, 2026 presumably any date in those years, no need day boundary. For N3: 2022-2026 inclusive. N5: 2017-2026 inclusive? "nine years prior" to 2026 means years 2017 through 2026, and "ten-year window" includes 2017-2026, 10 calendar years? Let's count: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026 = 10 years. Yes.
Need exclusions:
E1 colorectal cancer (C18-C21) any time on/before 2026-12-31. none?
E2 total colectomy any time. none.
E3 hospice any time during measurement year. 71021 has hospice election 2026-10-14 -> excluded if otherwise eligible.
E4 Age >=66 as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone does not and advanced alone doesn't. Need age. Members age 66+ at end: DOB <=1960-12-31? Let's calculate. Age as of Dec 31 2026 = 2026 - year, if birthday occurred? Actually age at date = full years. For DOB 1960-09-06, on 2026-12-31 age 66 (birthday Sept) yes. DOB 1950-06-09 age 76, 1950-02-11 age 76, 1951-11-26 age 75 (because birthday before Dec 31, yes 75). 1963 DOB age 63. 1971 age 55. 1976 age 50. 1979 age 47. 1980 age 46. 1981 age 45. So age eligibility 46-75 inclusive: excludes 71028 age 45 and 71026/71030 age 76 (over 75). Check 71031 age 75 yes eligible age. 71021 age 46 yes.
Continuous enrolment: full measurement year with no more than one gap up to 45 days. Members:
71021 continuous yes.
71022 continuous yes.
71023 enrolled 2026-04-10 through 2026-12-31; not enrolled before 2026-04-10. Missing Jan1-Apr10. Is that a gap? It's an initial gap of 99 days? Not full measurement year. More than one gap? It has one gap from Jan1 to Apr10 if require full year? No, no more than one gap of up to 45 days, and full measurement year. Missing first 99 days not allowed. So not eligible. But maybe continuous enrolment could allow gap? Need full measurement year with no more than one gap of up to 45 days; starting late is a gap at beginning from Jan1 to Apr10 = 99 days, too long. not_eligible. likely yes.
71026 continuous yes age not eligible (too old).
71027 continuous yes.
71028 continuous yes age 45 not eligible.
71029 continuous yes.
71030 continuous yes age 76 not eligible.
71031 continuous yes age 75 eligible.
71032: Enrolment Jan1-Mar30, Apr17-Jun26, Jul9-Dec31. Gaps of 17 (Mar31-Apr16) and 12 (Jun27-Jul8). That is "no more than one gap of up to 45 days"; it has two gaps, even though each <=45. Should be not_eligible. Need check maybe phrase "no more than one gap of up to 45 days" exactly two gaps => not_eligible. Also there is no gap between? Jan 1 to Mar 30 continuous, Apr 17 to Jun 26, Jul9 to Dec31. yes two gaps 17 and 12 days. Not eligible. Also only 55? no age but enrl fail.
Need age. 71032 DOB 1963-12-19: as of 2026-12-31 age 63. eligible if enrl.
Need apply exclusions before numerator only for eligible population. For ineligible members, don't use exclusions even if present? Status definitions: Not_eligible never enters eligible population (age, event, or enrolment). Exclusions evaluated before numerator only for members in eligible population. So member 71026 age 76 not_eligible even no exclusions. 71030 not eligible. 71021 eligible? Age 46, enrl continuous, but hospice election in 2026 => excluded (E3). Could she also numerator? no screening? Stool DNA 2023 not window, no FIT 2026. So would be non_compliant if not excluded. Excluded 71021.
71024 age 50 eligible, then maybe E4? Age <66, so E4 not apply. Frailty + advanced illness both documented but age <66; E4 requires age 66+. So not excluded by E4. Also no CRC/colectomy/hospice. Eligible and numerator? Has colonoscopy 2016-03-04. For colonoscopy lookback 2017-2026? 2016 is not within 10-year window if measured from 2026-12-31 or calendar 2017-2026. Need maybe if ten-year window back from 2026-12-31 includes 2016-12-31 through 2026-12-31, so 2016-03-04 outside. Need check. They provided dates such as 2016 maybe outside. Need likely count not compliant. No other screening. Need no E4 because age<66. So non_compliant. However if "ten-year window" from date 2026-12-31 back 10 years: from 2016-12-31 to 2026-12-31. Colonoscopy in March 2016 is before 2016-12-31, outside. So no numerator. If using period 2017-2026, also outside. So non.
71025 age 50 eligible; frailty only not E4; screening flexible sig 2023-09-25 and FIT 2025-02-14. FIT only during 2026 required, 2025 not; flexible sig within 2022-2026 yes. So numerator compliant. no exclusions.
71026 age 76 not eligible. Stool DNA 2023? but age out.
71027 age 47 FIT 2026 -> compliant.
71028 age 45 not eligible.
71029 age 66 eligible. Screening: colonoscopy 2019-04-22, stool DNA 2024-09-15. Need numerator: colonoscopy within 2017? 2026, yes 2019-04-22 inside. Also stool DNA within 2024-2026, yes. Compliant. No exclusion? age 66, but no frailty/advanced illness; E4 false. no colon cancer etc. Compliant.
71030 age 76 not eligible; has stool DNA Dec 2025, but age out.
71031 age 75 eligible; no screening denominator non_compliant, no exclusion.
71043 age 63, enrl two gaps > one, not_eligible. Has colonoscopy 2015 outside (also not relevant). Frailty only no exclusion. not_eligible.
Need double check other members:
71021 colonoscopy? none (stool DNA 2023 not within 2024-26). Exclusion hospice yes.
71022 stool DNA 2024-08-05 within N2 window? 2024-2026 yes. Age 55 eligible, continuous. No exclusions. Compliant.
71023 DOB 1963-07-10 age 63 eligible. Enrolment start 2026-04-10 only. Not continuous full year; missing Jan-Apr 99 days. Not eligible. Colonoscopy 2018 within 2017-2026 but enrolment fail. Not eligible. Need consider if they might still be eligible if no more than one gap? Starting 04/10 means first coverage gap 2026-01-01 to 2026-04-10 = 99 days >45, not allowed. Not eligible.
71024 as above non.
71025 compliant.
71026 age >75, not.
71027 FIT 2026 Jul, yes.
71028 age <46, not eligible; sigmoid 2024 but age fail.
71029 compliant.
71030 age 76 not, stool DNA 2025 but age fail.
71031 non.
71032 enrl fail, colonoscopy 2015, not.
Need counts and rate.
Let's list categories precisely.
Members:
71021 eligible? age yes, enr yes, but E3 excluded. -> excluded.
71022 eligible compliant.
71023 not_eligible (enrl gap 99 days).
71024 eligible non_compliant (screening colonoscopy outside; Frailty/advanced no exclusion because age<66; no other exclusion).
71025 eligible compliant.
71026 not_eligible age 76.
71027 eligible compliant.
71028 not_eligible age 45.
71029 eligible compliant.
71030 not_eligible age 76.
71031 eligible non_compliant.
71032 not_eligible enrolment (two gaps; age63).
Total eligible after exclusions: denominator = compliant + non_compliant. If excluded before numerator, denominator excludes excluded. Eligible population before exclusions includes all age/enr (11? Actually 71021,22,24,25,27,29,31 =7? Let's count: all age/enroll eligible are 71021,22,24,25,27,29,31 maybe 7; plus 71032? no. Let's list all from 12: 71021 excl; 22 comp; 23 not; 24 non;25 comp;26not;27comp;28not;29comp;30not;31non;32not. So 7 eligible before exclusion, one excluded, denom=6. numerator=3 (71022,71025? wait 71025 yes, 71027, 71029 = 4? Let's list comp: 71022 (stool DNA 2024), 71025 (flex sig 2023), 71027 (FIT 2026), 71029 (stool+colon). That's 4. Plus? 71021 no, 71024 no, 71031 no. So numerator=4. Denominator 4 comp +2 non=6. Rate 4/6*100 = 66.666... = 66.7. Need round half up one decimal. 66.666 -> 66.7 yes.
But wait: 71025 has Flexible sig 2023 and FIT 2025. The FIT 2025-02-14 not during 2026; flex sig lookback from 2026-12-31: is a 2023 sigmoidoscopy within five years? Yes. Unless exact from Dec 31 2021? Actually from 2026-12-31 back 4 years to 2022-12-31? But "during 2026 or the four years prior (five-year window)" Calendar years 2022-2026. 2023 yes.
Need check "E3 Hospice at any time during measurement year" for 71021 election 2026-10-14. We assumed any hospice election during year counts. Excluded.1
Potential nuance: The eligible population includes continuous enrolment, but "Hospice at any time during measurement year" may require at least one month? No specification says any time. Use 2026-10-14 within year. Excluded.
Potential nuance: Age inclusive "46 through 75 years as of 2026-12-31." We calculated ages. Count 71031 DOB 1951-11-26 age 75. yes.
Potential nuance: Continuous enrollment "with no more than one gap of up to 45 days." For 71023 no gap? If they started coverage after 2026-01-01, is that considered a "gap" from Jan to Apr? Or maybe "continuous enrolment: full measurement year with no more than one gap" means if not enrolled until Apr 10, there is a gap from Jan1-Apr10 of 99 days, fail. Yes.
Potential nuance: 71032 has two gaps. However "no more than one gap of up to 45 days" might mean "no more than one gap, and any gaps up to 45 days" i.e., one gap allowed; two gaps fail even if each. Also each <=45 days, but two gaps fail. Yes.
Need mention "compliant_members" array all IDs strings. Excluded has 71021. noncompliant 71024, 71031. not_eligible 71023,71026,71028,71030,71032. Total lists lengths: 4+2+1+5=12. denominator count = 6 (4+2). excluded count 1. not eligible count 5. rate = 66.7.
But need ensure 71024 not excluded by E4 due to age 50. Yes.
Let's think if there is any hidden exclusion with "No colorectal cancer, no colectomy, no...". We trust. For 71024 no colorectal cancer etc; but frailty + advanced illness => if age >=66; not. At age 50, need not? Exclusion E4 criteria says age 66 or older AND both documented. If age 50, no.
Potential nuance: "Hospice at any time during measurement year" for 71021 could maybe hospice election is not same as patient actually in hospice? The prompt says "Hospice election" and spec E3 "Hospice at any time during the measurement year." Use as documented. Excluded. If there is "hospice election" likely counts. Need not second guess.
Let's inspect all records for documentation of exclusions:
71021: hospice election -> excluded.
71022: "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented."
71023: Same no, but no? yes.
71024: Frailty + advanced illness, but age 50.
71025: Frailty only.
71026: none.
71027: none.
71028: none.
71029: none.
71030: none.
71031: none.
71032: Frailty only; no age etc.
Need maybe assess "advanced illness documented" with heart failure code I50.22; not necessarily advanced illness? The prompt says "Advanced illness documented (heart failure, I50.22)." So yes. Frailty documented. But E4 age condition.
Help? Need output exact JSON keys. "rate" number, no string. "excluded_members" array. "not_eligible_members" array. "non_compliant_members" array. Our output likely.
Let's ensure no key "compliant_members" order arbitrary. We can choose. Required exactly those keys. Need include "denominator", "numerator", etc.
Let's consider if 71032's age/enrollment: age 63. Has gap 17 and 12. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Some measures define continuous enrollment with allowed gap: The combined gap can be up to 45 days. If two gaps, but each <=45, not eligible. "no more than one" means one gap count; two gaps not allowed. So not_eligible. Good.
Let's consider if 71023's start 2026-04-10: Is missing from 2026-01-01 to 04-10: 99 days. More than 45. Not eligible. Also if the member left and re-enrolled? no. Not eligible.
Let's compute ages precisely:
As of 2026-12-31, full years.
71021 DOB 1980-08-11: from 1980-08-11 to 2026-08-10 =45? Wait! Important. Need calculate age on date 2026-12-31. Age = 2026 - 1980 - (birthday after date? Birth Aug 11, date Dec 31: birthday has occurred, so 46. yes.
71022: 1971-12-22, date Dec31 after birthday, 55. yes.
71023: 1963-07-10 -> 63.
71024: 1976-04-19 -> 50.
71025: 1976-05-12 -> 50.
71026: 1950-06-09 -> on 2026-12-31 after birthday June? yes age 76.
71027: 1979-10-14 -> 47.
71028: 1981-08-16 -> 45! 2026-1981=45, birthday occurred? Aug before Dec, yes exactly 45. not eligible.
71029: 1960-09-06 -> 66.
71030: 1950-02-11 -> 76.
71031: 1951-11-26 -> 75.
71032: 1963-12-19 -> 63 (Dec 19 before Dec31 yes).
Age at end: 71026 and 71030 76 outside upper. 71028 45 below lower. What about 71021 exactly 46 yes.
Need maybe age calculation for members born Feb 1950: On 2026-12-31, 76 not 77; no.
Rate question: numerator/denominator *100 "rounded half up to one decimal place e.g. 62.5". 66.7. Use number. JSON number 66.7.
Let's final.
Let's consider if "denominator" members eligible population after exclusions remove; denominator includes numerator+noncompliant. so 6. Good.
"excluded" count means members in eligible before exclusions but removed due exclusion. Count 1. Good.
"not_eligible" count includes all not eligible because age/enrollment, even if possibly excluded? The list: 71023,71026,71028,71030,71032. Wait what about 71028? "MEMBER 71028. Date of birth 1981-08-16, so 45 years old on 2026-12-31. Male. Enrolment: ... continuous." yes not eligible age. Add. 71026 and 71030. What about members over 75: two. 71028 under 46. Total 3 age fail + 2 enrollment fail = 5. Good.
Should 71023 have "colonoscopy 2018" which meets numerator had enrolled? But not eligible. yes.
Potential hidden "exclusion" for 71021: she also has stool DNA 2023-11-23, outside N2 only, and hospice = excluded. Correct.
Potential issue: Stool DNA test is N2 with 2026 or two years prior, so 2024-08-05 qualifies (71022). 2024-09-15 qualifies (71029). 2023-05 (71026 not eligible), 2023-11 (71021 not compliant/excluded), 2025-12 (71030 not eligible). Good.
Potential issue: FIT 2025 no numerator? N1 only "during 2026". So member 71025 doesn't count via FIT 2025, but does via sig 2023. If not, maybe 2025 is within one-year prior? No, N1 says during 2026 only. But 71025 has flexible sig 2023. Fine.
Potential issue: "Flexible sigmoidoscopy during 2026 or the four years prior (five-year window)" So 2023 counts. Good.
Colonoscopy 2019-04-22 in 71029 counts; if exact lookback from 2026-12-31, 2019 > 7 years, within 10. Good.
Colonoscopy 2016 in 71024 does not count; 2018 in 71023 not eligible; 2015 in 71032 not eligible.
Need maybe one member 71029's colonoscopy 2019 plus stool DNA 2024. It's compliant. No.
Let's think if "Eligible population age 46 through 75 as of 2026-12-31" could include 76 if they turn 76 after date? no. "Date of birth 1950-06-09, so 76 years old" yes. They might be 76. Good.
No need additional prose, output only JSON fenced.
Let's format:
```json
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
```
Need maybe array order anywhere; any order. Good.
Let's ensure no hidden task says "Citing every rule in document is penalised" but no explanation field. We don't need.
Potential issue: "Status definitions ... not_eligible never enters eligible population (age, event, or enrolment)" includes "event" maybe not? Enrolment. okay.
Need maybe "Age 66 or older as of 2026-12-31 AND both..." E4 "frailty and advanced illness documented during measurement year." Is 71024 ineligible due to exclusion? no because age only 50. Good.
Let's final.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,105 tokens
Let me work through each member:
**Measure: QM-CRC Colorectal Cancer Screening**
- Measurement year: 2026-01-01 to 2026-12-31
- Age: 46-75 as of 2026-12-31 (born 1951-01-01 through 1980-12-31)
- Continuous enrolment: full year, max one gap ≤45 days
**Numerator windows (looking back from 2026-12-31):**
- N1: FIT/FOBT in 2026
- N2: Stool DNA 2024-01-01 to 2026-12-31 (3 years including 2026 and two prior)
- N3: Flex sig 2022-01-01 to 2026-12-31 (5 years)
- N4: CT colonography 2022-01-01 to 2026-12-31 (5 years)
- N5: Colonoscopy 2017-01-01 to 2026-12-31 (10 years)
**Exclusions:**
- E1: colorectal cancer C18-C21
- E2: total colectomy
- E3: hospice during measurement year
- E4: age ≥66 as of 2026-12-31 AND both frailty and advanced illness documented in measurement year
Let me check each member:
**MEMBER 71021** DOB 1980-08-11 → 46 on 2026-12-31. Age OK (46-75).
Enrolment: full year continuous. Eligible.
Screening: 2023-11-23 stool DNA → outside 3-year window (needs 2024-2026). Not compliant.
Other: 2026-10-14 hospice → E3 exclusion.
Since excluded, goes in excluded_members, not non_compliant.
**MEMBER 71022** DOB 1971-12-22 → 55. Age OK.
Enrolment continuous. Eligible.
Screening: 2024-08-05 stool DNA → within 3-year window (2024-2026). Compliant.
**MEMBER 71023** DOB 1963-07-10 → 63. Age OK.
Enrolment: 2026-04-10 through 2026-12-31 only. Not full year. Not continuously enrolled for the full measurement year. Not eligible.
**MEMBER 71024** DOB 1976-04-19 → 50. Age OK.
Enrolment: full year. Eligible.
Screening: 2016-03-04 colonoscopy → outside 10-year window. Not compliant.
Other: frailty and advanced illness documented in 2026, but age 50, not ≥66, so E4 doesn't apply. Not excluded.
Non-compliant.
**MEMBER 71025** DOB 1976-05-12 → 50. Age OK.
Enrolment: full year. Eligible.
Screening: 2023-09-25 flex sig → outside 5-year window (needs 2022-2026; wait, 2023 is within 2022-2026. Let me check: window for flex sig is 2026 or four years prior = 2022-2026. 2023-09-25 is within 2022-2026. So that's within the window. Compliant.
Wait, also 2025-02-14 FIT → if needed, but within 2026? FIT needs 2026 only. But flex sig in 2023 within 2022-2026 is fine. Compliant.
Also frailty documented, but no advanced illness, and age 50, so no exclusion.
**MEMBER 71026** DOB 1950-06-09 → 76 on 2026-12-31. Over 75. Not age-eligible. Also age ≥66 but no frailty/illness documented, so E4 doesn't apply. Not eligible.
**MEMBER 71027** DOB 1979-10-14 → 47. Age OK.
Enrolment: full year. Eligible.
Screening: 2026-07-26 FIT → within 2026. Compliant.
**MEMBER 71028** DOB 1981-08-16 → 45 on 2026-12-31. Under 46. Not eligible.
**MEMBER 71029** DOB 1960-09-06 → 66. Age OK.
Enrolment: full year. Eligible.
Screening: 2019-04-22 colonoscopy → outside 10 years (needs 2017-2026; 2019 is within 2017-2026. Wait, 2019 is within 2017-2026, so that's within the 10-year window). Compliant.
Also 2024-09-15 stool DNA → within 2024-2026, also fine. Compliant.
**MEMBER 71030** DOB 1950-02-11 → 76. Over 75. Not eligible.
**MEMBER 71031** DOB 1951-11-26 → 75. Age OK (46-75 inclusive).
Enrolment: full year continuous. Eligible.
Screening: none. Not compliant.
**MEMBER 71032** DOB 1963-12-19 → 63. Age OK.
Enrolment: multiple gaps. Gaps of 17 and 12 days. "no more than one gap of up to 45 days." Two gaps → not continuously enrolled. Not eligible.
Also 2015 colonoscopy outside window anyway.
Let me now tally:
- 71021: excluded (E3 hospice)
- 71022: compliant
- 71023: not_eligible (enrolment)
- 71024: non_compliant
- 71025: compliant
- 71026: not_eligible (age)
- 71027: compliant
- 71028: not_eligible (age)
- 71029: compliant
- 71030: not_eligible (age)
- 71031: non_compliant
- 71032: not_eligible (enrolment)
Wait, let me double-check 71024. Age 50. E4 requires age ≥66. Not excluded. Confirmed non-compliant.
Check 71032: enrolment gaps: 2026-01-01 to 2026-03-30, then 2026-04-17 to 2026-06-26, then 2026-07-09 to 2026-12-31. Two gaps: Mar 31-Apr 16 (17 days) and Jun 27-Jul 8 (12 days). Two gaps → doesn't meet "no more than one gap". Not eligible.
So:
- Denominator = 71022, 71024, 71025, 71027, 71029, 71031 = 6
- Numerator = 71022, 71025, 71027, 71029 = 4
- Excluded = 1 (71021)
- Not eligible = 71023, 71026, 71028, 71030, 71032 = 5
Rate = 4/6 * 100 = 66.666... → 66.7
Let me double-check each member's age and window.
Member 71021: DOB 1980-08-11. On 2026-12-31, age = 46 years 4 months. Age 46. OK.
Stool DNA 2023-11-23. Window for stool DNA: 2026, 2025, 2024. 2023 is outside. Not compliant on that. Hospice 2026-10-14 → E3 exclusion.
Member 71022: DOB 1971-12-22 → 55. Stool DNA 2024-08-05 → within 2024-2026. Compliant.
Member 71023: 63. Enrolment only from 2026-04-10. Not full year. Not eligible.
Member 71024: 50. Colonoscopy 2016-03-04. Window 2017-2026. 2016 is outside. Non-compliant. Frailty and advanced illness in 2026 but age 50, so E4 not met. Non-compliant.
Member 71025: 50. Flex sig 2023-09-25. Window 2022-2026. Compliant. Also FIT 2025-02-14 but outside 2026. Doesn't matter, flex sig qualifies.
Member 71026: 76. Over 75. Not eligible.
Member 71027: 47. FIT 2026-07-26. Compliant.
Member 71028: 45. Under 46. Not eligible.
Member 71029: 66. Colonoscopy 2019-04-22 within 2017-2026. Compliant.
Member 71030: 76. Over 75. Not eligible.
Member 71031: 75. No screening. Non-compliant.
Member 71032: 63. Multi-gap enrolment. Not eligible.
Tally:
- Compliant: 71022, 71025, 71027, 71029 (4)
- Non-compliant: 71024, 71031 (2)
- Excluded: 71021 (1)
- Not eligible: 71023, 71026, 71028, 71030, 71032 (5)
Total = 12 ✓
Rate = 4/6 × 100 = 66.666... → 66.7
I need to output the JSON accordingly.json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}67Claude Haiku 4.5 · Anthropic66.8s · 8,012 out | 64.6s · 7,131 out | 62.5s · 6,929 out
Reasoning · 7,871 tokens
Let me analyze each member against the QM-CRC measure specifications.
**MEASURE SPECIFICATIONS:**
- Measurement year: 2026-01-01 through 2026-12-31
- Age: 46-75 years as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**NUMERATOR (need any one of):**
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or prior two years (3-year window: 2024-01-01 to 2026-12-31)
- N3: Flexible sigmoidoscopy during 2026 or prior four years (5-year window: 2022-01-01 to 2026-12-31)
- N4: CT colonography during 2026 or prior four years (5-year window: 2022-01-01 to 2026-12-31)
- N5: Colonoscopy during 2026 or prior nine years (10-year window: 2017-01-01 to 2026-12-31)
**EXCLUSIONS:**
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2: Total colectomy any time on or before 2026-12-31
- E3: Hospice at any time during the measurement year (2026)
- E4: Age 66+ as of 2026-12-31 AND both frailty AND advanced illness documented during 2026. (Frailty alone or advanced illness alone does NOT exclude)
Let me go through each member:
**MEMBER 71021**
- DOB: 1980-08-11, age 46 on 2026-12-31 ✓ (within 46-75)
- Continuous enrollment through 2026 confirmed, eligible
- Stool DNA test from 2023-11-23 falls outside the 3-year window
- Hospice election on 2026-10-14 triggers E3 → EXCLUDED
**MEMBER 71022**
- DOB: 1971-12-22, age 55 on 2026-12-31 ✓, continuous enrollment confirmed, eligible
- Checking stool DNA test dated 2024-08...
-05 (within 3-year window: 2024-01-01 to 2026-12-31) → Meets N2 ✓
- Status: COMPLIANT
**MEMBER 71023**
- DOB: 1963-07-10, age 63 ✓
- Enrollment starts 2026-04-10, creating a 100-day gap from 2026-01-01, exceeding the 45-day threshold
- Fails continuous enrollment → NOT_ELIGIBLE
**MEMBER 71024**
- DOB: 1976-04-19, age 50 ✓
- Checking 2026 enrollment span...
, continuous ✓
- Eligible: YES
- Screening: flex sig 2023-09-25 satisfies N3 (within 5-year window), FIT 2025-02-14 satisfies N1
- Frailty alone doesn't exclude someone under 66
- Status: COMPLIANT
**MEMBER 71026**
- DOB 1950-06-09, turns 76 on 2026-12-31 — outside the 46-75 range, fails age requirement
**MEMBER 71027**
- DOB 1979-10-14, age 47, enrolled full year, FIT done 2026-07-26 satisfies N1 — COMPLIANT
**MEMBER 71028**
- DOB 1981-08-16, only 45 as of 2026-12-31 — under the age floor, NOT_ELIGIBLE
**MEMBER 71029**
- DOB 1960-09-06, turns 66 on 2026-
12-31, enrolled continuously all year. Colonoscopy 2019-04-22 falls in the 10-year window (2017-2026), satisfying N5, and stool DNA test 2024-09-15 falls in the 3-year window, satisfying N2. Either alone would suffice — COMPLIANT.
**MEMBER 71030**
- DOB 1950-02-11, turns 76, exceeding the 75 age cap — NOT_ELIGIBLE
**MEMBER 71031**
- Age 75, continuous enrollment, eligible. No colorectal screening documented anywhere → NON_COMPLIANT
**MEMBER 71032**
- Age 63, eligible age. Enrollment split across three segments with gaps of 17 days and 12 days — both under the 45-day threshold, so continuous enrollment holds.
Wait, "no more than one gap of up to 45 days" allows only a single gap, not multiple gaps regardless of individual size. Since this member has two separate gaps, that violates the requirement even though each is small → NOT_ELIGIBLE
Sanity-checking ages against 2026-12-31:
- 71021 (DOB 1980-08-11): 46 ✓
- 71022 (DOB 1971-12-22): 55 ✓
- 71023 (DOB 1963-07-10): 63 ✓
- 71024 (DOB 1976-04-19): 2026 -
026-12-31: 66 years old ✓
MEMBER 71030: DOB 1950-02-11, as of 2026-12-31: 76 years old ✗ (exceeds 75)
MEMBER 71031: DOB 1951-11-26, as of 2026-12-31: 75 years old ✓
MEMBER 71032: DOB 1963-12-19, as of 2026-12-31: 63 years old ✓
Now checking screening dates for N1 (FOBT/FIT during 2026), starting with 71025 who had a FIT on 2025-02-14.
(NOT during 2026)
- MEMBER 71027: FIT 2026-07-26 ✓ (during 2026)
**N2: Stool DNA test, 3-year window 2024-01-01 to 2026-12-31**
- 71021: 2023-11-23 (NOT in window)
- 71022: 2024-08-05 ✓
- 71029: 2024-09-15 ✓
- 71030: 2025-12-12 ✓
**N3: Flexible sigmoidoscopy, 5-year window 2022-01-01 to 2026-12-31**
- 71025: 2023-09-25
in window ✓
N4 CT colonography (5-year window 2022-2026): none found.
N5 Colonoscopy (10-year window 2017-2026):
- 71023: 2018-02-20 ✓
- 71024: 2016-03-04 (NOT in window)
- 71029: 2019-04-22 ✓
- 71032: 2015-10-17 (NOT in window)
Now recategorizing with exclusions in mind, starting with 71021 - age 46, eligible, continuous enrollment with no gaps.
MEMBER 71021: hospice 2026-10-14 during measurement year → EXCLUDED (E3).
MEMBER 71022: age 55, continuous enrollment, no exclusions. Stool DNA test 2024-08-05 satisfies N2 → COMPLIANT.
MEMBER 71023: age 63, enrollment gap before 2026-04-10 needs checking against continuous enrollment requirement.
YES
- Exclusions: none apply
- Numerator: flexible sigmoidoscopy 2023-09-25 falls within 5-year window → meets N3
- Status: **COMPLIANT**
**MEMBER 71026:** Age 76 exceeds upper limit → **NOT_ELIGIBLE**
**MEMBER 71027:** Age 47, continuous enrollment, no exclusions apply, eligible YES
2026-12-31) → Meets N5 ✓; stool DNA test 2024-09-15 also satisfies N2 ✓
- Status: **COMPLIANT**
**MEMBER 71030:** Age 76 exceeds max → **NOT_ELIGIBLE**
**MEMBER 71031:**
- Age 75 ✓, continuous enrollment ✓, no exclusions
- No colorectal screening found on record
- Status: **NON_COMPLIANT**
**MEMBER 71032:**
- Age 63 ✓
- Enrollment has three periods with two gaps (17 days and 12 days
Since "no more than one gap" allows only a single gap, having two gaps disqualifies this member regardless of individual gap lengths being under 45 days.
- Eligible: NO
- Status: **NOT_ELIGIBLE**
Reconsidering the enrollment structure more carefully:
- 2026-01-01–2026-03-30, gap 17 days, 2026-04-17–2026-06-26, gap 12 days, 2026-07-09–2026-12-31
Two separate gaps means this fails the "no more than one gap" requirement, confirming ineligibility for the full measurement year.
Final tally:
- Compliant: 71022, 71025, 71027, 71029 (4)
- Non-compliant: 71024, 71031 (2)
- Excluded: 71021 (1)
- Not eligible: 71023, 71026, 71028, 71030, 71032 (5)
Denominator = 6, Numerator = 4, Rate = 4/6 × 100 = 66.7%
Let me double-check the eligible population membership.
excluded from hospice, leaving no exclusions elsewhere.
Denominator: 71022, 71024, 71025, 71027, 71029, 71031 (6 members).
Checking numerator compliance: 71022 has stool DNA 2024-08-05 ✓, 71024 has nothing in window ✗, 71025 has flex sig 2023-09-25 ✓, 71027 has FIT 2026-07-26 ✓, 71029 has colonoscopy 2019 and stool DNA 2024-09-15 ✓, 71031 has no screening ✗.
Numerator totals 4 compliant members.
Rate: 4/6 = 66.7%
Let me re-verify the specific screening windows for FIT and stool DNA tests. For N1 (FIT/FOBT during 2026), 71025's test was 2025-02-14 which falls outside 2026, while 71027's 2026-07-26 test qualifies. For N2 (stool DNA within 2024-2026 three-year window), 71021's 2023-11-23 test falls just before the window starts, disqualifying it, while 71022's 2024-08-05 test qualifies.
For N3 (flex sig, five-year window 2022-2026), 71025's 2023-09-25 test qualifies. For N5 (colonoscopy, ten-year window 2017-2026), 71023's 2018-02-20 test would qualify but the member isn't eligible due to enrollment gaps; 71024's 2016-03-04 test falls just outside the window, and 71032's 2015-10-17 test also falls before 2017.
Now finalizing the denominator: members need age 46-75 as of year-end, continuous enrollment (max one 45-day gap), and no exclusions. Checking each member against age/enrollment criteria before exclusions:
- 71021 (age 46): passes both
- 71022 (age 55): passes both
- 71023 (age 63): fails enrollment - gap exceeds 45 days
- 71024 (age 50): passes both
- 71025 (age 50): continuing enrollment check
Continuing through remaining members: 71026 and 71030 fail age (76), 71027 (age 47) passes both, 71028 fails age (45, too young), 71029 (age 66) passes both, 71031 (age 75) passes both, 71032 fails enrollment (two gaps).
This gives eligible population before exclusions: 71021, 71022, 71024, 71025, 71027, 71029, 71031 (7 members).
Applying exclusions: 71021 is excluded due to hospice enrollment (E3). 71022 has no exclusions. For 71024 (age 50), E4 doesn't apply since that requires age 66+, so despite frailty/advanced illness indicators, this member isn't excluded.
Similarly, 71025 (age 50) escapes E4 despite frailty, and 71027, 71029, 71031 have no applicable exclusions - 71029 has no frailty/advanced illness combo despite being 66.
Denominator: 71022, 71024, 71025, 71027, 71029, 71031 (6 members).
Checking numerator criteria: 71022 has Stool DNA 2024-08-05 (N2) - qualifies. 71024's colonoscopy from 2016 is too old (fails N5's 10-year window). 71025's flexible sigmoidoscopy 2023-09-25 (N3) qualifies. 71027's FIT 2026-07-26 (N1) qualifies. 71029 qualifies via colonoscopy 2019-04-22 (N5) and also has Stool DNA 2024-09-15 (N2). 71031 has no screening recorded.
Numerator = 4 (71022, 71025, 71027, 71029), giving rate = 4/6 × 100 = 66.7%.
Compiling final results: denominators=6, numerator=4, excluded=1, not_eligible=5, rate=66.7, with compliant members 71022/71025/71027/71029, non-compliant 71024/71031, excluded 71021, not eligible 71023/71026/71028/71030/71032.
Double-checking 71024 against E4: age 50 fails the 66+ requirement even though frailty (2026-08-18) and advanced illness (2026-02-04) are both documented - exclusion doesn't apply since age gate isn't met.
For 71032, verifying the two enrollment gaps: 2026-03-31 to 2026-04-16 (17 days) and 2026-06-27 to 2026-07-08 (12 days). Since the spec allows only one gap and this member has two, they fail continuous enrollment regardless of individual gap lengths - correctly NOT_ELIGIBLE.
Checking the colonoscopy window: current year plus nine years prior gives 2017-01-01 to 2026-12-31. MEMBER 71024's colonoscopy on 2016-03-04 falls outside this window, correctly excluded.
MEMBER 71029: colonoscopy 2019-04-22 → within window, counts.
MEMBER 71032: colonoscopy 2015-10-17 → outside window, excluded.
Rate calculation: 4/6 × 100 = 66.7% (rounded to one decimal).
Denominator = 6.
Checking the key naming though — the spec calls for "denominator" (singular), not "denominators". Need to fix that in the final JSON output along with all other required fields: numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 4,
"got": 4,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 66.7,
"got": 66.7,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71022",
"71025",
"71027",
"71029"
],
"got": [
"71022",
"71025",
"71027",
"71029"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71024",
"71031"
],
"got": [
"71024",
"71031"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71021"
],
"got": [
"71021"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"got": [
"71023",
"71026",
"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,990 tokens
Let me work through each member against the measure QM-CRC criteria.
The measurement year is 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION CRITERIA:
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days
NUMERATOR (any one):
- N1. Faecal occult blood test or faecal immunochemical test during 2026
- N2. Stool DNA test during 2026 or the two years prior (three-year window: 2024-01-01 through 2026-12-31)
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31)
- N4. CT colonography during 2026 or the four years prior (five-year window: 2022-01-01 through 2026-12-31)
- N5. Colonoscopy during 2026 or the nine years prior (ten-year window: 2017-01-01 through 2026-12-31)
REQUIRED EXCLUSIONS:
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2. Total colectomy any time on or before 2026-12-31
- E3. Hospice at any time during the measurement year
- E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Frailty alone does not exclude, and advanced illness alone does not exclude.
Let me evaluate each member:
---
MEMBER 71021
- DOB: 1980-08-11, turns 46 by year end, meets age range
- Continuous enrolment all year, no gaps
- Hospice election 2026-10-14 triggers E3
- EXCLUDED
---
MEMBER 71022
- DOB: 1971-12-22, age 55 at year end, meets age range
- Checking enrolment next
2026-01-01 through 2026-12-31, no gaps, no exclusions found. Stool DNA test on 2024-08-05 falls within the three-year N2 window, so numerator satisfied — COMPLIANT.
---
MEMBER 71023
- DOB: 1963-07-10, age 63 at year end, meets age range
- Enrolment starts 2026-04-10, not covered before that date, checking for gap in first part of year
A 99-day gap (2026-01-01 to 2026-04-09) exceeds the 45-day allowance for continuous enrolment. NOT_ELIGIBLE.
---
MEMBER 71024
- DOB: 1976-04-19, age 50 at year end, meets age range
- Enrolment 2026-01-01 through 2026-12-31, continuous, no gaps
- Frailty documented 2026-08-18
Advanced illness documented 2026-02-04, but E4 exclusion needs age 66+ with both frailty and advanced illness. Member is only 50, so E4 doesn't apply.
Checking screening history: colonoscopy from 2016-03-04 falls outside the N5 window (2017-01-01 through 2026-12-31), so it doesn't count. No other screening found in the measurement year or valid windows. Status: NON_COMPL
Member 71025: DOB 1976-05-12, age 50 on 2026-12-31, fits 46-75 range. Enrollment continuous all year, no gaps. Frailty documented 2026-07-12, but no advanced illness documented — and since age is 50, not 66+, E4 exclusion doesn't apply regardless.
Screening: flexible sigmoidoscopy dated 2023-09-25 falls within N3 window (2022-01-01 through 2026-12-31), satisfying the numerator. Status: COMPLIANT.
MEMBER 71026 - DOB 1950-06-09, turns 76 by 2026-12-31, exceeds the 75 cap. NOT_ELIGIBLE.
MEMBER 71027 - DOB 1979-10-14, age 47, within range. Enrollment full year with no gaps, no exclusions. FIT test on 2026-07-26 meets N1 criteria. COMPLIANT.
MEMBER 71028 - DOB 1981-08-16, only 45 years old, below the 46 threshold. NOT_ELIGIBLE.
MEMBER 71029 - DOB 1960-09-06, age on
no gaps ✓
- No exclusions apply
- Screening history: no colorectal screening on record
- Status: NON_COMPLIANT (denominator met, no exclusions, numerator unmet)
---
MEMBER 71032
- DOB: 1963-12-19, Age on 2026-12-31: 63 years old ✓
(within 46-75)
- Enrollment periods: 2026-01-01 to 2026-03-30; 2026-04-17 to 2026-06-26; 2026-07-09 to 2026-12-31
- Gap 1 (2026-03-31 to 2026-04-16): 17 days ✓
- Gap 2 (2026-06-27 to 2026-07-08): 12 days ✓
- Both gaps individually fall under 45 days, but the rule specifies "no more than one gap" - so having two separate gaps disqualifies continuous enrollment regardless of each gap's length.
Reconsidering MEMBER 71032: the phrase "no more than one gap of up to 45 days" is ambiguous between allowing only one gap total (interpretation 1) vs. allowing multiple gaps as long as each is ≤45 days (interpretation 2). Standard health plan convention supports interpretation 1 - only a single gap is permitted, so this member fails eligibility with two gaps despite each being under the threshold. Status: NOT_ELIGIBLE.
Now verifying gap calculations for other members. MEMBER 71021 and 71022 both run continuously 2026-01-01 to 2026-12-31 with zero gaps - both eligible on this criterion.
MEMBER 71023 has a gap from 2026-01-01 to 2026-04-09 before enrollment starts. Calculating days: January (31) + February (29, leap year) + March (31) + April 1-9 (9) = 100 days total.
Since 100 days exceeds the 45-day threshold as a single gap, this member is NOT_ELIGIBLE.
MEMBER 71024, 71025, and 71027 all show continuous enrollment for the full year with no gaps - eligible on this criterion.
MEMBER 71026 and 71028 fall outside the age range, so enrollment isn't evaluated for them.
MEMBER 71029: continuous 2026-01-01 through 2026-12-31, no gaps ✓
MEMBER 71030 is out of age range, skip.
MEMBER 71031: continuous full year, no gaps ✓
MEMBER 71032 has two separate gaps (17 days and 12 days) within the year, making this NOT_ELIGIBLE despite each gap being individually under 45 days.
Reviewing the eligible population now:
- 71021: age/enrollment fine but hospice exclusion (E3) applies → EXCLUDED
- 71022, 71024, 71025, 71027: pass age, enrollment, no exclusions → proceed to numerator
- 71023: enrollment fails (100-day gap) → NOT_ELIGIBLE
- 71026: age 76 exceeds limit → NOT_ELIGIBLE
- 71028: age 45 below minimum → NOT_ELIGIBLE
- 71029: age qualifies, enrollment continuous → need exclusion check
Verifying exclusions for the qualifying group: only 71021 has documented hospice (E3); 71024 checked against E4 but age 50 doesn't meet the 66+ threshold, so E4 doesn't apply. No other members show E1/E2/E3/E4.
Checking numerator satisfaction: 71022's stool DNA test on 2024-08-05 falls within the N2 window (2024-01-01–2026-12-31) → COMPLIANT.
For 71024, the colonoscopy on 2016-03-04 predates the N5 window start (2017-01-01) → NON_COMPLIANT. 71025's sigmoidoscopy (2023-09-25) fits N3 (2022-2026) → COMPLIANT. 71027's FIT test (2026-07-26) satisfies N1's calendar-year 2026 requirement → COMPLIANT. 71029 has both a 2019 colonoscopy within N5 and a 2024 stool DNA test within N2 → COMPLIANT. 71031 shows no screening at all → NON_COMPLIANT.
Final tally: 4 compliant (71022, 71025, 71027, 71029), 2 non-compliant (71024, 71031).
Adding excluded (71021, count 1) and not eligible (71023, 71026, 71028, 71030, 71032, count 5) confirms 4+2+1+5=12, matching the total membership.
Denominator = compliant + non-compliant = 6, numerator = 4, giving a rate of 4/6×100 = 66.7% after rounding half up to one decimal.
round up to 66.7. ✓
Reconsidering MEMBER 71025's N3 window: their flexible sigmoidoscopy on 2023-09-25 falls within the 2022-01-01 to 2026-12-31 range, so this needs closer verification against the five-year eligibility window.
So N3 holds. The 2025-02-14 FIT doesn't count toward N1 since it's outside 2026, but with N3 satisfied, this member is COMPLIANT.
For E4, both conditions must hold simultaneously — age 66+ as of 2026-12-31 AND documentation of both frailty and advanced illness in the measurement year. Neither frailty nor advanced illness alone triggers exclusion.
Checking members: 71024 is 50, 71025 is 50, and 71032 is 63 — all under 66, so E4 doesn't apply to any of them regardless of frailty status. 71032 has frailty documented but fails the age threshold anyway, and separately is NOT_ELIGIBLE due to enrollment gaps.
On the continuous enrollment rule — "full measurement year with no more than one gap of up to 45 days" — I read this as requiring enrollment for the whole year, allowing at most one gap that's ≤45 days.
For 71023: enrolled 2026-04-10 to 2026-12-31, leaving a gap from 01-01 to 04-09 (~100 days), which exceeds the 45-day limit. NOT_ELIGIBLE confirmed.
For 71032: three enrollment periods create two gaps — 17 days and 12 days, both individually under 45 days. But since the rule permits only one gap total, having two gaps disqualifies this member regardless of their length. NOT_ELIGIBLE confirmed.
Finalizing: Denominator = 6 (71022, 71024, 71025, 71027, 71029, 71031); Numerator = 4 (71022, 71025, 71027...
Excluded: 71021 (1). Not eligible: 71023, 71026, 71028, 71030, 71032 (5). Rate = 66.7%.
Compliant: 71022, 71025, 71027, 71029. Non-compliant: 71024, 71031. Since ordering isn't required, no need to sort the lists.
Now checking E3 for 71021 — hospice exclusion applies at any point during the measurement year, and this member has a hospice election dated 2026-10-14.
That falls squarely within 2026-01-01–2026-12-31, so E3 confirms the exclusion.
Verifying numerator logic for 71024 and 71031 next.
71024's only screening on record is a colonoscopy from 2016-03-04. The N5 ten-year lookback runs 2017-01-01 through 2026-12-31, and 2016-03-04 falls outside that window with nothing else documented, so this member stays NON_COMPLIANT.
71031 has no colorectal screening at all, also NON_COMPLIANT.
With everything checked, I'm ready to compile the final counts: denominator 6, numerator 4, excluded 1, not_eligible 5, rate 66.7%, compliant members 71022, 71025, 71027, 71029.
.5)". So the rate is a plain number, matching the 62.5 format. My final values check out: denominator 6, numerator 4, excluded 1, not_eligible 5.
```json
{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
```
Double-checking: 4 compliant + 2 non-compliant + 1 excluded + 5 not eligible = 12 total members. Denominator = 4+2 = 6, rate = 4/6×100 = 66.7%.
json{
"denominator": 6,
"numerator": 4,
"excluded": 1,
"not_eligible": 5,
"rate": 66.7,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030", "71032"]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 6,
"got": 6,
"ok": true,
"present": true
},
{
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"ok": true,
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{
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},
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"want": [
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],
"ok": true,
"present": true
},
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"want": [
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"71028",
"71030",
"71032"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,788 tokens
Let me analyze each member against the measure specification for colorectal cancer screening (QM-CRC).
The measurement year is 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION (denominator):
- Age: 46-75 as of 2026-12-31
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days
NUMERATOR (any one):
- N1. FOBT or FIT during 2026
- N2. Stool DNA test during 2026 or prior 2 years (3-year window: 2024-01-01 to 2026-12-31)
- N3. Flexible sigmoidoscopy during 2026 or prior 4 years (5-year window: 2022-01-01 to 2026-12-31)
- N4. CT colonography during 2026 or prior 4 years (5-year window: 2022-01-01 to 2026-12-31)
- N5. Colonoscopy during 2026 or prior 9 years (10-year window: 2017-01-01 to 2026-12-31)
EXCLUSIONS (evaluated before numerator):
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2. Total colectomy any time on or before 2026-12-31
- E3. Hospice at any time during measurement year (2026)
- E4. Age 66+ AND both frailty AND advanced illness during measurement year
Let me evaluate each member:
**MEMBER 71021**
- DOB: 1980-08-11, Age on 2026-12-31: 46 years old ✓ (in range 46-75)
- Enrolment: continuous through 2026, no gaps ✓
- ELIGIBLE for denominator
- Checking exclusions: no cancer, no colectomy, but hospice election 2026-10-14 triggers E3
- EXCLUDED due to hospice
**MEMBER 71022**
- DOB: 1971
-12-22, turns 55 by 2026-12-31, within 46-75 range ✓
- Continuous enrolment all year ✓, no exclusions found → in denominator
- Stool DNA test done 2024-08-05, falls within the 3-year lookback window
- Satisfies N2, compliant
**MEMBER 71023**
- DOB places age at 63 by year-end, within range ✓
- Enrolment starts 2026-04-10, not covering full year
Checking the gap before enrollment start: from Jan 1 to Apr 9 (day before coverage begins), that's 31+28+31+9 = 99 days uncovered.
This isn't a mid-year gap but a missing chunk at the start, so the member simply isn't enrolled for the full measurement year. Since 99 days exceeds the 45-day allowance, member 71023 fails continuous enrollment.
Status: not_eligible
**MEMBER 71024**
- DOB 1976-04-19 → age 50 on 2026-12-31 ✓ (46-75 range)
- Enrolled continuously 2026-01-01 to 2026-12-31, no gaps ✓
- Meets denominator age/enrollment criteria
- Exclusions: no colorectal cancer, no colectomy, no hospice; E4 doesn't apply (age 50, not 66+)
- Included in denominator
- Screening history shows a 2016-03-04 colonoscopy, which falls outside the required 10-year window (2017-01-01 to 2026-12-31)
No recent screening qualifies; doesn't satisfy N1-N5. Status: non_compliant
**MEMBER 71025**
- DOB 1976-05-12 → age 50 on 2026-12-31 ✓
- Continuous enrollment 2026-01-01 to 2026-12-31 ✓
- Denominator eligible
- Exclusions checked (E1-E3 clear, E4 not applicable at age 50)
- In denominator
- Screening: flexible sigmoidoscopy 2023-09-25 falls within 5-year window ✓; FIT test 2025-02-14 within 3-year window
- Satisfies N3
**MEMBER 71026**
- DOB 1950-06-09 → age 76 exceeds range
Status: not_eligible
**MEMBER 71027**
- DOB 1979-10-14 → age 47 ✓
- Continuous enrollment ✓, no exclusions
- In denominator
- FIT test 2026-07-26 during measurement year satisfies N1
Status: compliant
**MEMBER 71028**
- DOB 1981-08-16 → age 45, below minimum threshold
Status: not_eligible
**MEMBER 71029**
- DOB 1960-09-06, age on 2026
Turning to member 71029, born 1960-09-06 puts them at 66 on 2026-12-31, comfortably within 46-75. Enrollment runs continuously all year with no gaps. Checking exclusions: no colorectal cancer, no colectomy, no hospice care, and while age 66 could trigger E4, no frailty or advanced illness is documented so this exclusion doesn't apply. They land in the denominator. Screening history shows a colonoscopy on 2019-04-22, falling within the required 10-year lookback (2017-01-01 to 2026-12-31), plus a stool DNA test from 2024-09-15 within its 3-year window. The colonoscopy alone satisfies N5.
Status: compliant
Member 71030, born 1950-02-11, turns 76 by year-end—too old for the measure.
Status: not_eligible
Moving to member 71031, born 1951-11-26...
2015 which is before the 2017-2026 window)
- Meets none of N1-N5
Status: non_compliant
Now compiling results across all members:
**Compliant:**
- 71022: Stool DNA test 2024-08-05 (N2)
Continuing the review:
- 71025: Flexible sigmoidoscopy 2023-09-25 satisfies N3
- 71027: FIT test 2026-07-26 satisfies N1
- 71029: Colonoscopy 2019-04-22 satisfies N5
**Non-compliant:**
- 71024: colonoscopy from 2016 falls outside the 10-year window
- 71031: no screening documented
- 71032: colonoscopy from 2015, also outside window
**Excluded:** 71021 has hospice election 2026-10-14 (E3)
**Not eligible:** 71023 (enrollment gap of 99 days), 71026 and 71030 (age 76, over range), 71028 (age 45, under range)
Tallying: Denominator = 71022, 71024, 71025, 71027, 71029, 71031, 71032 → 7 members
Numerator = 71022, 71025,
2022-01-01 to 2026-12-31 (5 years)**
- 71025: 2023-09-25 Flex sig ✓
N4 window (5 years): none found.
N5 window (10 years, 2017+):
- 71029: 2019 colonoscopy ✓
- 71024 and 71032 fall before 2017, so both excluded
- 71023: 2018 colonoscopy falls within range
71023's enrolment gap is 99 days (2026-01-01 to 2026-04-09), exceeding the 45-day allowance—so this member fails continuous enrolment and should be excluded regardless of screening dates.
For 71032, checking the gap between the first two enrolment periods: period 1 ends 2026-03-30, period 2 starts 2026-04-17, leaving days not enrolled from 03-31 through 04-16.
1-16 (16 days) = 17 days ✓
Gap 2 falls between periods 2 and 3: enrollment ends 2026-06-26 and resumes 2026-07-09, covering June 27-30 (4 days) plus July 1-8 (8 days) = 12 days ✓
Both gaps stay under the 45-day threshold, so 71032 satisfies enrollment.
Checking 71024's colonoscopy on 2016-03-04 against the N5 window (2017-01-01 to 2026-12-31) — this date falls outside, before the window even starts.
Reconsidering the lookback windows more precisely, measured back from 2026-12-31:
N1 (current year only): 2026-01-01 to 2026-12-31
N2 (current year + 2 prior years): 2024-01-01 to 2026-12-31
N3 (current year + 4 prior years): starts from 2026 minus 5 years
(the current year) plus 2025 down through 2017 — window confirmed as 2017-01-01 to 2026-12-31, matching my earlier calculation.
Finalizing:
Compliant: 71022, 71025, 71027, 71029
Non-compliant: 71024, 71031, 71032
Excluded: 71021
Not eligible: 71023, 71026, 71028, 71030
Denominator = 7, Numerator = 4, Excluded = 1
Total = 7 + 1 + 4 = 12 ✓
Rate = 4/7 = 57.1%
Reconsidering 71021's exclusion status — checking eligibility first: age 46 fits the 46-75 range, continuous enrollment through 2026 holds. So 71021 belongs in the eligible population, and I need to verify exclusion criteria apply: no colorectal cancer, no colectomy, but hospice election needs checking.
Hospice date 2026-10-14 falls within the measurement year, triggering E3 — confirming exclusion.
For 71032: age 63, meets enrollment, no cancer/colectomy/hospice history, and E4 doesn't apply since age is under 66 and no advanced illness is documented (frailty alone isn't sufficient). Not excluded.
Final tally: denominator 7, numerator 4, excluded 1, not eligible 4.
Rate check: 4/7 = 0.5714... → 57.1% when rounded to one decimal.
```json
{
"denominator": 7,
"numerator": 4,
"excluded": 1,
"not_eligible": 4,
"rate": 57.1,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031", "71032"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030"]
}
```
71021 - excluded due to hospice status starting 2026-10-14, otherwise met age and enrollment criteria.
71022 - compliant, stool DNA test on 2024-08-05 falls within the N2 window, no exclusions apply.
71023 - not eligible based on enrollment gaps despite meeting the age requirement.
**71023** - Not eligible
Gap from 2026-04-10 to 2026-12-31 totals 99 days, well over the 45-day allowance.
**71024** - Non-compliant
Colonoscopy from 2016-03-04 falls before the N5 window (starting 2017-01-01), so this doesn't count. No exclusions apply, age and enrollment check out.
**71025** - Compliant
Age and enrollment both check out fine. Frailty diagnosis alone doesn't trigger exclusion here.
**71026** - Not eligible
Age 76 falls outside the 46-75 range.
**71027** - Compliant
Age 47 qualifies, full-year enrollment confirmed, no exclusions. FIT test on 2026-07-26 falls within N1 window.
**71028** - Not eligible
Age 45 is below the 46-75 range.
**71029** - Compliant
Age 66 with no frailty or advanced illness documented, so no exclusion applies. Colonoscopy from 2019-04-22 falls within N5 window.
**71030** - Not eligible
Age 76 puts this member outside the qualifying range.
**71031** - Non-compliant
Age 75 qualifies, enrolled full year with no exclusions, but no screening documented at all.
**71032** - Non-compliant
Age 63 qualifies (E4 exclusion doesn't apply since under 66). Enrollment gaps of 17 and 12 days both fall within the 45-day threshold. Colonoscopy from 2015-10-17 predates the N5 window starting 2017-01-01, making this non-compliant.
Final tally confirmed:
```json
{
"denominator": 7,
"numerator": 4,
"excluded": 1,
"not_eligible": 4,
"rate": 57.1,
"compliant_members": ["71022", "71025", "71027
json{
"denominator": 7,
"numerator": 4,
"excluded": 1,
"not_eligible": 4,
"rate": 57.1,
"compliant_members": ["71022", "71025", "71027", "71029"],
"non_compliant_members": ["71024", "71031", "71032"],
"excluded_members": ["71021"],
"not_eligible_members": ["71023", "71026", "71028", "71030"]
}
Grader detail
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],
"fabricated": true,
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}0DeepSeek V3.2 · DeepSeek5.8s · 129 out | 5.9s · 129 out | 6.1s · 129 out
json{
"denominator": 7,
"numerator": 3,
"excluded": 2,
"not_eligible": 3,
"rate": 42.9,
"compliant_members": ["71022", "71027", "71029"],
"non_compliant_members": ["71023", "71025", "71028", "71031"],
"excluded_members": ["71021", "71024"],
"not_eligible_members": ["71026", "71030", "71032"]
}
Grader detail
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Grader detail
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