Colorectal screening, twenty-six members
Roster generated from a seeded stream (seed 2111) 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
88.1
across 28 models
Models scoring 100
23
of 28
Models scoring 0
2
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 — 26 members
MEMBER 71111. Date of birth 1971-04-18, so 55 years old on 2026-12-31. Male.
Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01.
Screening history:
2023-11-04 Stool DNA test.
2025-01-02 Colonoscopy.
Other history:
2026-10-27 Frailty documented (gait abnormality, R26.2).
MEMBER 71112. Date of birth 1954-02-14, so 72 years old on 2026-12-31. Female.
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 71113. Date of birth 1979-02-27, so 47 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2020-07-03 CT colonography.
2025-11-08 Flexible sigmoidoscopy.
Other history:
2025-07-17 Diagnosis C18.7, malignant neoplasm of sigmoid colon.
MEMBER 71114. Date of birth 1951-11-18, so 75 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2021-12-07 CT colonography.
Other history:
2026-12-17 Frailty documented (gait abnormality, R26.2).
2026-05-05 Advanced illness documented (heart failure, I50.22).
MEMBER 71115. Date of birth 1979-09-19, so 47 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days.
Screening history:
2016-12-23 Colonoscopy.
Other history:
2026-07-07 Frailty documented (gait abnormality, R26.2).
2026-02-06 Advanced illness documented (heart failure, I50.22).
MEMBER 71116. Date of birth 1976-01-11, so 50 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days.
Screening history:
2023-01-09 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71117. Date of birth 1963-09-02, so 63 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days.
Screening history:
2026-01-11 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71118. Date of birth 1979-03-23, so 47 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days.
Screening history:
2021-11-12 Flexible sigmoidoscopy.
2022-07-04 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71119. Date of birth 1950-03-25, so 76 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-03-04 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71120. Date of birth 1951-03-21, so 75 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
No colorectal screening on record.
Other history:
2026-02-01 Advanced illness documented (heart failure, I50.22).
MEMBER 71121. Date of birth 1971-08-17, so 55 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days.
Screening history:
2026-02-22 CT colonography.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71122. Date of birth 1954-09-15, so 72 years old on 2026-12-31. Male.
Enrolment: 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-22.
Screening history:
No colorectal screening on record.
Other history:
2026-10-08 Frailty documented (gait abnormality, R26.2).
2026-01-13 Advanced illness documented (heart failure, I50.22).
MEMBER 71123. Date of birth 1959-03-08, so 67 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days.
Screening history:
No colorectal screening on record.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71124. Date of birth 1960-08-15, so 66 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-04-15 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71125. Date of birth 1950-05-08, so 76 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-04-02 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71126. Date of birth 1981-12-20, so 45 years old on 2026-12-31. Female.
Enrolment: 2026-03-17 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-17.
Screening history:
No colorectal screening on record.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71127. Date of birth 1981-01-14, so 45 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-06-25; 2026-07-20 through 2026-12-31. One gap of 24 days.
Screening history:
2024-12-13 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71128. Date of birth 1951-12-10, so 75 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2020-02-10 CT colonography.
2026-08-17 Stool DNA test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71129. Date of birth 1959-07-23, so 67 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-07-08 Flexible sigmoidoscopy.
2023-09-13 CT colonography.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71130. Date of birth 1981-09-13, so 45 years old on 2026-12-31. Male.
Enrolment: 2026-05-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-16.
Screening history:
2020-08-25 CT colonography.
2026-12-08 Faecal immunochemical test.
Other history:
2024-11-25 Diagnosis C18.7, malignant neoplasm of sigmoid colon.
MEMBER 71131. Date of birth 1950-05-05, so 76 years old on 2026-12-31. Female.
Enrolment: 2026-04-12 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-12.
Screening history:
2026-09-20 CT colonography.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71132. Date of birth 1950-02-01, so 76 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-04-19; 2026-05-26 through 2026-12-31. One gap of 36 days.
Screening history:
2026-11-15 Faecal immunochemical test.
Other history:
2019-11-07 Diagnosis C18.7, malignant neoplasm of sigmoid colon.
MEMBER 71133. Date of birth 1967-01-22, so 59 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2021-04-12 CT colonography.
2021-09-09 CT colonography.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71134. Date of birth 1981-09-26, so 45 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-10-21 Flexible sigmoidoscopy.
Other history:
2023-04-23 Total colectomy.
MEMBER 71135. Date of birth 1971-08-26, so 55 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2016-11-12 Colonoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71136. Date of birth 1981-11-11, so 45 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-07-01; 2026-08-11 through 2026-12-31. One gap of 40 days.
Screening history:
2026-02-13 Flexible sigmoidoscopy.
Other history:
2026-03-06 Advanced illness documented (heart failure, I50.22).json{
"kind": "fields",
"fields": {
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
}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 · Anthropic13.9s · 1,255 out | 12.9s · 1,146 out | 18.8s · 1,285 out
Reasoning · 1,040 tokens
[omitted]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 931 tokens
[omitted]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,070 tokens
[omitted]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.7 Flash · Google25.9s · 3,987 out | 27.9s · 3,817 out | 20.1s · 3,232 out
Reasoning · 3,650 tokens
**Analyzing Member Criteria**
I'm currently evaluating each member against the defined specifications, focusing particularly on age and continuous enrollment requirements for the QM-CRC measure. My analysis is progressing through these initial data points.
**Processing Member Data**
I've begun processing individual member records. Specifically, I'm applying the eligibility rules and initial exclusion criteria, like age and continuous enrollment status. Member 71111 has already been flagged as not eligible due to enrollment timing.
**Evaluating Member Eligibility**
I've continued my assessment, processing members 71112 through 71117. Several individuals have been excluded based on specific criteria such as advanced illness or screening timing outside the defined window, while others have been identified as non-compliant due to missing screening records.
**Reviewing Member Data**
I'm continuing to process individual member records. Member 71118 and 71124 have been confirmed compliant based on their screening dates and eligibility. However, members 71119, 71120, 71121, 71122, and 71123 were excluded due to age, lack of screening, or enrollment gaps.
**Confirming Compliance Criteria**
I've confirmed two additional members, 71128 and 71129, as compliant after verifying their age, enrollment, and specific screening methods and dates against the requirements. Member 71133 and 71135 are non-compliant due to screening dates falling outside the acceptable windows. Several other members were excluded due to age or lack of required screening.
**Validating Member 71117**
I have confirmed member 71117 as compliant based on their age, enrollment status, and recent stool DNA screening. I am continuing to meticulously review the remaining members against all specified criteria.
**Processing Recent Member Updates**
I've just confirmed member 04 as compliant with the 2022-2026 window. Additionally, I've categorized several members based on age, enrollment gaps, and specific screening types and dates, further refining the compliant and non-compliant lists.
**Recalculating Final Rates**
I have meticulously re-verified the status of all 26 members. The denominator is now confirmed at 11, with 5 members meeting all criteria, leading to a precise rate of 45.5%.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,480 tokens
**Analyzing QM-CRC eligibility**
I'm currently scrutinizing each of the 26 members against the QM-CRC measure for 2026. My focus is on confirming eligibility, specifically those aged 46-75 by year-end 2026. This involves cross-referencing their birth dates against the specified range.
**Confirming continuous enrolment**
My current focus is on verifying continuous enrolment for all potential candidates. This involves meticulously checking for any gaps exceeding 45 days within the measurement year, ensuring they meet the full measurement year requirement to be considered for the QM-CRC measure.
**Evaluating screening compliance**
I am now assessing the numerator for compliance. Specifically, I'm reviewing the timing of the screenings for individuals, ensuring they fall within the required measurement period of 2024-2026 to be considered compliant.
**Processing individual cases**
I've now completed the eligibility assessment for several individuals. I found two compliant cases (71118, 71124), one not eligible due to age (71119), and three not eligible due to enrollment issues (71120, 71121, 71122, 71123). Patient 71120 is non-compliant due to lack of screening.
**Reviewing New Data**
I've processed additional member data. Patients 71128 and 71129 are now confirmed compliant. However, several others, like 71127, 71130, 71131, 71132, and 71134, were excluded due to age criteria. Cases 71133 and 71135 are non-compliant for screening timing.
**Processing Recent Cases**
My current focus is on processing the latest batch of member data. I've confirmed a compliant case (71117) with continuous enrollment and a valid screening. I've also identified additional non-compliant cases due to screening timing (71115, 71116) and eligibility issues (71120, 71121, 71122, 71123).
**Updating Member Status**
I've processed a new wave of member data, confirming two more compliant individuals. However, several others were flagged as not eligible due to age criteria, and two were deemed non-compliant because their screenings fell outside the required windows. The current tally shows 5 compliant, 6 non-compliant, and 2 excluded.
json{
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"rate": 45.5,
"compliant_members": [
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"71124",
"71128",
"71129"
],
"non_compliant_members": [
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"71116",
"71120",
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],
"excluded_members": [
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"71111",
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"71125",
"71126",
"71127",
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"71134",
"71136"
]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 11,
"got": 11,
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},
{
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"71116",
"71120",
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
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"71123",
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"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,895 tokens
**Analyzing QM-CRC Requirements**
I'm currently dissecting the QM-CRC measure, specifically focusing on the 2026 measurement period. My current efforts are concentrated on defining the eligible population, with a detailed look at the age criteria for individuals born between 1951 and 1980.
**Defining Numerator Options**
I'm now concentrating on the numerator definitions, specifically the various screening options. I'm mapping out the specific timelines for FOBT/FIT, Stool DNA, flexible sigmoidoscopy, CT colonography, and colonoscopy, as well as their associated lookback periods.
**Evaluating Patient Compliance**
I am now processing individual patient data to determine compliance. My current focus is on evaluating enrolment continuity and applying exclusion criteria, particularly for advanced illness and frailty, before assessing numerator screening adherence within the defined measurement windows.
**Processing Patient Data**
I've completed the initial patient data processing for eligibility and compliance. Several cases were evaluated for age, continuous enrollment, and exclusion criteria. Two patients met all criteria and are considered compliant.
**Confirming Compliance Details**
I'm currently reviewing specific patient records to confirm compliance status for the QM-CRC measure. My focus is on validating the screening dates against the defined measurement and lookback periods, particularly for cases involving Stool DNA and flexible sigmoidoscopy.
**Validating Screening Records**
I'm currently confirming the compliance of several individuals. My focus is on reconciling their reported screenings against the required measurement intervals, noting that patient 71117's Stool DNA in 2026 and 71118's flexible sigmoidoscopy in 2022 are correctly within their respective windows.
json{
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"rate": 45.5,
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"71124",
"71128",
"71129"
],
"non_compliant_members": [
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],
"excluded_members": [
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],
"not_eligible_members": [
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"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
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"71134",
"71136"
]
}
Grader detail
json{
"fields": [
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"want": 11,
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{
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"ok": true,
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},
{
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"want": [
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],
"got": [
"71113",
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],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
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"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.5 · OpenAI13.4s · 1,434 out | 17.3s · 1,635 out | 16.8s · 1,679 out
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
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],
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"71115",
"71116",
"71120",
"71133",
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],
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"71114"
],
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"71125",
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"71132",
"71134",
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]
}
Grader detail
json{
"fields": [
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"want": 11,
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},
{
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},
{
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"want": [
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],
"got": [
"71113",
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],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
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"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,415 tokens
**Clarifying eligibility windows**
I'm considering what "12-31" might mean in terms of a ten-year window, from 2016-12-31 to 2026-12-31. The phrasing is a bit ambiguous, especially since a look-back window is mentioned. If I'm looking at specific dates, like 2016-12-23, it falls outside the compliant range. Other dates, such as those for stool DNA tests or advanced illness eligibility, also need careful calculation. I'll need to ensure all these timelines match compliance standards, noting any gaps.
**Reviewing eligibility criteria**
I'm assessing several cases regarding enrollment gaps and age eligibility. For instance, 71121 has two gaps and is not eligible, even with CT 2026. Then there's 71122, age 72, who starts later and is not eligible due to frailty. 71124, age 66, is compliant due to full eligibility. However, individuals like 71125 and 71126 fail due to age issues. It's critical to note these cases, especially where exclusions may not be properly evaluated.json{
"denominator": 11,
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"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
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"71128",
"71129"
],
"non_compliant_members": [
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"71115",
"71116",
"71120",
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],
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],
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"71125",
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"71130",
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"71136"
]
}
Grader detail
json{
"fields": [
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"field": "denominator",
"want": 11,
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},
{
"field": "numerator",
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}
],
"fabricated": false,
"abstained": false
}json{
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}
Grader detail
json{
"fields": [
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},
{
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{
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"ok": true,
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},
{
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"want": [
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],
"got": [
"71113",
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],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
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"71121",
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"71123",
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"71130",
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"ok": true,
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}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Sol · OpenAI8.2s · 680 out | 8.7s · 697 out | 11.4s · 728 out
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
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"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
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}
Grader detail
json{
"fields": [
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"want": 11,
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{
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],
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}json{
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}
Grader detail
json{
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{
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},
{
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"ok": true,
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},
{
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"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 546 tokens
**Calculating JSON format**
I'm trying to figure out how to express the rate of 45.5 accurately, using the half-up rounding method. I have a value of 45.454 that rounds to 45.5, but I need to ensure I have the exact JSON structure for that. It's essential to represent this clearly, especially when dealing with data formats. I’ll focus on getting this done right since the exactness in JSON is so crucial!json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.6 · xAI59.6s · 4,099 out | 48.5s · 3,420 out | 56.5s · 4,129 out
Reasoning · 3,918 tokens
The user wants me to process a measure population for colorectal cancer screening. I need to evaluate each member and produce JSON.
{
"measure": "QM-CRC",
"year": "2026",
"eligible_population": 26,
"numerator": 0,
"denominator": 26,
"exclusions": 0,
"exclusions_applied": [],
"details": [
]
} Wait, I need to continue processing all members.
MEMBER 71119
76 years old. Age OK (through 75? Wait, 76 is over 75, so NOT ELIGIBLE.
Age 46 through 75 inclusive. 76 is too old. NOT ELIGIBLE.
MEMBER 71120
75 years old. Eligible.
No screening.
Advanced illness only. E4 requires BOTH frailty and advanced illness. So NON_COMPLIANT.
MEMBER 71121
55 years old. Eligible? Wait, two gaps. NOT ELIGIBLE.
MEMBER 71122
72 years old. 80 day gap. NOT ELIGIBLE.
MEMBER 71123
67 years old. Two gaps. NOT ELIGIBLE.
MEMBER 71124
66 years old. Eligible.
Screening: 2026-04-15 Flex sig. N3. COMPLIANT.
MEMBER 71125 76 years old. NOT ELIGIBLE.
MEMBER 71126 45 years old. NOT ELIGIBLE.
MEMBER 71127 45 years old. NOT ELIGIBLE.
MEMBER 71128
75 years old. Eligible.
Screening: 2026-08-17 Stool DNA 2026. N2. COMPLIANT.
MEMBER 71129
67 years old. Eligible.
Screening: 2023-07-08 Flex sig (2022-2026 window). N3.
2023-09-13 CT colonography (2022-2026). N4.
COMPLIANT.
MEMBER 71130
45 years old. NOT ELIGIBLE.
MEMBER 71131
76 years old. NOT ELIGIBLE.
MEMBER 71132
76 years old. NOT ELIGIBLE.
MEMBER 71133
59 years old. Eligible.
Screening: 2021 CT colonography (2021 < 2022). No numerator. NON_COMPLIANT.
MEMBER 71134
45 years old. NOT ELIGIBLE.
MEMBER 71135
55 years old. Eligible.
Screening: 2016 colonoscopy (2016 < 2017).json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,239 tokens
The user wants me to evaluate a measure population for colorectal cancer screening. I need to place every member against the specification and output JSON only.
{
"measure": "QM-CRC",
"year": "2026",
"eligible_population": [
{
"member_id": "71111",
"age": 55,
"enrolment": "continuous",
"eligible": true,
"exclusions": [],
"numerator": {
"n1": false,
"n2": false,
"n3": false,
"n4": false,
"n5": false
},
"exclusions": [
{
"code": "E1",
"reason": "col 2026-05-01 to 2026-12-31"
}
],
"status": "not_eligible"
},
{
"member_id": "71112",
"age": 72,
"enrolment": "continuous",
"eligible": true,
"ex "n1": false,
"n2": false,
"n3": false,
"n4": false,
"n5": false
},
"exclusions": [],
"status": "non_compliant"
},
{
"member_id": "71113",
"age": 47,
"enrolment": "continuous",
"eligible": true,
"exclusions": [
{
"code": "E1",
"reason": "C18.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,948 tokens
The user wants me to evaluate a measure population for colorectal cancer screening. I need to place every member against the specification and output JSON.
```json
{
"measure": "QM-CRC - Colorectal Cancer Screening",
"measurement_year": "2026-01-01 through 2026-12-31",
"eligible_population": 26,
"numerator": 0,
"compliant": 0,
"non_compliant": 0,
"excluded": 0,
"not_eligible": 26,
"members": [
{
"id": "71111",
"age": 55,
"enrolment": "partial",
"status": "not_eligible",
"reason": "Gap >45 days at start of year"
},
{
"id": "71112",
"age": 72,
"enrolment": "full",
"status": "non_compliant",
"reason": "No screening documented"
},
{
"id": "71113",
"age": 47,
"enrolment": "full",
"status": "excluded",
"reason": "Colorectal cancer (C18.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.5 · xAI29.9s · 2,208 out | 38.9s · 2,659 out | 34.8s · 2,553 out
Reasoning · 2,027 tokens
The task requires me to analyze each member against the QM-CRC measure specification and categorize them.
{
"denominator": 26,
"numerator": 1,
"excluded": 2,
"not_eligible": 1,
"rate": 4.0,
"compliant_members": [
"71112"
],
"non_compliant_members": 23,
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71119"
]
} **Correction after review:**
- Denominator is only the members who meet the continuous-enrollment and age criteria (11 members).
- Numerator is only the 1 member (71112) who had a qualifying screening.
- Excluded: 2 members (71113, 71114).json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,478 tokens
The task requires me to evaluate 26 members against the QM-CRC measure specification and report the population in a specific JSON format.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,372 tokens
The task requires me to evaluate 26 members against the QM-CRC measure specification and report the population in a specific JSON format.
{
"population": 26,
"compliant": 0,
"non_compliant": 12,
"excluded": 3,
"not_eligible": 11,
"rate": 0.0
} **Explanation of classifications (for reference only):**
- **Compliant (0)**: Members who met the numerator criteria (N2 or N3) and had no exclusions.
Examples: 71117 (Stool DNA), 71118 (sigmoidoscopy), 71124 (sigmoidoscopy), 711 28 (Stool DNA), 71129 (sigmoidoscopy + CT colonography).
- **Non-compliant (12)**: Members who did not meet the numerator criteria and had no exclusions.
Examples: 71112 (no screening), 71115 (old colonoscopy), 71116 (old Stool DNA 2023), 71120 (advanced illness only), 71133 (old CT colonography), 71135 (old colonoscopy).
- **Excluded (3)**: Members who met the numerator criteria but had an exclusion (E1 or E4).json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.1 Pro · Google62.7s · 9,154 out | 51.6s · 7,878 out | 50.4s · 7,152 out
Reasoning · 8,817 tokens
**QM-CRC Measure Evaluation for Measurement Year 2026**
My task was to meticulously assess 26 patient records against the specifications for the QM-CRC measure for the 2026 measurement year and then compile these findings into a structured JSON output. This involved a deep dive into each patient's eligibility based on age and enrollment continuity, followed by a thorough examination for any disqualifying exclusions, and finally, a confirmation of whether they met the numerator criteria for colorectal cancer screening.
First, I established the core requirements: the measurement year is January 1, 2026, to December 31, 2026. For eligibility (the denominator), patients needed to be between 46 and 75 years old as of December 31, 2026, and have continuous enrollment throughout the entire measurement year, with allowances for a single gap not exceeding 45 days.
The numerator criteria were quite specific, requiring evidence of certain screening modalities within defined timeframes:
* FOBT or FIT within 2026.
* A stool DNA test in 2026 or the two preceding years (2024, 2025).
* A flexible sigmoidoscopy in 2026 or the four preceding years (2022, 2023, 2024, 2025).
* A CT colonography in 2026 or the four preceding years (2022, 2023, 2024, 2025).
* A colonoscopy in 2026 or the nine preceding years (2017 through 2025).
Crucially, exclusions were evaluated *before* the numerator, and only applied to those already meeting the eligible population criteria. These included:
* A diagnosis of colorectal cancer (C18-C21) at any point up to December 31, 2026.
* A total colectomy performed at any point up to December 31, 2026.
* Receipt of hospice care during 2026.
* For members aged 66 or older as of December 31, 2026, both frailty and advanced illness documented during the measurement year (2026).
I then proceeded to evaluate each of the 26 individuals one by one. For **71111**, although 55 years old (eligible), their enrollment started on May 1, 2026, creating a gap of over 45 days at the beginning of the year, thus making them **not_eligible**. **71112**, aged 72 and continuously enrolled with no exclusions, unfortunately had no numerator findings, classifying them as **non_compliant**. **71113**, a 47-year-old with continuous enrollment, was correctly identified as **excluded** due to a colorectal cancer diagnosis in 2025. Similarly, **71114**, aged 75 and continuously enrolled, met exclusion E4 (age 66+ with frailty and advanced illness in 2026) and was **excluded**.
The case of **71115** required careful attention to the colonoscopy window; their 2016 procedure fell outside the required 2017-2026 timeframe, leading to a **non_compliant** status despite meeting age and enrollment criteria. **71116** also proved **non_compliant** as their stool DNA test in 2023 was outside the 2024-2026 window. However, **71117** (63 years old) and **71118** (47 years old) were found to be **compliant**, having valid stool DNA and flexible sigmoidoscopy results, respectively, within their defined timeframes, and meeting all other eligibility and exclusion criteria.
Several individuals were marked as **not_eligible** due to age: **71119**, **71125**, **71131**, and **71132** were over 75, while **71126**, **71127**, **71130**, **71134**, and **71136** were under 46. Others were not eligible due to enrollment issues: **71121** had two enrollment gaps, **71122** had a gap exceeding 45 days at the start of the year, and **71123** also had two enrollment gaps.
**71120**, aged 75 and continuously enrolled, was **non_compliant** because although they had advanced illness, they did not also have documented frailty to meet exclusion E4, and lacked any numerator screening. **71124**, a 66-year-old, was **compliant** with a valid flexible sigmoidoscopy in 2026. **71128** (75 years old) and **71129** (67 years old) were both **compliant**, demonstrating valid stool DNA and CT colonography/flexible sigmoidoscopy results, respectively, within their specified windows.
Finally, **71133** was **non_compliant** due to a 2021 CT colonography that was outside the 2022-2026 window, and **71135** was also **non_compliant** for a 2016 colonoscopy, which fell outside the 2017-2026 window.
After this comprehensive review, I determined the following counts:
* **Denominator (Eligible Population):** 11 members (those who met age and enrollment criteria before exclusions).
* **Numerator (Compliant Members):** 5 members (those who met denominator, no exclusions, and at least one numerator criterion).
* **Excluded:** 2 members (those who met denominator but had a specific exclusion).
* **Not Eligible:** 13 members (those who failed age, enrollment, or initial eligibility checks).
This leads to a calculated **rate** of 45.5% (5 compliant / 11 denominator, rounded to one decimal place). The structured breakdown of compliant, non-compliant, excluded, and not eligible members, along with their respective counts and individual IDs, forms the basis of the final JSON output. My process involved carefully cross-referencing each patient's data against all defined rules, paying particular attention to the precise time windows for numerator services and the conditions for exclusions.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,541 tokens
**Evaluation of QM-CRC Measure for 26 Members**
My task was to evaluate 26 members against the QM-CRC measure specification for the measurement year 2026. This involved determining eligibility based on age and continuous enrollment, applying specific exclusions, and then checking for numerator compliance based on a look-back period for various colorectal cancer screening tests.
First, I focused on the **eligibility criteria**: members needed to be between 46 and 75 years old as of December 31, 2026, and have continuous enrollment for the full measurement year, allowing for no more than one gap of up to 45 days. My initial review identified several members who did not meet these criteria and were therefore deemed **not eligible**. This included:
* **Member 71111**: Their enrollment gap from January 1 to April 30 was 120 days, exceeding the allowed single gap of 45 days.
* **Member 71119**: They were 76 years old on December 31, 2026, putting them outside the eligible age range.
* **Member 71121**: They had two enrollment gaps (28 days and 15 days), which violates the "no more than one gap" rule.
* **Member 71122**: Their enrollment started on March 22, 2026, creating an initial gap of 80 days, which is more than the allowed 45 days.
* **Member 71123**: Similar to Member 71121, they had two enrollment gaps (13 days and 25 days).
* **Members 71125, 71131, 71132**: These individuals were 76 years old, exceeding the maximum age.
* **Members 71126, 71127, 71130, 71134, 71136**: These members were 45 years old, falling below the minimum eligible age.
A total of 13 members were thus classified as 'not eligible'.
Next, I applied the **exclusion criteria** to the remaining eligible members. These exclusions are evaluated before checking for numerator compliance.
* **Member 71113**: Was excluded because they had a diagnosis of colorectal cancer (C18.7) on July 17, 2025, falling under exclusion E1.
* **Member 71114**: Was excluded as they were 75 years old (thus meeting the age 66+ requirement for E4) and had both frailty and advanced illness documented during 2026.
This resulted in 2 members being 'excluded'.
With the 'not eligible' and 'excluded' members set aside, I proceeded to assess the remaining members for **numerator compliance**. The numerator requires evidence of a qualifying screening test within specified timeframes.
I found **5 members to be compliant**:
* **Member 71117**: Aged 63 with a single 45-day enrollment gap, they had a Stool DNA test in January 2026, which falls within the required 2024-2026 window (N2).
* **Member 71118**: Aged 47 with a 42-day enrollment gap, they had a Flexible sigmoidoscopy in July 2022, which is within the 2022-2026 window (N3).
* **Member 71124**: Aged 66 and continuously enrolled, they had a Flexible sigmoidoscopy in 2026 (N3).
* **Member 71128**: Aged 75 and continuously enrolled, they had a Stool DNA test in August 2026, meeting the 2024-2026 requirement (N2).
* **Member 71129**: Aged 67 and continuously enrolled, they had both a Flexible sigmoidoscopy in 2023 and a CT colonography in 2023, both within their respective look-back windows (N3 and N4).
This leaves **6 members who are non-compliant**:
* **Member 71112**: Aged 72 and continuously enrolled, but had no qualifying screening test documented.
* **Member 71115**: Aged 47 with a 35-day enrollment gap. While eligible, their Colonoscopy was in December 2016, which is outside the required 2017-2026 window (N5).
* **Member 71116**: Aged 50 with a 35-day enrollment gap. Their Stool DNA test was in January 2023, outside the required 2024-2026 window (N2).
* **Member 71120**: Aged 75 and continuously enrolled, but had no qualifying screening test. They had advanced illness but lacked frailty, so exclusion E4 did not apply.
* **Member 71133**: Aged 59 and continuously enrolled. Their CT colonography was in 2021, which is outside the required 2022-2026 window (N4).
* **Member 71135**: Aged 55 and continuously enrolled. Their Colonoscopy was in November 2016, outside the required 2017-2026 window (N5).
In summary, out of the 26 members evaluated:
* **Not Eligible**: 13 members
* **Excluded**: 2 members
* **Compliant**: 5 members
* **Non-Compliant**: 6 members
The **denominator** for the measure consists of all members who were eligible and not excluded, which totals 11 members (5 compliant + 6 non-compliant). The **numerator** is the number of compliant members, which is 5.
Therefore, the **rate** for the QM-CRC measure is calculated as (Numerator / Denominator) * 100: (5 / 11) \* 100 = 45.4545...%, which rounds to **45.5%**.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,815 tokens
**Colorectal Cancer Screening Measure (QM-CRC) Evaluation**
My task here is to meticulously assess 26 individuals against the criteria for the Colorectal Cancer Screening (QM-CRC) measure. This involves defining the eligible population (denominator), identifying those who have met the screening requirements (numerator), and cataloging those who are excluded or otherwise ineligible. I'm proceeding member by member, cross-referencing their demographic data, enrollment history, and screening records against the specified rules.
First, I've established the core criteria for eligibility. The denominator includes individuals aged 46 to 75 as of December 31, 2026, who have been continuously enrolled throughout 2026 with no more than one enrollment gap exceeding 45 days.
Next, I've outlined the numerator requirements, which are met if a member has undergone any of the following screenings during specific timeframes:
* **N1:** Faecal occult blood test or FIT in 2026.
* **N2:** Stool DNA test 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 through 2026.
I've also noted the exclusion criteria:
* **E1:** Diagnosed with colorectal cancer (ICD-10 codes C18-C21) on or before December 31, 2026.
* **E2:** History of total colectomy on or before December 31, 2026.
* **E3:** Enrolled in hospice during 2026.
* **E4:** Individuals aged 66 or older as of December 31, 2026, who also had frailty and advanced illness documented in 2026.
Now, let's walk through the evaluation of each member:
* **MEMBER 71111:** This individual is 55 years old, which is within the eligible age range. However, their enrollment began on May 1, 2026, meaning their enrollment period at the start of the year constitutes a gap exceeding 45 days. Therefore, they are **not_eligible**.
* **MEMBER 71112:** This 72-year-old is within the eligible age range and has full, continuous enrollment with no exclusions. However, they have no recorded screenings. This makes them **non_compliant**.
* **MEMBER 71113:** At 47 years old, they are in the eligible age bracket with continuous enrollment. Critically, they have a diagnosis of Malignant neoplasm of the sigmoid colon (C18.7) from July 2025. This meets exclusion **E1**, so they are **excluded**.
* **MEMBER 71114:** This 75-year-old is within the eligible age range and has continuous enrollment. They also meet exclusion **E4** due to being 66 or older and having documented frailty and advanced illness in 2026. Thus, they are **excluded**.
* **MEMBER 71115:** At 47 years old, they are eligible by age and have a single enrollment gap of 35 days, which is within the acceptable limit. They do not meet exclusion **E4** as their age is below 66. Their only recorded screening is a colonoscopy from December 2016, which falls outside the required 10-year lookback window (2017-2026). Therefore, they are **non_compliant**.
* **MEMBER 71116:** This 50-year-old is eligible by age and has a 35-day enrollment gap, which is acceptable. There are no exclusions. Their recorded screening is a Stool DNA test from January 2023. This is outside the required 3-year lookback window (2024-2026). Consequently, they are **non_compliant**.
* **MEMBER 71117:** This 63-year-old is eligible by age and has an enrollment gap of exactly 45 days, which is permissible. There are no exclusions. They have a Stool DNA test recorded in January 2026, which falls within the required screening period. This individual is **compliant**.
* **MEMBER 71118:** At 47 years old, they are eligible by age and have a 42-day enrollment gap, which is acceptable. No exclusions apply. Their screening history includes a flexible sigmoidoscopy in July 2022, which is within the required 5-year lookback window (2022-2026). This member is **compliant**.
* **MEMBER 71119:** This individual is 76 years old, which is beyond the maximum eligible age of 75. They are **not_eligible**.
* **MEMBER 71120:** This 75-year-old is within the eligible age range and has continuous enrollment. While they have documented advanced illness, they do not meet the criteria for exclusion **E4** as frailty is not documented. They have no recorded screenings, making them **non_compliant**.
* **MEMBER 71121:** At 55 years old, they are within the eligible age range. However, their enrollment shows two separate gaps (one of 28 days and another of 15 days). The rule allows for no more than one gap. Therefore, they are **not_eligible**.
* **MEMBER 71122:** This 72-year-old is eligible by age, but their enrollment started on March 22, 2026. This creates an initial gap of approximately 80 days (January 1 to March 21), which significantly exceeds the 45-day limit. Thus, they are **not_eligible**.
* **MEMBER 71123:** This 67-year-old is eligible by age. Their enrollment contains two gaps: one of 13 days and another of 25 days. Having more than one gap disqualifies them from continuous enrollment. They are **not_eligible**.
* **MEMBER 71124:** At 66 years old, they are eligible by age and have continuous enrollment. They have a flexible sigmoidoscopy recorded in April 2026, which meets the numerator requirement. This individual is **compliant**.
* **MEMBER 71125:** This individual is 76 years old, exceeding the maximum eligible age of 75. They are **not_eligible**.
* **MEMBER 71126:** This individual is 45 years old, falling below the minimum eligible age of 46. They are **not_eligible**.
* **MEMBER 71127:** This individual is 45 years old, below the minimum eligible age of 46. They are **not_eligible**.
* **MEMBER 71128:** This 75-year-old is within the eligible age range and has continuous enrollment. They have a Stool DNA test recorded in August 2026, which fulfills the numerator criteria. This member is **compliant**.
* **MEMBER 71129:** At 67 years old, they are eligible by age and have continuous enrollment. They have a flexible sigmoidoscopy from July 2023, which falls within the 5-year lookback window (2022-2026). This member is **compliant**.
* **MEMBER 71130:** This individual is 45 years old, below the minimum eligible age of 46. They are **not_eligible**.
* **MEMBER 71131:** This individual is 76 years old, exceeding the maximum eligible age of 75. They are **not_eligible**.
* **MEMBER 71132:** This individual is 76 years old, exceeding the maximum eligible age of 75. They are **not_eligible**.
* **MEMBER 71133:** At 59 years old, they are eligible by age and have continuous enrollment. There are no exclusions. Their recorded screening is a CT colonography from April 2021. This falls outside the required 5-year lookback window (2022-2026). Thus, they are **non_compliant**.
* **MEMBER 71134:** This individual is 45 years old, below the minimum eligible age of 46. They are **not_eligible**.
* **MEMBER 71135:** This 55-year-old is eligible by age and has continuous enrollment. No exclusions apply. Their only recorded screening is a colonoscopy from November 2016, which is outside the required 10-year lookback window (2017-2026). Therefore, they are **non_compliant**.
* **MEMBER 71136:** This individual is 45 years old, below the minimum eligible age of 46. They are **not_eligible**.
**Summary of Results:**
* **Compliant Members (Numerator Met):** 5 individuals (71117, 71118, 71124, 71128, 71129)
* **Non-Compliant Members (Eligible but Numerator Not Met):** 6 individuals (71112, 71115, 71116, 71120, 71133, 71135)
* **Excluded Members (Eligible but meet exclusion criteria):** 2 individuals (71113, 71114)
* **Not Eligible Members (Fail initial denominator criteria):** 13 individuals (71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136)
This systematic evaluation ensures that each individual is assessed rigorously against all defined parameters of the QM-CRC measure. The process confirmed 5 compliant members out of a potential 11 in the denominator population.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Opus 5 · Anthropic16.4s · 1,287 out | 15.0s · 1,342 out | 18.6s · 1,263 out
Reasoning · 1,072 tokens
[omitted]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
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Grader detail
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}Reasoning · 1,127 tokens
[omitted]json{
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Grader detail
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Grader detail
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}100Gemini 3 Flash · Google76.0s · 12,044 out | 83.0s · 17,165 out | 86.9s · 17,287 out
Reasoning · 11,707 tokens
**My Thought Process for QM-CRC Measure Analysis**
As I review the specifications for the QM-CRC (Colorectal Cancer Screening) measure for the 2026 measurement year, my primary goal is to systematically determine the compliance status of each member on the provided roster. This involves meticulously applying the eligibility criteria for the denominator, identifying exclusions, and then checking for numerator attainment.
First, I focus on defining the **Denominator Population**. This includes individuals who were between 46 and 75 years old as of December 31, 2026. To establish this age range, I'm looking at birth years from January 1, 1951, to December 31, 1980. Crucially, they must have been continuously enrolled throughout the entire measurement year (January 1, 2026, to December 31, 2026), with a strict allowance for no more than a single gap in coverage lasting up to 45 days. If any of these conditions are not met, the member is immediately classified as `not_eligible`.
For those who meet the denominator criteria, I then look for **Exclusions**. These are specific conditions that remove a member from the compliant pool, even if they would otherwise meet the measure. The exclusions I'm tracking are:
* A diagnosis of colorectal cancer (codes C18-C21) on or before December 31, 2026 (E1).
* A total colectomy performed on or before December 31, 2026 (E2).
* Hospice care during 2026 (E3).
* Individuals aged 66 or older who also had both frailty and advanced illness documented in 2026 (E4).
If a member falls into any of these exclusion categories, they are marked as `excluded`.
For members who are in the denominator and have no exclusions, I then assess the **Numerator**. To be compliant, a member must have undergone *any one* of the following screening activities within specific timeframes:
* Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT) in 2026 (N1).
* Stool DNA test in 2026, 2025, or 2024 (N2).
* Flexible sigmoidoscopy in 2026, 2025, 2024, 2023, or 2022 (N3).
* CT colonography in 2026, 2025, 2024, 2023, or 2022 (N4).
* Colonoscopy in 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, or 2017 (N5).
If a member meets the denominator, has no exclusions, and has a qualifying numerator event, they are classified as `compliant`. If they meet the denominator and have no exclusions but *do not* have a qualifying numerator event within the specified windows, they are classified as `non_compliant`.
Now, let's apply this logic to the provided member data:
* **Member 71111:** Born 1971-04-18 (age 55). Enrolled starting May 1, 2026. This creates a gap of approximately 120 days from Jan 1 to Apr 30. This exceeds the allowable single 45-day gap. Therefore, `not_eligible`.
* **Member 71112:** Born 1950-06-15 (age 76). Not eligible due to age (limit is 75). Ah, wait, checking DOB again. Born 1954-06-15, so 72 on 2026-12-31. Eligible age. Continuous enrollment in 2026. No exclusions. No screening history found. Thus, `non_compliant`.
* **Member 71113:** Born 1979-02-27 (age 47). Eligible age. Continuous enrollment. However, has a diagnosis of C18.7 (colorectal cancer) on 2025-07-17. This meets exclusion E1. Therefore, `excluded`.
* **Member 71114:** Born 1951-11-18 (age 75). Eligible age. Continuous enrollment. Has a documented frailty on 2026-12-17 and advanced illness on 2026-05-05. This meets exclusion E4 (age 66+, both frailty and advanced illness in 2026). Therefore, `excluded`.
* **Member 71115:** Born 1979-09-19 (age 47). Eligible age. Continuous enrollment with one gap of 35 days (within the 45-day limit). Not excluded (E4 does not apply as age is < 66). Numerator check: Colonoscopy on 2016-12-23. The colonoscopy window is 2017-2026. This date is outside the window. Therefore, `non_compliant`.
* **Member 71116:** Born 1976-01-11 (age 50). Eligible age. Continuous enrollment with one gap of 35 days (within the 45-day limit). No exclusions. Numerator check: Stool DNA test on 2023-01-09. The Stool DNA window is 2024-2026. This date is outside the window. Therefore, `non_compliant`.
* **Member 71117:** Born 1963-09-10 (age 63). Eligible age. Continuous enrollment with one gap of 45 days (within the 45-day limit). No exclusions. Numerator check: Stool DNA test on 2026-01-11. This date falls within the 2024-2026 window. Therefore, `compliant`.
* **Member 71118:** Born 1979-03-23 (age 47). Eligible age. Continuous enrollment with one gap of 42 days (within the 45-day limit). No exclusions. Numerator check: Flexible sigmoidoscopy on 2022-07-04. This date falls within the 2022-2026 window. Therefore, `compliant`.
* **Member 71119:** Born 1950-03-25 (age 76). Not eligible due to age (limit is 75). Therefore, `not_eligible`.
* **Member 71120:** Born 1951-03-21 (age 75). Eligible age. Continuous enrollment. No exclusions (only advanced illness documented, no frailty for E4). No screening history. Therefore, `non_compliant`.
* **Member 71121:** Born 1971-08-17 (age 55). Eligible age. Has two gaps in enrollment (28 days and 15 days). The rule states "no more than one gap." This fails the enrollment criteria. Therefore, `not_eligible`.
* **Member 71122:** Born 1954-07-01 (age 72). Eligible age. Enrolled starting March 22, 2026. This creates a gap of approximately 80 days from Jan 1 to Mar 21. This exceeds the allowable single 45-day gap. Therefore, `not_eligible`.
* **Member 71123:** Born 1959-03-08 (age 67). Eligible age. Has two gaps in enrollment (13 days and 25 days). This fails the enrollment criteria ("no more than one gap"). Therefore, `not_eligible`.
* **Member 71124:** Born 1960-04-20 (age 66). Eligible age. Continuous enrollment. No exclusions. Numerator check: Flexible sigmoidoscopy on 2026-04-15. This falls within the 2022-2026 window. Therefore, `compliant`.
* **Member 71125:** Born 1950-05-08 (age 76). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71126:** Born 1981-12-20 (age 45). Not eligible due to age (limit is 46). Therefore, `not_eligible`.
* **Member 71127:** Born 1981-01-14 (age 45). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71128:** Born 1951-12-10 (age 75). Eligible age. Continuous enrollment. No exclusions. Numerator check: Stool DNA test on 2026-08-17. This falls within the 2024-2026 window. Therefore, `compliant`.
* **Member 71129:** Born 1959-05-29 (age 67). Eligible age. Continuous enrollment. No exclusions. Numerator check: Flexible sigmoidoscopy on 2023-07-08. This falls within the 2022-2026 window. Therefore, `compliant`.
* **Member 71130:** Born 1981-09-13 (age 45). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71131:** Born 1950-05-05 (age 76). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71132:** Born 1950-02-01 (age 76). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71133:** Born 1967-07-14 (age 59). Eligible age. Continuous enrollment. No exclusions. Numerator check: CT colonography on 2021-09-09. The CT colonography window is 2022-2026. This date is outside the window. Therefore, `non_compliant`.
* **Member 71134:** Born 1981-09-26 (age 45). Not eligible due to age. Therefore, `not_eligible`.
* **Member 71135:** Born 1971-01-01 (age 55). Eligible age. Continuous enrollment. No exclusions. Numerator check: Colonoscopy on 2016-11-12. The colonoscopy window is 2017-2026. This date is outside the window. Therefore, `non_compliant`.
* **Member 71136:** Born 1981-11-11 (age 45). Not eligible due to age. Therefore, `not_eligible`.
**Summary of Categorization:**
* **Compliant Members (Numerator):** 71117, 71118, 71124, 71128, 71129. (Total: 5)
* **Non-Compliant Members (Denominator without Numerator):** 71112, 71115, 71116, 71120, 71133, 71135. (Total: 6)
* **Excluded Members:** 71113, 71114. (Total: 2)
* **Not Eligible Members:** 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. (Total: 13)
**Calculation of the Measure Rate:**
The denominator consists of members who are eligible and not excluded, which is the sum of `compliant` and `non_compliant` members: 5 + 6 = 11 members.
The numerator is the count of `compliant` members: 5 members.
The measure rate is calculated as (Numerator / Denominator) * 100.
Rate = (5 / 11) * 100
Rate = 0.454545... * 100
Rate = 45.4545...
Rounding this to one decimal place, as is standard practice, results in **45.5%**.
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}
Grader detail
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"fabricated": false,
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}Reasoning · 16,828 tokens
**Colorectal Cancer Screening Performance Analysis: My Thought Process**
I've just been through the data to assess our performance on a colorectal cancer screening measure for the 2026 measurement year. My goal was to meticulously evaluate each member against the defined criteria, ensuring accuracy in their eligibility, compliance, exclusion, or non-eligibility status.
Here’s a breakdown of my thought process:
**1. Establishing the Measurement Framework:**
First, I concretely defined the parameters of the measurement year: January 1, 2026, to December 31, 2026. For a member to even be considered, they needed to fall within the age range of 46 to 75 years old *as of December 31, 2026*. This meant I had to carefully calculate ages based on their date of birth relative to that specific end date.
Crucially, I noted the enrollment requirement: continuous coverage for the *entire* 2026 measurement year, with the allowance of only *one* gap, and that gap must not exceed 45 days. This is a strict criterion, and I knew I’d have to scrutinize each member's enrollment history for any deviations.
**2. Decoding the Numerator and Exclusions:**
Next, I focused on the positive indicators (numerator) and the reasons a member might be removed from the denominator (exclusions).
* **Numerator Options (at least one needed for compliance):**
* N1: FOBT or FIT in 2026.
* N2: Stool DNA test (sDNA) in 2024, 2025, or 2026 (a 3-year lookback).
* N3: Flexible sigmoidoscopy in 2022, 2023, 2024, 2025, or 2026 (a 5-year lookback).
* N4: CT colonography in 2022, 2023, 2024, 2025, or 2026 (a 5-year lookback).
* N5: Colonoscopy in 2017 through 2026 (a 10-year lookback).
* **Exclusion Criteria (members meeting these are removed from the denominator):**
* E1: Diagnosed with colorectal cancer (C18-C21) on or before December 31, 2026.
* E2: Undergone a total colectomy on or before December 31, 2026.
* E3: Received hospice care at any point during 2026.
* E4: Was 66 years or older *and* had both frailty and advanced illness documented during 2026.
**3. The Iterative Evaluation Process:**
For each individual member in the dataset, I followed a structured process:
* **Age Check:** I first determined their age as of December 31, 2026. If they were outside the 46-75 range, they were immediately marked as "Not Eligible" and I moved to the next member. This was a primary filter.
* **Enrollment Check:** For those who met the age criteria, I then examined their enrollment data for 2026. I counted the number of gaps and the duration of each gap. If there was more than one gap, or if a single gap exceeded 45 days, they were marked as "Not Eligible."
* **Exclusion Check:** If a member passed the age and enrollment checks, I then rigorously applied the exclusion criteria (E1-E4). I specifically cross-referenced dates of diagnoses, procedures, and hospice care against the measurement year. If any exclusion was met, the member was marked as "Excluded." This is critical because exclusions happen *before* assessing compliance for the numerator.
* **Numerator Check (for those who are eligible and not excluded):** For members who were deemed eligible (passed age and enrollment) and not excluded, I then reviewed their screening history. I looked for any qualifying tests (N1-N5) within their respective lookback periods.
* If a qualifying test was found within the valid timeframe, the member was marked as "Compliant." This forms our numerator.
* If, after reviewing all screening options, no qualifying test was found within the valid lookback periods, the member was marked as "Non-compliant." This forms part of our denominator.
**4. Example Walkthroughs and Self-Correction:**
I meticulously worked through each member's case, cross-referencing their specific data points. For instance:
* **Member 71114:** Was 75 (eligible), continuously enrolled (eligible), but met exclusion E4 (age 66+, frailty in Dec 2026, advanced illness in May 2026). Thus, "Excluded."
* **Member 71115:** Was 47 (eligible), had a single gap of 35 days (eligible), and no exclusions. However, their colonoscopy was in December 2016. The 10-year lookback for colonoscopies (N5) starts in 2017. Therefore, it was too old, and they were marked as "Non-compliant."
* **Member 71117:** Was 63 (eligible), continuously enrolled (eligible), and had no exclusions. They had a stool DNA test in January 2026 (N2). This falls within the 3-year lookback (2024-2026). Thus, "Compliant."
* **Member 71111:** Was 55 (eligible), but their enrollment gap from January 1st to May 1st was 120 days, far exceeding the 45-day limit. Thus, "Not Eligible."
* **Member 71126:** Was 45 years old on December 31, 2026. This is below the minimum age of 46. Thus, "Not Eligible."
I performed several self-checks. For instance, I re-verified the age calculations for members turning exactly 46 or 75, and those born in years that might cause confusion (like 1981 for the lower age bound or 1950 for the upper). I also double-checked the enrollment gap calculations, ensuring I was accurately counting days and adhering to the "one gap" rule. For screening tests, I meticulously applied the correct lookback periods for each type of test.
**5. Final Tally and Rate Calculation:**
After evaluating all 26 members, I categorized them:
* **Compliant:** 5 members (71117, 71118, 71124, 71128, 71129). These contribute to the numerator.
* **Non-compliant:** 6 members (71112, 71115, 71116, 71120, 71133, 71135). These are in the denominator but didn't meet the numerator criteria.
* **Excluded:** 2 members (71113, 71114). These are removed from the denominator due to specific clinical conditions or circumstances.
* **Not Eligible:** 13 members (71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136). These members did not meet the basic age or enrollment requirements.
The **denominator** consists of all eligible members who are *not* excluded. This is: Compliant (5) + Non-compliant (6) = 11 members.
The **numerator** is the count of compliant members: 5.
Therefore, the rate is calculated as (Numerator / Denominator) * 100: (5 / 11) * 100 = 45.4545...%, which rounds to **45.5%**.
This detailed process allowed me to arrive at the final performance metric, ensuring that every decision was grounded in the measure's specifications.
json{
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"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
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"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
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"71115",
"71116",
"71120",
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],
"excluded_members": [
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],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
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"got": [
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"ok": true,
"present": true
},
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"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
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"71121",
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"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
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"71121",
"71122",
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"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 16,950 tokens
**My Thought Process for Understanding and Applying the QM-CRC Measure**
Okay, let's break down how I'm processing this Colorectal Cancer Screening (QM-CRC) measure for the 2026 measurement year. My primary goal is to accurately determine eligibility, exclusions, compliance, and ultimately, the performance rate for this measure.
First, I need to establish the **measurement year**. This is clearly defined as January 1, 2026, to December 31, 2026.
Next, I'm focusing on the **denominator**. To be eligible for the denominator, a member must meet two key criteria:
1. **Age:** They must be between 46 and 75 years old, inclusive, *as of December 31, 2026*. This means I need to consider their date of birth relative to that specific end date.
2. **Continuous Enrolment:** They must have been continuously enrolled for the *full measurement year* (meaning from January 1, 2026, to December 31, 2026). The key nuance here is the allowance for "no more than one gap of up to 45 days." This means a single absence from enrollment for a period of 45 days or less is permissible, but two or more gaps, or a single gap exceeding 45 days, renders them ineligible for the denominator based on enrollment.
After identifying potential candidates for the denominator, I then move to the **numerator** criteria to determine compliance. A member is compliant if they have undergone any of the following screening services within specific timeframes:
* **FIT/FOBT (N1):** Must have occurred *during 2026*.
* **Stool DNA test (N2):** Must have occurred during 2026, 2025, or 2024. This is a three-year window.
* **Flexible Sigmoidoscopy (N3):** Must have occurred during 2026, 2025, 2024, 2023, or 2022. This is a five-year window.
* **CT Colonography (N4):** Also has a five-year window, requiring the service during 2026, 2025, 2024, 2023, or 2022.
* **Colonoscopy (N5):** Has the longest look-back period, requiring the service during 2026, or any of the nine years prior. This means the window extends back to 2017 (2026 - 9 years = 2017). So, from January 1, 2017, to December 31, 2026.
Crucially, these numerator screenings must fall *within* their respective defined windows relative to the measurement year's end (December 31, 2026).
Next, I apply the **exclusions**. These are members who *would otherwise be in the denominator* but are specifically removed due to certain conditions or events. These exclusions are considered *after* determining initial eligibility based on age and enrolment.
* **E1: Colorectal Cancer:** Diagnosed with colorectal cancer (codes C18-C21) at any point on or before December 31, 2026.
* **E2: Total Colectomy:** Had a total colectomy performed on or before December 31, 2026.
* **E3: Hospice:** Was in hospice care during the entire measurement year (2026).
* **E4: Frailty & Advanced Illness (Age-Specific):** This is a bit more complex. It applies *only* to members who are 66 years or older as of December 31, 2026, *AND* who have documented evidence of *both* frailty *and* advanced illness during the measurement year 2026. Both conditions must be present in 2026 for this exclusion to apply.
Now, I'm going to walk through each of the 26 members provided to apply these rules systematically. My process involves checking each criterion for every individual:
* **Member 71111:** Age 55 (Eligible). Enrolment from May to December 2026. This is a gap of approximately 4 months at the start of the year. This is more than the allowed "no more than one gap of up to 45 days." So, **Not Eligible** due to enrolment.
* **Member 71112:** Age 72 (Eligible). Continuous enrolment (Eligible). No exclusions. No screening history. This member is in the denominator but did not meet a numerator criterion. **Non-Compliant**.
* **Member 71113:** Age 47 (Eligible). Continuous enrolment (Eligible). Has diagnosis C18.7 (Colorectal Cancer) in 2025. This is an E1 exclusion. **Excluded**.
* **Member 71114:** Age 75 (Eligible). Continuous enrolment (Eligible). Age 75 is >= 66. Documented Frailty (Dec 2026) and Advanced Illness (May 2026), both in 2026. This meets E4 exclusion criteria. **Excluded**.
* **Member 71115:** Age 47 (Eligible). Enrolment gap of 35 days (one gap <= 45 days, Eligible). No exclusions apply (age is < 66). Numerator: Colonoscopy on 2016-12-23. The 10-year window for colonoscopy starts Jan 1, 2017. This screening is too old. **Non-Compliant**.
* **Member 71116:** Age 50 (Eligible). Enrolment gap of 35 days (Eligible). No exclusions. Numerator: Stool DNA test on 2023-01-09. The 3-year window for Stool DNA starts Jan 1, 2024. This screening is too old. **Non-Compliant**.
* **Member 71117:** Age 63 (Eligible). Enrolment gap of 45 days (Eligible). No exclusions. Numerator: Stool DNA test on 2026-01-11. This is within the 2024-2026 window. **Compliant**.
* **Member 71118:** Age 47 (Eligible). Enrolment gap of 42 days (Eligible). No exclusions. Numerator: Flexible sigmoidoscopy on 2022-07-04. The 5-year window for flexible sigmoidoscopy is 2022-2026. This screening falls within the window. **Compliant**.
* **Member 71119:** Age 76. This is outside the 46-75 age range. **Not Eligible**.
* **Member 71120:** Age 75 (Eligible). Continuous enrolment (Eligible). Has advanced illness (Feb 2026), but *no frailty documented*. E4 requires *both*, so E4 does not apply here. No other exclusions. Numerator: No screening history. **Non-Compliant**.
* **Member 71121:** Age 55 (Eligible). Enrolment has two gaps (28 days and 15 days). The rule allows "no more than *one* gap." This member has two gaps. **Not Eligible** due to enrolment.
* **Member 71122:** Age 72 (Eligible). Enrolment starts March 22, 2026. This represents a gap of over 80 days at the beginning of the year, violating the "full measurement year" requirement. **Not Eligible** due to enrolment.
* **Member 71123:** Age 67 (Eligible). Enrolment has two gaps (13 days and 25 days). Again, the rule allows "no more than *one* gap." **Not Eligible** due to enrolment.
* **Member 71124:** Age 66 (Eligible). Continuous enrolment (Eligible). No exclusions. Numerator: Flexible sigmoidoscopy on 2026-04-15. This is within the 2022-2026 window. **Compliant**.
* **Member 71125:** Age 76. Outside the 46-75 age range. **Not Eligible**.
* **Member 71126:** Age 45. Outside the 46-75 age range. **Not Eligible**.
* **Member 71127:** Age 45. Outside the 46-75 age range. **Not Eligible**.
* **Member 71128:** Age 75 (Eligible). Continuous enrolment (Eligible). No exclusions. Numerator: Stool DNA test on 2026-08-17. This is within the 2024-2026 window. **Compliant**.
* **Member 71129:** Age 67 (Eligible). Continuous enrolment (Eligible). No exclusions. Numerator: Flexible sigmoidoscopy on 2023-07-08. This is within the 2022-2026 window. **Compliant**.
* **Member 71130:** Age 45. Outside the 46-75 age range. **Not Eligible**. (Also has cancer diagnosis, but not eligible first).
* **Member 71131:** Age 76. Outside the 46-75 age range. **Not Eligible**.
* **Member 71132:** Age 76. Outside the 46-75 age range. **Not Eligible**. (Also has cancer diagnosis, but not eligible first).
* **Member 71133:** Age 59 (Eligible). Continuous enrolment (Eligible). No exclusions. Numerator: CT colonography on 2021-09-09. The 5-year window for CT colonography is 2022-2026. This screening is too old. **Non-Compliant**.
* **Member 71134:** Age 45. Outside the 46-75 age range. **Not Eligible**. (Also has colectomy, but not eligible first).
* **Member 71135:** Age 55 (Eligible). Continuous enrolment (Eligible). No exclusions. Numerator: Colonoscopy on 2016-11-12. The 10-year window for colonoscopy starts Jan 1, 2017. This screening is too old. **Non-Compliant**.
* **Member 71136:** Age 45. Outside the 46-75 age range. **Not Eligible**.
After this individual assessment, I can categorize all 26 members:
* **Compliant Members (5):** 71117, 71118, 71124, 71128, 71129. These members met all denominator requirements and had a qualifying screening within the specified timeframe.
* **Non-Compliant Members (6):** 71112, 71115, 71116, 71120, 71133, 71135. These members met the denominator criteria but did not have a qualifying screening within the specified timeframe or their screening was too old.
* **Excluded Members (2):** 71113, 71114. These members met the denominator criteria but were removed due to specific exclusions (cancer or frailty/advanced illness).
* **Not Eligible Members (13):** 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. These members failed to meet the age or continuous enrolment criteria.
Now, I calculate the **denominator**. This is the sum of compliant and non-compliant members (those who met the age and enrolment criteria and were not excluded).
Denominator = Compliant (5) + Non-Compliant (6) = 11 members.
The **numerator** is simply the count of compliant members: 5 members.
Finally, the **rate** is calculated as (Numerator / Denominator) * 100:
Rate = (5 / 11) * 100 = 45.4545...%
Rounding this to one decimal place, I get **45.5%**.
This structured approach ensures that every criterion is considered for each individual, leading to an accurate calculation of the measure's performance.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
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"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
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"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
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"want": [
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"got": [
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"ok": true,
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},
{
"field": "non_compliant_members",
"want": [
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],
"got": [
"71112",
"71115",
"71116",
"71120",
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K3 · Moonshot41.8s · 1,987 out | 114.6s · 5,198 out | 65.4s · 2,836 out
Reasoning · 1,794 tokens
Let me work through each member.
Measure: age 46–75 as of 2026-12-31; continuous enrolment full measurement year with no more than one gap of up to 45 days.
Note: "the full measurement year with no more than one gap of up to 45 days" — so enrolment must cover 2026-01-01 through 2026-12-31 with ≤1 gap ≤45 days. Members who enrolled mid-year (not enrolled before some date) fail continuous enrolment → not_eligible. Members with two gaps fail (more than one gap).
Numerator look-back windows from 2026-12-31:
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2024-01-01 through 2026-12-31 (2026 or two years prior).
- N3: Flex sig during 2022-01-01 through 2026-12-31.
- N4: CT colonography 2022-01-01 through 2026-12-31.
- N5: Colonoscopy 2017-01-01 through 2026-12-31 (2026 or nine years prior).
Wait: "during 2026 or the nine years prior (ten-year window)" — 2026 plus nine years prior = 2017-01-01 through 2026-12-31. So colonoscopy on 2016-12-23 is outside; 2016-11-12 outside.
Exclusions:
- E1: CRC C18-C21 any time on/before 2026-12-31.
- E2: total colectomy any time on/before 2026-12-31.
- E3: hospice during MY.
- E4: age 66+ AND both frailty and advanced illness documented during MY.
Exclusions evaluated only for eligible members.
Now each member:
71111: DOB 1971-04-18, age 55. Enrolment starts 2026-05-01, not full year → not_eligible (enrolment fail). Even though has screenings. Not eligible.
71112: 72, enrolled full year. No screening. No exclusions. Eligible → non_compliant.
71113: 47, full year. C18.7 on 2025-07-17 → E1 exclusion. Excluded. (Screenings: CT colo 2020-07-03 outside 5-yr window; flex sig 2025-11-08 within. But exclusion first → excluded.)
71114: 75, full year. CT colo 2021-12-07 — window for N4 is 2022-01-01 onward → outside. Frailty 2026-12-17 and advanced illness 2026-05-05, both during MY, age 75 ≥66 → E4 excluded.
71115: 47, one gap 35 days ≤45 → eligible. Colonoscopy 2016-12-23 → outside ten-year window (2017-01-01+). Frailty + advanced illness during MY, but age 47 <66 → E4 doesn't apply. Non_compliant.
71116: 50, one gap 35 days → eligible. Stool DNA 2023-01-09 → N2 window is 2024-01-01+ → outside. Non_compliant.
71117: 63, one gap 45 days — "no more than one gap of up to 45 days" → 45 days OK. Eligible. Stool DNA 2026-01-11 → N2 met. Compliant.
71118: 47, one gap 42 days → eligible. Flex sig 2021-11-12 outside (needs 2022-01-01+); 2022-07-04 within → N3 met. Compliant.
71119: 76 → age over 75 → not_eligible.
71120: 75, full year. No screening. Advanced illness only, no frailty → E4 not met. Non_compliant.
71121: 55, gaps of 28 and 15 days → two gaps → fails continuous enrolment (no more than one gap) → not_eligible.
71122: 72, enrolled from 2026-03-22, not full year → not_eligible.
71123: 67, gaps of 13 and 25 → two gaps → not_eligible.
71124: 66, full year. Flex sig 2026-04-15 → N3 met. Compliant.
71125: 76 → not_eligible.
71126: 45 → under 46 → not_eligible. (Also enrolment starts 2026-03-17.) Not eligible.
71127: 45 → not_eligible (age).
71128: 75, full year. CT colo 2020-02-10 outside; stool DNA 2026-08-17 → N2 met. Compliant.
71129: 67, full year. Flex sig 2023-07-08 → N3 met. Compliant.
71130: 45 → not_eligible (age). Also CRC dx. Age evaluated first → not_eligible.
71131: 76 → not_eligible.
71132: 76 → not_eligible (age). Exclusions only for eligible.
71133: 59, full year. CT colo 2021-04-12 and 2021-09-09 — both before 2022-01-01 → outside N4. Non_compliant.
71134: 45 → not_eligible (age). Colectomy irrelevant.
71135: 55, full year. Colonoscopy 2016-11-12 → before 2017-01-01 → outside N5. Non_compliant.
71136: 45 → not_eligible (age).
Count:
- not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 = 13.
- excluded: 71113, 71114 = 2.
- compliant: 71117, 71118, 71124, 71128, 71129 = 5.
- non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6.
Total: 13+2+5+6 = 26. ✓
Denominator = 11, numerator = 5, rate = 5/11 = 45.4545... → 45.5.
Double-check gap day calculations as given in records — they're stated ("One gap of 35 days", etc.), so trust them.
71117: gap 45 days — "up to 45 days" includes 45. Eligible.
71121: two gaps → not eligible regardless of CT colo 2026.
Check 71113: C18.7 is sigmoid colon cancer, within C18-C21 → E1. Excluded.
Check 71114: age 75 ≥ 66, frailty 2026-12-17 during MY, advanced illness 2026-05-05 during MY → E4 excluded.
Check 71115: frailty 2026-07-07 during MY, advanced illness 2026-02-06 during MY, but age 47 → no exclusion. Colonoscopy 2016-12-23: ten-year window from 2026-12-31 is 2017-01-01 to 2026-12-31. 2016-12-23 is before → not compliant.
71135: colonoscopy 2016-11-12 → outside. Non-compliant.
71116: stool DNA 2023-01-09; three-year window = 2024-01-01 to 2026-12-31 → outside. Non-compliant.
71133: CT colo 2021 → outside 2022-01-01+. Non-compliant.
71112: no screening → non-compliant.
71120: no screening, advanced illness alone not exclusion → non-compliant.
Rate: 5/11 = 45.4545 → round half up to one decimal = 45.5.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
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],
"got": [
"71117",
"71118",
"71124",
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,005 tokens
Let me work through each member carefully.
Measure QM-CRC: Colorectal Cancer Screening
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION:
- 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 (look-back from 2026-12-31):
- N1. FOBT or FIT during 2026.
- N2. Stool DNA test during 2026 or the two years prior (2024-01-01 through 2026-12-31).
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (2022-01-01 through 2026-12-31).
- N4. CT colonography during 2026 or the four years prior (2022-01-01 through 2026-12-31).
- N5. Colonoscopy during 2026 or the nine years prior (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 during the measurement year.
- E4. Age 66+ as of 2026-12-31 AND both frailty and advanced illness during the measurement year.
Now let's go member by member.
MEMBER 71111: DOB 1971-04-18, age 55. Age OK (46-75).
Enrolment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. So not enrolled for the full measurement year — gap from 2026-01-01 to 2026-04-30 (about 120 days). That's more than one gap of up to 45 days — actually it's a gap of ~120 days before enrolment started. Continuous enrolment requires the full measurement year with no more than one gap of up to 45 days. Not enrolled Jan-Apr = fails continuous enrolment. NOT_ELIGIBLE.
Wait — but does "not enrolled before 2026-05-01" count as a gap? The enrolment must cover the full measurement year with no more than one gap up to 45 days. Enrolment starting 2026-05-01 means missing 120 days of the year — fails. NOT_ELIGIBLE.
MEMBER 71112: DOB 1954-02-14, age 72. Age OK.
Enrolment: full year, no gaps. Eligible.
Screening: none. No exclusions (age 72 but no frailty/advanced illness). NON_COMPLIANT.
MEMBER 71113: DOB 1979-02-27, age 47. Age OK.
Enrolment: full year. Eligible.
Screening: 2020-07-03 CT colonography (outside 5-year window: 2022-01-01 to 2026-12-31 — 2020 is outside), 2025-11-08 flexible sigmoidoscopy (within 5-year window — compliant via N3).
Other: 2025-07-17 C18.7 colorectal cancer. E1 exclusion — colorectal cancer any time on or before 2026-12-31. EXCLUDED (exclusions evaluated before numerator; a member who meets both exclusion and numerator is excluded).
MEMBER 71114: DOB 1951-11-18, age 75. Age OK (75 inclusive).
Enrolment: full year. Eligible.
Screening: 2021-12-07 CT colonography. Five-year window: 2022-01-01 through 2026-12-31. 2021-12-07 is before 2022-01-01, so outside window. Not compliant via N4.
Exclusions: Age 75 ≥ 66. Frailty 2026-12-17 (during measurement year) and advanced illness 2026-05-05 (during measurement year). Both documented during MY. E4 exclusion applies. EXCLUDED.
MEMBER 71115: DOB 1979-09-19, age 47. Age OK.
Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days (2026-07-17 to 2026-08-20). One gap ≤ 45 days — enrolment OK. Eligible.
Screening: 2016-12-23 colonoscopy. Ten-year window: 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017-01-01 — outside. Not compliant.
Exclusions: Age 47 < 66, so E4 does not apply regardless of frailty/advanced illness. No cancer, colectomy, hospice. NON_COMPLIANT.
MEMBER 71116: DOB 1976-01-11, age 50. Age OK.
Enrolment: one gap of 35 days. Eligible.
Screening: 2023-01-09 stool DNA. Three-year window: 2024-01-01 through 2026-12-31. 2023-01-09 is before 2024-01-01 — outside window. Not compliant. NON_COMPLIANT.
MEMBER 71117: DOB 1963-09-02, age 63. Age OK.
Enrolment: one gap of 45 days (2026-06-03 to 2026-07-17). "No more than one gap of up to 45 days" — 45 days is allowed ("up to 45 days"). Eligible.
Screening: 2026-01-11 stool DNA — within 2026. Compliant via N2. COMPLIANT.
MEMBER 71118: DOB 1979-03-23, age 47. Age OK.
Enrolment: one gap of 42 days. Eligible.
Screening: 2021-11-12 flex sig (outside 5-year window starting 2022-01-01), 2022-07-04 flex sig (within window). Compliant via N3. COMPLIANT.
MEMBER 71119: DOB 1950-03-25, age 76. Age 76 > 75 — NOT_ELIGIBLE (fails age). Even though screening present. Age is evaluated first: not eligible.
MEMBER 71120: DOB 1951-03-21, age 75. Age OK.
Enrolment: full year. Eligible.
Screening: none.
Exclusions: Advanced illness 2026-02-01, but no frailty. E4 requires both. Not excluded. NON_COMPLIANT.
MEMBER 71121: DOB 1971-08-17, age 55. Age OK.
Enrolment: gaps of 28 and 15 days — two gaps. Requirement: no more than one gap. Two gaps = fails continuous enrolment. NOT_ELIGIBLE.
(Screening 2026-02-22 CT colonography would be compliant, but enrolment fails.)
MEMBER 71122: DOB 1954-09-15, age 72. Age OK.
Enrolment: 2026-03-22 through 2026-12-31. Not enrolled Jan 1–Mar 21 = ~80 days gap. Fails continuous enrolment. NOT_ELIGIBLE.
MEMBER 71123: DOB 1959-03-08, age 67. Age OK.
Enrolment: gaps of 13 and 25 days — two gaps. Fails. NOT_ELIGIBLE.
MEMBER 71124: DOB 1960-08-15, age 66. Age OK.
Enrolment: full year. Eligible.
Screening: 2026-04-15 flex sig — during 2026. Compliant via N3. COMPLIANT.
MEMBER 71125: DOB 1950-05-08, age 76. > 75. NOT_ELIGIBLE.
MEMBER 71126: DOB 1981-12-20, age 45 on 2026-12-31. Age 45 < 46. NOT_ELIGIBLE. (Also enrolment starts 2026-03-17, fails enrolment too, but age disqualifies first.)
MEMBER 71127: DOB 1981-01-14, age 45 on 2026-12-31. Age 45 < 46. NOT_ELIGIBLE.
MEMBER 71128: DOB 1951-12-10, age 75. Age OK.
Enrolment: full year. Eligible.
Screening: 2026-08-17 stool DNA — during 2026. Compliant via N2. COMPLIANT.
(2020-02-10 CT colonography outside window, irrelevant.)
MEMBER 71129: DOB 1959-07-23, age 67. Age OK.
Enrolment: full year. Eligible.
Screening: 2023-07-08 flex sig (within 5-year window 2022-01-01+), 2023-09-13 CT colonography (within window). Compliant via N3/N4. COMPLIANT.
MEMBER 71130: DOB 1981-09-13, age 45. < 46. NOT_ELIGIBLE. (Also enrolment from 2026-05-16 fails, and cancer diagnosis would exclude, but age fails first → not_eligible.)
MEMBER 71131: DOB 1950-05-05, age 76. > 75. NOT_ELIGIBLE.
MEMBER 71132: DOB 1950-02-01, age 76. > 75. NOT_ELIGIBLE. (Cancer too, but age fails first.)
MEMBER 71133: DOB 1967-01-22, age 59. Age OK.
Enrolment: full year. Eligible.
Screening: 2021-04-12 and 2021-09-09 CT colonography. Five-year window: 2022-01-01 through 2026-12-31. Both 2021 — outside. Not compliant. NON_COMPLIANT.
MEMBER 71134: DOB 1981-09-26, age 45. < 46. NOT_ELIGIBLE. (Colectomy would exclude, but age fails first.)
MEMBER 71135: DOB 1971-08-26, age 55. Age OK.
Enrolment: full year. Eligible.
Screening: 2016-11-12 colonoscopy. Ten-year window: 2017-01-01 through 2026-12-31. 2016-11-12 is before 2017-01-01 — outside. Not compliant. NON_COMPLIANT.
MEMBER 71136: DOB 1981-11-11, age 45. < 46. NOT_ELIGIBLE. (Enrolment has one gap of 40 days which would be fine; screening 2026-02-13 flex sig would be compliant; advanced illness but age 45 < 66. But age fails → not eligible.)
Let me double-check age calculations:
- 71111: born 1971-04-18 → on 2026-12-31, age 55. ✓ (46-75, eligible by age)
- 71112: 1954-02-14 → 72. ✓
- 71113: 1979-02-27 → 47. ✓
- 71114: 1951-11-18 → 75. ✓ (75 included)
- 71115: 1979-09-19 → 47. ✓
- 71116: 1976-01-11 → 50. ✓
- 71117: 1963-09-02 → 63. ✓
- 71118: 1979-03-23 → 47. ✓
- 71119: 1950-03-25 → 76. ✗
- 71120: 1951-03-21 → 75. ✓
- 71121: 1971-08-17 → 55. ✓
- 71122: 1954-09-15 → 72. ✓
- 71123: 1959-03-08 → 67. ✓
- 71124: 1960-08-15 → 66. ✓
- 71125: 1950-05-08 → 76. ✗
- 71126: 1981-12-20 → 45. ✗
- 71127: 1981-01-14 → 45. ✗
- 71128: 1951-12-10 → 75. ✓
- 71129: 1959-07-23 → 67. ✓
- 71130: 1981-09-13 → 45. ✗
- 71131: 1950-05-05 → 76. ✗
- 71132: 1950-02-01 → 76. ✗
- 71133: 1967-01-22 → 59. ✓
- 71134: 1981-09-26 → 45. ✗
- 71135: 1971-08-26 → 55. ✓
- 71136: 1981-11-11 → 45. ✗
Enrolment checks for those passing age:
- 71111: starts 2026-05-01 → fails (gap of 120 days from start of year; not enrolled full year). NOT_ELIGIBLE.
- 71112: full year. ✓
- 71113: full year. ✓
- 71114: full year. ✓
- 71115: one gap 35 days. ✓
- 71116: one gap 35 days. ✓
- 71117: one gap 45 days. ✓ ("up to 45 days" — 45 allowed)
- 71118: one gap 42 days. ✓
- 71120: full year. ✓
- 71121: two gaps. ✗ NOT_ELIGIBLE.
- 71122: starts 2026-03-22. Gap Jan 1–Mar 21 = 80 days. ✗ NOT_ELIGIBLE.
- 71123: two gaps. ✗ NOT_ELIGIBLE.
- 71124: full year. ✓
- 71128: full year. ✓
- 71129: full year. ✓
- 71133: full year. ✓
- 71135: full year. ✓
Eligible population (before exclusions): 71112, 71113, 71114, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135. That's 13 members.
Exclusions among eligible:
- 71113: C18.7 colorectal cancer 2025-07-17 → E1. EXCLUDED.
- 71114: age 75 ≥ 66, frailty 2026-12-17 during MY, advanced illness 2026-05-05 during MY → E4. EXCLUDED.
- 71115: frailty + advanced illness but age 47 < 66 → not excluded.
- 71120: advanced illness only, no frailty → not excluded.
Excluded: 71113, 71114. Count = 2.
Denominator = 13 - 2 = 11: 71112, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135.
Numerator:
- 71112: no screening → NON_COMPLIANT.
- 71115: colonoscopy 2016-12-23, outside 10-year window (2017-01-01+) → NON_COMPLIANT.
- 71116: stool DNA 2023-01-09, outside 3-year window (2024-01-01+) → NON_COMPLIANT.
- 71117: stool DNA 2026-01-11 → COMPLIANT (N2).
- 71118: flex sig 2022-07-04 → COMPLIANT (N3).
- 71120: no screening → NON_COMPLIANT.
- 71124: flex sig 2026-04-15 → COMPLIANT (N3).
- 71128: stool DNA 2026-08-17 → COMPLIANT (N2).
- 71129: flex sig 2023-07-08, CT colonography 2023-09-13 → COMPLIANT (N3, N4).
- 71133: CT colonography 2021 → outside 5-year window → NON_COMPLIANT.
- 71135: colonoscopy 2016-11-12 → outside 10-year window → NON_COMPLIANT.
Compliant: 71117, 71118, 71124, 71128, 71129 → 5.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135 → 6.
Denominator = 5 + 6 = 11. ✓
Not eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Count = 13.
Total: 11 + 2 + 13 = 26. ✓
Rate = 5/11 × 100 = 45.4545... → 45.5.
Let me double-check a couple of tricky ones:
71117 gap: enrolled 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap = 2026-06-03 to 2026-07-17. June 3–30 = 28 days; July 1–17 = 17 days; total 45 days. "no more than one gap of up to 45 days" — 45 is up to 45, so OK. Eligible.
71115: gap 2026-07-17 to 2026-08-20: July 17–31 = 15 days; Aug 1–20 = 20 days; 35 days. OK.
71116: gap 2026-03-17 to 2026-04-20: March 17–31 = 15; April 1–20 = 20; 35 days. OK.
71118: gap 2026-06-15 to 2026-07-26: June 15–30 = 16; July 1–26 = 26; 42 days. OK.
71121: gaps 2026-03-22 to 2026-04-18 (28 days) and 2026-07-07 to 2026-07-21 (15 days). Two gaps → fails.
71123: two gaps → fails.
71136: age 45 → not eligible regardless.
Windows double-check:
- N2 stool DNA: "during 2026 or the two years prior" = 2024, 2025, 2026 → 2024-01-01 through 2026-12-31. 71116's 2023-01-09 is outside. 71127's 2024-12-13 would be inside but member not eligible by age.
- N3 flex sig: 2022-01-01 through 2026-12-31. 71118's 2022-07-04 inside. ✓
- N4 CT colonography: 2022-01-01 through 2026-12-31. 71133's 2021s outside. 71114's 2021-12-07 outside (but excluded anyway). 71128's 2020-02-10 outside (but stool DNA 2026 compliant).
- N5 colonoscopy: 2017-01-01 through 2026-12-31. 71115's 2016-12-23 outside (just barely). 71135's 2016-11-12 outside.
71111: enrolment starts 2026-05-01. Not enrolled for 4 months of the measurement year. The requirement is "the full measurement year with no more than one gap of up to 45 days". The period before enrolment (Jan 1 – Apr 30, 120 days) exceeds 45 days → fails. NOT_ELIGIBLE. Correct.
71122: starts 2026-03-22 → 80 days missing → fails. NOT_ELIGIBLE.
71126: age 45 → fails age. NOT_ELIGIBLE.
71130: age 45 → fails age. Even though has cancer (E1) — not eligible because age fails first. Per spec: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
71131: age 76 → not eligible.
71132: age 76 → not eligible.
71134: age 45 → not eligible (colectomy documented, but age fails first).
71119: age 76 → not eligible.
71125: age 76 → not eligible.
71127: age 45 → not eligible.
71136: age 45 → not eligible.
So not_eligible = [71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136] → 13 members.
Excluded = [71113, 71114] → 2.
Compliant = [71117, 71118, 71124, 71128, 71129] → 5.
Non_compliant = [71112, 71115, 71116, 71120, 71133, 71135] → 6.
Denominator = 11. Numerator = 5. Rate = 45.5.
5/11 = 0.454545... × 100 = 45.4545 → rounded half up to one decimal = 45.5.
Output JSON.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,643 tokens
Let me work through each member carefully.
Measure QM-CRC:
- Age: 46 through 75 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: N1 FOBT/FIT during 2026; N2 stool DNA during 2026 or two years prior (2024-01-01 through 2026-12-31); N3 flex sig 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 colorectal cancer (C18-C21) any time on/before 2026-12-31; E2 total colectomy any time on/before 2026-12-31; E3 hospice during MY; E4 age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during MY.
MEMBER 71111: age 55 — eligible age. Enrolment 2026-05-01 through 2026-12-31 — not full year, not enrolled before 2026-05-01. That's a gap of Jan 1–Apr 30 (120 days) — fails continuous enrolment. Not eligible. Frailty at 55 doesn't matter.
MEMBER 71112: age 72, full enrolment, no screening. Eligible, no exclusion, no numerator → non_compliant.
MEMBER 71113: age 47, full enrolment. Screening: CT colonography 2020-07-03 (outside 5-year window, need 2022+), flex sig 2025-11-08 (within 5-year window — meets N3). But exclusion E1: C18.7 diagnosis 2025-07-17 → excluded. Exclusion evaluated before numerator. Excluded.
MEMBER 71114: age 75, full enrolment. CT colonography 2021-12-07 — outside 5-year window (needs 2022-01-01 or later). Frailty 2026-12-17, advanced illness 2026-05-05, both during MY, age 75 ≥ 66 → E4 exclusion. Excluded.
MEMBER 71115: age 47, enrolment with one gap of 35 days → eligible. Colonoscopy 2016-12-23 — 10-year window is 2017-01-01 through 2026-12-31. 2016-12-23 is just before. Not numerator. Frailty and advanced illness both in 2026 but age 47 < 66, so E4 doesn't apply. Non_compliant.
MEMBER 71116: age 50, one gap of 35 days → eligible. Stool DNA 2023-01-09 — 3-year window: 2024-01-01 through 2026-12-31. 2023-01-09 is outside. Non_compliant.
MEMBER 71117: age 63, one gap of 45 days — "no more than one gap of up to 45 days" — 45 is allowed. Eligible. Stool DNA 2026-01-11 — within MY → N2 met. Compliant.
MEMBER 71118: age 47, one gap of 42 days → eligible. Flex sig 2021-11-12 (outside 5-year window, needs 2022-01-01+), flex sig 2022-07-04 (within window → N3 met). Compliant.
MEMBER 71119: age 76 as of 2026-12-31 — above 75 → not eligible (age).
MEMBER 71120: age 75, full enrolment. No screening. Advanced illness only, no frailty → E4 requires both. Not excluded. Non_compliant.
MEMBER 71121: age 55. Enrolment gaps of 28 and 15 days — two gaps. Spec: "no more than one gap of up to 45 days" → fails continuous enrolment → not eligible. Even though CT colonography 2026-02-22. Not eligible.
MEMBER 71122: age 72, enrolled from 2026-03-22 — not full year → not eligible.
MEMBER 71123: age 67, gaps of 13 and 25 days — two gaps → not eligible.
MEMBER 71124: age 66, full enrolment. Flex sig 2026-04-15 → N3 met. Compliant.
MEMBER 71125: age 76 → not eligible (age).
MEMBER 71126: age 45 — below 46 → not eligible. Also enrolled from 2026-03-17, fails enrolment too, but age alone suffices. Not eligible.
MEMBER 71127: age 45 → not eligible (age).
MEMBER 71128: age 75, full enrolment. CT colonography 2020-02-10 (outside window), stool DNA 2026-08-17 (during 2026 → N2 met). Compliant.
MEMBER 71129: age 67, full enrolment. Flex sig 2023-07-08 (within 5-year window → N3), CT colonography 2023-09-13 (within 5-year window → N4). Compliant.
MEMBER 71130: age 45 → not eligible (age). Also C18.7. Not eligible.
MEMBER 71131: age 76 → not eligible (age). Also enrolled from 2026-04-12. Not eligible.
MEMBER 71132: age 76 → not eligible (age). Even though FIT in 2026 and C18.7. Not eligible.
MEMBER 71133: age 59, full enrolment. CT colonography 2021-04-12 and 2021-09-09 — both before 2022-01-01, outside 5-year window. Non_compliant.
MEMBER 71134: age 45 → below 46 → not eligible. Even though total colectomy. Not eligible.
MEMBER 71135: age 55, full enrolment. Colonoscopy 2016-11-12 — 10-year window starts 2017-01-01. 2016-11-12 is outside. Non_compliant.
MEMBER 71136: age 45 → not eligible (age).
Wait — check ages carefully. 71126: DOB 1981-12-20, so on 2026-12-31 she just turned 45. Not eligible. 71127: DOB 1981-01-14, 45 on 2026-12-31 → not eligible. 71130: 45 → not eligible. 71134: 45 → not eligible. 71136: 45 → not eligible.
71119: 76 → not eligible. 71125: 76 → not eligible. 71131: 76 → not eligible. 71132: 76 → not eligible.
Now check 71115 window: colonoscopy 2016-12-23. Ten-year window: "during 2026 or the nine years prior" — the nine years prior to 2026 are 2017–2025. So 2017-01-01 through 2026-12-31. 2016-12-23 outside. Non_compliant. Correct.
71135: colonoscopy 2016-11-12 — outside. Non_compliant.
71116: stool DNA 2023-01-09. Three-year window: 2026 or two years prior = 2024, 2025, 2026 → 2024-01-01 through 2026-12-31. 2023-01-09 outside. Non_compliant.
71133: CT colonography 2021 — five-year window = 2022-01-01 through 2026-12-31. Outside. Non_compliant.
71114: CT colonography 2021-12-07 — outside 5-year window; also excluded via E4 anyway. Excluded.
71113: C18.7 2025 → E1 excluded.
Excluded: 71113, 71114. Count = 2.
Not eligible: 71111 (enrolment), 71119 (age), 71121 (two gaps), 71122 (enrolment), 71123 (two gaps), 71125 (age), 71126 (age+enrolment), 71127 (age), 71130 (age), 71131 (age+enrolment), 71132 (age), 71134 (age), 71136 (age). Count = 13.
Compliant: 71117, 71118, 71124, 71128, 71129. Count = 5.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. Count = 6.
Total: 5 + 6 + 2 + 13 = 26. ✓
Denominator = compliant + non_compliant = 11.
Rate = 5/11 × 100 = 45.4545... → 45.5.
Double-check 71117: gap of 45 days allowed ("up to 45 days"). Enrolment 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap from 06-03 to 07-17 = 45 days. Stated as 45 days. Allowed. Stool DNA 2026-01-11 during MY → compliant. ✓
Check 71118: 2022-07-04 flex sig within 2022-01-01..2026-12-31 → N3. Compliant. ✓
Check 71124: flex sig 2026-04-15 → N3. Age 66 but no frailty/AI. Compliant. ✓
Check 71128: stool DNA 2026-08-17 → N2. Age 75, eligible. Compliant. ✓
Check 71129: flex sig 2023-07-08 within 5-year window. Compliant. ✓
Check 71112: 72, full enrolment, no screening, no exclusions → non_compliant. ✓
Check 71115: gap 35 days fine; colonoscopy 2016-12-23 outside 10-year window; E4 not applicable (age 47). Non_compliant. ✓
Check 71116: gap 35 fine; stool DNA 2023-01-09 outside 3-year window. Non_compliant. ✓
Check 71120: age 75, full enrolment, advanced illness only (no frailty) → not excluded; no screening → non_compliant. ✓
Check 71133: CT colonography 2021 (x2) outside window → non_compliant. ✓
Check 71135: colonoscopy 2016-11-12 outside 10-year window → non_compliant. ✓
Check 71121: two gaps (28, 15) → fails "no more than one gap" → not_eligible. ✓
Check 71123: two gaps (13, 25) → not_eligible. ✓
Check 71111: enrolled only from May → not full year → not_eligible. ✓
71122: from March → not_eligible. ✓
71131: age 76 anyway → not_eligible. ✓
Denominator 11, numerator 5, rate 45.5.
Rate rounding: 5/11 = 0.454545... × 100 = 45.4545 → round half up to one decimal = 45.5.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 2.5 Pro · Google61.8s · 7,363 out | 46.3s · 6,106 out | 59.3s · 7,271 out
Reasoning · 7,026 tokens
Okay, I've thoroughly reviewed the QM-CRC measure specification for the 2026 measurement year and applied it to the roster of 26 members. My thought process involved a meticulous, step-by-step evaluation of each individual against the defined criteria for eligibility, exclusions, and numerator compliance.
First, I internalized the core requirements for the **Eligible Population**:
* **Age:** Must be between 46 and 75 years old as of December 31, 2026. This meant I had to calculate or verify the age for each member based on their birthdate and the specified end date. For members born in 1981, I confirmed that they would be 45 years old on December 31, 2026, and thus not yet meet the minimum age of 46.
* **Continuous Enrollment:** They must have been continuously enrolled throughout the entire measurement year (January 1, 2026, to December 31, 2026), with the allowance of no more than one enrollment gap lasting up to 45 days. This required careful examination of enrollment dates and any listed gaps.
Then, I focused on the **Numerator (Compliant)** criteria, recognizing that *any one* of the specified screenings within the relevant look-back window would suffice:
* **FOBT or FIT (1-year look-back):** Performed in 2026.
* **Stool DNA test (3-year look-back):** Performed in 2024, 2025, or 2026.
* **Flexible Sigmoidoscopy (5-year look-back):** Performed in 2022, 2023, 2024, 2025, or 2026.
* **CT Colonography (5-year look-back):** Performed in 2022, 2023, 2024, 2025, or 2026.
* **Colonoscopy (10-year look-back):** Performed between January 1, 2017, and December 31, 2026.
Crucially, I paid close attention to the **Required Exclusions**:
* **E1:** Colorectal cancer diagnosis (ICD-10 codes C18-C21) on or before December 31, 2026.
* **E2:** Total colectomy performed on or before December 31, 2026.
* **E3:** Enrolled in hospice care during 2026.
* **E4:** Members aged 66 or older as of December 31, 2026, AND documented with both frailty AND advanced illness during 2026.
My workflow for each member was as follows:
1. **Age Check:** First, I determined if their age as of 2026-12-31 fell within the 46-75 range. If not, they were immediately categorized as **`not_eligible`**.
2. **Enrollment Check:** If their age was within range, I then evaluated their enrollment status for the full measurement year, allowing for a single gap of up to 45 days. Any deviation from this resulted in **`not_eligible`**.
3. **Exclusion Check:** For those who met both age and enrollment criteria, I systematically checked for the presence of any exclusion criteria (E1-E4). If any exclusion was met, the member was categorized as **`excluded`**. For E4, I specifically ensured *both* frailty and advanced illness were present for members aged 66+.
4. **Numerator Check:** If a member was eligible and not excluded, I then searched their records for a valid screening test that fell within the respective look-back windows.
* If a valid screening was found, they were classified as **`compliant`**.
* If no valid screening was found within any of the look-back periods, they were classified as **`non_compliant`**.
A key aspect of my review involved carefully managing the look-back periods for each screening type. For instance, I noted that a colonoscopy in late 2016 was too early for the 10-year look-back (which starts in 2017), and a stool DNA test in early 2023 was too early for the 3-year look-back (which starts in 2024). Similarly, CT colonography and flexible sigmoidoscopy in 2021 and early 2022 fell outside their respective 5-year windows (starting in 2022).
I meticulously recorded the status of each of the 26 members. This iterative process led to the following breakdown:
* **`not_eligible_members` (13):** These members did not meet the fundamental age or continuous enrollment requirements. This included individuals who were too young (age 45), too old (age 76), or had enrollment gaps that exceeded the allowed limit or duration.
* **`excluded_members` (2):** These members met the eligibility criteria but were specifically excluded due to documented colorectal cancer diagnoses or meeting the criteria for E4 (older age with both frailty and advanced illness).
* **`compliant_members` (5):** These individuals were eligible, not excluded, and had a documented screening test within the specified look-back periods. I confirmed these screenings included a Stool DNA test in 2026, a Flexible Sigmoidoscopy in 2022 and 2026, a Stool DNA test in 2026, and a CT Colonography in 2023.
* **`non_compliant_members` (6):** These members were eligible and not excluded but lacked a qualifying screening test within the required look-back windows. This included those with screenings that were too old or no screening on record.
Summing up the eligible members (those not categorized as `not_eligible` or `excluded`) gives us the **denominator**: 5 compliant + 6 non-compliant = 11 members.
The **numerator** is the count of `compliant_members`, which is 5.
Therefore, the calculated **rate** is (5 / 11) * 100, which rounds to 45.5%.
I have verified my calculations and the categorization of each member against the specification, ensuring accuracy in the final counts and the derived rate. The age checks for those born in 1981 were particularly important to confirm they indeed were 45 and not yet 46 by the end of 2026.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,769 tokens
Alright, I've just completed a thorough evaluation of this roster of 26 members against the QM-CRC measure specification for the 2026 measurement year. My process involved meticulously examining each member against the defined eligible population, numerator criteria, and exclusions.
First, I focused on establishing the **Eligible Population (Denominator)**. This meant checking two primary criteria for each member:
1. **Age:** They had to be between 46 and 75 years old as of December 31, 2026.
2. **Continuous Enrolment:** They needed to be enrolled for the entire measurement year, 2026, with no more than one gap of up to 45 days.
If a member didn't meet *both* of these criteria, they were immediately classified as **not_eligible**. I found several such cases:
* **MEMBER 71111** wasn't eligible because their enrolment only started on May 1, 2026, failing the continuous enrolment requirement.
* **MEMBER 71119** and **MEMBER 71125** were too old, being 76.
* **MEMBER 71121** and **MEMBER 71123** failed the enrolment rule due to having more than one gap in their coverage.
* **MEMBER 71122** also failed enrolment by not covering the full year.
* A significant group, **MEMBERS 71126, 71127, 71130, 71134, and 71136**, were all 45 years old on December 31, 2026, which falls below the minimum age of 46. I specifically re-verified the DOBs for these members to ensure accuracy against the 46-75 age range.
* **MEMBERS 71131** and **71132** were also too old at 76.
In total, 13 members were categorized as `not_eligible`.
Next, for those who were eligible, I then checked for **Exclusions**. If any of these applied, the member was classified as **excluded**, regardless of screening status:
1. **E1:** Colorectal cancer (C18-C21) diagnosed anytime on or before 2026-12-31.
2. **E2:** Total colectomy performed anytime on or before 2026-12-31.
3. **E3:** Hospice care at any point during 2026.
4. **E4:** Aged 66 or older as of 2026-12-31 AND documented frailty AND advanced illness during 2026.
I encountered two members who met exclusion criteria:
* **MEMBER 71113** had a diagnosis of Colorectal Cancer (C18.7) in 2025, clearly falling under E1.
* **MEMBER 71114** was 75 (satisfying the age part of E4) and had both frailty and advanced illness documented in 2026, triggering E4.
These two members were classified as `excluded`.
For the remaining members, who were eligible and not excluded, I then assessed their **Numerator (Compliant)** status. Compliance means they had one of the following screenings within the specified look-back windows:
* **N1 (1-year):** Faecal occult blood test or faecal immunochemical test in 2026.
* **N2 (3-year):** Stool DNA test in 2024, 2025, or 2026.
* **N3 (5-year):** Flexible sigmoidoscopy in 2022, 2023, 2024, 2025, or 2026.
* **N4 (5-year):** CT colonography in 2022, 2023, 2024, 2025, or 2026.
* **N5 (10-year):** Colonoscopy in 2017 through 2026.
Members who met the eligible and non-excluded criteria but *did not* have a qualifying screening were marked as **non_compliant**. This included:
* **MEMBER 71112**: Eligible, no exclusions, but no screening on record.
* **MEMBER 71115**: Eligible, no exclusions, but their only colonoscopy was in 2016, too far back for the 10-year lookback (N5). I double-checked their enrolment gap (35 days) which was within the acceptable limit.
* **MEMBER 71116**: Eligible, no exclusions. Their Stool DNA test in 2023 was too old for the 3-year lookback (N2), which begins in 2024. Their enrolment gap was 35 days, which was acceptable.
* **MEMBER 71120**: Eligible, no exclusions. While aged 75 and having advanced illness, they did *not* have documented frailty, so E4 did not apply. No screening on record.
* **MEMBER 71133**: Eligible, no exclusions. Their CT colonographies were both in 2021, too old for the 5-year lookback (N4), which begins in 2022.
* **MEMBER 71135**: Eligible, no exclusions. Their colonoscopy in 2016 was too old for the 10-year lookback (N5).
This resulted in 6 `non_compliant` members.
Finally, members who were eligible, not excluded, *and* had a qualifying screening were marked as **compliant**. These are the ones that contribute to the numerator.
* **MEMBER 71117**: Eligible, no exclusions. Compliant via a Stool DNA test in January 2026 (N2). Their enrolment gap was exactly 45 days, which is within the acceptable limit.
* **MEMBER 71118**: Eligible, no exclusions. Compliant via a Flexible Sigmoidoscopy in July 2022 (N3). Their enrolment gap was 42 days, which is acceptable.
* **MEMBER 71124**: Eligible, no exclusions. Compliant via a Flexible Sigmoidoscopy in April 2026 (N3). They were 66 but did not meet E4 criteria as they lacked both frailty and advanced illness documentation.
* **MEMBER 71128**: Eligible, no exclusions. Compliant via a Stool DNA test in August 2026 (N2).
* **MEMBER 71129**: Eligible, no exclusions. Compliant via a CT colonography in September 2023 (N4). They were 67 but did not meet E4 criteria.
This gives me 5 `compliant` members.
**In summary of my findings:**
* **Not Eligible:** 13 members (due to age or enrolment issues).
* **Excluded:** 2 members (due to cancer diagnosis or age/frailty/illness criteria).
* **Denominator:** The sum of compliant and non-compliant members (5 + 6 = 11 members). These are the members who were eligible and not excluded.
* **Numerator:** The 5 `compliant` members.
* **Rate:** Calculating the performance measure: (Numerator / Denominator) * 100 = (5 / 11) * 100 = 45.4545...%, which I'll round to **45.5%**.
I've double-checked the enrolments gaps, date windows for screenings, and the specific conditions for exclusions like E4 to ensure accuracy. The logic followed each step of the measure specification precisely.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
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],
"got": [
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"71118",
"71124",
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
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],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
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],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,934 tokens
Here's a summary of my thought process as I evaluated the roster against the QM-CRC measure specification:
My primary objective was to meticulously assess each of the 26 members in the roster against the defined criteria for the Colorectal Cancer Screening (QM-CRC) measure for the 2026 measurement year. This involved a systematic, step-by-step approach for every individual, ensuring strict adherence to the eligibility, exclusion, and numerator requirements.
First, I focused on defining the **Eligible Population (Denominator)**. This meant I had to verify two core conditions for each member:
1. **Age:** They had to be between 46 and 75 years old, inclusive, as of December 31, 2026.
2. **Continuous Enrolment:** They needed to have been continuously enrolled for the entire measurement year (January 1, 2026, to December 31, 2026), allowing for no more than one gap in coverage that did not exceed 45 days.
Following the eligibility check, the next crucial phase was identifying **Required Exclusions**. If a member met the eligibility criteria, I then checked if they fell into any of these exclusion categories:
* A diagnosis of colorectal cancer (ICD-10 codes C18-C21) at any point up to December 31, 2026.
* A history of total colectomy at any point up to December 31, 2026.
* Being in hospice care at any point during the 2026 measurement year.
* For members aged 66 or older (as of December 31, 2026), having documented frailty *and* advanced illness in 2026.
If a member was eligible and not excluded, I then moved on to assess their **Numerator (Compliance)**. This meant checking if they had received one of the specified colorectal cancer screenings within the relevant look-back periods, all relative to December 31, 2026:
* **FOBT/FIT (N1):** Screened anytime during 2026.
* **Stool DNA (N2):** Screened in 2026 or the two preceding years (2024-2026).
* **Flexible Sigmoidoscopy (N3):** Screened in 2026 or the four preceding years (2022-2026).
* **CT Colonography (N4):** Screened in 2026 or the four preceding years (2022-2026).
* **Colonoscopy (N5):** Screened in 2026 or the nine preceding years (2017-2026).
My evaluation process for each member was structured as follows:
1. **Eligibility First:** I determined if the member met both the age and continuous enrollment criteria. If not, they were immediately classified as "not_eligible."
2. **Exclusions Next:** If a member was eligible, I then checked for any exclusion criteria. If any exclusion was met, the member was classified as "excluded," regardless of whether they had a screening.
3. **Numerator Compliance:** For members who were eligible and not excluded, I checked if they had a qualifying screening within the specified timeframe. If yes, they were "compliant."
4. **Non-Compliance:** If a member was eligible, not excluded, but did *not* have a qualifying screening, they were classified as "non_compliant."
I then proceeded to meticulously apply this framework to each of the 26 members. I paid particularly close attention to the nuances of the enrollment criteria (especially the "no more than one gap" rule and the 45-day limit), the specific age cutoffs for exclusions (E4), and the precise look-back windows for each type of screening. For instance, with Member 71111, I immediately flagged them as "Not Eligible" due to their enrollment gap clearly exceeding 45 days and occurring at the start of the year, making them not continuously enrolled. Member 71113 was eligible on paper but was then correctly classified as "Excluded" due to their prior colorectal cancer diagnosis, even though they might have had a recent screening. Similarly, Member 71114, despite being 75, met the exclusion criteria for frailty and advanced illness, overriding any consideration of their screening history.
I also conducted careful re-checks of my age calculations, particularly for those born in 1981 (making them 45 in late 2026) and those born around 1950 (making them 76 in late 2026), ensuring they correctly fell outside the 46-75 age range. For Member 71134, the total colectomy was an exclusion, but since their age was 45, they were "Not Eligible" to begin with, which is the primary determination.
After individually processing each member, I compiled the results into distinct lists: Compliant, Non-compliant, Excluded, and Not Eligible. I then tallied the counts for each category to ensure they summed up to the total roster size of 26.
Finally, based on these counts, I calculated the measure's rate. The numerator is the count of compliant members (those who met eligibility, were not excluded, and had a qualifying screening), and the denominator is the sum of compliant and non-compliant members (those who were eligible and not excluded). I performed the calculation (5 compliant / 11 in the denominator) and rounded the result to 45.5%.
My process was about systematically applying each rule layer by layer, prioritizing eligibility and exclusions before moving to the numerator, and carefully verifying the date ranges and conditions for each criterion.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.2 · Z.ai50.8s · 5,749 out | 116.4s · 6,251 out | 21.2s · 3,013 out
Reasoning · 5,392 tokens
Let me carefully work through each member against the measure specification.
**MEASURE QM-CRC — COLORECTAL CANCER SCREENING**
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
Numerator (any one):
- N1: FOBT/FIT during 2026
- N2: Stool DNA during 2026 or two years prior (3-year window: 2024-2026)
- N3: Flexible sigmoidoscopy during 2026 or four years prior (5-year window: 2022-2026)
- N4: CT colonography during 2026 or four years prior (5-year window: 2022-2026)
- N5: Colonoscopy during 2026 or nine years prior (10-year window: 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 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
Let me go through each member:
**MEMBER 71111**
- DOB 1971-04-18, age 55 on 2026-12-31 ✓ (46-75)
- Enrolment: 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01. This is NOT full year enrolment. Gap from 2026-01-01 to 2026-04-30 (120+ days). Does not meet continuous enrolment.
- Status: not_eligible (fails continuous enrolment)
**MEMBER 71112**
- DOB 1954-02-14, age 72 ✓
- Enrolment: full year, no gaps ✓
- Screening: none on record
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71113**
- DOB 1979-02-27, age 47 ✓
- Enrolment: full year ✓
- Screening: 2020-07-03 CT colonography (outside 5-year window 2022-2026), 2025-11-08 Flexible sigmoidoscopy (within 5-year window 2022-2026 ✓)
- Other: 2025-07-17 Diagnosis C18.7 (colorectal cancer, C18-C21) on or before 2026-12-31 → E1 exclusion
- Eligible population (age and enrolment met), meets exclusion E1 → excluded
**MEMBER 71114**
- DOB 1951-11-18, age 75 ✓
- Enrolment: full year ✓
- Screening: 2021-12-07 CT colonography (outside 5-year window 2022-2026, since 2021 < 2022) → not numerator
- Other: 2026-12-17 Frailty, 2026-05-05 Advanced illness. Age 75 (66+), both frailty and advanced illness documented during MY → E4 exclusion
- Eligible, meets exclusion E4 → excluded
**MEMBER 71115**
- DOB 1979-09-19, age 47 ✓
- Enrolment: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. One gap of 35 days (≤45) ✓
- Screening: 2016-12-23 Colonoscopy (outside 10-year window 2017-2026) → not numerator
- Other: 2026-07-07 Frailty, 2026-02-06 Advanced illness. Age 47 (not 66+) → E4 does not apply
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71116**
- DOB 1976-01-11, age 50 ✓
- Enrolment: 2026-01-01 to 2026-03-16; 2026-04-21 to 2026-12-31. One gap of 35 days ✓
- Screening: 2023-01-09 Stool DNA. Window for stool DNA: 2024-2026 (3-year window). 2023 < 2024 → outside window → not numerator
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71117**
- DOB 1963-09-02, age 63 ✓
- Enrolment: 2026-01-01 to 2026-06-02; 2026-07-18 to 2026-12-31. One gap of 45 days (≤45) ✓
- Screening: 2026-01-11 Stool DNA. During 2026 ✓ → N2 met
- No exclusions
- Eligible, no exclusion, numerator met → compliant
**MEMBER 71118**
- DOB 1979-03-23, age 47 ✓
- Enrolment: 2026-01-01 to 2026-06-14; 2026-07-27 to 2026-12-31. One gap of 42 days ✓
- Screening: 2021-11-12 Flexible sigmoidoscopy (outside 5-year window 2022-2026), 2022-07-04 Flexible sigmoidoscopy (within 5-year window 2022-2026 ✓) → N3 met
- No exclusions
- Eligible, no exclusion, numerator met → compliant
**MEMBER 71119**
- DOB 1950-03-25, age 76 on 2026-12-31. Age 76 > 75 → not in age range
- Status: not_eligible (age)
**MEMBER 71120**
- DOB 1951-03-21, age 75 ✓
- Enrolment: full year ✓
- Screening: none
- Other: 2026-02-01 Advanced illness (heart failure). No frailty. Age 75 (66+) but only advanced illness, no frailty → E4 does not apply (needs both)
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71121**
- DOB 1971-08-17, age 55 ✓
- Enrolment: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gaps of 28 and 15 days. Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps → does not meet continuous enrolment.
- Status: not_eligible (enrolment - more than one gap)
**MEMBER 71122**
- DOB 1954-09-15, age 72 ✓
- Enrolment: 2026-03-22 through 2026-12-31, not enrolled before. Not full year → fails continuous enrolment
- Status: not_eligible (enrolment)
**MEMBER 71123**
- DOB 1959-03-08, age 67 ✓
- Enrolment: 2026-01-01 to 2026-02-23; 2026-03-09 to 2026-06-27; 2026-07-23 to 2026-12-31. Gaps of 13 and 25 days. Two gaps → fails continuous enrolment (more than one gap)
- Status: not_eligible (enrolment)
**MEMBER 71124**
- DOB 1960-08-15, age 66 ✓
- Enrolment: full year ✓
- Screening: 2026-04-15 Flexible sigmoidoscopy (during 2026) → N3 met
- No exclusions (age 66 but no frailty/advanced illness)
- Eligible, no exclusion, numerator met → compliant
**MEMBER 71125**
- DOB 1950-05-08, age 76 on 2026-12-31. Age 76 > 75 → not_eligible (age)
**MEMBER 71126**
- DOB 1981-12-20, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age)
**MEMBER 71127**
- DOB 1981-01-14, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age)
Wait, let me recalculate. DOB 1981-01-14. On 2026-12-31, age = 2026 - 1981 = 45. Yes, 45 years old. Age 45 < 46 → not eligible.
**MEMBER 71128**
- DOB 1951-12-10, age 75 ✓
- Enrolment: full year ✓
- Screening: 2020-02-10 CT colonography (outside 5-year window 2022-2026), 2026-08-17 Stool DNA (during 2026) → N2 met
- No exclusions
- Eligible, no exclusion, numerator met → compliant
**MEMBER 71129**
- DOB 1959-07-23, age 67 ✓
- Enrolment: full year ✓
- Screening: 2023-07-08 Flexible sigmoidoscopy (within 5-year window 2022-2026 ✓) → N3 met. Also 2023-09-13 CT colonography (within 5-year window ✓) → N4 met.
- No exclusions
- Eligible, no exclusion, numerator met → compliant
**MEMBER 71130**
- DOB 1981-09-13, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age)
Wait, let me recalculate. DOB 1981-09-13. On 2026-12-31, age = 2026 - 1981 = 45. Yes, 45. Not in 46-75 range.
But wait, the member also has C18.7 diagnosis. However, since they fail age, they are not_eligible regardless.
- Status: not_eligible (age)
**MEMBER 71131**
- DOB 1950-05-05, age 76 on 2026-12-31. Age 76 > 75 → not_eligible (age)
**MEMBER 71132**
- DOB 1950-02-01, age 76 on 2026-12-31. Age 76 > 75 → not_eligible (age)
Wait, but the member has C18.7 diagnosis (colorectal cancer). But since they fail age, they are not_eligible. The exclusion only applies to members in the eligible population.
- Status: not_eligible (age)
**MEMBER 71133**
- DOB 1967-01-22, age 59 ✓
- Enrolment: full year ✓
- Screening: 2021-04-12 CT colonography (outside 5-year window 2022-2026), 2021-09-09 CT colonography (outside 5-year window 2022-2026). Both in 2021, which is before 2022. The 5-year window is 2022-2026. So neither counts.
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71134**
- DOB 1981-09-26, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age)
But wait, also has total colectomy (E2). However, since they fail age, they are not_eligible. The exclusion only applies to members in the eligible population.
- Status: not_eligible (age)
**MEMBER 71135**
- DOB 1971-08-26, age 55 ✓
- Enrolment: full year ✓
- Screening: 2016-11-12 Colonoscopy. Window for colonoscopy: 2017-2026 (10-year window). 2016 < 2017 → outside window → not numerator
- No exclusions
- Eligible, no exclusion, no numerator → non_compliant
**MEMBER 71136**
- DOB 1981-11-11, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age)
Wait, let me recalculate. DOB 1981-11-11. On 2026-12-31, age = 2026 - 1981 = 45. Yes, 45. Not in 46-75 range.
But the member has advanced illness. However, since they fail age, they are not_eligible.
- Status: not_eligible (age)
Let me now compile all the results:
**not_eligible:**
- 71111 (enrolment - not full year, enrolled from 2026-05-01)
- 71119 (age 76)
- 71121 (enrolment - two gaps)
- 71122 (enrolment - not full year, enrolled from 2026-03-22)
- 71123 (enrolment - two gaps)
- 71125 (age 76)
- 71126 (age 45)
- 71127 (age 45)
- 71130 (age 45)
- 71131 (age 76)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
**excluded:**
- 71113 (E1 - colorectal cancer C18.7)
- 71114 (E4 - age 66+, frailty + advanced illness)
**compliant:**
- 71117 (N2 - stool DNA during 2026)
- 71118 (N3 - flexible sigmoidoscopy 2022-07-04 within 5-year window)
- 71124 (N3 - flexible sigmoidoscopy 2026-04-15)
- 71128 (N2 - stool DNA 2026-08-17)
- 71129 (N3/N4 - flexible sigmoidoscopy 2023-07-08 and CT colonography 2023-09-13 within 5-year window)
**non_compliant:**
- 71112 (no screening)
- 71115 (colonoscopy 2016 outside 10-year window)
- 71116 (stool DNA 2023 outside 3-year window)
- 71120 (no screening; advanced illness only, no frailty, so no E4)
- 71133 (CT colonography 2021 outside 5-year window)
- 71135 (colonoscopy 2016 outside 10-year window)
Let me double-check each one:
**71112**: Age 72 ✓, enrolment full ✓, no screening, no exclusions. Eligible, no numerator → non_compliant ✓
**71115**: Age 47 ✓, enrolment one gap 35 days ✓, colonoscopy 2016-12-23. 10-year window: 2017-2026. 2016 < 2017 → outside. Frailty + advanced illness but age 47 (not 66+) → E4 doesn't apply. Non_compliant ✓
**71116**: Age 50 ✓, enrolment one gap 35 days ✓, stool DNA 2023-01-09. 3-year window: 2024-2026. 2023 < 2024 → outside. Non_compliant ✓
**71120**: Age 75 ✓, enrolment full ✓, no screening. Advanced illness only, no frailty. E4 requires both frailty AND advanced illness AND age 66+. Only advanced illness → E4 doesn't apply. Non_compliant ✓
**71133**: Age 59 ✓, enrolment full ✓, CT colonography 2021-04-12 and 2021-09-09. 5-year window: 2022-2026. Both in 2021 < 2022 → outside. Non_compliant ✓
**71135**: Age 55 ✓, enrolment full ✓, colonoscopy 2016-11-12. 10-year window: 2017-2026. 2016 < 2017 → outside. Non_compliant ✓
Now let me verify the excluded members:
**71113**: Age 47 ✓, enrolment full ✓. Eligible population. C18.7 diagnosed 2025-07-17 → E1 (colorectal cancer C18-C21 any time on or before 2026-12-31). Excluded ✓
**71114**: Age 75 ✓, enrolment full ✓. Eligible population. Age 75 (66+) ✓, frailty documented 2026-12-17 (during MY) ✓, advanced illness documented 2026-05-05 (during MY) ✓ → E4. Excluded ✓
Now let me verify the not_eligible members:
**71111**: Age 55 ✓ but enrolment from 2026-05-01, not full year. Not_eligible (enrolment) ✓
**71119**: Age 76 > 75. Not_eligible (age) ✓
**71121**: Age 55 ✓ but enrolment has two gaps (28 and 15 days). Rule says "no more than one gap." Two gaps → fails. Not_eligible (enrolment) ✓
**71122**: Age 72 ✓ but enrolment from 2026-03-22, not full year. Not_eligible (enrolment) ✓
**71123**: Age 67 ✓ but enrolment has two gaps (13 and 25 days). Not_eligible (enrolment) ✓
**71125**: Age 76 > 75. Not_eligible (age) ✓
**71126**: Age 45 < 46. Not_eligible (age) ✓
**71127**: Age 45 < 46. Not_eligible (age) ✓
**71130**: Age 45 < 46. Not_eligible (age) ✓ (also has C18.7 but age fails first)
**71131**: Age 76 > 75. Not_eligible (age) ✓
**71132**: Age 76 > 75. Not_eligible (age) ✓ (also has C18.7 but age fails first)
**71134**: Age 45 < 46. Not_eligible (age) ✓ (also has total colectomy but age fails first)
**71136**: Age 45 < 46. Not_eligible (age) ✓
Now let me count:
- not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 → 13 members
- excluded: 71113, 71114 → 2 members
- compliant: 71117, 71118, 71124, 71128, 71129 → 5 members
- non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 → 6 members
Total: 13 + 2 + 5 + 6 = 26 ✓
denominator = compliant + non_compliant = 5 + 6 = 11
numerator = 5 (compliant)
excluded = 2
not_eligible = 13
rate = 5/11 × 100 = 45.4545... → 45.5 (rounded half up to one decimal place)
Let me double check: 5/11 = 0.454545... × 100 = 45.4545... → rounds to 45.5
Let me verify all the numerator checks more carefully:
**71117**: Stool DNA 2026-01-11. N2: stool DNA during 2026 or two years prior (2024-2026). 2026 is within window. ✓
**71118**: Flexible sigmoidoscopy 2022-07-04. N3: flexible sigmoidoscopy during 2026 or four years prior (2022-2026). 2022 is within window. ✓
**71124**: Flexible sigmoidoscopy 2026-04-15. N3: during 2026. ✓
**71128**: Stool DNA 2026-08-17. N2: during 2026. ✓
**71129**: Flexible sigmoidoscopy 2023-07-08 and CT colonography 2023-09-13. N3 window 2022-2026, N4 window 2022-2026. Both within. ✓
All checks pass.
Let me also double-check the window calculations:
N2 (stool DNA): "during 2026 or the two years prior (three-year window)" → 2024, 2025, 2026
N3 (flexible sigmoidoscopy): "during 2026 or the four years prior (five-year window)" → 2022, 2023, 2024, 2025, 2026
N4 (CT colonography): "during 2026 or the four years prior (five-year window)" → 2022, 2023, 2024, 2025, 2026
N5 (colonoscopy): "during 2026 or the nine years prior (ten-year window)" → 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026
Let me re-verify each member's screening against these windows:
**71111**: Stool DNA 2023-11-04 (2023 < 2024, outside N2 window), Colonoscopy 2025-01-02 (2025 within 2017-2026, N5 met). But 71111 is not_eligible due to enrolment, so it doesn't matter.
**71113**: CT colonography 2020-07-03 (2020 < 2022, outside N4), Flexible sigmoidoscopy 2025-11-08 (2025 within 2022-2026, N3 met). But 71113 is excluded due to E1, so it doesn't matter.
**71114**: CT colonography 2021-12-07 (2021 < 2022, outside N4). But 71114 is excluded due to E4, so it doesn't matter.
**71115**: Colonoscopy 2016-12-23 (2016 < 2017, outside N5). Non_compliant ✓
**71116**: Stool DNA 2023-01-09 (2023 < 2024, outside N2). Non_compliant ✓
**71133**: CT colonography 2021-04-12 and 2021-09-09 (both 2021 < 2022, outside N4). Non_compliant ✓
**71135**: Colonoscopy 2016-11-12 (2016 < 2017, outside N5). Non_compliant ✓
All confirmed.
Final answer:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 45.5
- compliant_members: ["71117", "71118", "71124", "71128", "71129"]
- non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
- excluded_members: ["71113", "71114"]
- not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,920 tokens
Let me carefully work through each member against the measure specification.
**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 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) → 2024-2026
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window) → 2022-2026
- 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) → 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
- 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 71111**
- DOB: 1971-04-18 → age 55 on 2026-12-31 ✓ (46-75)
- Enrolment: 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01
- This is NOT continuous for the full measurement year. The member started on 2026-05-01, which means they were not enrolled for the full year (Jan-Apr missing).
- Wait, "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means they need to be enrolled for the full year. Not being enrolled from Jan-Apr is not a gap; it's a lack of enrolment. So this member is NOT continuously enrolled for the full measurement year.
- Actually, let me re-read: "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 measurement year, with no more than one gap of up to 45 days. A gap means a period of dis-enrolment within the year. But if the member wasn't enrolled at all from Jan-Apr, that's not a gap - that's not being enrolled for the full year.
- Hmm, but some measure specs consider "continuous enrolment" as being enrolled from some start date with allowable gaps. Let me re-read the spec: "the full measurement year with no more than one gap of up to 45 days." This seems to require enrolment for the full year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
- MEMBER 71111: enrolled 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01. This means they were not enrolled for Jan-Apr, which is more than just a gap - they weren't enrolled at all for the first 4 months. This doesn't meet "full measurement year" requirement.
- Status: **not_eligible** (fails continuous enrolment)
Wait, I need to think about this more carefully. The spec says "the full measurement year with no more than one gap of up to 45 days." In HEDIS-like measures, continuous enrolment typically means the member is enrolled for the full period, allowing one gap. But if the member starts mid-year, that's not continuous enrolment for the full year.
Let me reconsider. In many HEDIS measures, continuous enrolment means enrolled from the start of the year to the end, with at most one gap. If someone enrolls mid-year, they don't meet continuous enrolment for the full year.
So for members who start mid-year (not enrolled from 2026-01-01), they fail continuous enrolment → not_eligible.
Let me re-examine each member:
**MEMBER 71111**
- Age: 55 ✓
- Enrolment: 2026-05-01 through 2026-12-31, not enrolled before → NOT full year → **not_eligible**
**MEMBER 71112**
- Age: 72 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Screening: No colorectal screening on record
- Exclusions: None (no CRC, no colectomy, no hospice, no frailty/advanced illness)
- Status: In denominator, no exclusion, no numerator → **non_compliant**
**MEMBER 71113**
- Age: 47 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2020-07-03 CT colonography (2020 is outside the 5-year window for N4: 2022-2026), 2025-11-08 Flexible sigmoidoscopy (2025 is within 2022-2026 for N3 ✓)
- Other history: 2025-07-17 Diagnosis C18.7 → Colorectal cancer (C18-C21)
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31 → YES, C18.7 is in C18-C21
- Exclusions are evaluated before numerator. Member has E1.
- Status: **excluded** (E1)
**MEMBER 71114**
- Age: 75 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2021-12-07 CT colonography → 2021 is outside the 5-year window for N4 (2022-2026). Wait, the window is "2026 or the four years prior" = 2022, 2023, 2024, 2025, 2026. 2021 is outside this window. So this doesn't count for N4.
- Any other screening? No.
- Other history: 2026-12-17 Frailty documented, 2026-05-05 Advanced illness documented
- E4: Age 66 or older AND both frailty and advanced illness documented during the measurement year
- Age 75 ✓ (≥66)
- Frailty documented during MY: 2026-12-17 ✓
- Advanced illness documented during MY: 2026-05-05 ✓
- E4 applies → **excluded**
**MEMBER 71115**
- Age: 47 ✓
- Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days.
- Gap: 2026-07-17 through 2026-08-20 = let me calculate. July 17 to August 20. July has 31 days, so July 17-31 = 15 days, Aug 1-20 = 20 days. Total gap = 15 + 20 = 35 days. ✓ (≤45 days, one gap)
- Full year enrolment ✓
- Screening: 2016-12-23 Colonoscopy → N5 window is 2017-2026. 2016 is outside. Does not count.
- Other history: 2026-07-07 Frailty, 2026-02-06 Advanced illness
- E4: Age 47 (< 66) → does NOT apply
- No other exclusions
- Status: In denominator, no exclusion, no numerator → **non_compliant**
Wait, let me double-check the colonoscopy date. 2016-12-23. N5: "Colonoscopy during 2026 or the nine years prior (ten-year window)." Nine years prior to 2026 = 2017. So the window is 2017-2026. 2016 is before 2017, so it's outside the window. Non-compliant.
**MEMBER 71116**
- Age: 50 ✓
- Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days.
- Gap: 2026-03-17 through 2026-04-20 = March 17-31 = 15 days, April 1-20 = 20 days. Total = 35 days ✓ (≤45, one gap)
- Full year enrolment ✓
- Screening: 2023-01-09 Stool DNA test → N2 window: 2024-2026. 2023 is outside. Does not count.
- No exclusions
- Status: In denominator, no exclusion, no numerator → **non_compliant**
Wait, N2 says "Stool DNA test during 2026 or the two years prior (three-year window)." Two years prior to 2026 = 2024 and 2025. So the window is 2024-2026. 2023 is outside. Non-compliant.
**MEMBER 71117**
- Age: 63 ✓
- Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days.
- Gap: 2026-06-03 through 2026-07-17 = June 3-30 = 28 days, July 1-17 = 17 days. Total = 45 days. ✓ (≤45, one gap)
- Full year enrolment ✓
- Screening: 2026-01-11 Stool DNA test → N2 window: 2024-2026. 2026 ✓
- No exclusions
- Status: In denominator, no exclusion, meets numerator → **compliant**
**MEMBER 71118**
- Age: 47 ✓
- Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days.
- Gap: 2026-06-15 through 2026-07-26 = June 15-30 = 16 days, July 1-26 = 26 days. Total = 42 days. ✓ (≤45, one gap)
- Full year enrolment ✓
- Screening: 2021-11-12 Flexible sigmoidoscopy, 2022-07-04 Flexible sigmoidoscopy
- N3 window: 2022-2026. 2022-07-04 is within ✓
- 2021 is outside
- No exclusions
- Status: In denominator, no exclusion, meets numerator (2022 flex sig) → **compliant**
**MEMBER 71119**
- Age: 76 on 2026-12-31 → 76 > 75 → **not_eligible** (fails age)
**MEMBER 71120**
- Age: 75 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: No colorectal screening on record
- Other history: 2026-02-01 Advanced illness documented (heart failure, I50.22)
- E4: Age 66 or older (75 ✓) AND both frailty AND advanced illness. Advanced illness is documented, but frailty is NOT documented. So E4 does not apply (needs both).
- No other exclusions
- Status: In denominator, no exclusion, no numerator → **non_compliant**
**MEMBER 71121**
- Age: 55 ✓
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days.
- This has TWO gaps. The spec says "no more than one gap of up to 45 days." Two gaps exceed the allowed 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 → fails continuous enrolment → **not_eligible**
Hmm, but wait. Let me reconsider. The spec says "no more than one gap of up to 45 days." This means at most one gap, and that gap must be ≤45 days. Two gaps means more than one gap, so this fails.
**MEMBER 71122**
- Age: 72 ✓
- Enrolment: 2026-03-22 through 2026-12-31, not enrolled before 2026-03-22 → NOT full year → **not_eligible**
**MEMBER 71123**
- Age: 67 ✓
- Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days.
- Two gaps → fails continuous enrolment (more than one gap) → **not_eligible**
**MEMBER 71124**
- Age: 66 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2026-04-15 Flexible sigmoidoscopy → N3 window: 2022-2026. 2026 ✓
- No exclusions (no CRC, no colectomy, no hospice, no frailty/advanced illness)
- E4: Age 66 ✓ but no frailty and no advanced illness → does not apply
- Status: In denominator, no exclusion, meets numerator → **compliant**
**MEMBER 71125**
- Age: 76 on 2026-12-31 → 76 > 75 → **not_eligible** (fails age)
**MEMBER 71126**
- Age: 45 on 2026-12-31 → 45 < 46 → **not_eligible** (fails age)
**MEMBER 71127**
- Age: 45 on 2026-12-31 → 45 < 46 → **not_eligible** (fails age)
**MEMBER 71128**
- Age: 75 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2020-02-10 CT colonography (2020 outside N4 window 2022-2026), 2026-08-17 Stool DNA test → N2 window: 2024-2026. 2026 ✓
- No exclusions
- Status: In denominator, no exclusion, meets numerator (2026 stool DNA) → **compliant**
**MEMBER 71129**
- Age: 67 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2023-07-08 Flexible sigmoidoscopy → N3 window: 2022-2026. 2023 ✓
- 2023-09-13 CT colonography → N4 window: 2022-2026. 2023 ✓
- No exclusions
- E4: Age 67 ✓ but no frailty and no advanced illness → does not apply
- Status: In denominator, no exclusion, meets numerator → **compliant**
**MEMBER 71130**
- Age: 45 on 2026-12-31 → 45 < 46 → **not_eligible** (fails age)
- Even though they have C18.7 diagnosis (which would be E1 exclusion), age fails first. "A member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
**MEMBER 71131**
- Age: 76 on 2026-12-31 → 76 > 75 → **not_eligible** (fails age)
**MEMBER 71132**
- Age: 76 on 2026-12-31 → 76 > 75 → **not_eligible** (fails age)
- Even though they have C18.7 (E1 exclusion) and FIT test, age fails first.
**MEMBER 71133**
- Age: 59 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2021-04-12 CT colonography, 2021-09-09 CT colonography
- N4 window: 2022-2026. Both 2021 dates are outside. Does not count.
- No exclusions
- Status: In denominator, no exclusion, no numerator → **non_compliant**
**MEMBER 71134**
- Age: 45 on 2026-12-31 → 45 < 46 → **not_eligible** (fails age)
- Even though they have total colectomy (E2 exclusion), age fails first.
**MEMBER 71135**
- Age: 55 ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- Screening: 2016-11-12 Colonoscopy → N5 window: 2017-2026. 2016 is outside. Does not count.
- No exclusions
- Status: In denominator, no exclusion, no numerator → **non_compliant**
**MEMBER 71136**
- Age: 45 on 2026-12-31 → 45 < 46 → **not_eligible** (fails age)
- Even though they have advanced illness, age fails first (and E4 requires age ≥66 anyway).
Let me now compile the lists:
**not_eligible members (fail age or enrolment):**
- 71111 (fails enrolment - not full year, started 2026-05-01)
- 71119 (age 76)
- 71121 (two gaps in enrolment)
- 71122 (fails enrolment - not full year, started 2026-03-22)
- 71123 (two gaps in enrolment)
- 71125 (age 76)
- 71126 (age 45)
- 71127 (age 45)
- 71130 (age 45)
- 71131 (age 76)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
**excluded members (in eligible population, meet an exclusion):**
- 71113 (E1 - colorectal cancer C18.7)
- 71114 (E4 - age 75, frailty + advanced illness)
**compliant members (in denominator, no exclusion, meet numerator):**
- 71117 (stool DNA 2026)
- 71118 (flex sig 2022)
- 71124 (flex sig 2026)
- 71128 (stool DNA 2026)
- 71129 (flex sig 2023 / CT colonography 2023)
**non_compliant members (in denominator, no exclusion, no numerator):**
- 71112 (no screening)
- 71115 (colonoscopy 2016, outside window; frailty+advanced illness but age <66 so E4 doesn't apply)
- 71116 (stool DNA 2023, outside window)
- 71120 (no screening; advanced illness only, no frailty, so E4 doesn't apply)
- 71133 (CT colonography 2021, outside window)
- 71135 (colonoscopy 2016, outside window)
Let me verify the counts:
- not_eligible: 13 members (71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136)
- excluded: 2 members (71113, 71114)
- compliant: 5 members (71117, 71118, 71124, 71128, 71129)
- non_compliant: 6 members (71112, 71115, 71116, 71120, 71133, 71135)
Total: 13 + 2 + 5 + 6 = 26 ✓
denominator = compliant + non_compliant = 5 + 6 = 11
numerator = 5
excluded = 2
not_eligible = 13
rate = 5/11 × 100 = 45.454... → 45.5
Let me double-check some of the tricky ones:
**MEMBER 71111**: Enrolled 2026-05-01 through 2026-12-31, not enrolled before. The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means they need to be enrolled for the full measurement year (2026-01-01 through 2026-12-31). Since they weren't enrolled Jan-Apr, they don't have full-year enrolment. → not_eligible ✓
**MEMBER 71121**: Two gaps (28 and 15 days). The spec allows "no more than one gap." Two gaps = more than one → not_eligible ✓
**MEMBER 71123**: Two gaps (13 and 25 days). Same as above → not_eligible ✓
**MEMBER 71115**: Age 47, so E4 doesn't apply even though frailty + advanced illness are documented. Colonoscopy 2016-12-23 is outside N5 window (2017-2026). → non_compliant ✓
Wait, I need to re-examine MEMBER 71115's enrolment. 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. That's one gap ≤45 days, so enrolment is fine. Age 47, fine. No exclusion (E4 doesn't apply because age <66). No numerator (colonoscopy 2016 outside window). → non_compliant ✓
**MEMBER 71120**: Age 75, enrolled full year. No screening. Advanced illness only (no frailty), so E4 doesn't apply. → non_compliant ✓
Let me also double-check the look-back windows:
- N1: FOBT/FIT during 2026 → just 2026
- N2: Stool DNA during 2026 or two years prior → 2024, 2025, 2026
- N3: Flex sig during 2026 or four years prior → 2022, 2023, 2024, 2025, 2026
- N4: CT colonography during 2026 or four years prior → 2022, 2023, 2024, 2025, 2026
- N5: Colonoscopy during 2026 or nine years prior → 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026
Let me verify each member's screening against these windows:
**71113**: 2025-11-08 Flex sig → N3 window 2022-2026 ✓. But has E1 exclusion (C18.7). Excluded.
**71116**: 2023-01-09 Stool DNA → N2 window 2024-2026. 2023 is outside. Non-compliant. ✓
**71118**: 2022-07-04 Flex sig → N3 window 2022-2026 ✓. Compliant. ✓
**71128**: 2026-08-17 Stool DNA → N2 window 2024-2026 ✓. Compliant. ✓
**71129**: 2023-07-08 Flex sig → N3 window 2022-2026 ✓. Compliant. ✓
**71133**: 2021-04-12 and 2021-09-09 CT colonography → N4 window 2022-2026. Both 2021, outside. Non-compliant. ✓
**71135**: 2016-11-12 Colonoscopy → N5 window 2017-2026. 2016 is outside. Non-compliant. ✓
All checks pass. Let me also verify the not_eligible members more carefully:
**71130**: Age 45 → not_eligible. Even though has C18.7 (E1) and FIT 2026, age fails first. ✓
**71132**: Age 76 → not_eligible. Even though has C18.7 (E1) and FIT 2026, age fails first. ✓
**71134**: Age 45 → not_eligible. Even though has total colectomy (E2), age fails first. ✓
**71136**: Age 45 → not_eligible. ✓
Now let me also reconsider: MEMBER 71111 has a screening history (2023 stool DNA, 2025 colonoscopy) and frailty, but they fail enrolment so they're not_eligible regardless.
Let me also reconsider MEMBER 71122: Age 72, enrolled from 2026-03-22, not full year → not_eligible. Even though they have frailty + advanced illness, they fail enrolment.
All good. Final answer:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 5/11 × 100 = 45.4545... → 45.5
- compliant_members: ["71117", "71118", "71124", "71128", "71129"]
- non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
- excluded_members: ["71113", "71114"]
- not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,951 tokens
Let me go through each member carefully against the measure specification.
**Eligibility criteria:**
- 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):**
- 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
- E4: Age 66+ AND both frailty AND advanced illness documented during measurement year
**Numerator (any one):**
- N1: FOBT/FIT during 2026
- N2: Stool DNA during 2026 or two years prior (3-year window: 2024-2026)
- N3: Flex sig during 2026 or four years prior (5-year window: 2022-2026)
- N4: CT colonography during 2026 or four years prior (5-year window: 2022-2026)
- N5: Colonoscopy during 2026 or nine years prior (10-year window: 2017-2026)
Let me process each member:
**71111**: DOB 1971-04-18 → 55 years old. Age ✓ (46-75)
Enrolment: 2026-05-01 through 2026-12-31, not enrolled before. Gap: not enrolled Jan-Apr. This is not continuous for the full measurement year. The gap from 2026-01-01 to 2026-04-30 is more than 45 days. So NOT eligible (continuous enrolment requirement fails).
Status: not_eligible
**71112**: DOB 1954-02-14 → 72 years old. Age ✓
Enrolment: continuous full year. ✓
No screening on record. No exclusions.
Status: non_compliant
**71113**: DOB 1979-02-27 → 47 years old. Age ✓
Enrolment: continuous. ✓
Screening: CT colonography 2020-07-03 (outside 5-year window), flex sig 2025-11-08 (within 5-year window 2022-2026) → N3 met.
But E1: C18.7 diagnosis 2025-07-17 → colorectal cancer. Exclusion applies.
Status: excluded
**71114**: DOB 1951-11-18 → 75 years old. Age ✓
Enrolment: continuous. ✓
Screening: CT colonography 2021-12-07 (outside 5-year window 2022-2026). Not numerator.
Exclusions: E4 check - age 75 (≥66), frailty documented 2026-12-17, advanced illness documented 2026-05-05. Both during measurement year. E4 applies.
Status: excluded
**71115**: DOB 1979-09-19 → 47 years old. Age ✓
Enrolment: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. Gap of 35 days (one gap ≤45 days). ✓
Screening: Colonoscopy 2016-12-23 (outside 10-year window 2017-2026). Not numerator.
Exclusions: E4 - age 47 (<66). Doesn't apply. No other exclusions.
Status: non_compliant
**71116**: DOB 1976-01-11 → 50 years old. Age ✓
Enrolment: gap of 35 days (one gap ≤45). ✓
Screening: Stool DNA 2023-01-09 (outside 3-year window 2024-2026). Not numerator.
No exclusions.
Status: non_compliant
**71117**: DOB 1963-09-02 → 63 years old. Age ✓
Enrolment: 2026-01-01 to 2026-06-02; 2026-07-18 to 2026-12-31. Gap of 45 days (one gap ≤45). ✓
Screening: Stool DNA 2026-01-11 (within 2026). N2 met. ✓
No exclusions (age 63 <66, no E4).
Status: compliant
**71118**: DOB 1979-03-23 → 47 years old. Age ✓
Enrolment: 2026-01-01 to 2026-06-14; 2026-07-27 to 2026-12-31. Gap of 42 days (one gap ≤45). ✓
Screening: Flex sig 2021-11-12 (outside 5-year window), flex sig 2022-07-04 (within 5-year window 2022-2026). N3 met. ✓
No exclusions.
Status: compliant
**71119**: DOB 1950-03-25 → 76 years old. Age ✗ (76 > 75)
Status: not_eligible
**71120**: DOB 1951-03-21 → 75 years old. Age ✓
Enrolment: continuous. ✓
No screening on record. Not numerator.
Exclusions: E4 - age 75 (≥66), advanced illness 2026-02-01, but no frailty documented. Frailty alone doesn't exclude, advanced illness alone doesn't exclude. Need both. No frailty → E4 doesn't apply.
Status: non_compliant
**71121**: DOB 1971-08-17 → 55 years old. Age ✓
Enrolment: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gaps of 28 and 15 days. Two gaps. The requirement says "no more than one gap of up to 45 days." Two gaps → NOT eligible.
Status: not_eligible
**71122**: DOB 1954-09-15 → 72 years old. Age ✓
Enrolment: 2026-03-22 through 2026-12-31, not enrolled before. Gap from 2026-01-01 to 2026-03-21 is more than 45 days. NOT continuously enrolled.
Status: not_eligible
**71123**: DOB 1959-03-08 → 67 years old. Age ✓
Enrolment: 2026-01-01 to 2026-02-23; 2026-03-09 to 2026-06-27; 2026-07-23 to 2026-12-31. Gaps of 13 and 25 days. Two gaps → NOT eligible.
Status: not_eligible
**71124**: DOB 1960-08-15 → 66 years old. Age ✓
Enrolment: continuous. ✓
Screening: Flex sig 2026-04-15 (within 2026). N3 met. ✓
Exclusions: E4 - age 66 (≥66), but no frailty or advanced illness documented. Doesn't apply.
Status: compliant
**71125**: DOB 1950-05-08 → 76 years old. Age ✗ (76 > 75)
Status: not_eligible
**71126**: DOB 1981-12-20 → 45 years old. Age ✗ (45 < 46)
Status: not_eligible
**71127**: DOB 1981-01-14 → 45 years old. Age ✗ (45 < 46)
Status: not_eligible
**71128**: DOB 1951-12-10 → 75 years old. Age ✓
Enrolment: continuous. ✓
Screening: CT colonography 2020-02-10 (outside 5-year window), stool DNA 2026-08-17 (within 2026). N2 met. ✓
No exclusions.
Status: compliant
**71129**: DOB 1959-07-23 → 67 years old. Age ✓
Enrolment: continuous. ✓
Screening: Flex sig 2023-07-08 (within 5-year window 2022-2026). N3 met. ✓
No exclusions (age 67 ≥66 but no frailty/advanced illness).
Status: compliant
**71130**: DOB 1981-09-13 → 45 years old. Age ✗ (45 < 46)
Status: not_eligible
Wait, let me recheck. DOB 1981-09-13. On 2026-12-31, age = 2026 - 1981 = 45 (hasn't had birthday yet? No, September is before December). So 45 years old. 45 < 46. Not eligible.
Status: not_eligible
**71131**: DOB 1950-05-05 → 76 years old. Age ✗ (76 > 75)
Status: not_eligible
**71132**: DOB 1950-02-01 → 76 years old. Age ✗ (76 > 75)
Status: not_eligible
Wait, but this member has colorectal cancer diagnosis (C18.7) from 2019-11-07. But since age fails first, they're not_eligible. The rule says: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
Status: not_eligible
**71133**: DOB 1967-01-22 → 59 years old. Age ✓
Enrolment: continuous. ✓
Screening: CT colonography 2021-04-12 and 2021-09-09 (both outside 5-year window 2022-2026). Not numerator.
No exclusions.
Status: non_compliant
**71134**: DOB 1981-09-26 → 45 years old. Age ✗ (45 < 46)
Status: not_eligible
Wait, DOB 1981-09-26. On 2026-12-31, age = 45. 45 < 46. Not eligible. Even though total colectomy (E2) is documented, age fails first.
Status: not_eligible
**71135**: DOB 1971-08-26 → 55 years old. Age ✓
Enrolment: continuous. ✓
Screening: Colonoscopy 2016-11-12. 10-year window is 2017-2026. 2016-11-12 is before 2017. Outside window. Not numerator.
No exclusions.
Status: non_compliant
**71136**: DOB 1981-11-11 → 45 years old. Age ✗ (45 < 46)
Status: not_eligible
Wait, DOB 1981-11-11. On 2026-12-31, age = 45 (birthday November, already passed). 45 < 46. Not eligible.
Hmm, let me double-check: 2026 - 1981 = 45. Yes, 45 years old. Not in 46-75 range.
Status: not_eligible
Now let me compile:
**not_eligible**: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136
Let me count: 13 not_eligible.
**excluded**: 71113 (E1), 71114 (E4)
Count: 2
**compliant**: 71117, 71118, 71124, 71128, 71129
Count: 5
**non_compliant**: 71112, 71115, 71116, 71120, 71133, 71135
Count: 6
Total: 13 + 2 + 5 + 6 = 26 ✓
denominator = compliant + non_compliant = 5 + 6 = 11
numerator = 5
excluded = 2
not_eligible = 13
rate = 5/11 * 100 = 45.4545... → 45.5json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Claude Opus 4.8 · Anthropic27.2s · 2,276 out | 30.1s · 2,594 out | 31.2s · 2,728 out
Reasoning · 2,061 tokens
[omitted]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
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}Reasoning · 2,379 tokens
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Grader detail
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}Reasoning · 2,513 tokens
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Grader detail
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}100Claude Sonnet 5 · Anthropic42.3s · 4,866 out | 50.7s · 6,174 out | 50.9s · 5,674 out
Reasoning · 4,651 tokens
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Grader detail
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}Reasoning · 5,959 tokens
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Grader detail
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}Reasoning · 5,459 tokens
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Grader detail
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}100Claude Sonnet 4.6 · Anthropic85.5s · 5,936 out | 92.1s · 6,511 out | 105.0s · 7,640 out
Reasoning · 5,739 tokens
Let me work through each member systematically.
**Eligibility criteria:**
- 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 criteria (any one):**
- N1: FOBT or FIT during 2026
- N2: Stool DNA during 2026 or 2024-2025 (3-year window: 2024-01-01 to 2026-12-31)
- N3: Flexible sigmoidoscopy in 2026 or the four years prior
- N4: CT colonography in 2026 or the four years prior
- N5: Colonoscopy in 2026 or the nine years prior
**Exclusions:**
- E1: Colorectal cancer diagnosis anytime on/before 2026-12-31
- E2: Total colectomy anytime on/before 2026-12-31
- E3: Hospice enrollment during the measurement year
- E4: Age 66+ combined with frailty and advanced illness indicators
Now checking each member against these criteria. Starting with member 71111 (age 55, male): their enrollment only runs from 2026-05-01 through year-end, missing January through April entirely — this isn't a gap that could be excused under the 45-day allowance, since they simply weren't enrolled at the start of the measurement year at all, so this member fails the continuous enrollment requirement.
Moving to member 71112 (age 72, female): full-year enrollment with no gaps, age fits the 46-75 range, no exclusions apply, and there's no screening on record, so this member is non-compliant.
For member 71113 (age 47, female): full-year enrollment, age qualifies, but they have a colorectal cancer diagnosis (C18.7) from July 2025, which triggers exclusion E1, so this member is excluded.
Now checking member 71114 (age 75, female) for enrollment continuity.
Member 71115: E4 doesn't apply since age is under 66. Checking numerator - colonoscopy from 2016-12-23 falls outside the required 10-year window starting 2017-01-01, and no other screening exists, so this member is **non_compliant**.
Member 71116: Enrollment gap of 35 days is within limits, age 50 qualifies, no exclusions apply. Checking the stool DNA test from 2023-01-09 against the required window of 2024-01-01 to 2026-12-31.
Since 2023-01-09 falls before the window starts, this member is **non_compliant**.
Now moving to Member 71117 (age 63, Female), checking enrollment continuity - there's a 45-day gap between June and July coverage periods, which is right at the boundary limit.
Recounting the gap carefully: from June 3 to July 17 inclusive comes out to exactly 45 days, so this qualifies. Their stool DNA screening on 2026-01-11 falls within the 2026 measurement year, meeting the N2 requirement with no exclusions applying, making this member **compliant**.
Moving on to Member 71118 (age 47, Female), examining their enrollment periods which show a gap between June 15 and July 26.
Member 71120: full year enrolled, age 75, no qualifying exclusion since frailty isn't documented alongside the advanced illness, and no screening on record — non_compliant.
Now checking member 71121, age 55, with a fragmented enrollment history across multiple periods in 2026.
Two gaps totaling 28 and 15 days each exceed the allowed single-gap criterion, so this member is not_eligible.
Member 71122 wasn't enrolled at the start of the year, only joining March 22, so they fail the full-year enrollment requirement and are not_eligible.
Now looking at member 71123, age 67, with enrollment split across three periods, checking the gap lengths between them.
This member has two gaps totaling 13 and 25 days, again exceeding the single-gap allowance, so not_eligible.
Member 71124, age 66 with full-year enrollment and no gaps, meets the age criteria and has no exclusions; their flexible sigmoidoscopy on April 15, 2026 satisfies the screening requirement, making them compliant.
Member 71125 turns 76 by year-end, putting them outside the eligible 46-75 age range, so not_eligible.
Checking member 71126, who is 45 years old and also falls outside the age range.
Continuing through 71127 (also 45, ineligible on age), then 71128 who is 75 with full enrollment and no exclusions — their 2020 CT colonography falls outside the valid window, but a stool DNA test in August 2026 satisfies the screening requirement, making them compliant. Now I'm moving into checking member 71129's details.
Right, age disqualifies before diagnosis matters, so member 71130 is not_eligible.
Members 71131 and 71132 also fall outside the age range and are not_eligible.
For member 71133, age and enrollment check out, but the CT colonography from 2021-04-12 falls before the N4 window starting 2022-01-01, so it doesn't count—I need to check if there's another qualifying screening.
Member 71134 fails on age despite having a total colectomy documented, so per the rule that age/event/enrollment failures take precedence, they're not_eligible regardless of the exclusion.
Member 71135 passes enrollment and age checks with no exclusions, but their 2016-11-12 colonoscopy predates the N5 window starting 2017-01-01, making them non_compliant.
Member 71136 is another age-45 case, outside the range, so not_eligible.
Now I'm compiling the full not_eligible list, gathering all members who failed on enrollment gaps or age across the roster.
Then I'm sorting excluded members - 71113 for colorectal cancer history and 71114 for age/frailty criteria - giving 2 excluded.
Compiling compliant members next: those with valid stool DNA tests, flexible sigmoidoscopies, or other screenings within the required windows, totaling 5 compliant so far.
Now I'm starting to review non_compliant cases, beginning with 71112 who has no screening on record, and checking 71115's older colonoscopy date against the compliance window.
Continuing the non_compliant list, then verifying totals: denominator (compliant + non_compliant), numerator, excluded, and not_eligible all sum correctly to 26, and calculating the compliance rate as 5/11, which rounds to 45.5%. Now I'm double-checking 71115's colonoscopy date against the ten-year lookback window.
2022-07-04 is within, compliant. Same for 71129's 2023-07-08.
71114 qualifies for exclusion E4: age 75 with both frailty and advanced illness documented during the measurement year.
Now I'm double-checking the gap calculations. For 71117, the coverage lapse from June 3 through July 17 totals 45 days exactly, meeting the threshold. For 71118, I'm working through the gap from June 15 through July 26.
For 71116, I'm confirming a 35-day gap from March 17 through April 20, and similarly for 71115, a 35-day gap from July 17 through August 20.
Now I'm tracking 71121's two separate gaps, starting with the March 22 to April 18 gap totaling 28 days.
eligible too, missing Jan-Apr. Then checking 71131 and 71132: both turn 76 during 2026, making them age 76 as of Dec 31, which falls outside the 46-75 range, so not_eligible for both. Now moving on to verify ages for the remaining members like 71112.
With everything checked, I land on the final results: denominator 11, numerator 5, excluded 2, not_eligible 13, rate 45.5%, with compliant members 71117, 71118, 71124, 71128, 71129, and non-compliant members 71112, 71115, 71116, 71120, 71133, 71135.
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Grader detail
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},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,314 tokens
Let me analyze each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION criteria:**
- 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 criteria (any one of):**
- N1: FOBT/FIT during 2026
- N2: Stool DNA during 2026 or two years prior (2024-01-01 to 2026-12-31)
- N3: Flexible sigmoidoscopy within four years prior, N4: CT colonography within four years prior, N5: Colonoscopy within nine years prior
**EXCLUSIONS:** colorectal cancer or total colectomy any time, hospice during the measurement year, or age 66+ with both frailty and advanced illness.
Now working through each member, I'm checking member 71111 (age 55) whose enrollment only starts May 1, 2026 - since they were never enrolled at the start of the year rather than having a gap, this doesn't meet the continuous enrollment requirement, so they should be marked not eligible.
For member 71112 (age 72), enrollment is continuous for the full year and age is in range, but there's no screening history and no exclusions apply, so this member is eligible but non-compliant.
For member 71113 (age 47), enrollment and age both check out, but a C18.7 colorectal cancer diagnosis in 2025 triggers exclusion E1, overriding any screening history - so this member is excluded.
For member 71114 (age 75), the E4 exclusion applies since age ≥66, frailty indicator, and advanced illness diagnosis all fall within the measurement year - excluding this member.
Now checking member 71115 (age 47), whose enrollment has a gap from July 17 to August 20, which is 35 days - within the 45-day allowance for continuous enrollment.
I'm checking whether E4 applies here, but the member is only 47, so this exclusion doesn't apply. Looking at colonoscopy screening history, the 2016-12-23 exam falls just before the qualifying window starting 2017-01-01, so it doesn't count. I'm now double-checking exactly how the "nine years prior" window should be calculated to make sure I'm not miscounting the boundary date.
That colonoscopy date falls before the window start, so it's non-compliant.
For member 71116, I'm checking enrollment gaps (35 days, within tolerance) and age eligibility (50, compliant), then looking at the stool DNA screening from 2023-01-09 against the three-year window starting 2024-01-01 - that date is too early to count, so I need to reconsider the correct window boundaries for this test type.
For member 71117, enrollment gaps of exactly 45 days pass the threshold, age 63 qualifies, and the 2026-01-11 stool DNA test falls within the current year, making this member compliant. Now I'm moving on to member 71118, checking their birth date to determine age eligibility.
For member 71118, age 47, the enrollment gap comes to 42 days which passes, and I'm checking their sigmoidoscopy history—the 2021 exam falls outside the five-year window but the 2022-07-04 exam looks like it qualifies.
Marking 71118 as compliant. Moving to member 71119, age 76 puts them outside the eligible range, so not_eligible. Member 71120, age 75, has continuous enrollment and no disqualifying exclusion since only advanced illness is documented without frailty, and with no screening on record they're non_compliant. Now starting on member 71121's enrollment details.
Member 71121 has two enrollment gaps (28 days and 15 days), which exceeds the allowed single gap, so I'm marking them not_eligible. Member 71122 has a large gap from missing enrollment at the start of the year, well beyond the 45-day threshold, so they're also not_eligible.
Member 71123 also shows two separate gaps (13 days and 25 days) in their 2026 enrollment, which again violates the one-gap rule, so this member fails eligibility too.
Moving through the remaining members: 71124 has continuous enrollment, is age 66, has no exclusions, and completed a flexible sigmoidoscopy in April 2026, so they're compliant. 71125 is 76, 71126 is 45, and both fall outside the eligible 46-75 age range, making them not_eligible.
For 71127, age 45 also puts them outside the range, so not_eligible. Member 71128 is 75, continuously enrolled, with no exclusions; their 2020 CT colonography falls outside the coverage window, but a 2026 stool DNA test satisfies the requirement, so they're compliant. Now checking 71129, who is 67 with continuous enrollment and no exclusions, looking at their 2023 flexible sigmoidoscopy screening.
Member 71129's sigmoidoscopy falls within the valid window, so they're compliant. Members 71130 (45), 71131 (76), and 71132 (76) all fall outside the eligible age range and are not_eligible regardless of diagnosis codes present. Now I'm starting to evaluate member 71133, age 59 with full enrollment.
Working out the ten-year window more precisely: nine years prior to 2026 pushes the start to 2017-01-01, meaning the 2016-11-12 colonoscopy falls just outside the eligible range. That makes member 71135 **non_compliant**.
Checking member 71136 next: born 1981-11-11, they're 45 years old, which falls outside the 46-75 eligibility range, so despite having advanced illness noted, age alone makes them **not_eligible**.
Now I'm tallying up the not_eligible list — gaps in enrollment, partial-year coverage, and age exclusions account for 13 members total (71111, 71119, 71121-71123, 71125-71127, 71130-71132, 71134, 71136). Moving on to compile the excluded category next.
Excluded members are 71113 (colorectal cancer diagnosis) and 71114 (advanced illness plus frailty indicators during the measurement year), giving 2 excluded.
For compliant, I'm confirming five members met screening criteria through various valid methods — stool DNA tests, flexible sigmoidoscopy within the five-year window — landing on 5 compliant.
For non_compliant, six members either had no screening at all or had tests that fell outside the required time windows, giving 6 non_compliant.
Adding it all up: 13 + 2 + 5 + 6 = 26, which checks out against the total population. That gives a denominator of 11 (5 compliant + 6 non_compliant), a numerator of 5, 2 excluded, and 13 not_eligible — working out to a compliance rate of roughly 45.45%.
Now I'm double-checking my date-window logic for one borderline case, a colonoscopy from December 2016 that needs to fall within the ten-year lookback. I'm testing different interpretations of "nine years prior to 2026" — whether that means the window starts January 1, 2017, or whether it should be anchored to December 31, 2016 — but either way this particular test still falls outside the valid window.
71116 has the same issue: colonoscopy on 2016-11-12 also falls before the 2017-01-01 cutoff, so it's outside the window and non-compliant too. Moving to 71116, checking stool DNA from 2023-01-09 against the three-year window—"during 2026 or the two years prior" means 2024-2026, so I need to verify if 2023 falls within that range.
Working through 71133 next, CT colonography dates in 2021 fall outside the five-year window of 2022-2026, so that's non-compliant. Then 71118's flexible sigmoidoscopy from 2022-07-04 falls within the same five-year window, making it compliant. For 71129, both the flexible sigmoidoscopy from 2023-07-08 and CT colonography from 2023-09-13 fall within the 2022-2026 window.
Reviewing 71114 again, age 75 meets the threshold, and both frailty and advanced illness documentation dates fall within measurement year 2026, so exclusion E4 applies correctly. For 71115, age 47 is under the 66 threshold so E4 doesn't apply despite having frailty and advanced illness documented, putting this case in the denominator as non-compliant. Now checking enrollment continuity for 71117, there's a gap between June 3 and July 17 that needs closer examination.
That confirms 45 days total, which is exactly at the allowed threshold, so it passes. Checking the other cases: 71118 has a gap of 42 days and 71116 has a gap of 35 days, both comfortably within the 45-day limit.
Sorting all cases into compliant, non-compliant, excluded, and not-eligible buckets, the counts add up to 26 total. With 5 compliant and 6 non-compliant out of 11 eligible cases, the compliance rate comes out to 45.5%.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
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"want": 11,
"got": 11,
"ok": true,
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"got": 5,
"ok": true,
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},
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"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
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"want": 13,
"got": 13,
"ok": true,
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},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
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},
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"ok": true,
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},
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},
{
"field": "not_eligible_members",
"want": [
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"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,443 tokens
Let me work through each member systematically.
**Eligible Population Criteria:**
- 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
**Status order:** not_eligible → excluded → compliant/non_compliant
Let me go through each member:
---
**MEMBER 71111** — DOB 1971-04-18, age 55 on 2026-12-31.
- Age: 55 ✓ (46-75)
- Enrollment only runs 2026-05-01 through 2026-12-31, missing Jan-Apr — not enrolled for the full measurement year, so this fails continuous enrollment.
- → not_eligible
Member 71112 — DOB 1954-02-14, age 72 on 2026-12-31. Age qualifies (46-75), enrollment is continuous with no gaps, and no exclusions apply (no colorectal cancer, colectomy, hospice, frailty, or advanced illness). Since they're 66+ but lack both frailty and advanced illness, exclusion E4 doesn't apply here.
Member 71113 — DOB 1979-02-27, age 47 on 2026-12-31. Enrollment is continuous with no gaps, but they have a C18.7 diagnosis (malignant neoplasm of sigmoid colon) from 2025-07-17, which triggers exclusion E1 for colorectal cancer, so they're excluded from the measure.
Member 71114 — DOB 1951-11-18, age 75 on 2026-12-31. Age qualifies, and enrollment is continuous with no gaps.
I'm checking whether age 66+ plus both frailty documentation (2026-12-17) and advanced illness documentation (2026-05-05) within the measurement year trigger the E4 exclusion, which it does, so this member is excluded.
Member 71115 — DOB 1979-09-19, age 47 on 2026-12-31, qualifying for the age range. I'm checking the enrollment gap of 35 days between 2026-07-16 and 2026-08-21 against the allowable gap threshold.
Since this member is only 47, E4 doesn't apply regardless of frailty or advanced illness, and there's no colorectal cancer, colectomy, or hospice exclusion either. For the numerator, I'm looking at a colonoscopy from 2016-12-23 and calculating whether it falls within the ten-year look-back window ending 2026-12-31, working out that nine years prior to that date lands on 2017-01-01.
I'm double-checking this window calculation since it's borderline—2016-12-23 could fall just outside or just inside depending on exactly how "nine years prior" is defined relative to the anchor date.
Confirming the window is 2017-01-01 through 2026-12-31, so 2016-12-23 falls before the start and doesn't qualify → **non_compliant**. Moving on to the next member, DOB 1976-01-11, age 50 as of 2026.
Age 50 falls within the 46-75 range, and enrollment checks out with only a 35-day gap. No exclusions apply. For the numerator, checking the stool DNA test from 2023-01-09 against the two-years-prior window (2024-2025 plus 2026), which starts 2024-01-01 — so 2023-01-09 falls outside and doesn't count.
This means the member has no qualifying screening, making them non-compliant.
Moving to member 71117, DOB 1963-09-02, age 63 as of year-end, which is within range. Checking enrollment periods with a gap of 45 days in June.
That confirms 45 days, within the limit, so this member is compliant given the stool DNA test in January 2026 falls within the required window.
Now checking member 71118, born March 1979, age 47 as of end of 2026, within the eligible age range. Their enrollment has one gap of 42 days that I need to verify against the 45-day threshold.
I calculate the gap runs 42 days, still under the limit, so continuity holds. Looking at the numerator, an earlier flexible sigmoidoscopy from 2021 falls just outside the five-year window, but a second sigmoidoscopy from July 2022 lands within the required 2022-2026 range, so this member qualifies as compliant.
Moving to member 71119, at age 76 they exceed the 46-75 eligible range and are marked not_eligible. For member 71120, age 75 fits, enrollment is continuous through 2026 with no gaps, and I'm checking exclusions — they're 75 (meets the 66+ criterion), have an advanced illness diagnosis from February 2026 within the measurement year, no frailty documented, and now I'm checking the E4 criteria next.
Since E4 requires both frailty and advanced illness together, having only the illness isn't sufficient, so E4 doesn't apply here; with no screening on record, this member is non_compliant. Member 71121 at age 55 fits the range but has two enrollment gaps (28 and 15 days) which violates the single-gap rule, making them not_eligible. Now I'm starting to review member 71122, age 72, checking their enrollment dates.
Member 71122 wasn't enrolled until 2026-03-22, leaving an 80-day gap from Jan 1 that exceeds the 45-day threshold, so they're not_eligible on continuous enrollment grounds — no need to check exclusions since eligibility already fails. Now moving to member 71123, age 67, which falls within the valid range.
Checking their enrollment shows two separate gaps (13 and 25 days) across the year, which also disqualifies them from meeting continuous enrollment → not_eligible.
For member 71124, age 66 passes, and enrollment runs continuously through the full year with no gaps. No exclusions apply, so I'm checking the numerator criteria — they had a flexible sigmoidoscopy on 2026-04-15, which satisfies the N3 pathway for screening during 2026.
This member is compliant.
Moving through the next batch: 71125 is age 76, over the limit, so not_eligible. 71126 and 71127 are both 45, under the age threshold, so not_eligible for each. 71128 is 75, within range, with continuous enrollment and no exclusions — now checking their numerator criteria for screening completion.
Their CT colonography from 2020 falls outside the five-year lookback window, but a stool DNA test from August 2026 satisfies the requirement, so this member is compliant.
Now moving to 71129, age 67, within the eligible range with continuous enrollment throughout 2026.
For 71130 with a colorectal cancer diagnosis on record, their sigmoidoscopy and CT colonography both fall within the required windows, making them compliant as well.
71131 is age 45 which is below the 46 minimum, so this member is not_eligible regardless of the cancer diagnosis on file.
71132 (age 76 at end of 2026) exceeds the upper age limit of 75, so this member is also not_eligible.
Now checking member 71133's date of birth.
Age check fails so this one is also not_eligible.
MEMBER 71135 — DOB 1971-08-26, age 55, meets age and enrollment criteria with no exclusions. Checking the numerator: colonoscopy on 2016-11-12, but the ten-year window for N5 requires screening between 2017-2025 or during 2026, so this date falls just outside the qualifying window.
Either way, member 71111's date falls outside the window, so that one is non_compliant. Checking member 71136, age 45 at year-end means not_eligible.
Now I'm compiling the final results list, going through each member and confirming which bucket they fall into based on enrollment gaps, age thresholds, and window compliance — building out the not_eligible group first with 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, and 71131.
Adding 71132, 71134, and 71136 brings the not_eligible count to 13. Then I'm identifying the excluded members: 71113 for colorectal cancer diagnosis and 71114 for frailty plus advanced illness during the measurement year, totaling 2 excluded. Now I'm listing out compliant members based on their screening dates — stool DNA tests and flexible sigmoidoscopies falling within valid timeframes for 71117, 71118, 71124, 71128, and continuing to check 71129's sigmoidoscopy date.
Confirming 71129 as compliant, I count 5 compliant members total. Then I identify 6 non_compliant members — those with no screening or with tests that fall outside their valid windows (colonoscopy beyond 10 years, stool DNA beyond 3 years, CT colonography beyond 5 years). Verifying the totals: 13 + 2 + 5 + 6 = 26 checks out, and the denominator for the measure is compliant plus non_compliant.
So denominator = 11, numerator = 5, excluded = 2, not_eligible = 13, giving a rate of 5/11 × 100 = 45.5%. I'm now spot-checking edge cases — for 71111, despite having a valid gap pattern, they weren't enrolled at all for the first four months of the year, which disqualifies them from continuous enrollment rather than counting as an allowable gap, so they're correctly marked not_eligible. For 71115, I'm confirming the 35-day gap is within the allowed threshold and checking whether any frailty or advanced illness exclusion applies.
Now I'm working through the colonoscopy screening window for 71115, who had a colonoscopy on 2016-12-23. The spec defines this as occurring "during 2026 or the nine years prior," measured back from 2026-12-31 as a ten-year window, and I'm trying to pin down exactly how that window's start date should be calculated — whether it's the start of 2017, or 2017-12-31, since a strict ten-year span back from 2026-12-31 would actually reach back to 2016-12-31.
Reading "during 2026 or the nine years prior" as calendar years, the natural interpretation is 2026 plus the nine preceding calendar years (2017-2025), giving a window of 2017-01-01 to 2026-12-31. Since this patient's colonoscopy on 2016-12-23 falls just before that window starts, I'm marking them non_compliant for measure 71115, and now moving on to check the stool DNA test for measure 71116.
Checking the stool DNA test on 2023-01-09 against the two-year-prior window (2024-2026): since 2023 falls outside that range, this is non_compliant. For 71133, the CT colonography dates in 2021 fall outside the four-year-prior window (2022-2026), so that's also non_compliant. Now I'm checking the colonoscopy from 2016-11-12 against the ten-year window for measure 71135.
For 71118's flexible sigmoidoscopy, the 2021 date is outside the five-year window but the 2022-07-04 date falls within it, making that compliant. Similarly for 71129, the 2023 sigmoidoscopy date lands within the 2022-2026 window, so it's compliant too. For 71114, both frailty and advanced illness were documented during the measurement year, triggering the E4 exclusion.
For 71122, enrollment starting 2026-03-22 means they're missing the first 80 days of the year — not a gap, but simply not enrolled — so they fail the full measurement year requirement and are not_eligible. Their advanced illness diagnosis on 2026-01-13 falls before enrollment even starts, but this is moot since they're already excluded from the eligible population due to enrollment timing. 71121 has two enrollment gaps (28 and 15 days), confirming not_eligible there as well.
71123 also has two gaps (13 and 25 days), so not_eligible. I've now verified all 26 members are accounted for, and I'm tallying the final counts: 13 not_eligible, 2 excluded, 5 compliant, and 6 non_compliant members.
Computing the rate: with a denominator of 11 (5 compliant + 6 non_compliant) and numerator of 5, that gives 45.4545...%, rounding to 45.5.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
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"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
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},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
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},
{
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"want": 13,
"got": 13,
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{
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"want": 45.5,
"got": 45.5,
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"want": [
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"ok": true,
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}
],
"fabricated": false,
"abstained": false
}100Qwen3.7 Max · Alibaba81.6s · 6,198 out | 105.6s · 7,596 out | 100.4s · 7,487 out
Reasoning · 5,855 tokens
The task is to evaluate 26 members against the QM-CRC measure specification and classify them into compliant, non_compliant, excluded, or not_eligible.
Measure: QM-CRC
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 (look-back window from 2026-12-31):
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, 2023, 2024, 2025, 2026).
N5. Colonoscopy during 2026 or the nine years prior (2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 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 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Let's evaluate each member:
MEMBER 71111
DOB: 1971-04-18, Age 55.
Enrolment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. Gap is > 45 days (Jan 1 to Apr 30 is ~120 days).
Status: not_eligible (enrolment)
MEMBER 71112
DOB: 1954-02-14, Age 72.
Enrolment: continuous, no gaps.
Screening: None.
Exclusions: None.
Status: non_compliant
MEMBER 71113
DOB: 1979-02-27, Age 47.
Enrolment: continuous, no gaps.
Screening: 2020-07-03 CT colonography (outside 5-yr window: 2022-2026). 2025-11-08 Flex sig (within 5-yr window).
Exclusions: 2025-07-17 Diagnosis C18.7 (Colorectal cancer).
Status: excluded (E1)
MEMBER 71114
DOB: 1951-11-18, Age 75.
Enrolment: continuous, no gaps.
Screening: 2021-12-07 CT colonography (outside 5-yr window: 2022-2026).
Exclusions: Age 75 (>= 66). Frailty (2026-12-17) and Advanced illness (2026-05-05) both documented in 2026.
Status: excluded (E4)
MEMBER 71115
DOB: 1979-09-19, Age 47.
Enrolment: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. Gap of 35 days (<= 45). Continuous enrolment met.
Screening: 2016-12-23 Colonoscopy (outside 10-yr window: 2017-2026).
Exclusions: Age 47 (< 66). Frailty and advanced illness don't trigger E4.
Status: non_compliant
MEMBER 71116
DOB: 1976-01-11, Age 50.
Enrolment: Gap of 35 days (<= 45). Met.
Screening: 2023-01-09 Stool DNA test (within 3-yr window: 2024, 2025, 2026? Wait. "during 2026 or the two years prior" means 2024, 2025, 2026. 2023 is outside the 3-year window).
Let's re-read N2: "Stool DNA test during 2026 or the two years prior (three-year window)."
Measurement year is 2026. Two years prior are 2025 and 2024. So 2024-01-01 to 2026-12-31.
2023-01-09 is outside.
Exclusions: None.
Status: non_compliant
MEMBER 71117
DOB: 1963-09-02, Age 63.
Enrolment: Gap of 45 days (<= 45). Met.
Screening: 2026-01-11 Stool DNA test (within 3-yr window).
Exclusions: None.
Status: compliant
MEMBER 71118
DOB: 1979-03-23, Age 47.
Enrolment: Gap of 42 days (<= 45). Met.
Screening: 2021-11-12 Flex sig (outside 5-yr). 2022-07-04 Flex sig (within 5-yr window: 2022, 2023, 2024, 2025, 2026).
Exclusions: None.
Status: compliant
MEMBER 71119
DOB: 1950-03-25, Age 76.
Age > 75.
Status: not_eligible (age)
MEMBER 71120
DOB: 1951-03-21, Age 75.
Enrolment: continuous.
Screening: None.
Exclusions: Age 75 (>= 66). Advanced illness documented, but NO frailty. E4 requires BOTH.
Status: non_compliant
MEMBER 71121
DOB: 1971-08-17, Age 55.
Enrolment: Gaps of 28 and 15 days. Wait, "no more than one gap of up to 45 days". This member has TWO gaps.
Status: not_eligible (enrolment)
MEMBER 71122
DOB: 1954-09-15, Age 72.
Enrolment: 2026-03-22 through 2026-12-31. Not enrolled before. Gap > 45 days.
Status: not_eligible (enrolment)
MEMBER 71123
DOB: 1959-03-08, Age 67.
Enrolment: Gaps of 13 and 25 days. TWO gaps.
Status: not_eligible (enrolment)
MEMBER 71124
DOB: 1960-08-15, Age 66.
Enrolment: continuous.
Screening: 2026-04-15 Flex sig (within 5-yr).
Exclusions: None.
Status: compliant
MEMBER 71125
DOB: 1950-05-08, Age 76.
Age > 75.
Status: not_eligible (age)
MEMBER 71126
DOB: 1981-12-20, Age 45.
Age < 46.
Status: not_eligible (age)
MEMBER 71127
DOB: 1981-01-14, Age 45.
Age < 46.
Status: not_eligible (age)
MEMBER 71128
DOB: 1951-12-10, Age 75.
Enrolment: continuous.
Screening: 2020-02-10 CT (outside). 2026-08-17 Stool DNA (within 3-yr).
Exclusions: None.
Status: compliant
MEMBER 71129
DOB: 1959-07-23, Age 67.
Enrolment: continuous.
Screening: 2023-07-08 Flex sig (within 5-yr: 2022-2026). 2023-09-13 CT (within 5-yr).
Exclusions: None.
Status: compliant
MEMBER 71130
DOB: 1981-09-13, Age 45.
Age < 46.
Status: not_eligible (age)
MEMBER 71131
DOB: 1950-05-05, Age 76.
Age > 75.
Status: not_eligible (age)
MEMBER 71132
DOB: 1950-02-01, Age 76.
Age > 75.
Status: not_eligible (age)
MEMBER 71133
DOB: 1967-01-22, Age 59.
Enrolment: continuous.
Screening: 2021-04-12 CT (outside 5-yr). 2021-09-09 CT (outside 5-yr).
Exclusions: None.
Status: non_compliant
MEMBER 71134
DOB: 1981-09-26, Age 45.
Age < 46.
Status: not_eligible (age)
MEMBER 71135
DOB: 1971-08-26, Age 55.
Enrolment: continuous.
Screening: 2016-11-12 Colonoscopy (outside 10-yr: 2017-2026).
Exclusions: None.
Status: non_compliant
MEMBER 71136
DOB: 1981-11-11, Age 45.
Age < 46.
Status: not_eligible (age)
Let's double check some members.
MEMBER 71111: Age 55. Enrolment 2026-05-01 to 12-31. Not eligible (enrolment).
MEMBER 71112: Age 72. Enrolment continuous. No screening. Non-compliant.
MEMBER 71113: Age 47. Enrolment continuous. Excluded (E1 - CRC).
MEMBER 71114: Age 75. Excluded (E4 - Age>=66, frailty + advanced illness).
MEMBER 71115: Age 47. Gap 35 days. 2016-12-23 Colonoscopy (10 years prior is 2017-2026, so 2016 is out). Non-compliant.
MEMBER 71116: Age 50. Gap 35 days. 2023-01-09 Stool DNA (3 years prior is 2024-2026, so 2023 is out). Non-compliant.
MEMBER 71117: Age 63. Gap 45 days. 2026-01-11 Stool DNA. Compliant.
MEMBER 71118: Age 47. Gap 42 days. 2022-07-04 Flex sig (5 years prior is 2022-2026). Compliant.
MEMBER 71119: Age 76. Not eligible (age).
MEMBER 71120: Age 75. Advanced illness, no frailty. Non-compliant.
MEMBER 71121: Age 55. Two gaps (28 and 15 days). "no more than one gap". Not eligible (enrolment).
MEMBER 71122: Age 72. Enrolment starts 2026-03-22. Not eligible (enrolment).
MEMBER 71123: Age 67. Two gaps (13 and 25 days). Not eligible (enrolment).
MEMBER 71124: Age 66. 2026-04-15 Flex sig. Compliant.
MEMBER 71125: Age 76. Not eligible (age).
MEMBER 71126: Age 45. Not eligible (age).
MEMBER 71127: Age 45. Not eligible (age).
MEMBER 71128: Age 75. 2026-08-17 Stool DNA. Compliant.
MEMBER 71129: Age 67. 2023-07-08 Flex sig. Compliant.
MEMBER 71130: Age 45. Not eligible (age).
MEMBER 71131: Age 76. Not eligible (age).
MEMBER 71132: Age 76. Not eligible (age).
MEMBER 71133: Age 59. 2021 CT (out). Non-compliant.
MEMBER 71134: Age 45. Not eligible (age).
MEMBER 71135: Age 55. 2016 Colonoscopy (out). Non-compliant.
MEMBER 71136: Age 45. Not eligible (age).
Let's recount to ensure 26 members:
71111: not_eligible
71112: non_compliant
71113: excluded
71114: excluded
71115: non_compliant
71116: non_compliant
71117: compliant
71118: compliant
71119: not_eligible
71120: non_compliant
71121: not_eligible
71122: not_eligible
71123: not_eligible
71124: compliant
71125: not_eligible
71126: not_eligible
71127: not_eligible
71128: compliant
71129: compliant
71130: not_eligible
71131: not_eligible
71132: not_eligible
71133: non_compliant
71134: not_eligible
71135: non_compliant
71136: not_eligible
Total: 26 members.
Lists:
compliant: 71117, 71118, 71124, 71128, 71129 (5)
non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 (6)
excluded: 71113, 71114 (2)
not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 (13)
Total = 5 + 6 + 2 + 13 = 26.
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = compliant = 5.
Excluded = 2.
Not eligible = 13.
Rate = 5 / 11 * 100 = 45.4545... -> 45.5
Let me re-verify all windows and ages.
Age on 2026-12-31:
71111: 1971 -> 55
71112: 1954 -> 72
71113: 1979 -> 47
71114: 1951 -> 75
71115: 1979 -> 47
71116: 1976 -> 50
71117: 1963 -> 63
71118: 1979 -> 47
71119: 1950 -> 76
71120: 1951 -> 75
71121: 1971 -> 55
71122: 1954 -> 72
71123: 1959 -> 67
71124: 1960 -> 66
71125: 1950 -> 76
71126: 1981 -> 45
71127: 1981 -> 45
71128: 1951 -> 75
71129: 1959 -> 67
71130: 1981 -> 45
71131: 1950 -> 76
71132: 1950 -> 76
71133: 1967 -> 59
71134: 1981 -> 45
71135: 1971 -> 55
71136: 1981 -> 45
Ages 46-75:
71111 (55) - NE (enrol)
71112 (72) - NC
71113 (47) - Excl
71114 (75) - Excl
71115 (47) - NC
71116 (50) - NC
71117 (63) - C
71118 (47) - C
71119 (76) - NE
71120 (75) - NC
71121 (55) - NE (enrol)
71122 (72) - NE (enrol)
71123 (67) - NE (enrol)
71124 (66) - C
71125 (76) - NE
71126 (45) - NE
71127 (45) - NE
71128 (75) - C
71129 (67) - C
71130 (45) - NE
71131 (76) - NE
71132 (76) - NE
71133 (59) - NC
71134 (45) - NE
71135 (55) - NC
71136 (45) - NE
Check 71115: 2016-12-23 Colonoscopy. 10-year window is 2017-01-01 to 2026-12-31. 2016 is out. NC. Correct.
Check 71116: 2023-01-09 Stool DNA. 3-year window is 2024-01-01 to 2026-12-31. 2023 is out. NC. Correct.
Check 71118: 2022-07-04 Flex sig. 5-year window is 2022-01-01 to 2026-12-31. 2022 is in. C. Correct.
Check 71120: Age 75. Advanced illness only. E4 requires BOTH. So not excluded. NC. Correct.
Check 71124: Age 66. 2026 Flex sig. C. Correct.
Check 71128: Age 75. 2026 Stool DNA. C. Correct.
Check 71129: Age 67. 2023 Flex sig (5-yr window 2022-2026). C. Correct.
Check 71133: Age 59. 2021 CT (5-yr window 2022-2026). NC. Correct.
Check 71135: Age 55. 2016 Colonoscopy. NC. Correct.
Wait, are there any other exclusions?
71113: C18.7 in 2025. Excluded.
71114: Age 75, Frailty + Advanced Illness in 2026. Excluded.
71130: Age 45. NE. (Also has C18.7, but NE takes precedence as per instructions: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented").
71132: Age 76. NE. (Also has C18.7, but NE).
71134: Age 45. NE. (Also has Total colectomy, but NE).
Denominator: 11
Numerator: 5
Excluded: 2
Not Eligible: 13
Rate: 45.5
Let's do a final sanity check of the output format and values.
Keys:
"denominator": 11
"numerator": 5
"excluded": 2
"not_eligible": 13
"rate": 45.5
"compliant_members": ["71117", "71118", "71124", "71128", "71129"]
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"]
"excluded_members": ["71113", "71114"]
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Counts:
compliant: 5
non_compliant: 6
excluded: 2
not_eligible: 13
Sum = 26.
Denominator = 5 + 6 = 11.
Rate = 5 / 11 * 100 = 45.4545... -> 45.5.
Everything looks solid.
I will generate the JSON now.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,321 tokens
Let me evaluate each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION (denominator)**
- 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 two years prior (2024, 2025, 2026)
- N3. Flexible sigmoidoscopy during 2026 or four years prior (2022, 2023, 2024, 2025, 2026)
- N4. CT colonography during 2026 or four years prior (2022, 2023, 2024, 2025, 2026)
- N5. Colonoscopy during 2026 or nine years prior (2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026)
**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 2026
- E4. Age 66 or older as of 2026-12-31 AND both frailty AND advanced illness documented during 2026
Let me evaluate each member:
**MEMBER 71111**
- DOB: 1971-04-18, age 55 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. Gap from 2026-01-01 to 2026-04-30 = 120 days. This is more than 45 days. NOT eligible.
- Status: not_eligible
**MEMBER 71112**
- DOB: 1954-02-14, age 72 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator: No colorectal screening on record. Does not meet numerator.
- Status: non_compliant
**MEMBER 71113**
- DOB: 1979-02-27, age 47 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: 2025-07-17 Diagnosis C18.7 (colorectal cancer). E1 applies.
- Status: excluded
**MEMBER 71114**
- DOB: 1951-11-18, age 75 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: Age 75, which is ≥ 66. Frailty documented 2026-12-17, Advanced illness documented 2026-05-05. Both during measurement year. E4 applies.
- Status: excluded
**MEMBER 71115**
- DOB: 1979-09-19, age 47 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. ≤ 45 days, one gap. ✓
- Eligible population: Yes
- Exclusions: Age 47, not ≥ 66. E4 doesn't apply (even though frailty and advanced illness documented). No CRC, no colectomy, no hospice. No exclusions.
- Numerator: 2016-12-23 Colonoscopy. Look-back for colonoscopy is 10 years from 2026-12-31, so 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017-01-01. Does NOT meet N5.
- No other screenings. Does not meet numerator.
- Status: non_compliant
Wait, let me recalculate the 10-year window. "During 2026 or the nine years prior" means 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. So the window starts 2017-01-01. 2016-12-23 is outside this window. Correct.
**MEMBER 71116**
- DOB: 1976-01-11, age 50 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days. ≤ 45 days. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator: 2023-01-09 Stool DNA test. N2 window: 2024, 2025, 2026 (three-year window: 2026 or two years prior). 2023-01-09 is outside this window.
- No other screenings. Does not meet numerator.
- Status: non_compliant
Wait, let me reconsider N2. "Stool DNA test during 2026 or the two years prior (three-year window)." That means 2026, 2025, 2024. So starts 2024-01-01. 2023-01-09 is outside. Correct.
**MEMBER 71117**
- DOB: 1963-09-02, age 63 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days. ≤ 45 days. ✓
Wait, let me verify the gap. June 2 to July 18. The gap is from June 3 to July 17. Let me count: June has 30 days, so June 3 to June 30 = 28 days, July 1 to July 17 = 17 days. Total = 45 days. The spec says "up to 45 days" so 45 days is allowed. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator: 2026-01-11 Stool DNA test. N2 window: 2024-01-01 through 2026-12-31. 2026-01-11 is in 2026. Meets N2. ✓
- Status: compliant
**MEMBER 71118**
- DOB: 1979-03-23, age 47 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days. ≤ 45 days. ✓
Let me verify gap: June 15 to July 26. June 15-30 = 16 days, July 1-26 = 26 days. Total = 42 days. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator:
- 2021-11-12 Flexible sigmoidoscopy. N3 window: 2022-01-01 through 2026-12-31. 2021-11-12 is outside.
- 2022-07-04 Flexible sigmoidoscopy. N3 window: 2022-01-01 through 2026-12-31. 2022-07-04 is in window. Meets N3. ✓
- Status: compliant
**MEMBER 71119**
- DOB: 1950-03-25, age 76 on 2026-12-31. Age NOT eligible (must be 46-75). 76 > 75.
- Status: not_eligible
**MEMBER 71120**
- DOB: 1951-03-21, age 75 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: Age 75, ≥ 66. Advanced illness documented 2026-02-01. But no frailty documented. E4 requires BOTH frailty AND advanced illness. So E4 does not apply.
- No CRC, no colectomy, no hospice. No exclusions.
- Numerator: No colorectal screening on record. Does not meet numerator.
- Status: non_compliant
**MEMBER 71121**
- DOB: 1971-08-17, age 55 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days.
Wait, the spec says "no more than one gap of up to 45 days." This member has TWO gaps (28 days and 15 days). So this member does NOT meet continuous enrolment requirement.
- Status: not_eligible
**MEMBER 71122**
- DOB: 1954-09-15, age 72 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-03-22 through 2026-12-31. Not enrolled before 2026-03-22. Gap from 2026-01-01 to 2026-03-21 = 80 days. More than 45 days. NOT eligible.
- Status: not_eligible
**MEMBER 71123**
- DOB: 1959-03-08, age 67 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days.
Two gaps. The spec says "no more than one gap of up to 45 days." Two gaps means not eligible.
- Status: not_eligible
Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
So the member can have at most ONE gap, and that gap can be at most 45 days. Two gaps = not eligible.
**MEMBER 71124**
- DOB: 1960-08-15, age 66 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator: 2026-04-15 Flexible sigmoidoscopy. N3 window: 2022-01-01 through 2026-12-31. 2026-04-15 is in 2026. Meets N3. ✓
- Status: compliant
**MEMBER 71125**
- DOB: 1950-05-08, age 76 on 2026-12-31. Age NOT eligible (must be 46-75). 76 > 75.
- Status: not_eligible
**MEMBER 71126**
- DOB: 1981-12-20, age 45 on 2026-12-31. Age NOT eligible (must be 46-75). 45 < 46.
- Status: not_eligible
**MEMBER 71127**
- DOB: 1981-01-14, age 45 on 2026-12-31. Age NOT eligible (must be 46-75). 45 < 46.
- Status: not_eligible
**MEMBER 71128**
- DOB: 1951-12-10, age 75 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator:
- 2020-02-10 CT colonography. N4 window: 2022-01-01 through 2026-12-31. Outside.
- 2026-08-17 Stool DNA test. N2 window: 2024-01-01 through 2026-12-31. 2026-08-17 is in 2026. Meets N2. ✓
- Status: compliant
**MEMBER 71129**
- DOB: 1959-07-23, age 67 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator:
- 2023-07-08 Flexible sigmoidoscopy. N3 window: 2022-01-01 through 2026-12-31. 2023-07-08 is in window. Meets N3. ✓
- 2023-09-13 CT colonography. N4 window: 2022-01-01 through 2026-12-31. 2023-09-13 is in window. Meets N4. ✓
- Status: compliant
**MEMBER 71130**
- DOB: 1981-09-13, age 45 on 2026-12-31. Age NOT eligible (must be 46-75). 45 < 46.
- Status: not_eligible
**MEMBER 71131**
- DOB: 1950-05-05, age 76 on 2026-12-31. Age NOT eligible (must be 46-75). 76 > 75.
- Status: not_eligible
**MEMBER 71132**
- DOB: 1950-02-01, age 76 on 2026-12-31. Age NOT eligible (must be 46-75). 76 > 75.
- Status: not_eligible
**MEMBER 71133**
- DOB: 1967-01-22, age 59 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator:
- 2021-04-12 CT colonography. N4 window: 2022-01-01 through 2026-12-31. Outside.
- 2021-09-09 CT colonography. N4 window: 2022-01-01 through 2026-12-31. Outside.
- No other screenings. Does not meet numerator.
- Status: non_compliant
**MEMBER 71134**
- DOB: 1981-09-26, age 45 on 2026-12-31. Age NOT eligible (must be 46-75). 45 < 46.
- Status: not_eligible
**MEMBER 71135**
- DOB: 1971-08-26, age 55 on 2026-12-31. Age eligible (46-75). ✓
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Eligible population: Yes
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. No exclusions.
- Numerator: 2016-11-12 Colonoscopy. N5 window: 2017-01-01 through 2026-12-31. 2016-11-12 is outside this window. Does not meet N5.
- No other screenings. Does not meet numerator.
- Status: non_compliant
**MEMBER 71136**
- DOB: 1981-11-11, age 45 on 2026-12-31. Age NOT eligible (must be 46-75). 45 < 46.
- Status: not_eligible
Let me now summarize:
**Compliant:**
- 71117 (Stool DNA 2026)
- 71118 (Flex sig 2022)
- 71124 (Flex sig 2026)
- 71128 (Stool DNA 2026)
- 71129 (Flex sig 2023, CT colonography 2023)
**Non-compliant:**
- 71112 (no screening)
- 71115 (colonoscopy 2016 - outside 10yr window)
- 71116 (stool DNA 2023 - outside 3yr window)
- 71120 (no screening, advanced illness only, no frailty)
- 71133 (CT colonography 2021 - outside 5yr window)
- 71135 (colonoscopy 2016 - outside 10yr window)
**Excluded:**
- 71113 (CRC C18.7)
- 71114 (age 75, frailty + advanced illness)
**Not eligible:**
- 71111 (enrolment gap > 45 days, not enrolled before May)
- 71119 (age 76)
- 71121 (two gaps)
- 71122 (enrolment gap > 45 days, not enrolled before March)
- 71123 (two gaps)
- 71125 (age 76)
- 71126 (age 45)
- 71127 (age 45)
- 71130 (age 45)
- 71131 (age 76)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
Let me double-check counts:
- Compliant: 5 (71117, 71118, 71124, 71128, 71129)
- Non-compliant: 6 (71112, 71115, 71116, 71120, 71133, 71135)
- Excluded: 2 (71113, 71114)
- Not eligible: 13 (71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136)
Total: 5 + 6 + 2 + 13 = 26. ✓
Denominator = compliant + non_compliant = 5 + 6 = 11
Numerator = compliant = 5
Excluded = 2
Not eligible = 13
Rate = 5 / 11 × 100 = 45.454545... → rounded half up to one decimal = 45.5
Let me re-verify some members:
**MEMBER 71111**: Enrolment starts 2026-05-01. Not enrolled from 2026-01-01 to 2026-04-30. That's a gap of 120 days at the beginning. The spec says "the full measurement year with no more than one gap of up to 45 days." Not being enrolled from Jan 1 to Apr 30 means a gap of 120 days. So not eligible. ✓
**MEMBER 71115**: Colonoscopy 2016-12-23. The 10-year window is "2026 or the nine years prior." Nine years prior to 2026 is 2017. So the window is 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017-01-01. Not in window. ✓
**MEMBER 71116**: Stool DNA 2023-01-09. The 3-year window is "2026 or the two years prior." Two years prior to 2026 is 2024. So the window is 2024-01-01 through 2026-12-31. 2023-01-09 is before 2024-01-01. Not in window. ✓
**MEMBER 71121**: Two gaps of 28 and 15 days. Spec says "no more than one gap." Two gaps means not eligible. ✓
**MEMBER 71122**: Enrolment starts 2026-03-22. Gap from 2026-01-01 to 2026-03-21. Jan: 31 days, Feb: 28 days, Mar 1-21: 21 days. Total = 80 days. More than 45 days. Not eligible. ✓
**MEMBER 71123**: Two gaps of 13 and 25 days. Two gaps. Not eligible. ✓
**MEMBER 71130**: Age 45. Not eligible. Even though has CRC diagnosis (C18.7 in 2024), not eligible because age fails first. The instructions say "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." ✓
**MEMBER 71132**: Age 76. Not eligible. Even though has CRC diagnosis (C18.7 in 2019), not eligible because age fails first. ✓
**MEMBER 71134**: Age 45. Not eligible. Even though has total colectomy (2023), not eligible because age fails first. ✓
Let me verify 71118's gap:
Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31.
Gap: June 15 to July 26.
June: 30 - 14 = 16 days (June 15-30)
July: 26 days (July 1-26)
Total: 42 days. The record says "One gap of 42 days." ✓
Let me verify 71117's gap:
Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31.
Gap: June 3 to July 17.
June: 30 - 2 = 28 days (June 3-30)
July: 17 days (July 1-17)
Total: 45 days. The record says "One gap of 45 days." ✓
All looks correct. Let me also double-check 71115:
Frailty documented 2026-07-07, Advanced illness documented 2026-02-06. Age 47. E4 requires age 66 or older. 47 < 66, so E4 does not apply. ✓
And 71120:
Age 75, advanced illness documented 2026-02-01. No frailty documented. E4 requires BOTH frailty AND advanced illness. So E4 does not apply. ✓
And 71122:
Age 72, frailty documented 2026-10-08, advanced illness documented 2026-01-13. But not eligible due to enrolment gap. So not_eligible. ✓
Final counts:
- Denominator: 11
- Numerator: 5
- Excluded: 2
- Not eligible: 13
- Rate: 45.5
Compliant members: ["71117", "71118", "71124", "71128", "71129"]
Non-compliant members: ["71112", "71115", "71116", "71120", "71133", "71135"]
Excluded members: ["71113", "71114"]
Not eligible members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,212 tokens
Let me evaluate each member against the QM-CRC measure specification.
**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, look-back from 2026-12-31):
- N1. FOBT or FIT during 2026.
- N2. Stool DNA test during 2026 or the two years prior (2024, 2025, 2026 - three-year window).
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (2022, 2023, 2024, 2025, 2026 - five-year window).
- N4. CT colonography during 2026 or the four years prior (2022, 2023, 2024, 2025, 2026 - five-year window).
- N5. Colonoscopy during 2026 or the nine years prior (2017, 2018, ..., 2026 - 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.
Let me go through each member:
**MEMBER 71111**
- DOB: 1971-04-18, age 55 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. Gap from 2026-01-01 to 2026-04-30 is about 120 days. This is more than one gap of up to 45 days. ✗
- Not eligible (enrolment).
**MEMBER 71112**
- DOB: 1954-02-14, age 72 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: None.
- Exclusions: None.
- Not eligible for exclusions. No exclusions apply.
- Numerator: No screening. ✗
- Status: non_compliant
**MEMBER 71113**
- DOB: 1979-02-27, age 47 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2020-07-03 CT colonography (too old, need 2022+), 2025-11-08 Flexible sigmoidoscopy (within 5-year window: 2022-2026). ✓
- Exclusions: 2025-07-17 C18.7 (colorectal cancer). E1 applies.
- Status: excluded (E1)
**MEMBER 71114**
- DOB: 1951-11-18, age 75 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2021-12-07 CT colonography. Need 2022 or later for 5-year window. 2021 is outside. ✗
- Exclusions: Age 75, so ≥66. Frailty documented 2026-12-17, Advanced illness documented 2026-05-05. Both during measurement year. E4 applies.
- Status: excluded (E4)
Wait, let me re-check N4 for 71114. CT colonography 2021-12-07. Five-year window from 2026-12-31 is 2022-01-01 through 2026-12-31. 2021-12-07 is before 2022-01-01, so it's outside the window. Correct.
**MEMBER 71115**
- DOB: 1979-09-19, age 47 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. ✓ (≤45 days, one gap)
- Screening: 2016-12-23 Colonoscopy. Ten-year window: 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017-01-01. ✗
- Exclusions: Age 47, so <66. E4 doesn't apply. Frailty and advanced illness documented but age <66. No other exclusions.
- Status: non_compliant
**MEMBER 71116**
- DOB: 1976-01-11, age 50 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days. ✓
- Screening: 2023-01-09 Stool DNA test. Three-year window: 2024-01-01 through 2026-12-31. 2023-01-09 is before 2024-01-01. ✗
Wait, let me re-read: "N2. Stool DNA test during 2026 or the two years prior (three-year window)."
Two years prior to 2026 would be 2024 and 2025. So the window is 2024-01-01 through 2026-12-31.
2023-01-09 is outside this window. ✗
- Exclusions: None.
- Status: non_compliant
**MEMBER 71117**
- DOB: 1963-09-02, age 63 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days. ✓ (≤45 days)
Let me verify the gap: 2026-06-02 to 2026-07-18. June has 30 days. From June 3 to July 17 = 28 days in June (3-30) + 17 days in July = 45 days. ✓
- Screening: 2026-01-11 Stool DNA test. Within 2024-2026. ✓ N2
- Exclusions: None.
- Status: compliant
**MEMBER 71118**
- DOB: 1979-03-23, age 47 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days. ✓
Let me verify: June 15 to July 26 = 16 days in June (15-30) + 26 days in July = 42 days. ✓
- Screening: 2021-11-12 Flexible sigmoidoscopy, 2022-07-04 Flexible sigmoidoscopy.
Five-year window for flex sig: 2022-01-01 through 2026-12-31.
2022-07-04 is within window. ✓ N3
- Exclusions: None.
- Status: compliant
**MEMBER 71119**
- DOB: 1950-03-25, age 76 on 2026-12-31. ✗ (>75)
- Not eligible (age).
**MEMBER 71120**
- DOB: 1951-03-21, age 75 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: None.
- Exclusions: Age 75, ≥66. Advanced illness documented 2026-02-01. But no frailty documented. E4 requires BOTH frailty AND advanced illness. So E4 does not apply.
- Status: non_compliant
**MEMBER 71121**
- DOB: 1971-08-17, age 55 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days.
Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means more than one gap. ✗
- Not eligible (enrolment).
**MEMBER 71122**
- DOB: 1954-09-15, age 72 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-03-22 through 2026-12-31. Not enrolled before 2026-03-22. Gap from 2026-01-01 to 2026-03-21 is about 80 days. More than one gap of up to 45 days. ✗
- Not eligible (enrolment).
**MEMBER 71123**
- DOB: 1959-03-08, age 67 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days.
Two gaps. More than one gap. ✗
- Not eligible (enrolment).
Wait, let me re-read: "no more than one gap of up to 45 days." This means at most one gap, and that gap must be ≤45 days. Two gaps of any size disqualifies.
Actually, wait. Let me re-read more carefully: "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 measurement year, but is allowed no more than one gap, and that gap can be up to 45 days. So two gaps = not eligible.
71123 has two gaps (13 and 25 days). Not eligible.
**MEMBER 71124**
- DOB: 1960-08-15, age 66 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2026-04-15 Flexible sigmoidoscopy. Within 2022-2026. ✓ N3
- Exclusions: Age 66, ≥66. No frailty, no advanced illness. E4 doesn't apply.
- Status: compliant
**MEMBER 71125**
- DOB: 1950-05-08, age 76 on 2026-12-31. ✗ (>75)
- Not eligible (age).
**MEMBER 71126**
- DOB: 1981-12-20, age 45 on 2026-12-31. ✗ (<46)
- Not eligible (age).
**MEMBER 71127**
- DOB: 1981-01-14, age 45 on 2026-12-31. ✗ (<46)
- Not eligible (age).
**MEMBER 71128**
- DOB: 1951-12-10, age 75 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2020-02-10 CT colonography (outside 2022-2026), 2026-08-17 Stool DNA test (within 2024-2026). ✓ N2
- Exclusions: None.
- Status: compliant
**MEMBER 71129**
- DOB: 1959-07-23, age 67 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2023-07-08 Flexible sigmoidoscopy (within 2022-2026). ✓ N3
Also 2023-09-13 CT colonography (within 2022-2026). ✓ N4
- Exclusions: None.
- Status: compliant
**MEMBER 71130**
- DOB: 1981-09-13, age 45 on 2026-12-31. ✗ (<46)
- Not eligible (age).
Wait, but let me check: even though not eligible, there's a C18.7 diagnosis. But the instructions say "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So not_eligible.
**MEMBER 71131**
- DOB: 1950-05-05, age 76 on 2026-12-31. ✗ (>75)
- Not eligible (age).
**MEMBER 71132**
- DOB: 1950-02-01, age 76 on 2026-12-31. ✗ (>75)
- Not eligible (age).
**MEMBER 71133**
- DOB: 1967-01-22, age 59 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2021-04-12 CT colonography, 2021-09-09 CT colonography. Both outside 2022-2026 window. ✗
- Exclusions: None.
- Status: non_compliant
**MEMBER 71134**
- DOB: 1981-09-26, age 45 on 2026-12-31. ✗ (<46)
- Not eligible (age).
**MEMBER 71135**
- DOB: 1971-08-26, age 55 on 2026-12-31. ✓ (46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps. ✓
- Screening: 2016-11-12 Colonoscopy. Ten-year window: 2017-01-01 through 2026-12-31. 2016-11-12 is before 2017-01-01. ✗
- Exclusions: None.
- Status: non_compliant
**MEMBER 71136**
- DOB: 1981-11-11, age 45 on 2026-12-31. ✗ (<46)
- Not eligible (age).
Let me now compile the results:
**Compliant:**
- 71117 (Stool DNA 2026)
- 71118 (Flex sig 2022)
- 71124 (Flex sig 2026)
- 71128 (Stool DNA 2026)
- 71129 (Flex sig 2023, CT colonography 2023)
Count: 5
**Non-compliant:**
- 71112 (no screening)
- 71115 (colonoscopy 2016, outside window)
- 71116 (stool DNA 2023, outside window)
- 71120 (no screening)
- 71133 (CT colonography 2021, outside window)
- 71135 (colonoscopy 2016, outside window)
Count: 6
**Excluded:**
- 71113 (E1 - colorectal cancer C18.7)
- 71114 (E4 - age 75, frailty + advanced illness)
Count: 2
**Not eligible:**
- 71111 (enrolment - not enrolled before May, gap too large)
- 71119 (age 76)
- 71121 (enrolment - two gaps)
- 71122 (enrolment - not enrolled before March)
- 71123 (enrolment - two gaps)
- 71125 (age 76)
- 71126 (age 45)
- 71127 (age 45)
- 71130 (age 45)
- 71131 (age 76)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
Count: 13
Let me verify: 5 + 6 + 2 + 13 = 26. ✓
Denominator = compliant + non_compliant = 5 + 6 = 11
Numerator = compliant = 5
Excluded = 2
Not eligible = 13
Rate = 5 / 11 × 100 = 45.454545... → rounded half up to one decimal = 45.5
Let me double-check some members:
**71111**: Enrolment 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. The gap from start of year (2026-01-01) to enrollment start (2026-05-01) is Jan (31) + Feb (28) + Mar (31) + Apr (30) = 120 days. That's one gap but way more than 45 days. Not eligible.
Actually, wait. Is the gap from 2026-01-01 to 2026-04-30 considered a "gap"? The member was never enrolled at the start of the year. The specification says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If they weren't enrolled from Jan 1, they don't have continuous enrolment for the full measurement year. The gap is the period they weren't enrolled. So 120 days gap > 45 days. Not eligible. Correct.
**71115**: Colonoscopy 2016-12-23. Ten-year window from 2026-12-31 going back 9 years = 2017-01-01. 2016-12-23 < 2017-01-01. Outside window. Non-compliant. Correct.
Wait, "during 2026 or the nine years prior (ten-year window)". Nine years prior to 2026 would be 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. So the window is 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017-01-01. Correct.
**71116**: Stool DNA test 2023-01-09. "during 2026 or the two years prior (three-year window)". Two years prior to 2026 = 2024, 2025. Window: 2024-01-01 through 2026-12-31. 2023-01-09 is before 2024-01-01. Outside window. Correct.
**71117**: Stool DNA test 2026-01-11. Within 2024-2026. Compliant. Correct.
**71118**: Flex sig 2022-07-04. Five-year window: "during 2026 or the four years prior". Four years prior to 2026 = 2022, 2023, 2024, 2025. Window: 2022-01-01 through 2026-12-31. 2022-07-04 is within. Compliant. Correct.
**71120**: Age 75, advanced illness but no frailty. E4 requires BOTH. So not excluded. No screening. Non-compliant. Correct.
**71122**: Enrolment 2026-03-22 through 2026-12-31. Not enrolled before 2026-03-22. Gap from 2026-01-01 to 2026-03-21 = Jan (31) + Feb (28) + Mar 1-21 (21) = 80 days. One gap but >45 days. Not eligible. Correct.
**71123**: Two gaps (13 and 25 days). More than one gap. Not eligible. Correct.
**71133**: CT colonography 2021-04-12 and 2021-09-09. Five-year window: 2022-01-01 through 2026-12-31. Both outside. Non-compliant. Correct.
**71135**: Colonoscopy 2016-11-12. Ten-year window: 2017-01-01 through 2026-12-31. Outside. Non-compliant. Correct.
Let me also verify 71113:
- Age 47, enrolled full year, flex sig 2025-11-08 (within window), but C18.7 diagnosis 2025-07-17. E1 applies. Excluded. Correct.
And 71114:
- Age 75, enrolled full year, CT colonography 2021-12-07 (outside window - no screening met).
- Frailty 2026-12-17, Advanced illness 2026-05-05. Age ≥66. Both documented during measurement year. E4 applies. Excluded. Correct.
Now let me also re-verify the gap calculation for 71117:
Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31.
Gap: 2026-06-03 through 2026-07-17.
June: 30 - 2 = 28 days (June 3 to June 30)
July: 17 days (July 1 to July 17)
Total: 28 + 17 = 45 days. ✓ (up to 45 days is allowed)
And 71118:
Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31.
Gap: 2026-06-15 through 2026-07-26.
June: 30 - 14 = 16 days (June 15 to June 30)
July: 26 days (July 1 to July 26)
Total: 16 + 26 = 42 days. ✓
All looks correct.
Let me verify the rate: 5/11 = 0.454545... × 100 = 45.4545...
Rounded half up to one decimal: 45.5. Correct.
Final summary:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 45.5
- compliant_members: ["71117", "71118", "71124", "71128", "71129"]
- non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
- excluded_members: ["71113", "71114"]
- not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Let me double-check 71121:
Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days.
Two gaps. The spec says "no more than one gap of up to 45 days." Two gaps means more than one gap, so not eligible. Correct.
And 71123:
Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days.
Two gaps. Not eligible. Correct.
Everything checks out.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 · Z.ai40.9s · 7,860 out | 63.0s · 6,514 out | 75.3s · 6,727 out
Reasoning · 7,652 tokens
Let me work through each member carefully.
Measure: Colorectal cancer screening, 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 of up to 45 days.
Numerator (look-back from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window): 2024-2026.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window): 2022-2026.
- N4: CT colonography during 2026 or four years prior: 2022-2026.
- N5: Colonoscopy during 2026 or nine years prior (ten-year window): 2017-2026.
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.
Exclusions evaluated before numerator, and only for members in the eligible population. A member who fails age/enrolment is not_eligible even if exclusion documented.
Now go through each member:
MEMBER 71111: DOB 1971-04-18, 55 years old on 2026-12-31. Age OK (46-75).
Enrolment: 2026-05-01 through 2026-12-31, not enrolled before. That's not full measurement year continuous enrolment — enrolled only from May 1. Gap is more than 45 days (Jan 1 to Apr 30 = ~120 days). Not eligible (fails continuous enrolment). → not_eligible.
Wait, continuous enrolment: "the full measurement year with no more than one gap of up to 45 days." Enrolling 2026-05-01 means missing Jan 1 – Apr 30, which is a gap of 120 days. Exceeds 45 days. So not eligible.
71111 → not_eligible.
MEMBER 71112: DOB 1954-02-14, 72 years old. Age OK.
Enrolment: full year continuous. Eligible.
Screening: none on record. Numerator: no.
Exclusions: none. → non_compliant.
MEMBER 71113: DOB 1979-02-27, 47 years old. Age OK.
Enrolment: full year continuous. Eligible.
Screening: 2020-07-03 CT colonography (outside 5-year window 2022-2026); 2025-11-08 flexible sigmoidoscopy (within 5-year window 2022-2026 — yes, 2025 is within). So numerator would be met via N3.
Exclusion: E1 — C18.7 diagnosis on 2025-07-17, on or before 2026-12-31. So excluded.
Exclusions evaluated before numerator → excluded.
71113 → excluded.
MEMBER 71114: DOB 1951-11-18, 75 years old. Age OK (75 is within 46-75 inclusive).
Enrolment: full year continuous. Eligible.
Screening: 2021-12-07 CT colonography. Window for CT colonography: 2026 or four years prior = 2022-2026. 2021-12-07 is outside. Numerator not met.
Exclusion E4: age 66+? 75, yes. Frailty documented 2026-12-17 (during MY), advanced illness 2026-05-05 (during MY). Both documented during measurement year. → E4 met. Excluded.
71114 → excluded.
MEMBER 71115: DOB 1979-09-19, 47 years old. Age OK.
Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Gap: 2026-07-17 to 2026-08-20 = 35 days. One gap, up to 45 days. OK — continuous enrolment met (no more than one gap of up to 45 days). Eligible.
Screening: 2016-12-23 colonoscopy. Window: 2017-2026. 2016-12-23 is outside (2016 is nine years prior? Let's compute: colonoscopy during 2026 or the nine years prior = 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. So 2017-2026. 2016-12-23 outside). Numerator not met.
Exclusions: frailty 2026-07-07, advanced illness 2026-02-06 — both documented during MY, but age is 47, so E4 requires 66+. Not excluded. No other exclusions.
→ non_compliant.
71115 → non_compliant.
MEMBER 71116: DOB 1976-01-11, 50 years old. Age OK.
Enrolment: one gap of 35 days (2026-03-17 to 2026-04-20). Let me check: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. Gap 2026-03-17 to 2026-04-20 = 35 days. One gap ≤45. Eligible.
Screening: 2023-01-09 stool DNA test. Window: 2026 or two years prior = 2024-2026. 2023 is outside. Numerator not met.
No exclusions. → non_compliant.
71116 → non_compliant.
MEMBER 71117: DOB 1963-09-02, 63 years old. Age OK.
Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap: 2026-06-03 to 2026-07-17 = 45 days. One gap of up to 45 days — "no more than one gap of up to 45 days." 45 days is within "up to 45 days." Eligible.
Screening: 2026-01-11 stool DNA test. Within three-year window (2026 counts). Numerator met.
No exclusions (age 63 < 66; no E1/E2/E3). → compliant.
71117 → compliant.
MEMBER 71118: DOB 1979-03-23, 47 years old. Age OK.
Enrolment: one gap of 42 days. Eligible.
Screening: 2021-11-12 flex sig; 2022-07-04 flex sig. Window for flex sig: 2022-2026. 2022-07-04 within window. Numerator met.
No exclusions. → compliant.
71118 → compliant.
MEMBER 71119: DOB 1950-03-25, 76 years old. Age 76 > 75. Not eligible.
(Also note screening 2023 flex sig would have met numerator, but age fails.) → not_eligible.
71119 → not_eligible.
MEMBER 71120: DOB 1951-03-21, 75 years old. Age OK.
Enrolment: full year. Eligible.
Screening: none.
Exclusion E4: age 75 (66+), advanced illness documented 2026-02-05 (during MY), frailty? Not documented. Frailty alone doesn't exclude; advanced illness alone doesn't exclude. Need both. Only advanced illness. Not excluded.
→ non_compliant.
71120 → non_compliant.
MEMBER 71121: DOB 1971-08-17, 55 years old. Age OK.
Enrolment: three segments: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gaps: 2026-03-22 to 2026-04-18 = 28 days; 2026-07-07 to 2026-07-21 = 15 days. Two gaps. "No more than one gap" — two gaps fails continuous enrolment. → not_eligible.
71121 → not_eligible.
MEMBER 71122: DOB 1954-09-15, 72 years old. Age OK.
Enrolment: 2026-03-22 through 2026-12-31, not enrolled before. Missing Jan 1 – Mar 21, ~80 days gap. Fails continuous enrolment. → not_eligible.
Note: frailty 2026-10-08 and advanced illness 2026-01-13 documented, age 72 — E4 would have applied, but enrolment fails first. Rule: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. → not_eligible.
71122 → not_eligible.
MEMBER 71123: DOB 1959-03-08, 67 years old. Age OK.
Enrolment: three segments, gaps of 13 and 25 days. Two gaps → fails continuous enrolment ("no more than one gap"). → not_eligible.
71123 → not_eligible.
MEMBER 71124: DOB 1960-08-15, 66 years old. Age OK (46-75).
Enrolment: full year. Eligible.
Screening: 2026-04-15 flex sig. Within 2026. Numerator met.
Exclusions: E4 — age 66+ (66 exactly), but frailty and advanced illness? Not documented. No exclusions. → compliant.
71124 → compliant.
MEMBER 71125: DOB 1950-05-08, 76 years old. Age fails. → not_eligible. (Even though FIT in 2026.)
71125 → not_eligible.
MEMBER 71126: DOB 1981-12-20, 45 years old. Age 45 < 46. Not eligible. Also enrolment from 2026-03-17 fails. → not_eligible.
71126 → not_eligible.
MEMBER 71127: DOB 1981-01-14, 45 years old on 2026-12-31. Age 45 < 46. Not eligible. → not_eligible. (Even though stool DNA 2024-12-13 within window and enrolment has one gap of 24 days.)
71127 → not_eligible.
MEMBER 71128: DOB 1951-12-10, 75 years old. Age OK.
Enrolment: full year. Eligible.
Screening: 2020-02-10 CT colonography (outside window); 2026-08-17 stool DNA test (within window). Numerator met.
No exclusions. → compliant.
71128 → compliant.
MEMBER 71129: DOB 1959-07-23, 67 years old. Age OK.
Enrolment: full year. Eligible.
Screening: 2023-07-08 flex sig (within 2022-2026 window — yes). Numerator met. Also 2023-09-13 CT colonography (within window). Numerator met.
No exclusions (no frailty/advanced illness). → compliant.
71129 → compliant.
MEMBER 71130: DOB 1981-09-13, 45 years old on 2026-12-31. Age 45 < 46. Not eligible. (Also enrolment from 2026-05-16 fails; also C18.7 diagnosis 2024-11-25 would be E1, but fails eligibility first.) → not_eligible.
71130 → not_eligible.
MEMBER 71131: DOB 1950-05-05, 76 years old. Age fails. → not_eligible. (Also enrolment from April fails.)
71131 → not_eligible.
MEMBER 71132: DOB 1950-02-01, 76 years old. Age 76 > 75. Not eligible. (Even though FIT 2026 and one gap 36 days; also C18.7 2019 would be E1.) → not_eligible.
71132 → not_eligible.
MEMBER 71133: DOB 1967-01-22, 59 years old. Age OK.
Enrolment: full year. Eligible.
Screening: 2021-04-12 CT colonography; 2021-09-09 CT colonography. Window 2022-2026. 2021 outside. Numerator not met.
No exclusions. → non_compliant.
71133 → non_compliant.
MEMBER 71134: DOB 1981-09-26, 45 years old on 2026-12-31. Age 45 < 46. Not eligible. (Total colectomy 2023 would be E2, but fails age first.) → not_eligible.
71134 → not_eligible.
MEMBER 71135: DOB 1971-08-26, 55 years old. Age OK.
Enrolment: full year. Eligible.
Screening: 2016-11-12 colonoscopy. Window 2017-2026. 2016 outside. Numerator not met.
No exclusions. → non_compliant.
71135 → non_compliant.
MEMBER 71136: DOB 1981-11-11, 45 years old on 2026-12-31. Age 45 < 46. Not eligible. → not_eligible.
Wait — DOB 1981-11-11. On 2026-12-31, age is 45 (turned 45 on 2025-11-11... wait, 1981 + 45 = 2026, birthday Nov 11, 2026. So on 2026-12-31, age is 45). Yes, 45 years old. Age fails (needs 46-75). → not_eligible. (Also two enrolment... one gap of 40 days — that would have been fine — and flex sig 2026 would meet numerator, advanced illness but no frailty. But age fails.) → not_eligible.
71136 → not_eligible.
Now let me double-check ages:
71111: 1971-04-18 → 55 on 2026-12-31. Age OK, but enrolment fails.
71112: 1954-02-14 → 72. OK.
71113: 1979-02-27 → 47. OK.
71114: 1951-11-18 → 75. OK (inclusive).
71115: 1979-09-19 → 47. OK.
71116: 1976-01-11 → 50. OK.
71117: 1963-09-02 → 63. OK.
71118: 1979-03-23 → 47. OK.
71119: 1950-03-25 → 76. Fails.
71120: 1951-03-21 → 75. OK.
71121: 1971-08-17 → 55. OK age; enrolment fails (two gaps).
71122: 1954-09-15 → 72. OK age; enrolment fails.
71123: 1959-03-08 → 67. OK age; enrolment fails (two gaps).
71124: 1960-08-15 → 66. OK.
71125: 1950-05-08 → 76. Fails.
71126: 1981-12-20 → 45. Fails.
71127: 1981-01-14 → 45. Fails.
71128: 1951-12-10 → 75. OK.
71129: 1959-07-23 → 67. OK.
71130: 1981-09-13 → 45. Fails.
71131: 1950-05-05 → 76. Fails.
71132: 1950-02-01 → 76. Fails.
71133: 1967-01-22 → 59. OK.
71134: 1981-09-26 → 45. Fails.
71135: 1971-08-26 → 55. OK.
71136: 1981-11-11 → 45. Fails.
Enrolment checks:
71112: full year. OK.
71113: full year. OK.
71114: full year. OK.
71115: one gap 35 days. OK.
71116: one gap 35 days. OK.
71117: one gap 45 days. "Up to 45 days" — inclusive. OK.
71118: one gap 42 days. OK.
71120: full year. OK.
71121: two gaps (28, 15). Fails.
71123: two gaps (13, 25). Fails.
71124: full year. OK.
71128: full year. OK.
71129: full year. OK.
71133: full year. OK.
71135: full year. OK.
Members starting mid-year (71111 from May, 71122 from Mar, 71126 from Mar, 71130 from May, 71131 from Apr): these all fail continuous enrolment since the missing period exceeds 45 days. All also confirmed.
71132: gap of 36 days, one gap. Enrolment OK. But age 76 fails. Not eligible.
Now exclusions among eligible members:
71112: none.
71113: E1 (C18.7 2025-07-17). Excluded.
71114: E4 (age 75, frailty 2026-12-17, advanced illness 2026-05-05, both during MY). Excluded.
71115: frailty + advanced illness but age 47 — E4 not met. No exclusion.
71116: none.
71117: none.
71118: none.
71120: advanced illness only, age 75. E4 needs both. Not excluded.
71124: none.
71128: none.
71129: none.
71133: none.
71135: none.
Numerator among eligible, non-excluded:
71112: no screening. Non-compliant.
71115: colonoscopy 2016-12-23 — outside 2017-2026. Non-compliant.
71116: stool DNA 2023-01-09 — outside 2024-2026. Non-compliant.
71117: stool DNA 2026-01-11 — within. Compliant.
71118: flex sig 2022-07-04 — within 2022-2026. Compliant.
71120: no screening. Non-compliant.
71124: flex sig 2026-04-15 — within. Compliant.
71128: stool DNA 2026-08-17 — within. Compliant.
71129: flex sig 2023-07-08 within; CT colonography 2023-09-13 within. Compliant.
71133: CT colonography 2021 — outside 2022-2026. Non-compliant.
71135: colonoscopy 2016-11-12 — outside 2017-2026. Non-compliant.
Let me double-check 71135: colonoscopy 2016-11-12. Ten-year window: 2026 or the nine years prior. Nine years prior to 2026: 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. So window is 2017-01-01 through 2026-12-31. 2016-11-12 is outside. Non-compliant. Correct.
71115: colonoscopy 2016-12-23. Outside 2017-2026. Non-compliant. Correct.
71116: stool DNA 2023-01-09. Three-year window: 2026, 2025, 2024. Outside. Non-compliant. Correct.
71133: CT colonography 2021-04-12 and 2021-09-09. Five-year window: 2026, 2025, 2024, 2023, 2022. Outside. Non-compliant. Correct.
71118: flex sig 2022-07-04. Five-year window 2022-2026. Within. Compliant. Also 2021-11-12 outside but doesn't matter.
71113: flex sig 2025-11-08 within window — numerator met, but E1 exclusion applies first. Excluded. Correct per rules: "A member who meets both an exclusion and the numerator is excluded."
71114: CT colonography 2021-12-07 — outside window anyway (2022-2026). Numerator not met. But E4 applies. Excluded.
Now check 71117's gap: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap = June 3 to July 17. June 3–30 = 28 days, July 1–17 = 17 days, total 45 days. Stated as "one gap of 45 days." Up to 45 days allowed — inclusive per "up to 45 days". So eligible. Compliant.
Hmm, but is "no more than one gap of up to 45 days" inclusive of exactly 45? "Up to X" typically includes X. Yes, 45 days is allowed.
Now count:
Compliant: 71117, 71118, 71124, 71128, 71129. That's 5.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. That's 6.
Excluded: 71113, 71114. That's 2.
Not eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. That's 13.
Total: 5 + 6 + 2 + 13 = 26. ✓ Matches roster of 26.
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = 5.
Rate = 5/11 × 100 = 45.4545...% → rounded half up to one decimal: 45.5.
Wait: 45.4545... → one decimal: 45.5? 45.4545 rounds to 45.5 (since second decimal is 5... 45.4545: first decimal is 4, second is 5, so rounding to one decimal: 45.45 → the digit after the first decimal is 5, so round up: 45.5). Actually 45.4545... to one decimal place: look at 45.45..., the hundredths digit is 5 (45.45...), so round half up → 45.5. Yes.
Hmm, more precisely: 5/11 = 0.454545..., ×100 = 45.454545...%. Rounded to one decimal: 45.5.
Let me verify counts again.
Not eligible list:
- 71111 (enrolment from May 1, ~120 day gap)
- 71119 (age 76)
- 71121 (two gaps)
- 71122 (enrolment from Mar 22)
- 71123 (two gaps)
- 71125 (age 76)
- 71126 (age 45, enrolment from Mar 17)
- 71127 (age 45)
- 71130 (age 45, enrolment from May 16)
- 71131 (age 76, enrolment from Apr 12)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
That's 13 members.
Excluded: 71113 (E1), 71114 (E4). 2 members.
Compliant: 71117, 71118, 71124, 71128, 71129. 5 members.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. 6 members.
5+6+2+13 = 26. ✓
Denominator = 11, numerator = 5, excluded = 2, not_eligible = 13.
Rate = 45.5.
Let me double check each borderline:
71111: age 55 OK, enrolment 2026-05-01 onward. Missing Jan-Apr (119 days gap if counted as gap; or simply not continuously enrolled for full year). Either way fails. Not eligible. Note the frailty documented 2026-10-27, age 55 — E4 wouldn't apply anyway (age < 66). Stool DNA 2023-11-04 (outside 3-yr window), colonoscopy 2025-01-02 (within 10-yr window — would be numerator). But enrolment fails. Not eligible. ✓
71121: two gaps — the rule says "no more than one gap of up to 45 days." Two gaps fails. Even though CT colonography 2026-02-22 meets numerator. Not eligible. ✓
71123: gaps of 13 and 25 days — two gaps. Fails. ✓ (Age 67, no other issues.)
71122: enrolment from 2026-03-22. Missing Jan 1 – Mar 21 (80 days). Fails. Also has frailty + advanced illness + age 72 (E4), but enrolment failure takes precedence — not_eligible. ✓
71126: age 45 (DOB 1981-12-20; on 2026-12-31 she is 45 — turned 45 on 2025-12-20). Yes, 45. Fails age. Not eligible. ✓
71127: DOB 1981-01-14 → 45 on 2026-12-31 (turned 45 on 2026-01-14). Age 45. Fails. Not eligible. ✓
71130: DOB 1981-09-13 → turned 45 on 2026-09-13. Age 45. Fails. Not eligible. ✓
71134: DOB 1981-09-26 → 45. Fails. Not eligible. ✓
71136: DOB 1981-11-11 → 45. Fails. Not eligible. ✓
71132: DOB 1950-02-01 → 76 (turned 76 on 2026-02-01). Fails. Not eligible. Even with FIT in 2026 and E1 cancer history. ✓
71125: DOB 1950-05-08 → 76 (turned 76 on 2026-05-08). Fails. ✓
71131: DOB 1950-05-05 → 76. Fails. ✓
71119: DOB 1950-03-25 → 76. Fails. ✓
71124: age 66 — E4 threshold is "Age 66 or older." He's exactly 66, but no frailty/advanced illness documented, so no exclusion. Compliant via flex sig 2026. ✓
71114: age 75, frailty + advanced illness both during MY → E4. Excluded. ✓ Even though her CT colonography 2021 is out of window (would be non-compliant otherwise). Excluded regardless.
71113: age 47, C18.7 on 2025-07-17 → E1. Excluded. ✓ (Flex sig 2025-11-08 would have been numerator.)
71120: age 75, advanced illness only → not excluded. No screening → non-compliant. ✓
71115: age 47, frailty + advanced illness → E4 requires 66+. Not excluded. Colonoscopy 2016 out of window. Non-compliant. ✓
71133: CT colonography 2021 (both) out of 5-yr window (2022-2026). Non-compliant. ✓
71135: colonoscopy 2016-11-12 out of window. Non-compliant. ✓
71116: stool DNA 2023-01-09 out of 3-yr window (2024-2026). Non-compliant. ✓
71112: no screening. Non-compliant. ✓
71118: flex sig 2022-07-04 within window. Compliant. ✓ Enrolment: one gap 42 days. Eligible. Age 47. No exclusions. ✓
71117: stool DNA 2026-01-11. Compliant. ✓
71128: stool DNA 2026-08-17. Compliant. ✓ (Also CT colonography 2020 out of window — doesn't matter.)
71129: flex sig 2023-07-08 (within 2022-2026), CT colonography 2023-09-13 (within). Compliant. Age 67, no frailty/advanced illness → no E4. ✓
So final:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 45.5
- compliant_members: ["71117", "71118", "71124", "71128", "71129"]
- non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
- excluded_members: ["71113", "71114"]
- not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Rate: 5/11 × 100 = 45.454545... → 45.5.
Double-check rounding: 45.4545... The hundredths digit is 5 (45.4545 → tenths digit 4, hundredths digit 5). Round half up: 45.5. Yes.
Actually, let me be careful: 45.4545... — rounding to one decimal place. The number is 45.454545... The part being dropped is 0.0454545..., which is less than 0.05? 0.0454545 < 0.05. So rounding 45.4545 to one decimal: look at second decimal = 5? Wait: 45.4545. First decimal: 4. Second decimal: 5. Third: 4.
When rounding to one decimal place, we look at the second decimal digit: it's 5 (from 45.45...), so we round up: 45.5.
Hmm, but 45.4545 — the digits after the first decimal are "545...". The second decimal digit is 5, and the standard "round half up" means if the digit is ≥ 5, round up. So 45.4545 → 45.5? Let me think: 45.4545 is closer to 45.5 than 45.4? 45.4545 - 45.4 = 0.0545; 45.5 - 45.4545 = 0.0455. So it's closer to 45.5. Yes, 45.5.
Actually wait: 45.454545... vs. midpoint 45.45. 45.4545 > 45.45, so it rounds up to 45.5. Yes.
Rate = 45.5.
One more check on gap counting for 71111: enrolled 2026-05-01 through 2026-12-31. Continuous enrolment requires full measurement year with no more than one gap of up to 45 days. Missing Jan 1 – Apr 30 = 120 days. Fails. Not eligible. ✓
71122: from 2026-03-22, missing 80 days. Fails. ✓
71126: from 2026-03-17, missing 75 days. Fails. Also age 45. ✓
71130: from 2026-05-16, missing 135 days. Fails. Also age 45. ✓
71131: from 2026-04-12, missing 101 days. Fails. Also age 76. ✓
All good. Final answer.
The output musjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,306 tokens
Let me work through each member against the QM-CRC specification.
Eligible population (denominator candidates):
- 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 windows (measured 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? "during 2026 or the two years prior" — the two years prior to 2026 are 2025 and 2024. So window: 2024-01-01 through 2026-12-31. Actually "measured back from 2026-12-31": three-year window = 2024-01-01 through 2026-12-31 (approximately; 2026-12-31 minus 3 years = 2023-12-31, so dates on or after 2024-01-01... hmm, three-year window measured back from 2026-12-31 would be 2023-12-31 through 2026-12-31, effectively 2024-2026). Either way, for the members in question: 2024-12-13 stool DNA (member 71127) qualifies. 2023-01-09 (member 71116) does not.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window): 2022-2026 (2021-12-31 through 2026-12-31). So 2021-11-12 flex sig would be outside; 2022-07-04 would be inside. Let me be careful: five-year window measured back from 2026-12-31 = 2021-12-31 to 2026-12-31. "During 2026 or the four years prior" — four years prior to 2026: 2022, 2023, 2024, 2025. So window 2022-01-01 through 2026-12-31. Member 71118 has flex sig 2021-11-12 and 2022-07-04. The 2022-07-04 one is within the window (2022 is one of the four years prior). So 71118 meets numerator.
- N4: CT colonography during 2026 or four years prior (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. So 2016-12-23 (member 71115) is outside; 2016-11-12 (member 71135) outside. Wait, member 71115 colonoscopy 2016-12-23 — ten-year window measured back from 2026-12-31 is 2016-12-31 through 2026-12-31. 2016-12-23 is before 2016-12-31, so outside. Hmm, but "during 2026 or the nine years prior" — nine years prior to 2026: 2017-2025. So window 2017-01-01 through 2026-12-31. 2016-12-23 outside either way. Member 71135 colonoscopy 2016-11-12 — outside. Member 71111 colonoscopy 2025-01-02 — inside (2025 is within nine years prior).
Required 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 any time during MY.
- E4: Age 66+ as of 2026-12-31 AND both frailty AND advanced illness documented during the measurement year.
Order: exclusions evaluated before numerator, only for eligible members. Eligibility (age, event, enrolment) first.
Let me go member by member.
MEMBER 71111. DOB 1971-04-18, age 55. Eligible age. Enrolment: 2026-05-01 through 2026-12-31, not enrolled before. That's not the full measurement year — continuous enrolment requires the full measurement year. Enrolment from 2026-05-01 means not enrolled 2026-01-01 through 2026-04-30. That's a gap of... well, it's not a "gap" in the sense of one gap up to 45 days? The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Not enrolled from the start of the year — being enrolled only from May 1 means missing Jan 1 through Apr 30, which is 120 days. That's more than one gap of up to 45 days. So not continuously enrolled → not_eligible.
Hmm, but wait — could the "gap" logic treat "not enrolled before 2026-05-01" as a gap of 120 days? Either way it exceeds 45 days. So not_eligible.
MEMBER 71112. Age 72. Continuous enrolment full year. No screening. No exclusions. Non-compliant (in denominator). Status: non_compliant.
MEMBER 71113. Age 47. Continuous enrolment. Screening: flex sig 2025-11-08 (within 5-year window) — numerator met. But exclusion: C18.7 diagnosis 2025-07-17 (colorectal cancer). E1 applies (any time on or before 2026-12-31). Member is in eligible population (age 46-75, continuous enrolment). Exclusion before numerator: excluded.
MEMBER 71114. Age 75 (born 1951-11-18; turns 75 on 2025-11-18, so 75 on 2026-12-31 — yes, 75). Age 75 is within 46-75. Continuous enrolment. Screening: CT colonography 2021-12-07. Five-year window: 2022-2026. 2021-12-07 is outside (2021 is five years prior... wait, "during 2026 or the four years prior" = 2022, 2023, 2024, 2025, 2026. 2021 is outside). If measured back from 2026-12-31 as exactly five years: 2021-12-31 through 2026-12-31. 2021-12-07 is before 2021-12-31, so outside. Either way, outside the window. So numerator not met by that test.
Exclusions: frailty documented 2026-12-17 (during MY) and advanced illness 2026-05-05 (during MY). Age 75 ≥ 66. E4: age 66+ AND both frailty and advanced illness during MY. Both documented during MY. So E4 applies → excluded.
So 71114: excluded (via E4).
MEMBER 71115. Age 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Gap: 2026-07-17 through 2026-08-20 = 35 days. That's one gap ≤ 45 days. So continuous enrolment satisfied. Eligible.
Screening: colonoscopy 2016-12-23. Ten-year window: 2017-2026 (or 2016-12-31 through 2026-12-31). 2016-12-23 outside. No other screening. Numerator not met.
Exclusions: frailty 2026-07-07 and advanced illness 2026-02-06, both during MY. But age 47 < 66, so E4 does not apply. No other exclusions. So 71115: non_compliant.
MEMBER 71116. Age 50. Enrolment with one gap of 35 days (2026-03-17 through 2026-04-20 = 35 days: from 2026-01-01 through 2026-03-16, then 2026-04-21 through 2026-12-31; gap is 2026-03-17 through 2026-04-20, which is 35 days). One gap ≤ 45 → continuous. Eligible.
Screening: stool DNA 2023-01-09. Three-year window: 2024-2026 (or 2023-12-31 through 2026-12-31). 2023-01-09 outside. Numerator not met. No exclusions. Non_compliant.
MEMBER 71117. Age 63. Enrolment: one gap of 45 days (2026-06-03 through 2026-07-17 = 45 days: enrolment 2026-01-01 to 2026-06-02, then 2026-07-18 to 2026-12-31; gap = 2026-06-03 through 2026-07-17, 45 days). "No more than one gap of up to 45 days" — 45 days is allowed ("up to 45 days" includes 45). Eligible.
Screening: stool DNA 2026-01-11 — within 2026. N2 met. No exclusions. Compliant.
MEMBER 71118. Age 47. Enrolment: one gap of 42 days (2026-06-15 through 2026-07-26 = 42 days). One gap ≤ 45 → continuous. Eligible.
Screening: flex sig 2021-11-12 (outside five-year window: window is 2022-2026) and 2022-07-04 (within 2022-2026). N3 met. Compliant.
MEMBER 71119. Age 76 (born 1950-03-25). Age 76 > 75 → not_eligible. (Even though screening etc. — age fails.)
MEMBER 71120. Age 75 (born 1951-03-21; turns 75 on 2025-03-21; on 2026-12-31 still 75). Continuous enrolment. No screening. Advanced illness documented 2026-02-01 during MY, but no frailty. E4 requires both. Age 75 ≥ 66, but only advanced illness — "advanced illness alone does not exclude." So no exclusion. Numerator not met. Non_compliant.
MEMBER 71121. Age 55. Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps: 2026-03-22 through 2026-04-18 = 28 days; 2026-07-07 through 2026-07-21 = 15 days. That's two gaps. "No more than one gap" — two gaps violate continuous enrolment. So not_eligible.
Wait — need to count gap days carefully. Enrolment 2026-01-01 to 2026-03-21, then resumes 2026-04-19. Gap: 2026-03-22 through 2026-04-18 = 28 days (March 22-31 is 10 days, April 1-18 is 18 days, total 28). Second gap: 2026-07-07 through 2026-07-21 = 15 days. Two gaps → fails "no more than one gap." Not_eligible.
MEMBER 71122. Age 72. Enrolment: 2026-03-22 through 2026-12-31, not enrolled before. Missing 2026-01-01 through 2026-03-21 (80 days) — more than 45 days. Not continuously enrolled. Not_eligible.
Even though frailty + advanced illness during MY — but age/enrolment fails, so not_eligible (exclusions only for eligible population).
MEMBER 71123. Age 67. Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps: 2026-02-24 through 2026-03-08 = 13 days; 2026-06-28 through 2026-07-22 = 25 days. Two gaps → not_eligible.
MEMBER 71124. Age 66 (born 1960-08-15; on 2026-12-31, age 66). Age 66 within 46-75. Continuous enrolment. Screening: flex sig 2026-04-15 — N3 met (during 2026). No exclusions (no frailty/advanced illness). Compliant.
Note: E4 requires age 66+ AND frailty AND advanced illness. 71124 has neither frailty nor advanced illness. So no exclusion. Compliant.
MEMBER 71125. Age 76 (born 1950-05-08) → not_eligible (age > 75). Even though FIT in 2026.
MEMBER 71126. Age 45 (born 1981-12-20; on 2026-12-31 age 45). Age 45 < 46 → not_eligible. Also enrolment from 2026-03-17 only. Age fails anyway.
MEMBER 71127. Age 45 (born 1981-01-14; on 2026-12-31, turned 45 on 2026-01-14; age 45). 45 < 46 → not_eligible. Enrolment has one gap of 24 days (fine), but age fails. Not_eligible.
MEMBER 71128. Age 75 (born 1951-12-10; turns 75 on 2025-12-10; age 75 on 2026-12-31). Continuous enrolment. Screening: stool DNA 2026-08-17 — N2 met (during 2026). CT colonography 2020-02-10 outside window (2020 outside 2022-2026), but stool DNA 2026 is enough. No exclusions. Compliant.
MEMBER 71129. Age 67. Continuous enrolment. Screening: flex sig 2023-07-08 (within 2022-2026 five-year window) — N3 met. Also CT colonography 2023-09-13 within window. No exclusions (age 67 ≥ 66 but no frailty/advanced illness documented). Compliant.
MEMBER 71130. Age 45 (born 1981-09-13; on 2026-12-31 age 45) → not_eligible. Also enrolment from 2026-05-16. Also CRC diagnosis 2024-11-25 — but age/enrolment fails first, so not_eligible (exclusion only for eligible population). Status: not_eligible.
MEMBER 71131. Age 76 (born 1950-05-05) → not_eligible. Also enrolment from 2026-04-12. Age fails. Not_eligible.
MEMBER 71132. Age 76 (born 1950-02-01) → not_eligible. Age > 75. Not_eligible. (Enrolment one gap of 36 days — fine, but age fails. Also CRC 2019 — irrelevant since not eligible.)
MEMBER 71133. Age 59. Continuous enrolment. Screening: CT colonography 2021-04-12 and 2021-09-09. Five-year window for CT colonography: 2026 or four years prior = 2022-2026. 2021 outside. Alternatively measured back five years from 2026-12-31 = 2021-12-31; 2021-09-09 before that. Outside. Numerator not met. No exclusions. Non_compliant.
MEMBER 71134. Age 45 (born 1981-09-26; on 2026-12-31 age 45) → not_eligible (age < 46). Also total colectomy 2023-04-23 — exclusion, but only if eligible. Age fails → not_eligible.
MEMBER 71135. Age 55. Continuous enrolment. Screening: colonoscopy 2016-11-12. Ten-year window: 2017-2026 (or 2016-12-31 through 2026-12-31). 2016-11-12 outside. Numerator not met. No exclusions. Non_compliant.
MEMBER 71136. Age 45 (born 1981-11-11; on 2026-12-31 age 45) → not_eligible. Age < 46. Enrolment one gap of 40 days (fine) but age fails. Not_eligible.
Now let me tally.
Compliant:
- 71117 (stool DNA 2026)
- 71118 (flex sig 2022-07-04)
- 71124 (flex sig 2026)
- 71128 (stool DNA 2026)
- 71129 (flex sig 2023)
Non-compliant:
- 71112 (no screening)
- 71115 (colonoscopy 2016 outside window)
- 71116 (stool DNA 2023 outside window)
- 71120 (no screening; advanced illness alone doesn't exclude)
- 71133 (CT colonography 2021 outside window)
- 71135 (colonoscopy 2016 outside window)
Excluded:
- 71113 (CRC C18.7)
- 71114 (E4: age 75, frailty + advanced illness during MY)
Not eligible:
- 71111 (enrolment starts 2026-05-01)
- 71119 (age 76)
- 71121 (two gaps)
- 71122 (enrolment starts 2026-03-22)
- 71123 (two gaps)
- 71125 (age 76)
- 71126 (age 45)
- 71127 (age 45)
- 71130 (age 45)
- 71131 (age 76)
- 71132 (age 76)
- 71134 (age 45)
- 71136 (age 45)
Count: not_eligible = 13.
Total: 5 + 6 + 2 + 13 = 26. ✓
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = 5.
Excluded = 2.
Not eligible = 13.
Rate = 5 / 11 × 100 = 45.4545...% → rounded half up to one decimal: 45.5.
Let me double-check a few edge cases.
71111: enrolment 2026-05-01 through 2026-12-31, continuous from that date, not enrolled before. The member is age 55 (eligible age). Continuous enrolment requirement: "the full measurement year with no more than one gap of up to 45 days." Not enrolled Jan-Apr = a period of non-enrolment of ~120 days. Is that a "gap"? In HEDIS-like logic, continuous enrollment requires enrollment from start of year, with allowance for one gap of up to 45 days. Missing Jan 1 through Apr 30 far exceeds 45 days, so not eligible. Yes, not_eligible.
71114: age check — DOB 1951-11-18. On 2026-11-18, turns 75. On 2026-12-31, 75. Age 75 ≤ 75 → eligible age. Enrolment continuous. E4: age 66+ (75), frailty documented during MY (2026-12-17, gait abnormality R26.2), advanced illness during MY (2026-05-05, heart failure I50.22). Both during MY. Excluded. Correct.
Wait — is gait abnormality "frailty"? The record says "Frailty documented (gait abnormality, R26.2)" — the roster labels it as frailty documented, so I take it as frailty. Similarly heart failure as advanced illness. The harness presents these as documented frailty/advanced illness. Yes.
71115: age 47. E4 doesn't apply (age < 66). Colonoscopy 2016-12-23 — ten-year window. "Colonoscopy during 2026 or the nine years prior (ten-year window)." Nine years prior to 2026: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. Window: 2017-01-01 through 2026-12-31. 2016-12-23 outside. Non-compliant. Correct.
Alternatively if measured back from 2026-12-31 exactly ten years: 2016-12-31 through 2026-12-31. 2016-12-23 still outside. Good.
71116: stool DNA 2023-01-09. Three-year window: 2024-01-01 through 2026-12-31 (2026 or two years prior: 2025, 2024). Or measured back: 2023-12-31. 2023-01-09 outside either way. Non-compliant.
71117: gap 45 days. "no more than one gap of up to 45 days" — 45 is "up to 45." Eligible. Stool DNA 2026-01-11 during 2026 → N2 met. Compliant.
71118: flex sig 2022-07-04. Five-year window: 2022-2026. 2022 within. Compliant. The 2021-11-12 flex sig is outside but the 2022 one is inside. Good.
Let me double check gap calc for 71118: enrolment 2026-01-01 to 2026-06-14, then 2026-07-27 to 2026-12-31. Gap: 2026-06-15 through 2026-07-26 = 16 + 26 = 42 days. One gap ≤ 45. Continuous. Good.
71121: two gaps → not eligible. Good.
71124: age 66. DOB 1960-08-15. On 2026-08-15 turns 66. Age 66 on 2026-12-31. Eligible. Flex sig 2026-04-15 → N3. Compliant. No frailty/advanced illness → no E4. Good.
71128: age 75 (DOB 1951-12-10; turns 75 on 2025-12-10; on 2026-12-31 age 75). Eligible. Stool DNA 2026-08-17 → N2 met. Compliant. Good.
71129: age 67. Flex sig 2023-07-08 within 2022-2026. Compliant. Good.
71133: CT colonography 2021-04-12 and 2021-09-09. Five-year window 2022-2026 (or 2021-12-31 cutoff). Both outside. Non-compliant. Good.
71112: age 72, continuous, no screening, no exclusions. Non-compliant.
71120: age 75, continuous, no screening. Advanced illness during MY but no frailty → E4 requires both. Non-compliant. Good.
71135: age 55, continuous, colonoscopy 2016-11-12. Window 2017-2026 (or 2016-12-31). Outside. Non-compliant.
Now ages for the 45-year-olds: DOB 1981-12-20 → on 2026-12-31, age 45 (turned 45 on 2026-12-20). Yes 45. 1981-01-14 → 45. 1981-09-13 → 45. 1981-09-26 → 45. 1981-11-11 → 45. All not eligible (age < 46).
76-year-olds: 1950-03-25, 1950-05-08, 1950-05-05, 1950-02-01 → all 76 on 2026-12-31. Not eligible.
Now double-check 71111 more: could "not enrolled before 2026-05-01" with continuous enrolment from 2026-05-01 be treated as enrolment for part of year — the spec says "the full measurement year with no more than one gap of up to 45 days." Missing 119 days (Jan 1 – Apr 30) — even if considered a single gap, 119 > 45. Not eligible.
Similarly 71122: missing Jan 1 – Mar 21 = 80 days > 45. Not eligible.
Now the rate: 5/11 = 0.454545... × 100 = 45.4545...% → 45.5 (round half up to one decimal: 45.4545 → the second decimal is 5? Let's see: 45.4545... to one decimal: 45.45... the digit after the first decimal (45.4|545) — the next digit is 5, so round half up → 45.5? Wait: 45.4545 to one decimal place: look at the hundredths digit = 5 (45.45...), round up the tenths: 45.4 + 0.1 = 45.5. Yes, 45.5.
Actually let me compute: 5/11 × 100 = 45.454545...%. One decimal: 45.5 (since hundredths digit is 5, round half up). Yes, 45.5.
Member ID lists as strings:
compliant: ["71117", "71118", "71124", "71128", "71129"]
non_compliant: ["71112", "71115", "71116", "71120", "71133", "71135"]
excluded: ["71113", "71114"]
not_eligible: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Counts: denominator 11, numerator 5, excluded 2, not_eligible 13, rate 45.5.
One more check on 71113: is she in the eligible population? Age 47, continuous enrolment. Yes. E1 CRC 2025-07-17 → excluded. The numerator (flex sig 2025-11-08) would have been met, but exclusion takes precedence. Excluded. ✓
71130: age 45 → not eligible despite CRC. Per the task family instructions: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." ✓
71134: age 45 → not eligible despite colectomy. ✓
71132: age 76 → not eligible despite CRC. ✓
71122: fails enrolment; has frailty + advanced illness + age 72, but enrolment fails → not_eligible. ✓
Everything checks out. Final answer.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,519 tokens
Let me work through each member carefully.
Measure QM-CRC. 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 of up to 45 days.
Numerator (look-back from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window): so 2024, 2025, 2026? Wait, "during 2026 or the two years prior (three-year window)". Two years prior to 2026 is 2024 and 2025. So window = 2024-01-01 through 2026-12-31. Actually, more precisely, look-back windows are typically measured back from 2026-12-31: three-year window = 2024-01-01 to 2026-12-31 (measured back from end of measurement year). Let me think: "by the look-back window measured back from 2026-12-31". So N2: three-year window back from 2026-12-31: 2024-01-01 through 2026-12-31 (i.e., dates on or after 2023-12-31... actually 2026-12-31 minus 3 years = 2023-12-31, so dates from 2023-12-31 to 2026-12-31). Hmm, the simpler interpretation: "during 2026 or the two years prior (three-year window)" = calendar years 2024, 2025, 2026. Either interpretation — 2023-12-31 or 2024-01-01 start — matters for dates in late 2023. Let me check which members have screening events in late 2023: 71111 has stool DNA 2023-11-04. Under calendar-year interpretation, 2023-11-04 is outside the three-year window (2024-2026). Under "measured back from 2026-12-31" date interpretation, 2023-11-04 is more than 3 years before 2026-12-31 (3 years before 2026-12-31 is 2023-12-31), so 2023-11-04 is outside. Either way, outside. Good, no ambiguity for that one.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window): 2022-2026 calendar years, or dates from 2021-12-31 to 2026-12-31. Check member 71118: flex sig 2021-11-12 — outside either way (2021-11-12 < 2021-12-31 and outside calendar 2022). 2022-07-04 — inside either way.
- N4: CT colonography during 2026 or four years prior (five-year window): 2022-2026, or dates from 2021-12-31. Check 71133: CT colonography 2021-04-12 and 2021-09-09 — outside either way. 71113: CT colonography 2020-07-03 — outside. 71114: CT colonography 2021-12-07. Calendar interpretation: 2021 is outside (window 2022-2026). Date interpretation: 2021-12-07 vs window start 2021-12-31 — outside (2021-12-07 < 2021-12-31). Either way, outside. Good.
- N5: Colonoscopy during 2026 or nine years prior (ten-year window): 2017-2026 calendar years, or dates from 2016-12-31. Check 71115: colonoscopy 2016-12-23 — outside either way (2016-12-23 < 2016-12-31, and calendar 2016 not in 2017-2026). 71135: colonoscopy 2016-11-12 — outside either way. Good.
So both interpretations agree on all cases.
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 any time during measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year (2026). Frailty alone doesn't exclude; advanced illness alone doesn't exclude.
Now, member by member.
MEMBER 71111: DOB 1971-04-18, 55 years old on 2026-12-31. Age 46-75: yes. Enrolment: 2026-05-01 through 2026-12-31, not enrolled before. This is NOT continuous enrolment for the full year — enrolled only from 2026-05-01. So fails continuous enrolment → not_eligible. Even though frailty documented, E4 requires age 66+ — age 55, so no exclusion anyway, but he's not eligible due to enrolment. not_eligible.
MEMBER 71112: DOB 1954-02-14, 72. Age ok. Enrolment continuous full year, no gaps. Screening: none. No exclusions. → non_compliant.
MEMBER 71113: DOB 1979-02-27, 47. Age ok. Enrolment continuous. Screening: CT colonography 2020-07-03 (outside five-year window), flex sig 2025-11-08 (within five-year window 2022-2026 — yes, 2025 is within). So meets N3. But other history: 2025-07-17 diagnosis C18.7 — colorectal cancer any time on or before 2026-12-31 → E1 exclusion. Exclusions evaluated before numerator. So excluded.
MEMBER 71114: DOB 1951-11-18, 75. Age ok (75 is within 46-75 inclusive). Enrolment continuous. Screening: CT colonography 2021-12-07 — outside five-year window (as computed above). Other history: frailty 2026-12-17, advanced illness 2026-05-05 — both documented during 2026, age 75 ≥ 66 → E4 exclusion. Excluded.
MEMBER 71115: DOB 1979-09-19, 47. Age ok. Enrolment: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. One gap of 35 days. That's one gap ≤ 45 days → continuous enrolment OK. Screening: colonoscopy 2016-12-23 — outside ten-year window (window 2017-2026 or from 2016-12-31; 2016-12-23 is before 2016-12-31). So no numerator. Other history: frailty 2026-07-07 and advanced illness 2026-02-06 — but age 47 < 66, so E4 doesn't apply. E4 requires age 66+. So not excluded. → non_compliant.
MEMBER 71116: DOB 1976-01-11, 50. Age ok. Enrolment: one gap of 35 days → OK. Screening: stool DNA 2023-01-09 — three-year window is 2024-2026 (or from 2023-12-31). 2023-01-09 is outside. No other screening. → non_compliant.
MEMBER 71117: DOB 1963-09-02, 63. Age ok. Enrolment: 2026-01-01 to 2026-06-02; 2026-07-18 to 2026-12-31. Gap: 2026-06-03 to 2026-07-17. Let me count: June 3 to July 17. June 3-30 is 28 days, July 1-17 is 17 days, total 45 days. Stated as one gap of 45 days. "No more than one gap of up to 45 days" — 45 days is allowed ("up to 45"). So continuous enrolment OK. Screening: stool DNA 2026-01-11 — within three-year window (during 2026) → N2 met. → compliant.
MEMBER 71118: DOB 1979-03-23, 47. Age ok. Enrolment: one gap of 42 days → OK. Screening: flex sig 2021-11-12 (outside five-year window), 2022-07-04 (within 2022-2026) → N3 met. → compliant.
MEMBER 71119: DOB 1950-03-25, 76. Age 76 > 75 → not_eligible (age fails).
MEMBER 71120: DOB 1951-03-21, 75. Age ok. Enrolment continuous. Screening: none. Other: advanced illness 2026-02-01 only — advanced illness alone doesn't exclude; no frailty. Age 75 ≥ 66 but needs both frailty AND advanced illness. Only advanced illness → no E4. → non_compliant.
MEMBER 71121: DOB 1971-08-17, 55. Age ok. Enrolment: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gaps: 28 days and 15 days — that's TWO gaps. "No more than one gap of up to 45 days" — two gaps fail. → not_eligible (enrolment).
MEMBER 71122: DOB 1954-09-15, 72. Age ok. Enrolment: 2026-03-22 through 2026-12-31, not enrolled before → not continuous full year. → not_eligible (enrolment).
MEMBER 71123: DOB 1959-03-08, 67. Age ok. Enrolment: gaps of 13 and 25 days — two gaps → fails continuous enrolment. → not_eligible.
MEMBER 71124: DOB 1960-08-15, 66. Age ok (66 within 46-75). Enrolment continuous. Screening: flex sig 2026-04-15 → N3 met. No exclusions (no frailty/advanced illness). → compliant.
MEMBER 71125: DOB 1950-05-08, 76. Age 76 → not_eligible.
MEMBER 71126: DOB 1981-12-20, 45. Age 45 < 46 → not_eligible (age). Also enrolment starts 2026-03-17, not full year. Either way not_eligible.
MEMBER 71127: DOB 1981-01-14, 45. Age 45 < 46 → not_eligible. (Enrolment: one gap of 24 days, but age fails first.)
MEMBER 71128: DOB 1951-12-10, 75. Age ok. Enrolment continuous. Screening: CT colonography 2020-02-10 (outside five-year window), stool DNA 2026-08-17 (during 2026) → N2 met. → compliant.
MEMBER 71129: DOB 1959-07-23, 67. Age ok. Enrolment continuous. Screening: flex sig 2023-07-08 (within 2022-2026 five-year window) → N3 met. Also CT colonography 2023-09-13 (within window) → N4 met. → compliant.
MEMBER 71130: DOB 1981-09-13, 45. Age 45 < 46 → not_eligible. Also enrolment starts 2026-05-16. Also has CRC diagnosis 2024-11-25 (E1) — but exclusions only apply to members in the eligible population; age fails → not_eligible. The spec says: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." → not_eligible.
MEMBER 71131: DOB 1950-05-05, 76. Age 76 → not_eligible. (Also enrolment starts 2026-04-12.)
MEMBER 71132: DOB 1950-02-01, 76. Age 76 → not_eligible. Also has CRC 2019, FIT 2026 — but age fails → not_eligible.
MEMBER 71133: DOB 1967-01-22, 59. Age ok. Enrolment continuous. Screening: CT colonography 2021-04-12, 2021-09-09 — both outside five-year window (2022-2026). → non_compliant.
MEMBER 71134: DOB 1981-09-26, 45. Age 45 < 46 → not_eligible. Also total colectomy 2023 (E2), flex sig 2023. Age fails → not_eligible.
MEMBER 71135: DOB 1971-08-26, 55. Age ok. Enrolment continuous. Screening: colonoscopy 2016-11-12 — outside ten-year window (2017-2026). → non_compliant.
MEMBER 71136: DOB 1981-11-11, 45. Age 45 < 46 → not_eligible. (Also one gap of 40 days — that alone would be fine, but age fails.)
Now let me recount and verify each one.
71111: 55, enrolment from 2026-05-01 → not continuous full year → not_eligible. ✓
71112: 72, continuous, no screening, no exclusion → non_compliant. ✓
71113: 47, continuous, flex sig 2025-11-08 in window (numerator would be met), but CRC C18.7 on 2025-07-17 → E1 → excluded. ✓
71114: 75, continuous, CT colonography 2021-12-07 — let me double check the window. N4: "CT colonography during 2026 or the four years prior (five-year window)." Four years prior to 2026: 2022, 2023, 2024, 2025. Plus 2026 = five-year window: 2022-01-01 through 2026-12-31. 2021-12-07 is outside. Alternatively measured back from 2026-12-31: five years back = 2021-12-31; 2021-12-07 < 2021-12-31, outside. So no numerator. But E4: age 75 ≥ 66, frailty documented 2026-12-17 (during MY), advanced illness 2026-05-05 (during MY) → both during 2026 → E4 → excluded. ✓ (Note: even if numerator were met, exclusion wins.)
71115: 47, one gap 35 days → OK. Colonoscopy 2016-12-23: ten-year window 2017-2026 (or from 2016-12-31). Outside. Frailty + advanced illness in 2026 but age 47 → E4 doesn't apply. → non_compliant. ✓
71116: 50, one gap 35 days → OK. Stool DNA 2023-01-09: three-year window 2024-2026. Outside. → non_compliant. ✓
71117: 63, one gap 45 days → allowed ("up to 45 days"). Stool DNA 2026-01-11 → N2. → compliant. ✓
71118: 47, one gap 42 days → OK. Flex sig 2022-07-04 within five-year window → N3. → compliant. ✓
71119: 76 → not_eligible. ✓
71120: 75, continuous, no screening. Advanced illness only, no frailty → no E4 (needs both). → non_compliant. ✓
71121: 55, two gaps → not_eligible. ✓
71122: 72, enrolment from 2026-03-22 → not full year → not_eligible. ✓
71123: 67, two gaps (13 and 25) → not_eligible. ✓
71124: 66, continuous. Flex sig 2026-04-15 → N3. Age 66 but no frailty/advanced illness → no E4. → compliant. ✓
71125: 76 → not_eligible. ✓
71126: 45 → not_eligible. ✓
71127: 45 → not_eligible. ✓
71128: 75, continuous. Stool DNA 2026-08-17 → N2. → compliant. ✓
71129: 67, continuous. Flex sig 2023-07-08 within five-year window (2022-2026) → N3. CT colonography 2023-09-13 also within. → compliant. ✓
71130: 45 → not_eligible (age). Also has E1, but age fails → not_eligible. ✓
71131: 76 → not_eligible. ✓
71132: 76 → not_eligible. ✓
71133: 59, continuous. CT colonography 2021-04-12 and 2021-09-09 — outside five-year window (2022-2026). → non_compliant. ✓
71134: 45 → not_eligible. (Colectomy E2, but age fails → not_eligible.) ✓
71135: 55, continuous. Colonoscopy 2016-11-12 — outside ten-year window (2017-2026). → non_compliant. ✓
71136: 45 → not_eligible. ✓
Now tally:
Compliant: 71117, 71118, 71124, 71128, 71129. That's 5.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. That's 6.
Excluded: 71113, 71114. That's 2.
Not eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Let me count: 71111 (1), 71119 (2), 71121 (3), 71122 (4), 71123 (5), 71125 (6), 71126 (7), 71127 (8), 71130 (9), 71131 (10), 71132 (11), 71134 (12), 71136 (13). That's 13.
Total: 5 + 6 + 2 + 13 = 26. ✓ Matches roster of 26.
Denominator = compliant + non_compliant = 5 + 6 = 11. (Exclusions removed from denominator.)
Numerator = 5.
Rate = 5/11 × 100 = 45.4545...% → rounded half up to one decimal: 45.5.
Let me double-check the rate: 5/11 = 0.454545..., ×100 = 45.4545...%, rounds to 45.5. ✓
Let me double-check some borderline cases:
71117: gap of 45 days. "no more than one gap of up to 45 days" — 45 days is "up to 45 days", so allowed. Verified the gap: enrolment 2026-01-01 to 2026-06-02, then 2026-07-18. Gap days: 2026-06-03 through 2026-07-17. June: 30 days, so June 3-30 = 28 days; July 1-17 = 17 days; total 45. Yes, 45 days. Allowed. ✓
71115: gap 2026-07-17 through 2026-08-20: July 17-31 = 15 days, August 1-20 = 20 days, total 35. Stated as 35. One gap ≤ 45 → OK. ✓
71118: gap 2026-06-15 through 2026-07-26: June 15-30 = 16, July 1-26 = 26, total 42. Stated 42. OK. ✓
71116: gap 2026-03-17 through 2026-04-20: March 17-31 = 15, April 1-20 = 20, total 35. OK. ✓
71114 age: 75 as of 2026-12-31. DOB 1951-11-18. On 2026-12-31, age = 2026 - 1951 = 75, birthday Nov 18 already passed. 75. Within 46-75 inclusive. ✓
71128 age: DOB 1951-12-10. On 2026-12-31: birthday Dec 10 passed, age 75. ✓ Within range.
71120 age: DOB 1951-03-21 → 75 on 2026-12-31. ✓
71124: DOB 1960-08-15 → 66. Age 66 — within 46-75. E4 requires age 66+, but also needs both frailty and advanced illness documented during MY. 71124 has neither. So compliant via flex sig 2026-04-15 (N3, during 2026). ✓
71113: flex sig 2025-11-08 — within five-year window (2022-2026). Numerator met, but E1 (CRC 2025-07-17) exclusion. Exclusions evaluated before numerator → excluded. ✓
71114: E4 — age 75 ≥ 66, frailty 2026-12-17 during MY, advanced illness 2026-05-05 during MY → both documented during MY → E4. Excluded. ✓
71122: age 72 OK, but enrolment starts 2026-03-22 → not full MY → not_eligible. He has frailty (2026-10-08) and advanced illness (2026-01-13) — E4 would apply if eligible, but enrolment fails → not_eligible. Per the rule: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." ✓
71136: age 45 → not_eligible. Has advanced illness only (no frailty), and age 45 anyway. ✓
71130: age 45 → not_eligible despite CRC. ✓
71134: age 45 → not_eligible despite colectomy. ✓
71132: age 76 → not_eligible despite CRC and FIT. ✓
71127: age 45 → not_eligible. Stool DNA 2024-12-13 would have been in three-year window, but age fails. ✓
71126: age 45 → not_eligible. ✓
71111: age 55 OK, but enrolment from 2026-05-01, not full year → not_eligible. Frailty documented but age 55 < 66 and no advanced illness → E4 wouldn't apply anyway. ✓
71119: 76 → not_eligible. Flex sig 2023-03-04 irrelevant. ✓
71125: 76 → not_eligible. FIT 2026 irrelevant. ✓
71131: 76 → not_eligible. ✓
71121: two gaps → not_eligible. ✓
71123: two gaps → not_eligible. ✓
Now, one thing to consider: 71133's CT colonography dates 2021-04-12 and 2021-09-09. Five-year window: 2026 + four prior years = 2022, 2023, 2024, 2025, 2026. 2021 is outside. → non_compliant. ✓
71135 colonoscopy 2016-11-12: ten-year window = 2017-2026. 2016 outside. → non_compliant. ✓
71115 colonoscopy 2016-12-23: outside 2017-2026. → non_compliant. ✓
71116 stool DNA 2023-01-09: three-year window = 2024-2026. 2023 outside. → non_compliant. ✓
71118 flex sig 2021-11-12: outside 2022-2026. But 2022-07-04 flex sig is inside → compliant. ✓
71113 CT colonography 2020-07-03: outside. Flex sig 2025-11-08: inside → numerator met, but excluded. ✓
71128 CT colonography 2020-02-10: outside. Stool DNA 2026-08-17: inside → compliant. ✓
71129 flex sig 2023-07-08: inside five-year window. → compliant. ✓
71114 CT colonography 2021-12-07: outside. But E4 exclusion anyway. ✓
Final lists:
compliant_members: ["71117", "71118", "71124", "71128", "71129"]
non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
excluded_members: ["71113", "71114"]
not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
denominator = 11
numerator = 5
excluded = 2
not_eligible = 13
rate = 45.5
Wait — the denominator definition: "members in the eligible population after exclusions are removed (compliant + non_compliant)". So denominator = 5 + 6 = 11. Numerator = 5. Rate = 45.5.
Hmm, but let me reconsider whether the denominator should be the eligible population before exclusions. The key says: "denominator — members in the eligible population after exclusions are removed (compliant + non_compliant)". So it's 11. ✓
Rate: 5/11 × 100 = 45.4545... → 45.5. ✓
Let me double check rounding: 45.4545... rounds to 45.5 at one decimal place. Yes (45.45... the second decimal is 5, so 45.45 → 45.5? Actually 45.4545: first decimal 4, second 5, so 45.45 → round half up at one decimal: look at 45.4545 — the digit after the first decimal place is 5 (45.45...), so rounding half up gives 45.5. More precisely, 45.4545... > 45.45, so it rounds to 45.5. ✓
Everything checks out. Let me also verify member 71112's enrolment: continuous full year, no gaps → eligible. No screening → non_compliant. ✓
Member 71120: age 75, continuous. No screening. Advanced illness only — per spec, advanced illness alone does not exclude. → non_compliant. ✓
One more check on 71124: DOB 1960-08-15 → on 2026-12-31, age 66. ✓ Flex sig 2026-04-15 → N3 during 2026. Compliant. ✓
Counting again not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 = 13 members.
5 + 6 + 2 + 13 = 26. ✓
Final answer JSON.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Max · Alibaba155.1s · 7,194 out | 133.8s · 6,443 out | 137.0s · 6,388 out
Reasoning · 6,851 tokens
We need answer JSON only. Need solve measure population. Need careful. Let's parse spec and roster. Need classify each of 26 members: compliant, non_compliant, excluded, not_eligible.
Measurement year 2026-01-01 to 2026-12-31.
Eligible population: Age 46 through 75 as of 2026-12-31. Continuous enrollment full measurement year with no more than one gap up to 45 days.
Important: age inclusive 46-75. If age <46 or >75 not eligible regardless exclusions.
Continuous enrollment: Need full measurement year with no more than one gap up to 45 days. Need interpret gaps. If enrolled from 2026-01-01 through 2026-12-31 except at most one gap <=45 days. If starts after Jan 1 or ends before Dec 31, not eligible (unless maybe gap at beginning/end? Spec says full measurement year with no more than one gap up to 45 days. Usually continuous enrollment means must be enrolled Jan 1-Dec 31 with allowed gap? If not enrolled before May 1, that's a gap from Jan1-Apr30 length 120 days, >45 => not eligible. If enrolled from Mar22, gap Jan1-Mar21 = 80? >45. Not eligible. If enrolled from May16, gap 135. Not eligible. If starts Apr12 gap 102. Not eligible. So yes.) One gap up to 45 days allowed, if two gaps not eligible even if each <=45? Spec says no more than one gap of up to 45 days. So two gaps -> not eligible. Need count gap lengths perhaps inclusive? Need determine gap days. Roster often states gap length. We can rely but verify. For 71121: gaps 28 and 15 -> two gaps => not eligible. Others one gap <=45 eligible if age ok. One gap exactly 45 (71117) allowed. Need check if continuous from date to end, start after Jan1: gap before enrollment; if <=45? For 71111 enrolled from 2026-05-01, gap Jan1-Apr30 = Jan 31 + Feb28 + Mar31 + Apr30 = 120 days, >45, not eligible. 71122 from 2026-03-22: Jan1-Mar21 = 31+28+21=80? 2026 nonleap? 2026 not leap, Feb 28. 80 >45. not eligible. 71126 from 2026-03-17: age 45 too young anyway, not eligible. 71130 from 2026-05-16 age45 anyway. 71131 from 2026-04-12 age76 anyway. But enrollment also fail.
Exclusions evaluated only for eligible. Exclusions: E1 colorectal cancer C18-C21 any time on/before 2026-12-31. E2 total colectomy any time on/before. E3 hospice during measurement year. E4 age >=66 as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty or advanced illness alone not exclude.
Numerator: any one by lookback 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 date bounds? measured back from 2026-12-31. Three-year window likely 2024-01-01? But "during 2026 or the two years prior" means 2024-01-01 through 2026-12-31? Or exactly 3 years back: 2023-12-31? Need decide. Usually measurement year and prior two calendar years: 2024-2026. But phrase look-back window measured back from 2026-12-31: three-year window could be 2024-01-01 to 2026-12-31? If measured back 3 years from Dec31 => on/after 2024-01-01? Let's examine dates near boundary: 71111 stool DNA 2023-11-04. If 3-year calendar 2024-01-01, not counted; if exact 3 years from 2026-12-31 => 2024-01-01? Actually 2026-12-31 minus 3 years = 2023-12-31? Dates: window of 3 years ending 2026-12-31 could be 2024-01-01 through 2026-12-31 inclusive (3 calendar years) or 2023-12-31 through 2026-12-31? "during 2026 or the two years prior" strongly means calendar years 2026, 2025, 2024. Thus 2023-11-04 is out either way. Need for 71127 stool DNA 2024-12-13: in. 71116 2023-01-09 out. 71128 2026-08-17 in.
N3 flexible sigmoidoscopy during 2026 or four years prior: five-year window. likely 2022-01-01 through 2026? "four years prior" means calendar years 2022-2026? If exact five years back: 2022-01-01? Need dates: 2021-11-12 (71118) out if 2022 onward. 2021-12-07 CT (71114) out for N4. 2022-07-04 flex sig 71118 in if 2022. 2023 flex sig in. 2025 flex sig in.
N4 CT colonography during 2026 or four years prior (five-year window). 2021 dates? out if 2022+. 2021-04 and 2021-09 out. 2022? none? 2023 in. 2026 in.
N5 colonoscopy during 2026 or nine years prior (ten-year window). likely 2017-01-01 through 2026? If exact ten-year from 2026-12-31 maybe on/after 2017-01-01? Dates: 2016-12-23 and 2016-11-12 are out if 2017+. 2025 colonoscopy in. Need check if 2016 could be within exact 10 years? 2026-12-31 minus 10 years = 2016-12-31, so 2016-12-23 could be within if window includes 2016-12-31? Wait if ten-year window measured back from 2026-12-31, 10 years prior is 2016-12-31. But phrase "during 2026 or the nine years prior" means calendar years 2017-2026, not 2016. So 2016 out. Need be consistent. Given explicit "during [year] or the X years prior" seems calendar years: for 10-year window: 2026 plus nine prior years = 2017-2026. So 2016 out. For 5-year: 2022-2026. For 3-year: 2024-2026.
Need classify all.
Let's enumerate members.
First create table: ID, DOB age on 2026-12-31, enrollment, gaps, age eligibility, enrollment eligibility, exclusions, numerator.
Spec: Exclusions only for eligible. If not eligible due age/enrollment, ignore cancer/colectomy etc.
Member 71111: age55 eligible age. Enrollment: 2026-05-01 to 12/31, not before. Gap Jan1-Apr30 = 120 days >45 (or one gap? but too long). Not eligible. Even frailty only. Screening irrelevant. => not_eligible.
71112: age72 eligible. Enrollment continuous full. Exclusions: none. Numerator: no screening. => non_compliant.
71113: age47 eligible. Enrollment continuous. Other: C18.7 diagnosis 2025-07-17, on/before 2026 => E1 exclusion. Even though flex sig 2025 qualifies maybe, excluded. => excluded.
71114: age75 eligible. continuous. Exclusions E4? Age 75 (>=66) and frailty 2026-12-17 and advanced illness 2026-05-05 both during measurement year => E4 excluded. Screening CT 2021 out anyway. => excluded.
71115: age47 eligible. Enrollment: Jan1-Jul16 and Aug21-Dec31 one gap 35 days (Jul17-Aug20? 35 days) allowed. Need full measurement year with one gap <=45 => eligible. Exclusions E4? age47 <66 so no. Frailty and advanced illness present but age <66, not exclude. E1/E2/E3 none. Numerator: colonoscopy 2016-12-23. Ten-year window 2017-2026? out. If exact from 2026-12-31 ten years includes 2016-12-31 onward? 2016-12-23 is before 2016-12-31, out either way? If exact 10 years subtract: 2016-12-31, 2016-12-23 is 8 days before window; out. So no numerator. => non_compliant.
71116: age50 eligible. Enrollment one gap 35 days eligible. No exclusions. Screening stool DNA 2023-01-09. 3-year window 2024-2026, out. no other. => non_compliant.
71117: age63 eligible. Enrollment one gap exactly 45 days eligible. No exclusions. Stool DNA 2026-01-11 N2 in. => compliant.
71118: age47 eligible. Enrollment one gap 42 eligible. No exclusions. Flex sig 2021-11-12 out; 2022-07-04 in five-year window (2022-2026) => compliant.
71119: age76 on 2026-12-31. Age >75 not eligible. Enrollment continuous but age fails. => not_eligible. (Exclusions irrelevant.)
71120: age75 eligible. continuous. Exclusions: advanced illness only, no frailty => E4 no. No cancer/colectomy/hospice. Screening none. => non_compliant.
71121: age55 eligible age. Enrollment: three segments with two gaps 28 and 15. Spec allows no more than one gap. Thus not eligible. (Even though CT 2026). => not_eligible.
71122: age72 eligible. Enrollment from 2026-03-22, gap Jan1-Mar21 = 80 days >45, not eligible. Also advanced illness date 2026-01-13 before enrollment? But not relevant. => not_eligible.
71123: age67 eligible age. Enrollment: three segments gaps 13 and 25 -> two gaps, not eligible. => not_eligible.
71124: age66 eligible. continuous. No exclusions (age66 but no frailty/advanced). Flex sig 2026-04-15 N3 in. => compliant.
71125: age76 >75 not eligible. (FIT 2026 irrelevant). => not_eligible.
71126: age45 <46 not eligible. Also enrollment start Mar17. => not_eligible.
71127: age45 <46 not eligible. Though one gap, age fails. => not_eligible.
71128: age75 eligible. continuous. No exclusions. Screening: CT 2020 out; stool DNA 2026-08-17 N2 in. => compliant.
71129: age67 eligible. continuous. No exclusions. Flex sig 2023-07-08 N3 in (2022-2026); CT 2023 also N4 in. => compliant.
71130: age45 <46 not eligible. Also enrollment gap start May16 >45, cancer. Not eligible. => not_eligible.
71131: age76 >75 not eligible. Also enrollment from Apr12. => not_eligible.
71132: age76 >75 not eligible. Also cancer, but age fails. => not_eligible.
71133: age59 eligible. continuous. No exclusions. CT colonography 2021-04-12 and 2021-09-09. Five-year window 2022-2026, out. No other. => non_compliant.
71134: age45 <46 not eligible. Also colectomy but age fails. => not_eligible.
71135: age55 eligible. continuous. No exclusions. Colonoscopy 2016-11-12. Ten-year window 2017-2026, out. => non_compliant.
71136: age45 <46 not eligible. Also one gap, advanced illness. => not_eligible.
Need check ages: DOB and age stated. 71113 1979-02-27 => 47. 71115 47. 71118 47. 71126 1981-12-20 => 45. 71127 1981-01-14 => 45. 71130 1981-09-13 =>45. 71134 45. 71136 45. yes.
Need counts.
Let's list classifications:
71111 not_eligible
71112 non_compliant
71113 excluded
71114 excluded
71115 non_compliant
71116 non_compliant
71117 compliant
71118 compliant
71119 not_eligible
71120 non_compliant
71121 not_eligible
71122 not_eligible
71123 not_eligible
71124 compliant
71125 not_eligible
71126 not_eligible
71127 not_eligible
71128 compliant
71129 compliant
71130 not_eligible
71131 not_eligible
71132 not_eligible
71133 non_compliant
71134 not_eligible
71135 non_compliant
71136 not_eligible
Counts: compliant: 71117, 71118, 71124, 71128, 71129 = 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6. Check also any eligible no numerator: yes.
Excluded: 71113, 71114 = 2.
Not eligible: remaining 26-5-6-2=13. List: 71111,71119,71121,71122,71123,71125,71126,71127,71130,71131,71132,71134,71136 = 13.
Denominator = compliant + non_compliant = 11.
Numerator = 5.
Rate = 5/11*100 = 45.4545 -> rounded half up one decimal = 45.5. Need number 45.5.
Need ensure no missed exclusions: E1 cancer for eligible only. 71113 eligible and cancer => excluded. 71130 cancer but not eligible age/enroll. 71132 cancer but age not eligible. E2 total colectomy: 71134 colectomy but age 45 not eligible; if age eligible would exclude. None else. E3 hospice: none. E4: Need age 66+ and both frailty and advanced illness during measurement year. Check 71114 yes excluded. 71122 age72, frailty 2026-10-08, advanced illness 2026-01-13; but not eligible due enrollment. Exclusions evaluated only for eligible, so not excluded. 71120 advanced illness only no frailty. 71111 frailty only and not eligible. 71115 both but age47. 71136 advanced illness only and age45 not eligible. Good.
Need verify continuous enrollment gap counts. There may be nuance: "full measurement year with no more than one gap of up to 45 days." Does a member enrolled 2026-03-22 through 12/31 have one gap of 80 days? Not eligible. 71111 gap 120. 71121 two gaps -> not eligible. 71123 two gaps. What about 71127: age45, not eligible anyway; enrollment one gap 24 but age fails. 71136 age45, not eligible.
Need consider if enrollment gap length stated may be off due inclusive/exclusive. But given stated gap lengths for those with internal gaps. For starts after Jan1, no stated gap. We calculate. Could there be allowed gap at beginning if enrollment starts within 45 days? None. Earliest start after Jan1 is 2026-03-17 (75 days? Jan1-Mar16? Let's calculate 2026-03-17: gap Jan1-Mar16 = Jan31 + Feb28 + Mar16 =75, >45. 2026-03-22: 80. 2026-04-12: 102? Jan31+Feb28+Mar31+Apr11=101? Actually Jan1-Apr11: 31+28+31+11=101. >45. 2026-05-01: 120. 2026-05-16: 135. So none.
Need think about numerator windows exact date boundaries. Could affect 71118 if flex sig 2022-07-04 in; 71133 CT 2021 out; 71115 colonoscopy 2016 out; 71135 2016 out. If exact ten-year from 2026-12-31 maybe includes 2016-12-31? But dates 2016-12-23 and 2016-11-12 out. If exact 5-year from 2026-12-31 includes 2021-12-31? 71118 2021-11-12 out, 71114 2021-12-07 out. If exact 5-year includes from 2021-12-31, still out. If calendar 2022+, same. 71118 2022-07-04 in both. 71129 2023 in. 71128 stool DNA 2026 in. 71117 2026 in. Good. 71113 had flex sig 2025 but excluded. 71111 stool DNA 2023-11-04 out if 2024+; if exact three-year from 2026-12-31 includes from 2023-12-31? out. Colonoscopy 2025 in but 71111 not eligible. 71130 FIT 2026 but not eligible. 71132 FIT 2026 but age not eligible. 71125 FIT 2026 age not eligible. 71136 flex sig 2026 age not eligible. So numerator classifications stable.
Need output JSON exactly with required keys and no extra. Need arrays strings. Rate number maybe 45.5. Need ensure denominator integer, numerator etc.
Double-check counts by enumerating all 26:
1 71111 NE
2 71112 NC
3 71113 EX
4 71114 EX
5 71115 NC
6 71116 NC
7 71117 C
8 71118 C
9 71119 NE
10 71120 NC
11 71121 NE
12 71122 NE
13 71123 NE
14 71124 C
15 71125 NE
16 71126 NE
17 71127 NE
18 71128 C
19 71129 C
20 71130 NE
21 71131 NE
22 71132 NE
23 71133 NC
24 71134 NE
25 71135 NC
26 71136 NE
C=5, NC=6, EX=2, NE=13 sum26. Denom=11.
Need think: 71115 enrollment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap: from Jul17 to Aug20 inclusive = 35 days? Jul17-31 15 days, Aug1-20 20 =>35. allowed. Good.
71116 gap: Mar17-Apr20? 35. allowed.
71117: Jan1-Jun2; Jul18-Dec31. Gap Jun3-Jul17 inclusive: Jun3-30 28 days + Jul1-17 17 =45. allowed.
71118: gap Jun15-Jul26? Jun15-30 16 + Jul1-26 26 =42. allowed.
71121 two gaps: not eligible. But could "no more than one gap of up to 45 days" mean total gap days? It says no more than one gap, so two gaps disqualify. Yes.
71123 two gaps disqualify.
Potential nuance: Exclusions evaluated before numerator, only for eligible. For member 71113, cancer diagnosis C18.7 on 2025-07-17. E1 any time on or before 2026-12-31. Excluded. Good.
Potential nuance: E4 age 66 or older AND both frailty and advanced illness documented during measurement year. For 71114: age75, frailty 2026-12-17, advanced illness 2026-05-05 both in MY. excluded. For 71122: not eligible, so not excluded. If someone not eligible but meets exclusion, not_eligible. Yes.
Potential nuance: member 71120 age75 advanced illness only; no exclusion. noncompliant.
Rate rounding: 5/11*100 = 45.454545. Round half up to one decimal: 45.5. If denominator 0 would null? not here.
Output only fenced JSON. Ensure no trailing commas. Key order can be as required. Use arrays of strings. Could sort? any order. Use maybe ascending.
Let's craft:
{
"denominator":11,
"numerator":5,
"excluded":2,
"not_eligible":13,
"rate":45.5,
"compliant_members":["71117","71118","71124","71128","71129"],
"non_compliant_members":["71112","71115","71116","71120","71133","71135"],
"excluded_members":["71113","71114"],
"not_eligible_members":["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
}
Double-check if 71111 could be eligible due "continuous from that date" with no more than one gap up to 45 days? It says Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. The full measurement year requirement likely not met. Not eligible. Good.
One thing: continuous enrollment may require no more than one gap of up to 45 days but may allow not enrolled before start if gap <=45? Yes, we did. None start within 45 days. 71131 starts Apr12 gap >45, age76. Good.
Could age calculation be as of Dec31, stated ages are authoritative. For DOB 1950-05-05 age 76; >75. yes. 1950-03-25 age76. 1950-02-01 age76. 1951-* age75. eligible. 1954 age72. 1960 age66. 1959 age67.
Let's ensure 71124 age66 exactly, eligible. E4 requires age 66 or older. But no frailty/advanced. compliant.
Potential alternative: E4 requires frailty and advanced illness documented during measurement year; if advanced illness date 2026-01-13 for 71122 before enrollment? But not eligible. If eligible, would count? It says documented during measurement year, not necessarily enrollment. But not relevant. For 71114 both during. Good.
Could 71113 cancer C18.7 be malignant neoplasm sigmoid colon, yes colorectal cancer C18-C21. Exclude.
Could 71134 total colectomy and age45: not eligible. If not_eligible due age, not excluded. correct.
No hospice.
Need final only JSON fenced. Ensure no preamble. final.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,100 tokens
We need answer JSON only. Need solve measure population. Need carefully evaluate 26 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 enrollment full measurement year with no more than one gap up to 45 days. Need interpret gaps: likely allowed at most one gap, length <=45 days. If not enrolled before start but enrollment starts after Jan 1? Full measurement year requirement means must be enrolled Jan 1-Dec 31 except allowed gap? It says continuous enrolment: the full measurement year with no more than one gap of up to 45 days. If enrollment begins later than Jan 1, not full year unless maybe gap at beginning? In HEDIS, continuous enrollment with allowable gap: member must be enrolled for entire measurement year, but may have one gap up to 45 days. If not enrolled before date and starts May 1, that's a gap from Jan 1 to Apr 30 (120 days) more than 45, not eligible. But some tasks might treat enrollment from date to end continuous with no gap? Need infer. Roster entries often say "Not enrolled before ..." likely to test not eligible due to enrollment gap >45. We need apply full measurement year with no more than one gap up to 45 days. So if enrollment does not cover Jan 1 or missing period >45, not eligible. If multiple gaps => not eligible. If one gap exactly 45 allowed. Need count gap days inclusive? Need determine from dates. They provide gap lengths: 35, 45, 42, etc. For 71121 gaps of 28 and 15 days -> two gaps, not eligible even though each <=45. For 71123 gaps 13 and 25 -> two gaps, not eligible. For 71132 one gap 36 allowed. Need verify gap length calculations maybe inclusive/exclusive? Provided says one gap of X days, trust. For late enrollment: 71111 enrolled 2026-05-01 through 12-31, not before. Gap Jan1-Apr30 = 120 days? Not eligible. 71122 enrolled 2026-03-22 through 12-31: gap Jan1-Mar21 = 80? Not eligible. 71126 enrolled 2026-03-17: gap 75? not eligible. 71130 enrolled 2026-05-16: gap 135? not eligible. 71131 enrolled 2026-04-12: gap 101? not eligible. Also age not eligible for some. Need exclusions only for eligible population. If fails enrollment or age, not_eligible even if exclusion documented.
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 = 3-year window: likely 2024-01-01 through 2026-12-31? "during 2026 or the two years prior" means dates on/after 2024-01-01. Need consider exact 3 years measured back from 2026-12-31 maybe 2024-01-01? Usually HEDIS 2026: stool DNA between 1/1/2024 and 12/31/2026. Yes.
N3 flex sig during 2026 or four years prior = 5-year window: 2022-01-01 through 2026-12-31? If measured back from 12/31/2026, five-year window could be 2022-01-01? E.g. 2021-12-07 would be just over 5 years? Need decide. The wording: during 2026 or the four years prior. That suggests calendar years 2022, 2023, 2024, 2025, 2026 (five calendar years). But "look-back window measured back from 2026-12-31" could mean exact date: five years prior from 2026-12-31 is 2021-12-31? Need precise. For colonoscopy ten-year window during 2026 or nine years prior -> calendar years 2017-2026? Or exact 2016-12-31? Roster has colonoscopy 2016-12-23, 2016-11-12. If exact ten years from 2026-12-31, 2016-12-23 is within (>=2016-12-31? no, if 10-year window measured back: on/after 2016-12-31? 2016-12-23 is 10 years +8 days, outside). If calendar years 2017-2026, 2016 outside. Both outside. But if someone had 2017? none. CT colonography 2021-12-07 for 71114 and 2020 etc. Five-year window: if calendar 2022-2026, 2021-12-07 outside; if exact from 2021-12-31? outside. 2022-07-04 flex sig inside. 2021-11-12 outside. Stool DNA 2023-11-04 inside 3-year? 3-year window 2024-2026: 2023 outside. But if exact 3 years from 2023-12-31? outside. Need apply. There are edge dates maybe 2023-01-09 stool DNA: outside 2024-2026. 2023-11-04 outside. 2024-12-13 stool DNA inside. CT 2021-04/09 outside five-year if 2022 onward. Flexible sigmoidoscopy 2023 inside. CT colonography 2023-09-13 inside 5-year. FIT 2026 inside. So only edge could be 2021-12-07 CT for 71114. It is outside whether calendar 2022 or exact 2021-12-31? Actually exact five-year measured back from 2026-12-31: on/after 2021-12-31? 2021-12-07 before, outside. Good.
Exclusions:
E1 colorectal cancer C18-C21 any time on/before 2026-12-31.
E2 total colectomy any time on/before 2026-12-31.
E3 hospice during measurement year (none listed except maybe no hospice).
E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone or advanced illness alone not exclude. Documentation during measurement year: both dates in 2026 for relevant. Advanced illness 2026-01-13 for 71122 even if enrollment starts later? Exclusions evaluated only for eligible population; if not eligible no need. For eligible, dates must during 2026.
Need classify each of 26. Let's make table.
Member 71111:
DOB 1971-04-18 age 55 eligible age. Enrollment 2026-05-01 to 12-31, not before. Gap from Jan1 to Apr30 >45 (120), not eligible. Even though frailty only, colonoscopy 2025 inside numerator. not_eligible.
71112:
Age 72 (46-75). Enrollment continuous full year. No exclusions (no CRC, colectomy, hospice, frailty/adv). No screening. Eligible denominator, non_compliant.
71113:
Age 47. Enrollment continuous. Screening: CT 2020 outside, flex sig 2025-11-08 inside 5-year (2022-2026). But other history CRC C18.7 diagnosed 2025-07-17 on/before 2026 -> E1. Eligible population but excluded. Excluded. (Numerator also met but exclusion precedes.)
71114:
Age 75. Enrolled full. Screening CT 2021-12-07 outside 5-year? Need check. 5-year window maybe 2022-01-01 onwards, outside. No other. Other: frailty 2026-12-17, advanced illness 2026-05-05. Age 75 >=66 and both during measurement year => E4 excluded. Even if no numerator. Excluded.
71115:
Age 47. Enrollment: 2026-01-01 to 07-16; 08-21 to 12-31. One gap 35 days <=45 -> eligible enrollment. Screening colonoscopy 2016-12-23. Ten-year window? 2017-2026 if calendar, outside; exact from 2016-12-31? outside. No numerator. Other: frailty 2026-07-07 and advanced illness 2026-02-06. Age 47 <66, E4 not apply. Eligible, non_compliant.
71116:
Age 50. Enrollment one gap 35 days -> eligible. Screening stool DNA 2023-01-09. 3-year window 2024-2026, outside. No exclusions. non_compliant.
71117:
Age 63. Enrollment one gap 45 days allowed -> eligible. Screening stool DNA 2026-01-11 -> N2 during 2026. No exclusions. compliant.
71118:
Age 47. Enrollment one gap 42 days allowed. Screening flex sig 2021-11-12 outside; 2022-07-04 inside 5-year. No exclusions. compliant.
71119:
Age 76 >75 => not eligible (age). Enrollment full. not_eligible. Screening irrelevant.
71120:
Age 75. Enrolled full. No screening. Advanced illness only 2026-02-01, no frailty. E4 requires both, no. Eligible non_compliant.
71121:
Age 55. Enrollment multiple gaps (28,15) -> not eligible despite each <=45 because no more than one gap. Not eligible. Screening CT 2026 irrelevant.
71122:
Age 72. Enrollment starts 2026-03-22; gap Jan1-Mar21 >45 -> not eligible. Also frailty + advanced illness, age but not eligible. not_eligible.
71123:
Age 67. Enrollment gaps 13 and 25 -> two gaps, not eligible. not_eligible.
71124:
Age 66. Enrolled full. Flex sig 2026-04-15 -> N3. No exclusions. compliant. Age 66 but no frailty/adv.
71125:
Age 76 >75 -> not eligible. FIT 2026 irrelevant.
71126:
Age 45 (<46) -> not eligible. Also enrollment late. not_eligible.
71127:
Age 45 (<46) -> not eligible. Enrollment gap ok but age fails. not_eligible.
71128:
Age 75. Enrolled full. Screening CT 2020 outside; stool DNA 2026-08-17 -> N2. No exclusions. compliant.
71129:
Age 67. Enrolled full. Flex sig 2023-07-08 inside 5-year; CT 2023-09-13 inside. No exclusions. compliant.
71130:
Age 45 (<46) -> not eligible. Enrollment late. Also CRC 2024 but not eligible. not_eligible.
71131:
Age 76 -> not eligible. Enrollment late. not_eligible.
71132:
Age 76 -> not eligible? DOB 1950-12-10, age 76 on 2026-12-31. Age range 46-75. Not eligible. Even though one gap 36 and FIT 2026 and CRC exclusion. Age fails first. not_eligible.
71133:
Age 59. Enrolled full. CT colonography 2021-04-12 and 2021-09-09. Five-year window 2022-2026, both outside. No exclusions. non_compliant.
71134:
Age 45 (<46) -> not eligible. Also total colectomy 2023 but age fails. not_eligible.
71135:
Age 55. Enrolled full. Colonoscopy 2016-11-12. Ten-year window? If 2017-2026 outside; exact ten years from 2016-12-31? outside. No exclusions. non_compliant.
71136:
Age 45 (<46) -> not eligible. Enrollment one gap 40 but age fails. not_eligible.
Counts: Let's list categories.
Compliant: 71117, 71118, 71124, 71128, 71129 = 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6.
Excluded: 71113, 71114 = 2.
Not_eligible: remaining 26-5-6-2=13. Let's enumerate: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 = 13. Check all 26: 111-136 inclusive 26. Lists: compliant 5; non 6; excl 2; not 13 total 26.
Denominator = compliant + non_compliant = 11. Numerator = 5. Rate = 5/11*100 = 45.4545 -> round half up one decimal = 45.5. Need ensure denominator definition: members in eligible population after exclusions removed. Yes.
Need be extra careful on enrollment gap rules and numerator windows. Let's audit each edge.
Continuous enrollment: "full measurement year with no more than one gap of up to 45 days." Does a member enrolled 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31 one gap of 45 days: yes eligible. If gap length counted from 06-03 to 07-17 inclusive = 45 days? June 3-30 28 days + July 1-17 17 =45. Good. 71118 06-15 to 07-26? They say 42. Fine. 71115 07-17 to 08-20 = 35. Good. 71121 two gaps: not eligible. What about enrollment starts 2026-05-01 "continuous from that date. Not enrolled before". Could this be considered one gap of 120 days? No more than one gap up to 45, so fail. Good.
Age: "46 through 75 years as of 2026-12-31." Members listed ages: 71114 75, 71120 75, 71128 75 eligible; 71119/125/131/132 76 not eligible; 45 not eligible. Good.
Exclusions evaluated before numerator only for eligible population. 71113 eligible age/enroll, has CRC -> excluded. 71114 eligible age/enroll, E4 -> excluded. Any other CRC among eligible? 71130 CRC but not eligible age/enroll. 71132 CRC but age not eligible. 71134 colectomy but age not eligible. If age fails, not_eligible even if exclusion documented. Good.
Numerator details:
N1 FOBT/FIT during 2026. None except FIT 2026 for 71125 (not eligible age), 71130 (not eligible), 71132 (not eligible), 71124? flex sig not FIT. No.
N2 stool DNA during 2026 or two years prior. Dates:
71111 2023-11-04 outside. Also not eligible.
71116 2023-01-09 outside.
71117 2026-01-11 inside.
71127 2024-12-13 inside but age not eligible.
71128 2026-08-17 inside.
Any 2024? none eligible besides maybe 71127. Good.
N3 flex sig during 2026 or four years prior. Dates:
71113 2025-11-08 inside but excluded.
71118 2021-11-12 outside, 2022-07-04 inside. Need if window is 2022-01-01 onward; yes. If exact 5 years from 2026-12-31, on/after 2021-12-31, 2022-07 inside.
71119 2023-03-04 inside but age not eligible.
71124 2026-04-15 inside.
71129 2023-07-08 inside.
71134 2023-10-21 but age not eligible/colectomy.
71136 2026-02-13 but age not eligible.
N4 CT colonography during 2026 or four years prior:
71113 2020 outside.
71114 2021-12-07 outside? If exact five-year window from 2021-12-31? outside. If "during 2026 or four years prior" as calendar years 2022-2026, outside. If "measured back from 2026-12-31" exact date: five-year window starts 2021-12-31? Usually 5-year lookback could be on or after 2022-01-01? Let's think. If measurement year 2026, "during 2026 or the four years prior" explicitly means the measurement year plus four prior years: 2026, 2025, 2024, 2023, 2022. So 2021 outside. Good. 71121 CT 2026 inside but enrollment not eligible. 71128 CT 2020 outside. 71129 CT 2023 inside (also flex sig). 71130 CT 2020 outside not eligible. 71131 CT 2026 not eligible age/enroll. 71133 CT 2021 outside. Good.
N5 colonoscopy during 2026 or nine years prior. Measurement year plus nine prior years: 2026, 2025, ..., 2017. 71111 2025 inside but enrollment fail. 71115 2016 outside. 71135 2016 outside. Good. If exact ten-year window from 2026-12-31: on/after 2016-12-31? 2016-12-23 outside; 2016-11-12 outside. If calendar 2017 onward outside. Good.
Potential ambiguity: Stool DNA "during 2026 or the two years prior" = measurement year plus two prior years: 2026,2025,2024. So 2023 outside. Good.
Potential issue: E4 age >=66 and frailty + advanced illness during measurement year. 71114 qualifies. 71122 has both but not eligible enrollment; not excluded. 71120 advanced illness only no. 71111 frailty only and not eligible. 71115 both but age 47 no. 71136 advanced illness only and age 45 not eligible. Good.
Need output JSON exactly with required keys. Member IDs strings. Any order. Rate number 45.5. Need not include extra. Ensure arrays match counts. Could sort. Let's produce:
{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117","71118","71124","71128","71129"],
"non_compliant_members": ["71112","71115","71116","71120","71133","71135"],
"excluded_members": ["71113","71114"],
"not_eligible_members": ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
}
Double-check denominator: Does denominator key ask "members in the eligible population after exclusions are removed (compliant + non_compliant)". Yes 11.
Let's ensure no excluded member who fails eligibility? 71113 eligible. 71114 eligible. What about 71132 age 76 not eligible, but also CRC; not eligible. 71134 age 45 not eligible, but total colectomy; not eligible. Good.
Potential alternative interpretation of enrollment: Could "Not enrolled before 2026-05-01" but enrolled through end be considered a gap of 120 days? No, not eligible. If some harness expects "continuous enrollment from date" and only gaps within enrollment count? But spec says full measurement year. The wording "full measurement year with no more than one gap" strongly requires Jan1-Dec31. Roster explicitly notes not enrolled before for several to mark not eligible. If they intended only gap count within enrollment, those with start after Jan1 would be eligible? But then full measurement year violated. Also 71130 age 45 not eligible anyway; 71131 age 76; 71126/71136 age45; 71127 age45; 71132 age76. Only 71111 (55), 71122 (72) late enrollment but otherwise age eligible. They likely test not eligible due to enrollment. 71123 multiple gaps age 67. Good.
Potential issue: Gap length "up to 45 days" includes 45. 71117 gap 45 eligible. If they considered 45 not allowed? "up to" includes. Good.
Potential issue: multiple gaps: 71121 gaps 28 and 15. Could total gap days 43 <=45 and two gaps? Spec says no more than one gap. So not eligible. Good. 71123 total 38 but two gaps not eligible. Good.
Need final only fenced JSON. Ensure no commentary. Final JSON.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,045 tokens
We need answer JSON only. Need process 26 members for QM-CRC. Need compute statuses. Need be careful. Let's parse spec.
Measurement year 2026-01-01 to 2026-12-31.
Eligible denominator: Age 46 through 75 as of 2026-12-31. Continuous enrollment full year with no more than one gap up to 45 days. Need likely gaps count? "no more than one gap of up to 45 days." Means exactly one gap allowed if <=45 days. If two gaps not eligible, even if each <=45? Yes no more than one gap. Also enrollment must cover full measurement year? It says full measurement year with no more than one gap. If starts after Jan 1, is that a gap? Usually continuous enrollment with gap maybe initial enrollment not from Jan 1? Need interpret: full measurement year with no more than one gap up to 45 days. Members starting 2026-05-01 not enrolled before: gap Jan 1-Apr 30 length? It's not a gap in enrollment? They are not enrolled, so likely not continuous full year. But task says continuous enrolment: the full measurement year with no more than one gap of up to 45 days. If not enrolled before 2026-05-01, gap from Jan 1 to Apr 30 (120 days) >45 and one gap? Maybe not eligible. Similarly 71122 starts 2026-03-22, gap 80 days? Not eligible. 71126 starts 2026-03-17, gap 75 days? Not eligible. 71130 starts 2026-05-16, gap 135? not eligible. 71131 starts 2026-04-12, gap 101? not eligible. Need consider if they are continuous from that date but not enrolled before, measurement year not fully covered, not eligible. Yes.
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 from 2024-01-01? Let's calculate measured back from 2026-12-31: "during 2026 or the two years prior (three-year window)" = 2024-01-01 through 2026-12-31? If exact three years back would be 2023-12-31? But phrasing two years prior likely calendar years 2024,2025,2026. Need decide. Similarly flex sig 5-year window during 2026 or four years prior => 2022-01-01 through 2026-12-31. CT colonography 5-year. Colonoscopy 10-year => 2017-01-01 through 2026-12-31? Need infer from examples. Usually HEDIS colorectal screening: colonoscopy 10 years, flexible sigmoidoscopy 5 years, CT colonography 5 years, stool DNA 3 years, FOBT/FIT 1 year. The measurement year is 2026; lookback is often "during 2026 or the four years prior" = Jan 1 2022-Dec 31 2026. They explicitly say two years prior/three-year window. So use calendar year starts Jan 1 of year offset. Need if date 2023-11-04 stool DNA for 71111 is outside three-year (2024+), but colonoscopy 2025-01-02 inside 10-year, so compliant anyway.
Exclusions evaluated before numerator only for eligible population:
E1 colorectal cancer C18-C21 any time on/before 2026-12-31.
E2 total colectomy any time on/before 2026-12-31.
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.
If meets exclusion and numerator -> excluded.
Not eligible if age not 46-75 or enrollment not continuous. Exclusions only for eligible. If fails age/enrollment and has exclusion -> not_eligible.
Need classify all 26.
Let's make table.
Measurement year 2026.
Windows:
FIT/FOBT: 2026 only.
Stool DNA: 2024-01-01 to 2026-12-31 (three-year calendar). Need check dates: 2023-11-04 outside; 2023-01-09 outside; 2024-12-13 inside; 2026-01-11 inside; 2026-08-17 inside.
Flexible sigmoidoscopy: 2022-01-01 to 2026-12-31. Dates: 2021-11-12 outside; 2022-07-04 inside; 2023 etc inside; 2025 inside; 2026 inside.
CT colonography: 2022-01-01 to 2026-12-31. Dates: 2020 outside; 2021 outside; 2022? none? 2023 inside; 2026 inside.
Colonoscopy: 2017-01-01 to 2026-12-31. Dates: 2016-12-23 outside (just outside); 2016-11-12 outside; 2025-01-02 inside.
Age as of 2026-12-31 given; use 46-75 inclusive. 45 not eligible; 76 not eligible.
Enrollment gaps: Need evaluate. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If member has one gap <=45 and otherwise from Jan1-Dec31, eligible. If two gaps, not eligible. If start after Jan1, likely gap from Jan1 to enrollment start? Need maybe counts as gap? Let's reason. The spec says full measurement year with no more than one gap of up to 45 days. If member not enrolled before May 1, there is a gap in coverage from Jan1-Apr30 of 120 days; one gap but >45, not eligible. If not enrolled before Mar22, gap Jan1-Mar21 length? Jan1 to Mar21 inclusive? Need count? For allowed gap up to 45 days. Need compute lengths maybe for starts. 71122 enrolled 2026-03-22; days not enrolled Jan1-Mar21. Jan 31 + Feb28 + Mar21 = 80 days (since 2026 not leap). >45. Not eligible. 71126 start Mar17: Jan31+Feb28+Mar16=75 >45. 71130 start May16: Jan31+Feb28+Mar31+Apr30+May15=135 >45. 71131 start Apr12: Jan31+Feb28+Mar31+Apr11=101 >45. 71111 start May1: gap Jan1-Apr30 = 120 >45. Not eligible. If they treat gap between two enrollment segments only, these start-late members have no gaps in enrolled period but not full measurement year. They fail full measurement year anyway. So not eligible.
Need if enrollment gaps between segments: Need count gap days. Example 71115: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. Gap from Jul17-Aug20. Days: July 17-31 15 days? July has 31, 17-31 inclusive 15; Aug1-20 20; total 35. They state one gap of 35 days. OK. Use stated.
71116 gap 35; eligible age etc.
71117 gap 45 exactly; allowed up to 45; eligible.
71118 gap 42; eligible.
71121 gaps 28 and 15; two gaps -> not eligible.
71123 gaps 13 and 25 -> two gaps -> not eligible (age 67 but not eligible). Note if E? no.
71127 one gap 24 but age 45 -> not eligible.
71132 one gap 36, age 76 -> not eligible.
71136 one gap 40 but age 45 -> not eligible.
71134 continuous but age 45 -> not eligible despite colectomy/cancer? no cancer? total colectomy exclusion but not eligible due age.
Now classify each.
Member 71111: DOB 1971, age 55. Enrollment starts 2026-05-01, not before. Full measurement year? gap Jan1-Apr30 120 >45; not_eligible. Screening and frailty irrelevant. Status not_eligible.
71112: age72, continuous full year. No exclusions. No screening. eligible denominator, non_compliant.
71113: age47, continuous. Screening: CT 2020 outside, flex sig 2025-11-08 inside. But other history C18.7 on 2025-07-17, colorectal cancer before end -> E1 exclusion. Eligible, excluded. Exclusions before numerator; excluded_members.
71114: age75, continuous. Screening CT 2021-12-07: for CT 5-year window 2022-01-01 onward, outside. Other: frailty 2026-12-17 and advanced illness 2026-05-05, age 75 >=66, both during measurement year -> E4 exclusion. Eligible, excluded. Note screening noncompliant anyway, but excluded.
71115: age47. Enrollment one gap 35 -> eligible if no exclusions. Screening colonoscopy 2016-12-23 outside 10-year (window starts 2017-01-01), no numerator. Other frailty + advanced illness during 2026, but age 47 <66, E4 not exclude. No cancer/colectomy/hospice. denominator, non_compliant.
71116: age50, one gap35 eligible. Stool DNA 2023-01-09 outside 3-year window. No exclusions. non_compliant. If stool DNA three-year exact from 2023-12-31? 2023-01-09 definitely outside. non.
71117: age63, one gap45 eligible. Stool DNA 2026-01-11 inside 3-year and during 2026? Stool DNA allowed 3-year, yes numerator. No exclusions. compliant.
71118: age47, one gap42 eligible. Flex sig 2021-11-12 outside 5-year (starts 2022-01-01). Flex sig 2022-07-04 inside. No exclusions. compliant.
71119: age76 -> not eligible. Even continuous and screening flex sig inside. Age fails. not_eligible.
71120: age75, continuous. No screening. Advanced illness only, no frailty. E4 requires both; no exclusion. denominator non_compliant.
71121: age55, enrollment two gaps (28,15) -> not eligible. CT 2026 irrelevant. not_eligible.
71122: age72. Enrollment starts 2026-03-22 not full year -> not eligible. Other advanced illness 2026-01-13 before enrollment? frailty 2026-10-08. Age >=66 but advanced illness date before enrollment? But not eligible anyway. If exclusion only eligible; no. not_eligible.
71123: age67, two gaps -> not_eligible. No screening. not.
71124: age66, continuous. Flexible sigmoidoscopy 2026-04-15 inside. No exclusions (age 66 but no frailty/advanced). compliant.
71125: age76 -> not eligible. FIT 2026 irrelevant. not.
71126: age45 -> not eligible. Also start late. not.
71127: age45 -> not eligible. One gap, stool DNA 2024 inside but age fails. not.
71128: age75, continuous. CT 2020 outside, stool DNA 2026-08-17 inside. No exclusions. compliant.
71129: age67, continuous. Flex sig 2023-07-08 inside 5-year, CT 2023-09-13 inside. No exclusions. compliant.
71130: age45 -> not eligible (also start late, cancer 2024 but not eligible). not.
71131: age76 -> not eligible (start late). not.
71132: age76 -> not eligible. Also cancer C18.7 2019, but age fails. not_eligible.
71133: age59, continuous. CT colonography 2021-04-12 and 2021-09-09; both outside 5-year window (2022+). No other screening. No exclusions. denominator non_compliant.
71134: age45 -> not eligible. Total colectomy 2023 would exclude if eligible but age fails. not.
71135: age55, continuous. Colonoscopy 2016-11-12 outside 10-year. No exclusions. non_compliant.
71136: age45 -> not eligible. One gap40, advanced illness only, flex sig 2026 but age fails. not.
Let's tally.
Eligible denominator after exclusions = compliant + noncompliant.
Compliant: 71117, 71118, 71124, 71128, 71129 = 5? Check any others? 71113 excluded despite numerator; 71114 excluded; no. So numerator 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6. Any 71121? not eligible. So denominator = 11.
Excluded: 71113, 71114 = 2.
Not eligible: remaining 26 - 11 -2 = 13. List: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 = 13. Check 71136 yes. Count 13. Total 5+6+2+13=26.
Rate = numerator/denominator*100 = 5/11*100 = 45.4545... Round half up to one decimal = 45.5. Need JSON number 45.5.
Need ensure enrollment for 71115 etc: one gap up to 45 yes. 71115 age 47, E4 no due age <66. noncompliant because colonoscopy 2016-12-23 outside 10-year. If exact ten-year window measured back from 2026-12-31 could be 2016-12-31? Ten years prior maybe on/before 2016-12-31? Let's think. If "during 2026 or the nine years prior (ten-year window)" could mean 2017-01-01 through 2026-12-31 (nine full years prior 2017-2025 plus 2026). 2016-12-23 outside. If exact 3650 days from 2026-12-31, ten-year window could start 2016-12-31? Actually 10 years before 2026-12-31 is 2016-12-31. A colonoscopy on 2016-12-23 would be 10 years + 8 days, outside. So still outside. 71135 2016-11-12 outside. Good.
Need ensure stool DNA 2023-11-04 for 71111: if three-year window exact from 2023-12-31? outside. But not eligible anyway.
Potential ambiguity: Age 46 through 75 as of 2026-12-31. Some members listed "so X years old" maybe check DOB age. 71113 DOB 1979-02-27 => 47 yes. 71115 1979 => 47. 71126 DOB 1981-12-20 => 45 (birthday Dec20 before Dec31, yes 45). 71127 1981-01-14 =>45. 71130 1981-09-13 =>45. 71134 1981-09-26=>45. 71136 1981-11-11=>45. Good. 71119 1950-03-25=>76. 71125 1950-05-08=>76. 71131 1950-05-05=>76. 71132 1950-02-01=>76. Good.
Need ensure E4: advanced illness/frailty documented during measurement year. For 71122 advanced illness 2026-01-13 while not enrolled? But exclusion only for eligible population. 71122 not eligible. If he were eligible? advanced illness during measurement year but before enrollment? Spec says documented during measurement year, not necessarily enrolled? But irrelevant. 71111 frailty only during measurement year, no advanced. 71120 advanced only. 71136 advanced only, age 45 and not eligible.
Potential issue: Continuous enrollment: "full measurement year with no more than one gap of up to 45 days." For members with enrollment from Jan1-Dec31 but one gap, they are not enrolled full year but allowed one gap. For late enrollment with one initial absence, is that a gap? If the gap length is <=45 maybe could be eligible? None late starts with gap <=45 except maybe? 71122 start Mar22 gap 80; all >45. So no difference. What about 71111 start May1 gap 120; no.
Need ensure 71123 two gaps but each <=45; spec says no more than one gap, so not eligible. Yes.
Could there be exclusion E3 hospice? None documented.
Need final JSON exactly with required keys. Arrays of strings. Counts integer. Rate number one decimal. No extra keys. Ensure member IDs strings e.g. "71112". Order any. Maybe sort ascending.
Let's produce:
{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117","71118","71124","71128","71129"],
"non_compliant_members": ["71112","71115","71116","71120","71133","71135"],
"excluded_members": ["71113","71114"],
"not_eligible_members": ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
}
Double-check counts: denominator 11? Compliant 5 + non 6 =11. Excluded 2, not 13 total 26. Good.
Need consider if excluded members should be removed from denominator. Yes denominator after exclusions. Good.
But let's deeply verify each numerator window with exact dates and possible calendar vs rolling. If rolling exact years from 2026-12-31, windows:
FIT/FOBT: during 2026 maybe same.
Stool DNA 3-year window: if measured back from Dec31 2026, could be on/after 2024-01-01? Rolling 3 years would be on/after 2023-12-31? But "during 2026 or the two years prior" strongly calendar 2024-2026. For dates: 2024-12-13 inside either; 2023 dates outside either. Good.
Flex sig 5-year: if rolling five years back from 2026-12-31 = 2021-12-31? 2021-11-12 outside; 2022-07-04 inside. Same.
CT 5-year: 2021 dates outside if start 2021-12-31? 2021-12-07 outside; 2021-04,09 outside. Same.
Colonoscopy 10-year: rolling ten years back = 2016-12-31; 2016-12-23 outside; 2016-11-12 outside. Same. No boundary issues.
Could 71114 CT 2021-12-07 maybe inside if 5-year rolling from 2021-12-31? No before Dec31, outside. If five-year window includes 2021-12-07? Wait if five-year window measured back from 2026-12-31: 2026-12-31 minus 5 years = 2021-12-31. Service on 2021-12-07 is 24 days before start, outside. If calendar "2026 or four years prior" = 2022-2026, outside. So non numerator. Excluded anyway.
Could 71133 CT 2021-09-09 outside. non.
Potential issue: E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. 71114 has frailty 2026-12-17 advanced 2026-05-05. Yes. 71113 cancer, not E4 age 47. 71115 age47 both but no. 71122 age72 frailty 2026-10-08 advanced 2026-01-13 but not eligible due enrollment. If enrollment gap from Jan1-Mar21 length 80 days; one gap >45 not eligible. If one could treat not enrolled before start not as gap but fails full measurement year. Yes.
Need maybe "continuous enrollment full measurement year with no more than one gap of up to 45 days" could allow late enrollment if gap from Jan1 to start <=45. None. Good.
Now final only fenced JSON. Ensure no explanation. Use JSON null? no. Rate number, not string.
Need be mindful output contract: exactly one fenced JSON code block and nothing else. final can be just code block. Ensure no trailing commas.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 Flash · Z.ai149.3s · 4,029 out | 77.7s · 4,830 out | 86.9s · 5,353 out
Reasoning · 3,821 tokens
Let me work through each member carefully.
Measure: QM-CRC colorectal cancer screening.
Measurement year: 2026-01-01 to 2026-12-31.
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.
Numerator (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 through 2026-12-31? Actually "three-year window" — during 2026 or the two years prior, i.e., 2024, 2025, 2026.
- N3: Flex sig during 2026 or four years prior (five-year window): 2022–2026.
- N4: CT colonography during 2026 or four years prior (five-year window): 2022–2026.
- N5: Colonoscopy during 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 any time on or before 2026-12-31.
- E3: Hospice during measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
Order: eligibility (age, enrolment) first; then exclusions; then numerator.
Let me go member by member.
71111: DOB 1971-04-18 → 55. Enrolment 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01. Not enrolled full year → not_eligible (enrolment fail). Frailty alone doesn't exclude anyway. Screening: stool DNA 2023 (outside 3-year window), colonoscopy 2025 (in 10-year window) — but doesn't matter. → not_eligible.
71112: DOB 1954-02-14 → 72. Enrolled full year continuous. No screening. No exclusions (no frailty/advanced illness; hospice none). → non_compliant.
71113: DOB 1979-02-27 → 47. Enrolled full year. Screening: CT colonography 2020 (outside 5-year window 2022–2026), flex sig 2025-11-08 (in 5-year window). But other history: 2025-07-17 C18.7 colorectal cancer → E1 exclusion. → excluded.
71114: DOB 1951-11-18 → 75. Enrolled full year. Frailty 2026-12-17 and advanced illness 2026-05-05, both during measurement year, age 75 ≥ 66 → E4 applies → excluded. (CT colonography 2021 is outside 5-year window; irrelevant.)
71115: DOB 1979-09-19 → 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. Gap: 2026-07-17 to 2026-08-20 = let's compute: July 17–31 is 15 days, August 1–20 is 20 days = 35 days. One gap of 35 days ≤ 45 → enrolment OK. Colonoscopy 2016-12-23 — outside 10-year window (2017–2026). Frailty + advanced illness but age 47 < 66 → E4 doesn't apply. → non_compliant.
71116: DOB 1976-01-11 → 50. Enrolment gap: 2026-03-17 to 2026-04-20: March 17–31 = 15 days, April 1–20 = 20 days → 35 days. One gap ≤ 45 → OK. Stool DNA 2023-01-09 — outside 3-year window (2024–2026). → non_compliant.
71117: DOB 1963-09-02 → 63. Enrolment gap: 2026-06-03 to 2026-07-17: June 3–30 = 28 days, July 1–17 = 17 days → 45 days. One gap of up to 45 days → OK ("no more than one gap of up to 45 days"). Stool DNA 2026-01-11 → numerator N2 (during 2026). → compliant.
71118: DOB 1979-03-23 → 47. Enrolment gap: 2026-06-15 to 2026-07-26: June 15–30 = 16 days, July 1–26 = 26 days → 42 days. One gap ≤ 45 → OK. Flex sigs 2021 and 2022-07-04. Five-year window: 2026 or four years prior = 2022, 2023, 2024, 2025, 2026. 2022-07-04 is within → N3 met. → compliant.
71119: DOB 1950-03-25 → 76. Age > 75 → not_eligible. (Flex sig 2023 irrelevant.)
71120: DOB 1951-03-21 → 75. Enrolled full year. Advanced illness documented 2026-02-01 but no frailty → E4 requires both → doesn't exclude. No screening → non_compliant.
71121: DOB 1971-08-17 → 55. Enrolment gaps: 2026-03-22 to 2026-04-18: March 22–31 = 10 days, April 1–18 = 18 days → 28 days. Second gap: 2026-07-07 to 2026-07-21: July 7–21 = 15 days. Two gaps of 28 and 15 days. Rule: "no more than one gap of up to 45 days." Two gaps → fails continuous enrolment → not_eligible. CT colonography 2026-02-22 would meet numerator but enrolment fails.
Wait — need to be careful about gap counting. Enrolment 2026-01-01 through 2026-03-21; then 2026-04-19. Gap days: 2026-03-22 through 2026-04-18. That's 10 (Mar 22–31) + 18 (Apr 1–18) = 28 days. Then 2026-07-06 ends; 2026-07-22 starts. Gap: 2026-07-07 through 2026-07-21 = 15 days. Yes, two gaps → not_eligible.
71122: DOB 1954-09-15 → 72. Enrolment from 2026-03-22, not enrolled before → not full year → not_eligible. (Frailty + advanced illness both during year, but not eligible anyway.)
71123: DOB 1959-03-08 → 67. Enrolment gaps: 2026-02-24 to 2026-03-08: Feb 24–28 = 5 days (2026 not a leap year; Feb has 28 days), Mar 1–8 = 8 days → 13 days. Second gap: 2026-06-28 to 2026-07-22: June 28–30 = 3 days, July 1–22 = 22 days → 25 days. Two gaps → fails → not_eligible. No screening anyway.
71124: DOB 1960-08-15 → 66. Enrolled full year continuous. Flex sig 2026-04-15 → N3. No exclusions. → compliant.
71125: DOB 1950-05-08 → 76. Age > 75 → not_eligible. (FIT 2026 irrelevant.)
71126: DOB 1981-12-20 → 45. Age < 46 → not_eligible. Also enrolment not full year.
71127: DOB 1981-01-14 → 45. Age < 46 → not_eligible.
71128: DOB 1951-12-10 → 75. Enrolled full year. Stool DNA 2026-08-17 → N2. CT colonography 2020 irrelevant. → compliant.
71129: DOB 1959-07-23 → 67. Enrolled full year. Flex sig 2023-07-08 → within 5-year window (2022–2026) → N3. CT colonography 2023-09-13 → also within 5-year window → N4. Either way → compliant.
71130: DOB 1981-09-13 → 45. Age < 46 → not_eligible. (C18.7 diagnosis 2024-11-25 would be E1, but eligibility first: a member who fails age is not_eligible even if exclusion documented.)
71131: DOB 1950-05-05 → 76. Age > 75 → not_eligible. (CT colonography 2026 irrelevant.)
71132: DOB 1950-02-01 → 76. Age > 75 → not_eligible. Also C18.7 in 2019 would exclude, but not eligible first.
71133: DOB 1967-01-22 → 59. Enrolled full year. CT colonography 2021-04-12 and 2021-09-09 — outside 5-year window (2022–2026). → non_compliant.
71134: DOB 1981-09-26 → 45. Age < 46 → not_eligible. (Colectomy 2023 would be E2, but age fails first.)
71135: DOB 1971-08-26 → 55. Enrolled full year. Colonoscopy 2016-11-12 — outside 10-year window (2017–2026). → non_compliant.
71136: DOB 1981-11-11 → 45. Age < 46 → not_eligible. (Advanced illness documented, but age fails first; also E4 requires 66+.)
Now tally.
compliant: 71117, 71118, 71124, 71128, 71129 → 5.
non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 → 6.
excluded: 71113 (E1), 71114 (E4) → 2.
not_eligible: 71111 (enrolment), 71119 (age), 71121 (two gaps), 71122 (enrolment), 71123 (two gaps), 71125 (age), 71126 (age), 71127 (age), 71130 (age), 71131 (age), 71132 (age), 71134 (age), 71136 (age) → 13.
Total: 5 + 6 + 2 + 13 = 26. ✓
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = 5.
Rate = 5/11 × 100 = 45.4545... → 45.5 (rounded half up to one decimal).
45.45454... → one decimal: 45.5. Yes.
Double-check 71117's gap: enrolled through 2026-06-02, re-enrolled 2026-07-18. Gap: 2026-06-03 through 2026-07-17. June: 3–30 = 28 days; July: 1–17 = 17 days; total 45. "up to 45 days" → 45 is allowed. OK.
Double-check 71118's gap: through 2026-06-14, from 2026-07-27. Gap: 2026-06-15 through 2026-07-26. June 15–30 = 16; July 1–26 = 26; total 42. OK.
Double-check 71115's gap: through 2026-07-16, from 2026-08-21. Gap: 2026-07-17 through 2026-08-20. July 17–31 = 15; Aug 1–20 = 20; total 35. OK.
71116's gap: through 2026-03-16, from 2026-04-21. Gap: 2026-03-17 through 2026-04-20. Mar 17–31 = 15; Apr 1–20 = 20; total 35. OK.
71132's gap: through 2026-04-19, from 2026-05-26. Gap: 2026-04-20 through 2026-05-25. Apr 20–30 = 11; May 1–25 = 25; total 36. One gap ≤ 45, but age 76 → not_eligible regardless.
71136's gap: through 2026-07-01, from 2026-08-11. Gap: 2026-07-02 through 2026-08-10. July 2–31 = 30; Aug 1–10 = 10; total 40. One gap, but age 45 → not_eligible.
71134 colectomy — age 45 → not_eligible. Correct per instruction: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
71130 — age 45 → not_eligible even though C18.7 documented. Correct.
71132 — age 76 → not_eligible even though C18.7. Correct.
71113 — age 47, enrolled full year → eligible; E1 (C18.7 in 2025, on or before 2026-12-31) → excluded. Even though flex sig 2025 meets N3, exclusion evaluated before numerator → excluded. Correct.
71114 — age 75, enrolled full year, 66+, frailty (2026-12-17) and advanced illness (2026-05-05) both during measurement year → E4 → excluded. Correct.
71120 — advanced illness only, no frailty → not excluded. Age 75, enrolled → non_compliant. Correct.
71115 — frailty + advanced illness but age 47 < 66 → E4 doesn't apply. Colonoscopy 2016 outside 10-year window → non_compliant. Correct.
71112 — age 72, enrolled, no screening, no exclusions → non_compliant.
71133 — CT colonography 2021, outside 5-year window (2022–2026) → non_compliant. Correct.
71135 — colonoscopy 2016-11-12, outside 10-year window (2017-01-01? Actually window: "during 2026 or the nine years prior" = 2017–2026). 2016 is outside → non_compliant. Correct.
71121 — two gaps (28 and 15 days) → fails "no more than one gap" → not_eligible. Correct.
71123 — two gaps (13 and 25) → not_eligible. Correct.
71111 — enrolled only from 2026-05-01 → not full year → not_eligible. Correct.
71122 — enrolled from 2026-03-22 → not full year → not_eligible. Correct.
71126, 71127, 71130, 71134, 71136 — age 45 → not_eligible.
71119, 71125, 71131, 71132 — age 76 → not_eligible.
Final counts:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 45.5
compliant_members: ["71117", "71118", "71124", "71128", "71129"]
non_compliant_members: ["71112", "71115", "71116", "71120", "71133", "71135"]
excluded_members: ["71113", "71114"]
not_eligible_members: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Emit JSON only.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,622 tokens
Let me work through each of the 26 members against the QM-CRC specification.
Measurement year: 2026-01-01 through 2026-12-31.
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.
Numerator (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? Actually "during 2026 or the two years prior (three-year window)" — window would be 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 during 2026 or four years prior (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 (evaluated only for members in eligible population, 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 during measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
Enrolment rule: "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 (i.e., enrolled from 2026-01-01 through 2026-12-31), with no more than one gap, and the gap must be ≤45 days. A member who enrolls mid-year (not enrolled at start) fails the "full measurement year" requirement.
Let me go member by member.
MEMBER 71111: DOB 1971-04-18, age 55. Enrolment: 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01. Fails continuous enrolment (not enrolled for full year; enrolls mid-year). So not_eligible. Screening: 2023 stool DNA (outside 3-year window: would need 2024+), 2025-01-02 colonoscopy (within 10-year window — would be numerator). But not eligible. → not_eligible.
MEMBER 71112: DOB 1954-02-14, age 72. Enrolment continuous full year. No screening. No exclusions. → non_compliant.
MEMBER 71113: DOB 1979-02-27, age 47. Enrolment continuous full year. Screening: CT colonography 2020-07-03 (outside 5-year window), flex sig 2025-11-08 (within 5-year window 2022-2026 — numerator N3). Other history: 2025-07-17 C18.7 diagnosis — colorectal cancer any time on or before 2026-12-31 → E1 exclusion. Exclusions evaluated before numerator. In eligible population (age 47, continuous enrolment). → excluded.
MEMBER 71114: DOB 1951-11-18, age 75. Enrolment continuous full year. Screening: CT colonography 2021-12-07 (outside 5-year window). Other: 2026-12-17 frailty, 2026-05-05 advanced illness (both during measurement year). Age 75 ≥ 66. E4 met → excluded.
MEMBER 71115: DOB 1979-09-19, age 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days (2026-07-17 to 2026-08-20 = 35 days: July 17–31 is 15 days, Aug 1–20 is 20 days, total 35). One gap of up to 45 days → continuous enrolment satisfied. Screening: colonoscopy 2016-12-23. Ten-year window back from 2026-12-31: 2017-01-01 onwards. 2016-12-23 is outside → does not meet numerator. Frailty 2026-07-07 and advanced illness 2026-02-06 documented — but age is 47, less than 66, so E4 does not apply. No cancer, no colectomy, no hospice. → non_compliant.
MEMBER 71116: DOB 1976-01-11, age 50. Enrolment: gap of 35 days (one gap) → continuous OK. Screening: Stool DNA 2023-01-09. Three-year window: 2024-2026. 2023 is outside → does not meet. → non_compliant.
MEMBER 71117: DOB 1963-09-02, age 63. Enrolment: gap of 45 days (2026-06-03 to 2026-07-17: June 3–30 = 28 days, July 1–17 = 17 days, total 45 days). One gap of up to 45 days → OK. Screening: Stool DNA 2026-01-11 → N1? No, stool DNA is N2, but "during 2026" — wait, N2 says stool DNA test during 2026 or the two years prior (three-year window). 2026-01-11 is during 2026 → meets numerator. Actually N1 is FOBT/FIT; stool DNA is N2. Either way, 2026 stool DNA meets N2. → compliant.
MEMBER 71118: DOB 1979-03-23, age 47. Enrolment: gap of 42 days (2026-06-15 to 2026-07-26: June 15–30 = 16, July 1–26 = 26, total 42). One gap → OK. Screening: flex sig 2021-11-12 and 2022-07-04. Five-year window: 2022-01-01 through 2026-12-31. 2022-07-04 is within → N3 met. → compliant.
MEMBER 71119: DOB 1950-03-25, age 76. Age > 75 → not_eligible. (Flex sig 2023 would be numerator but fails age.)
MEMBER 71120: DOB 1951-03-21, age 75. Enrolment continuous full year. No screening. Advanced illness 2026-02-01 but no frailty → E4 not met. No other exclusions. → non_compliant.
MEMBER 71121: DOB 1971-08-17, age 55. Enrolment: gaps of 28 and 15 days — two gaps. "No more than one gap of up to 45 days" → two gaps fails continuous enrolment. → not_eligible. (CT colonography 2026-02-22 would be numerator.)
MEMBER 71122: DOB 1954-09-15, age 72. Enrolment: 2026-03-22 through 2026-12-31, not enrolled before → fails full-year enrolment. → not_eligible.
MEMBER 71123: DOB 1959-03-08, age 67. Enrolment: gaps of 13 and 25 days → two gaps → fails. → not_eligible.
MEMBER 71124: DOB 1960-08-15, age 66. Enrolment continuous full year. Screening: flex sig 2026-04-15 → N3 met. No exclusions. → compliant.
MEMBER 71125: DOB 1950-05-08, age 76 → not_eligible. (FIT 2026-04-02 would be numerator but fails age.)
MEMBER 71126: DOB 1981-12-20, age 45 → not_eligible (age). Also enrolment starts mid-year.
MEMBER 71127: DOB 1981-01-14, age 45 → not_eligible.
MEMBER 71128: DOB 1951-12-10, age 75. Enrolment continuous full year. Screening: CT colonography 2020-02-10 (outside 5-year window), stool DNA 2026-08-17 → meets N2. → compliant.
MEMBER 71129: DOB 1959-07-23, age 67. Enrolment continuous full year. Screening: flex sig 2023-07-08 (within 5-year window 2022–2026) → N3 met. CT colonography 2023-09-13 also within 5-year window → N4. Either way compliant. → compliant.
MEMBER 71130: DOB 1981-09-13, age 45 → not_eligible. (Also cancer C18.7 2024-11-25 — E1 — but fails age first, so not_eligible per the rule: a member who fails age is not_eligible even if an exclusion is documented.)
MEMBER 71131: DOB 1950-05-05, age 76 → not_eligible.
MEMBER 71132: DOB 1950-02-01, age 76 → not_eligible. (Also C18.7 2019 → E1, but age fails first.)
MEMBER 71133: DOB 1967-01-22, age 59. Enrolment continuous full year. Screening: CT colonography 2021-04-12 and 2021-09-09 — both outside 5-year window (2022–2026). → does not meet numerator. No exclusions. → non_compliant.
MEMBER 71134: DOB 1981-09-26, age 45 → not_eligible. (Also total colectomy 2023 → E2, but age fails first.)
MEMBER 71135: DOB 1971-08-26, age 55. Enrolment continuous full year. Screening: colonoscopy 2016-11-12 — outside 10-year window (2017–2026). → non_compliant.
MEMBER 71136: DOB 1981-11-11, age 45 → not_eligible.
Now compile lists:
not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71135? No wait, 71135 is non_compliant. Let me redo.
not_eligible members: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. That's 13.
excluded: 71113 (cancer), 71114 (frailty + advanced illness, age 75). That's 2.
compliant: 71117, 71118, 71124, 71128, 71129. That's 5.
non_compliant: 71112, 71115, 71116, 71120, 71133, 71135. That's 6.
Total: 13 + 2 + 5 + 6 = 26. ✓
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = 5.
Rate = 5/11 × 100 = 45.4545... → 45.5 (one decimal, rounded half up: 45.4545... → 45.5).
Wait, 5/11 = 0.454545..., ×100 = 45.4545...%, rounded to one decimal = 45.5.
Double-check gap calculations:
71115: enrolled through 2026-07-16, resumes 2026-08-21. Gap days: 2026-07-17 through 2026-08-20. July: 17–31 = 15 days. Aug: 1–20 = 20 days. Total 35 days. ✓ One gap ≤45 → OK.
71116: through 2026-03-16, resumes 2026-04-21. Gap: 03-17 to 04-20. March: 17–31 = 15. April: 1–20 = 20. Total 35. ✓
71117: through 2026-06-02, resumes 2026-07-18. Gap: 06-03 to 07-17. June: 3–30 = 28. July: 1–17 = 17. Total 45. ✓ Exactly 45, "up to 45 days" → OK.
71118: through 2026-06-14, resumes 2026-07-27. Gap: 06-15 to 07-26. June: 15–30 = 16. July: 1–26 = 26. Total 42. ✓
71121: through 2026-03-21, resumes 2026-04-19 (gap 03-22 to 04-18: 10 + 18 = 28). Then through 2026-07-06, resumes 2026-07-22 (gap 07-07 to 07-21: 15 days). Two gaps → fails.
71123: through 2026-02-23, resumes 2026-03-09 (gap 02-24 to 03-08: 5 + 8 = 13). Through 2026-06-27, resumes 2026-07-23 (gap 06-28 to 07-22: 3 + 22 = 25). Two gaps → fails.
71132: through 2026-04-19, resumes 2026-05-26. Gap: 04-20 to 05-25. April: 20–30 = 11. May: 1–25 = 25. Total 36. One gap ≤45 → enrolment OK, but age 76 fails anyway. Actually wait — 71132's DOB is 1950-02-01, age on 2026-12-31: 2026 - 1950 = 76 (birthday Feb 1 already passed). Age 76 > 75 → not_eligible. ✓
71136: through 2026-07-01, resumes 2026-08-11. Gap: 07-02 to 08-10. July: 2–31 = 30. Aug: 1–10 = 10. Total 40. One gap → OK, but age 45 → not_eligible.
Age checks:
- 71113: DOB 1979-02-27 → 47 on 2026-12-31. ✓ (47 within 46–75.)
- 71118: DOB 1979-03-23 → 47. ✓
- 71133: DOB 1967-01-22 → 59. ✓
- 71135: DOB 1971-08-26 → 55. ✓
Numerator windows check:
- 71117: stool DNA 2026-01-11 → within 2026 → meets. ✓
- 71118: flex sig 2022-07-04. Five-year window from 2026-12-31 back: 2022-01-01 to 2026-12-31. 2022-07-04 within. ✓
- 71124: flex sig 2026-04-15 → within. ✓
- 71128: stool DNA 2026-08-17 → within. ✓
- 71129: flex sig 2023-07-08 → within 2022–2026. ✓
Non-compliant checks:
- 71112: no screening. ✓
- 71115: colonoscopy 2016-12-23. Ten-year window: 2017-01-01 to 2026-12-31. 2016-12-23 is outside by 9 days. → non-compliant. ✓
- 71116: stool DNA 2023-01-09. Three-year window: 2024-01-01 to 2026-12-31. Outside. → non-compliant. ✓
- 71120: no screening. ✓
- 71133: CT colonography 2021-04-12, 2021-09-09. Five-year window starts 2022-01-01. Outside. → non-compliant. ✓
- 71135: colonoscopy 2016-11-12. Outside 10-year window. → non-compliant. ✓
Excluded checks:
- 71113: age 47, continuous enrolment full year → in eligible population. C18.7 on 2025-07-17 → E1. Excluded before numerator evaluation. ✓
- 71114: age 75, continuous. Frailty 2026-12-17 + advanced illness 2026-05-05, both during measurement year, age 75 ≥ 66 → E4. Excluded. (CT colonography 2021-12-07 outside window anyway, wouldn't meet numerator.) ✓
E4 check for others:
- 71111: frailty only, but not eligible anyway.
- 71115: frailty + advanced illness but age 47 < 66 → E4 not met. Non-compliant. ✓
- 71120: advanced illness only, no frailty → E4 not met. Non-compliant. ✓
- 71122: frailty + advanced illness, age 72, but not enrolled full year → not_eligible (enrolment fails before exclusion evaluation). ✓
- 71136: advanced illness only, age 45 → not_eligible.
Rate: 5/11 × 100 = 45.454545... → rounded half up to one decimal: 45.5.
Hmm, 45.4545... to one decimal: the second decimal is 5, then more digits. 45.4545... — one decimal place means look at second decimal: 45.4|545... The digit after the first decimal is 5 (with more digits following), so round up: 45.5. Yes, 45.5.
Actually, let me be careful: 45.4545... → to one decimal place: 45.45... The first decimal is 4, the next digit is 5, so we round the 4 up to 5 → 45.5. Correct.
Now output JSON:
```json
{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
```
Counts: compliant 5 ✓, non_compliant 6 ✓, excluded 2 ✓, not_eligible 13 ✓. Total 26 ✓.
Denominator 11, numerator 5, rate 45.5.
Output exactly one fenced JSON block, nothing else.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,145 tokens
Let me work through each of the 26 members.
Measure QM-CRC:
- 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.
- Numerator windows (back from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (3-year window: 2024-01-01 through 2026-12-31; i.e., dates ≥ 2024-01-01? "during 2026 or the two years prior (three-year window)" — three-year window means 2024, 2025, 2026).
- N3: Flex sig during 2026 or four years prior (five-year window: 2022–2026).
- N4: CT colonography 2022–2026.
- N5: Colonoscopy 2017–2026.
- 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 during measurement year.
- E4: Age ≥66 as of 2026-12-31 AND both frailty AND advanced illness documented during measurement year. Frailty alone or advanced illness alone does not exclude.
Order: eligible population first (age, enrolment), then exclusions, then numerator.
Let me go one by one.
**71111**: DOB 1971-04-18, age 55. Enrolment 2026-05-01 to 2026-12-31 — not enrolled full year (starts mid-year). Not continuously enrolled for the full measurement year. So not_eligible (enrolment). Screening: stool DNA 2023-11-04 (outside 3-year window anyway), colonoscopy 2025-01-02 (would be within 10-year window), frailty 2026-10-27 (alone doesn't exclude, and age 55 < 66 so E4 doesn't apply anyway). But enrolment fails → not_eligible.
**71112**: DOB 1954-02-14, age 72. Enrolled full year, no gaps. No screening, no exclusions. → non_compliant. Denominator.
**71113**: DOB 1979-02-27, age 47. Enrolled full year. Screening: CT colonography 2020-07-03 (outside 5-year window), flex sig 2025-11-08 (within 5-year window 2022–2026 → numerator). Exclusion: C18.7 diagnosed 2025-07-17 → E1 colorectal cancer on or before 2026-12-31. Exclusions evaluated before numerator → excluded. Wait — the rule says "A member who meets both an exclusion and the numerator is excluded, not compliant." So excluded.
**71114**: DOB 1951-11-18, age 75 (turns 76 on 2026-11-18? Wait DOB 1951-11-18, on 2026-12-31 they'd be 75... let's check: 2026 − 1951 = 75; birthday 2026-11-18 already passed, so age 75. Yes, prompt says 75). In range (46–75). Enrolled full year. Exclusion E4: age ≥66 (75), frailty 2026-12-17 documented during measurement year, advanced illness 2026-05-05 during measurement year. Both present → excluded. (CT colonography 2021-12-07 is outside 5-year window anyway.)
**71115**: DOB 1979-09-19, age 47. Enrolment: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. Gap: 2026-07-17 to 2026-08-20. Let me count days: July 17–31 = 15 days, Aug 1–20 = 20 days → 35 days. One gap of up to 45 days → enrolment OK. Screening: colonoscopy 2016-12-23 — 10-year window is 2017–2026 (2026 or nine years prior: 2026-12-31 back 10 years = 2017-01-01... let me think. "during 2026 or the nine years prior (ten-year window)". Nine years prior to 2026: 2017–2025. So window is 2017-01-01 to 2026-12-31. 2016-12-23 is outside → no numerator. Exclusions: frailty 2026-07-07 + advanced illness 2026-02-06, both during measurement year, but age 47 < 66 → E4 doesn't apply. No other exclusions. → non_compliant.
**71116**: DOB 1976-01-11, age 50. Enrolment: gap 2026-03-17 to 2026-04-20. March 17–31 = 15, April 1–20 = 20 → 35 days. One gap ≤45 → OK. Screening: stool DNA 2023-01-09 — 3-year window is 2024–2026. 2023 is outside → no numerator. No exclusions. → non_compliant.
**71117**: DOB 1963-09-02, age 63. Enrolment: gap 2026-06-03 to 2026-07-17. June 3–30 = 28, July 1–17 = 17 → 45 days. "no more than one gap of up to 45 days" → 45 days is allowed. OK. Screening: stool DNA 2026-01-11 → N1/N2 numerator (stool DNA during 2026). → compliant.
**71118**: DOB 1979-03-23, age 47. Enrolment: gap 2026-06-15 to 2026-07-26. June 15–30 = 16, July 1–26 = 26 → 42 days. One gap ≤45 → OK. Screening: flex sig 2021-11-12 and 2022-07-04. Five-year window: 2022–2026. 2022-07-04 is within → numerator. → compliant.
**71119**: DOB 1950-03-25, age 76 as of 2026-12-31 (prompt says 76). Out of age range (46–75) → not_eligible. (Flex sig 2023-03-04 would be within window but age fails.)
**71120**: DOB 1951-03-21, age 75 (birthday 2026-03-21 passed → 75). In range. Enrolled full year. Advanced illness 2026-02-06 during MY, but frailty? None documented. E4 requires both → doesn't exclude. No screening → non_compliant.
**71121**: DOB 1971-08-17, age 55. Enrolment: gaps 2026-03-22 to 2026-04-18 (28 days: Mar 22–31 = 10, Apr 1–18 = 18 → 28) and 2026-07-07 to 2026-07-21 (15 days). Two gaps — each ≤45 days, but "no more than one gap" → two gaps fails enrolment → not_eligible. Wait, let me verify gap days. First: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gap 1: 2026-03-22 through 2026-04-18 = 10 + 18 = 28 days. Gap 2: 2026-07-07 through 2026-07-21 = 15 days. Two gaps → fails "no more than one gap" → not_eligible. Hmm, but wait — do we combine adjacent gaps? Gap 1 ends 2026-04-18, next enrolment 2026-04-19 to 2026-07-06, then gap 2. These are separate gaps separated by 2026-04-19–07-06 enrolment. So two gaps total. NCQA-style would treat two gaps of ≤45 each... actually NCQA allows one gap of up to 45 days. Two gaps fails. → not_eligible.
Hmm, actually, let me double-check: NCQA HEDIS continuous enrolment allows "no more than one gap in enrolment of up to 45 days during the measurement year". Two gaps, even short, fail. Yes. → not_eligible.
**71122**: DOB 1954-09-15, age 72. Enrolment starts 2026-03-22 — not full year → not_eligible. (Frailty + advanced illness both documented, but enrolment fails first → not_eligible, and exclusion only applies to eligible population.)
**71123**: DOB 1959-03-08, age 67. Enrolment: gaps 2026-02-24 to 2026-03-08 (Feb 24–28 = 5, Mar 1–8 = 8 → 13 days) and 2026-06-28 to 2026-07-22 (Jun 28–30 = 3, Jul 1–22 = 22 → 25 days). Two gaps → fails → not_eligible.
**71124**: DOB 1960-08-15, age 66. Enrolled full year. Flex sig 2026-04-15 → within 5-year window → numerator. No exclusions (age ≥66 but no frailty/advanced illness). → compliant.
**71125**: DOB 1950-05-08, age 76 → out of range → not_eligible. (FIT 2026-04-02 would count but age fails.)
**71126**: DOB 1981-12-20, age 45 → out of range → not_eligible. Also enrolment starts mid-year, but age already fails. → not_eligible.
**71127**: DOB 1981-01-14, age 45 → out of range → not_eligible. (Stool DNA 2024-12-13 would be in 3-year window, but age fails.)
**71128**: DOB 1951-12-10, age 75 (birthday 2026-12-10 passed → 75). In range. Enrolled full year. Stool DNA 2026-08-17 → numerator. No exclusions. → compliant.
**71129**: DOB 1959-07-23, age 67. Enrolled full year. Flex sig 2023-07-08 — outside 5-year window (2022–2026). CT colonography 2023-09-13 — outside 5-year window (2022–2026). Hmm wait — five-year window: 2026 or four years prior → 2022, 2023, 2024, 2025, 2026. 2023-07-08 flex sig IS within 2022–2026! Let me recheck. "Flexible sigmoidoscopy during 2026 or the four years prior (five-year window)." Four years prior to 2026: 2025, 2024, 2023, 2022. So window 2022-01-01 to 2026-12-31. 2023-07-08 is within → numerator. Also CT colonography 2023-09-13 within → numerator. → compliant.
Wait, I need to double check the actual HEDIS spec: flexible sigmoidoscopy in last 5 years, CT colonography in last 5 years, colonoscopy in last 10 years, stool DNA-FIT in last 3 years, FIT/FOBT in last year. Yes, flex sig 5-year. So 2023 flex sig counts. → compliant.
**71130**: DOB 1981-09-13, age 45 → out of range → not_eligible. (Also C18.7 2024-11-25 would exclude, and FIT 2026-12-08 would be numerator, but age fails first → not_eligible. Per the rules: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented.")
**71131**: DOB 1950-05-05, age 76 → out of range → not_eligible. Also enrolment starts 2026-04-12 — but age already fails.
**71132**: DOB 1950-02-01, age 76 → out of range → not_eligible. (C18.7 2019-11-07 exclusion and FIT 2026-11-15 numerator irrelevant; age fails.)
**71133**: DOB 1967-01-22, age 59. Enrolled full year. CT colonography 2021-04-12 and 2021-09-09 — five-year window 2022–2026 → both outside. No numerator. No exclusions. → non_compliant.
**71134**: DOB 1981-09-26, age 45 → out of range → not_eligible. (Total colectomy 2023-04-23 exclusion irrelevant; age fails.)
**71135**: DOB 1971-08-26, age 55. Enrolled full year. Colonoscopy 2016-11-12 — 10-year window 2017–2026 → outside. No numerator. No exclusions (age <66, frailty not documented). → non_compliant.
**71136**: DOB 1981-11-11, age 45 → out of range → not_eligible. (Flex sig 2026-02-13 numerator, advanced illness — irrelevant; age fails.)
Now let me also double check the age-75 boundary members: eligible age 46–75 as of 2026-12-31.
- 71114: DOB 1951-11-18 → age on 2026-12-31: 2026−1951 = 75, birthday Nov 18 passed → 75. In range. Excluded via E4.
- 71120: DOB 1951-03-21 → 75. In range. Non-compliant.
- 71128: DOB 1951-12-10 → 75 (birthday Dec 10 passed). In range. Compliant.
- 71119: DOB 1950-03-25 → 76. Out.
- 71125: DOB 1950-05-08 → 76. Out.
- 71131: DOB 1950-05-05 → 76. Out.
- 71132: DOB 1950-02-01 → 76. Out.
Enrolment checks for those in age range:
- 71112: full year ✓
- 71113: full year ✓
- 71114: full year ✓
- 71115: one 35-day gap ✓
- 71116: one 35-day gap ✓
- 71117: one 45-day gap ✓ ("up to 45 days")
- 71118: one 42-day gap ✓
- 71121: two gaps ✗ → not_eligible
- 71123: two gaps ✗ → not_eligible
- 71124: full year ✓
- 71128: full year ✓
- 71129: full year ✓
- 71133: full year ✓
- 71135: full year ✓
- 71111: enrolment starts 2026-05-01 → not full year ✗ → not_eligible
- 71122: enrolment starts 2026-03-22 ✗ → not_eligible
Let me verify gap day counts precisely (count days not enrolled):
71115: enrolled through 2026-07-16, resumes 2026-08-21. Gap = 2026-07-17 to 2026-08-20 inclusive. July: 17–31 = 15 days. Aug: 1–20 = 20 days. Total 35. ✓ (prompt says 35)
71116: through 2026-03-16, resumes 2026-04-21. Gap = 2026-03-17 to 2026-04-20. Mar: 15, Apr: 20 → 35. ✓
71117: through 2026-06-02, resumes 2026-07-18. Gap = 2026-06-03 to 2026-07-17. Jun: 28 (3–30), Jul: 17 → 45. ✓ exactly 45, allowed.
71118: through 2026-06-14, resumes 2026-07-27. Gap = Jun 15–30 (16) + Jul 1–26 (26) = 42. ✓
71121: gap1 = Mar 22–31 (10) + Apr 1–18 (18) = 28; gap2 = Jul 7–21 (15). Two gaps → fail.
71123: gap1 = Feb 24–28 (5) + Mar 1–8 (8) = 13; gap2 = Jun 28–30 (3) + Jul 1–22 (22) = 25. Two gaps → fail.
Now compile results:
not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 → 13 members.
excluded: 71113 (C18.7), 71114 (E4 frailty+advanced illness, age 75) → 2 members.
Eligible after exclusions (denominator): 71112, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135 → 11 members.
compliant: 71117 (stool DNA 2026), 71118 (flex sig 2022), 71124 (flex sig 2026), 71128 (stool DNA 2026), 71129 (flex sig 2023, CTC 2023) → 5 members.
non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 → 6 members.
Check: 5 + 6 = 11 ✓ denominator. Total: 11 + 2 + 13 = 26 ✓.
Rate: 5/11 × 100 = 45.4545... → 45.5 (one decimal, round half up). 45.4545... rounds to 45.5? 45.4545... to one decimal: second decimal is 5? 45.4545... → 45.4|545... wait. 5/11 = 0.454545..., ×100 = 45.4545... One decimal place: 45.5 (since 45.4545... → the digit after first decimal is 4? Let me be careful: 45.4545 — first decimal is 4, second is 5. Round half up to one decimal: look at second decimal (5) → round up first decimal from 4 to 5 → 45.5. Yes, 45.5.
Hmm wait: 45.4545... The first decimal digit is 4 (45.4), remainder .0545... ≥ .05, so rounds up to 45.5. Correct.
Double-check 71113: in eligible population (age 47, full-year enrolment), exclusion E1 (C18.7 2025-07-17) → excluded. Yes, and flex sig 2025-11-08 would meet numerator but exclusion wins.
Double-check 71114: E4 requires age ≥66 AND frailty AND advanced illness, all during measurement year. Age 75 ✓, frailty 2026-12-17 ✓ (during MY), advanced illness 2026-05-05 ✓. → excluded. CT colonography 2021-12-07 outside 5-year window (2022–2026) so wouldn't be numerator anyway.
Double-check 71129: flex sig 2023-07-08 within 5-year window (2022-01-01 onward). Yes → compliant.
Double-check 71133: CTC 2021-04-12 and 2021-09-09 — outside 2022–2026 window → non-compliant. Correct.
Double-check 71115: colonoscopy 2016-12-23 — 10-year window from 2026-12-31 back: 2017-01-01 to 2026-12-31. 2016-12-23 outside → non-compliant. Also frailty+advanced illness but age 47 <66 → no exclusion. Non-compliant. ✓
Double-check 71116: stool DNA 2023-01-09 — 3-year window 2024–2026 → outside → non-compliant. ✓
Double-check 71120: age 75, advanced illness only → no exclusion, no screening → non_compliant. ✓
Double-check 71112: no screening → non-compliant. ✓
Double-check 71135: colonoscopy 2016-11-12 outside → non-compliant. ✓
Counts:
- denominator: 11
- numerator: 5
- excluded: 2
- not_eligible: 13
- rate: 45.5
Lists:
- compliant: ["71117", "71118", "71124", "71128", "71129"]
- non_compliant: ["71112", "71115", "71116", "71120", "71133", "71135"]
- excluded: ["71113", "71114"]
- not_eligible: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
Output exactly one fenced JSON code block.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Hunyuan 4 · Tencent197.6s · 13,480 out | 200.5s · 12,988 out | 241.7s · 15,409 out
Reasoning · 13,290 tokens
We need answer JSON only. Need classify each member per measure QM-CRC.
We have 26 members IDs 71111-71136. Need denominator (compliant+non_compliant), numerator (compliant), excluded, not_eligible. Rate = numerator/denominator*100 rounded half up to 1 decimal.
Let's parse measure spec.
Eligible population (denominator) before exclusions:
- Age 46 through 75 years as of 2026-12-31.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Important: "full measurement year" means enrolled 2026-01-01 through 2026-12-31? Continuous enrolment: the full measurement year with no more than one gap of up to 45 days. So need enrolment covering entire year, allowing at most one gap <=45 days. If enrolled late start (e.g., 2026-05-01 through 2026-12-31 continuous from that date, not enrolled before) means not full measurement year; missing Jan-Apr, so not continuous enrolment full year. Unless "full measurement year" means enrolled for the full 12 months with maybe one gap? Let's interpret: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That requires coverage from 2026-01-01 through 2026-12-31, but you can have one gap (no more than 45 days) during the year. If they start mid-year and not enrolled before, they were not enrolled for part of year => not continuous full year? In HEDIS-like measures, continuous enrollment often requires enrolled the entire measurement year, allowing one gap of up to 45 days. If not enrolled before start date, that's a gap >45 days before start (from Jan 1 to start) or not enrolled for full year. So not eligible. Let's confirm with examples: Member 71111 enrolled 2026-05-01 through 2026-12-31, not enrolled before. That is not full year; gap from Jan 1 to Apr 30 = 120 days, so fails continuous enrolment. Also they are 55 age ok. So not_eligible.
Any with late start (71122 start 3/22, 71126 start 3/17, 71131 start 4/12, 71130 start 5/16, 71111 start 5/1). All not eligible due to not full-year enrolment (unless allow anchor? no). Also age? Let's check each.
Age as of 2026-12-31: must be 46 through 75 inclusive. If DOB yields age:
- 1971-04-18 => 55 on 2026-12-31 (yes, turned 55 in 2026). Within 46-75.
- 1954-02-14 => 72. ok.
- 1979-02-27 => 47. ok.
- 1951-11-18 => 75. ok (inclusive 75).
- 1979-09-19 => 47 ok.
- 1976-01-11 => 50 ok.
- 1963-09-02 => 63 ok.
- 1979-03-23 => 47 ok.
- 1950-03-25 => 76 (out, >75). Not eligible.
- 1951-03-21 => 75 ok.
- 1971-08-17 => 55 ok.
- 1954-09-15 => 72 ok.
- 1959-03-08 => 67 ok.
- 1960-08-15 => 66 ok.
- 1960? Wait 71124 DOB 1960-08-15 => on 2026-12-31 age 66 (since birthday Aug 15, 2026, turns 66). ok.
- 71125 1950-05-08 => 76 (out).
- 71126 1981-12-20 => 45 on 2026-12-31 (since birthday Dec 20, 2026, turns 45). Out (46-75). Not eligible.
- 71127 1981-01-14 => 45 (birthday Jan 14, 2026, turns 45). Out.
- 71128 1951-12-10 => 75 ok (birthday Dec 10, 2026, turns 75).
- 71129 1959-07-23 => 67 ok.
- 71130 1981-09-13 => 45 (birthday Sep 13, 2026 turns 45). Out.
- 71131 1950-05-05 => 76 out.
- 71132 1950-02-01 => 76 out (birthday Feb 1, 2026 turns 76). Out.
- 71133 1967-01-22 => 59 (birthday Jan 22, 2026 turns 59) ok.
- 71134 1981-09-26 => 45 out.
- 71135 1971-08-26 => 55 ok.
- 71136 1981-11-11 => 45 out.
Age out: 71119 (76), 71125 (76), 71126 (45), 71127 (45), 71130 (45), 71131 (76), 71132 (76), 71134 (45), 71136 (45). Also check 711? 711? That's 9 age-out members.
Continuous enrolment evaluation: Need full measurement year 2026-01-01 to 2026-12-31 with no more than one gap up to 45 days. Let's list enrolment patterns for those age-eligible (and maybe age-out can also fail enrolment but already not_eligible; we only need not_eligible list includes all who fail age, event, or enrolment. Status definitions: not_eligible never enters eligible population (age, event, or enrolment). Age/event? "event" maybe? Actually exclusions? It says (age, event, or enrolment). Event maybe? But measure doesn't have event? The eligible population is age and continuous enrolment. There's no event like death? The status says not_eligible (age, event, or enrolment). Maybe "event" refers to? Wait in intro: "not_eligible never enters the eligible population (age, event, or enrolment)". The measure's eligible population specified age and continuous enrolment. Maybe "event" refers to not meeting the event? But measure doesn't have an event. Actually for some measures there is an event (e.g., discharge). Here no. We'll just use age and enrolment. Exclusions are E1-E4 evaluated only if in eligible population. If a member has an exclusion but fails enrolment/age, they are not_eligible, not excluded. Important for e.g., 71134 has total colectomy (E2) but age 45 -> not_eligible, not excluded. 71130 has colorectal cancer diagnosis C18.7 in 2024 (E1) but age 45 -> not_eligible. 71132 has cancer but age 76 -> not_eligible.
Now enrolment. For each member, determine eligible (age ok and continuous enrolment full year with gap rule). Let's parse each enrolment.
We'll go member by member.
Member 71111: DOB 1971-04-18 age 55. Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. So not enrolled Jan 1-Apr 30: gap 120 days (or not full year). Fails continuous enrolment. Also late start. Therefore not_eligible. Exclusions? None relevant. So not_eligible list.
71112: DOB 1954-02-14 age 72. Enrolment: 2026-01-01 through 2026-12-31 continuous no gaps. Eligible. Screening: no colorectal screening on record. Numerator? Need any one in windows:
N1 FOBT/FIT during 2026. None.
N2 Stool DNA during 2026 or two years prior (three-year window). Look-back window measured back from 2026-12-31: three-year window means 2024-01-01? Let's calculate: "during 2026 or the two years prior (three-year window)". Measurement year 2026. Two years prior = 2024 and 2025? Wait "during 2026 or the two years prior" means years 2026, 2025, 2024? That's three-year window (2024-2026). Actually if measurement year is 2026, "during 2026 or the two years prior" = 2026, 2025, 2024 (three years). Need dates on/after 2024-01-01. No screening at all. So none.
N3 Flexible sigmoidoscopy during 2026 or four years prior (five-year window): years 2022-2026? Wait "2026 or the four years prior" = 2026,2025,2024,2023,2022 = five-year window, on/after 2022-01-01. None.
N4 CT colonography during 2026 or four years prior (five-year): 2022-2026. None.
N5 Colonoscopy during 2026 or nine years prior (ten-year): 2017-2026? "2026 or the nine years prior" = 2026 + 2017-2025? Actually nine years prior to 2026 are 2017 through 2025, plus 2026 gives ten-year window 2017-01-01 to 2026-12-31. Wait if measurement year 2026, nine years prior is 2017. So window 2017-2026. Member has no colonoscopy. So not compliant. No exclusions: no CRC, colectomy, hospice, frailty/advanced illness. Age 72, E4 requires age 66+ AND both frailty and advanced illness during MY. Not documented. So non_compliant. Add to non_compliant list.
71113: DOB 1979-02-27 age 47. Enrolment full year continuous. Eligible. Other history: 2025-07-17 Diagnosis C18.7 malignant neoplasm of sigmoid colon. That is colorectal cancer (C18-C21) any time on or before 2026-12-31. Diagnosis in 2025, before end of 2026, qualifies E1 exclusion. Also screening history: 2020-07-03 CT colonography (outside 5-year? 2020 is six years prior? Wait from 2026 back: five-year window for CT colonography is 2022-2026, so 2020 is out. Flexible sigmoidoscopy 2025-11-08 is within five-year window (2022-2026), so meets N3 actually. But exclusion evaluated before numerator; member meets exclusion E1, so excluded (not compliant). Status excluded. Excluded list. Note: They are in denominator before exclusions? Wait denominator after exclusions = compliant+non_compliant. So excluded members are not in denominator. So excluded count separate. Good.
71114: DOB 1951-11-18 age 75 (ok). Enrolment full year continuous. Eligible. Screening: 2021-12-07 CT colonography. N4 five-year window 2022-2026? Wait need check: CT colonography during 2026 or the four years prior (five-year window). If measurement year is 2026, four years prior are 2025,2024,2023,2022. So window is 2022-01-01 through 2026-12-31. 2021-12-07 is before 2022-01-01, so not in window. Flexible sigmoidoscopy? none. Colonoscopy? none. Stool DNA? none. FIT? none. So no numerator? Wait check N3 Flexible sigmoidoscopy five-year window 2022-2026: none. N5 colonoscopy ten-year window 2017-2026: none (no colonoscopy). So no screening meets numerator. Exclusions: Other history: 2026-12-17 Frailty documented; 2026-05-05 Advanced illness documented (heart failure I50.22). Age 75, which is 66 or older as of 2026-12-31. Both frailty and advanced illness documented during measurement year (2026). So meets E4 exclusion (Age 66+ AND both frailty and advanced illness during MY). Frailty alone no, advanced alone no, but both yes, and age >=66. So excluded. Note: Member also has no numerator, but exclusion takes precedence. So excluded list.
71115: DOB 1979-09-19 age 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days (from Jul 17 to Aug 20 inclusive? gap 35 days). This is within one gap up to 45 days, and enrolled rest of year? Starts 01-01, gap 35 days, then from 08-21 to 12-31. Is that continuous enrolment full measurement year with no more than one gap of up to 45 days? Yes, they are enrolled Jan 1 to Jul 16, gap 35 days, then Aug 21 to Dec 31. They have one gap <=45 days, enrolled the rest. Does "full measurement year" mean they must be enrolled on 01-01 and 12-31, which they are. So eligible (enrolment ok). Screening: 2016-12-23 Colonoscopy. N5 colonoscopy ten-year window: 2017-2026? Wait "during 2026 or the nine years prior (ten-year window)". Nine years prior to 2026: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. Plus 2026. So window is 2017-01-01 to 2026-12-31. Colonoscopy date 2016-12-23 is before 2017-01-01, so outside ten-year window by 9 days. So not compliant. Check other screenings: none. Exclusions: Frailty documented 2026-07-07; Advanced illness documented 2026-02-06. Age 47, not 66+, so E4 does not apply (requires age 66 or older). No CRC/colectomy/hospice. So not excluded. Non_compliant. Add.
Wait check gap definition: "One gap of 35 days." They say enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Yes <=45, so continuous enrolment with one gap ok.
71116: DOB 1976-01-11 age 50. Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days. Eligible (age ok, one gap 35 <=45, enrolled full year ends). Screening: 2023-01-09 Stool DNA test. N2 stool DNA test during 2026 or two years prior (three-year window) = 2024-2026? Wait let's recalc precisely. Measurement year 2026. "during 2026 or the two years prior" = 2026, 2025, 2024. That's a three-year window: 2024-01-01 to 2026-12-31. Date 2023-01-09 is in 2023, which is three years prior to 2026? Let's count: 2026 - 3 = 2023. If the window includes "2026 or the two years prior", the years are 2026, 2025 (1 year prior), 2024 (2 years prior). That does NOT include 2023. But wait "three-year window" maybe they mean from end of 2026 back three years: 2024-01-01 to 2026-12-31? Actually three years back from 2026-12-31 gives 2023-12-31? Let's test: A three-year window measured back from 2026-12-31: if you go back 3 years to 2023-12-31, then window is 2024-01-01? No, date math: 2026-12-31 minus 3 years = 2023-12-31. A window "during 2026 or the two years prior" means years 2026, 2025, 2024. The phrase "two years prior" to 2026 is 2024? Wait the year prior to 2026 is 2025. Two years prior is 2024. So "2026 or the two years prior" = 2026, 2025, 2024. That's three calendar years. So 2023 is excluded. But they call it a three-year window, which would be 2024-2026? That's actually three years (2024,2025,2026). Yes. So 2023-01-09 is not in window.
But need be careful: sometimes HEDIS says "during the measurement year or the two years prior to the measurement year" meaning if MY is 2026, the two prior years are 2025 and 2024. Services on or after Jan 1, 2024. So 2023 is out. Good.
N5 colonoscopy ten-year window: "2026 or the nine years prior" = 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017? Wait count: nine years prior to 2026 are 2025 (1), 2024 (2), 2023 (3), 2022 (4), 2021 (5), 2020 (6), 2019 (7), 2018 (8), 2017 (9). Plus 2026 gives 2017 through 2026 (10 years). So 2023-01-09 stool DNA not colonoscopy. No FIT/FOBT in 2026. Flexible sigmoidoscopy? none. CT colonography? none. Colonoscopy? none. So no numerator. Exclusions none. So non_compliant.
Wait is Stool DNA test considered also for N2 only. Not FIT. So no.
71117: DOB 1963-09-02 age 63. Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days. Eligible (gap exactly 45 days allowed: "up to 45 days" inclusive). Screening: 2026-01-11 Stool DNA test. N2: Stool DNA during 2026 or two years prior. It is during 2026, so meets N2. Compliant (numerator met). Exclusions? No CRC, colectomy, hospice, no frailty/advanced. Age 63 <66, so E4 no. So compliant. Add.
Check enrolment: gap of 45 days. It says "One gap of 45 days." Allowed (no more than one gap of up to 45 days). Yes.
71118: DOB 1979-03-23 age 47. Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days. Eligible. Screening: 2021-11-12 Flexible sigmoidoscopy; 2022-07-04 Flexible sigmoidoscopy. N3 Flexible sigmoidoscopy during 2026 or four years prior (five-year window) = years 2022,2023,2024,2025,2026? Need check: "2026 or the four years prior" = 2026, 2025 (1), 2024 (2), 2023 (3), 2022 (4). So window 2022-01-01 to 2026-12-31. The 2022-07-04 flexible sigmoidoscopy is within window (2022). So meets N3. Compliant. No exclusions. Add.
Wait also 2021-11-12 is outside (2021 not in 2022-2026). But 2022-07-04 is in. So compliant.
71119: DOB 1950-03-25 age 76. Age out (must be 46-75). Not_eligible. No need further. Not_eligible list. Any exclusions? irrelevant.
71120: DOB 1951-03-21 age 75. Enrolment full year continuous. Eligible. Screening: No colorectal screening on record. Exclusions: 2026-02-01 Advanced illness documented (heart failure). No frailty. Age 75 >=66, but E4 requires BOTH frailty and advanced illness. Only advanced illness, no frailty, so does NOT meet E4. No CRC, colectomy, hospice. So not excluded. Numerator? No screening at all. So non_compliant. Add.
71121: DOB 1971-08-17 age 55. Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days. That's TWO gaps. Continuous enrolment allows no more than ONE gap of up to 45 days. Two gaps => fails enrolment. Even though each gap <=45, there are two gaps. So not_eligible. Age ok but enrolment fails. Add not_eligible. Let's double-check: "with no more than one gap of up to 45 days." Means at most one gap; if multiple gaps, not allowed. So not_eligible. Also not enrolled? They start Jan 1, end Dec 31. Two gaps. So fail. Noneligible.
71122: DOB 1954-09-15 age 72. Enrolment: 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-22. So missing Jan 1 - Mar 21 (about 80 days). Not full year; fails. Not_eligible. Also has frailty 2026-10-08 and advanced illness 2026-01-13 (but advanced illness date Jan 13 is before enrolment start? Still documented, but member not eligible). Not_eligible list.
71123: DOB 1959-03-08 age 67. Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days. Two gaps. Fails enrolment (more than one gap). Not_eligible. Wait check: There are two gaps: Feb 24 to Mar 8 = 13 days; Jun 28 to Jul 22 = 25 days. Yes two gaps. So not_eligible. Age ok. Add.
71124: DOB 1960-08-15 age 66. Enrolment full year continuous. Eligible. Screening: 2026-04-15 Flexible sigmoidoscopy. N3 five-year window 2022-2026: 2026 is in window, so meets N3. Compliant. Exclusions: Age 66, but no frailty/advanced illness documented. So not E4. No CRC etc. Compliant. Add.
71125: DOB 1950-05-08 age 76. Age out. Not_eligible. (Enrolment full, FIT in 2026, but age 76 >75). Not_eligible.
71126: DOB 1981-12-20 age 45. Age out (46-75). Not_eligible. Enrolment start 2026-03-17, also not full year. Not_eligible.
71127: DOB 1981-01-14 age 45. Age out. Not_eligible. Enrolment one gap 24 days, full year, but age 45. Not_eligible.
71128: DOB 1951-12-10 age 75. Enrolment full year continuous. Eligible. Screening history: 2020-02-10 CT colonography. N4 CT colonography five-year window 2022-2026: 2020 is outside (not in 2022-2026). 2026-08-17 Stool DNA test. N2 stool DNA during 2026 or two years prior: 2026 is in window. So meets N2. Compliant. No exclusions. Add.
Check: Stool DNA test during 2026 qualifies N2. Yes.
71129: DOB 1959-07-23 age 67. Enrolment full year continuous. Eligible. Screening: 2023-07-08 Flexible sigmoidoscopy. N3 five-year window 2022-2026: 2023 is in window, meets N3. Also 2023-09-13 CT colonography (N4 window 2022-2026): also meets, but one is enough. Compliant. Exclusions: none documented (no frailty/adv). Age 67 but no both. Compliant. Add.
71130: DOB 1981-09-13 age 45. Age out. Not_eligible. (Has cancer diagnosis C18.7 in 2024, but age out, so not excluded; not_eligible). Add not_eligible.
71131: DOB 1950-05-05 age 76. Age out. Not_eligible. (CT colonography 2026, but age 76). Add.
71132: DOB 1950-02-01 age 76. Age out. Not_eligible. Has cancer diagnosis 2019-11-07 C18.7 (E1). Age out. Not_eligible. Add.
71133: DOB 1967-01-22 age 59. Enrolment full year continuous. Eligible. Screening: 2021-04-12 CT colonography; 2021-09-09 CT colonography. N4 CT colonography five-year window 2022-2026: 2021 is outside (window starts 2022). Wait check: "during 2026 or the four years prior (five-year window)". Four years prior to 2026: 2025, 2024, 2023, 2022. So 2021 is five years prior? Let's count: 2026 measurement year. 2025 is 1 year prior. 2024 is 2 years prior. 2023 is 3 years prior. 2022 is 4 years prior. So 2021 is 5 years prior, not included. The five-year window is 2022-2026. So 2021 CT colonography not in window. Are there other screenings? No colonoscopy, no FIT, no stool DNA, no flexible sigmoidoscopy. So no numerator. Wait 2021-09-09 also 2021. So none. Non_compliant. Exclusions none. Add non_compliant.
Hold on: Need verify N5 colonoscopy ten-year window includes 2017-2026. No colonoscopy. So no.
71134: DOB 1981-09-26 age 45. Age out. Not_eligible. Has total colectomy 2023-04-23 (E2). But age out, so not_eligible. Add not_eligible.
71135: DOB 1971-08-26 age 55. Enrolment full year continuous. Eligible. Screening: 2016-11-12 Colonoscopy. N5 colonoscopy ten-year window: 2017-2026? Wait 2016-11-12 is before 2017-01-01, so outside ten-year window (window 2017-2026). Let's double-check: "during 2026 or the nine years prior (ten-year window)". Nine years prior to 2026: 2025 (1), 2024 (2), 2023 (3), 2022 (4), 2021 (5), 2020 (6), 2019 (7), 2018 (8), 2017 (9). So window is 2017-2026. 2016 is 10 years prior? Actually 2026 - 2016 = 10 years. If service date is 2016-11-12, and measurement end is 2026-12-31, the look-back measured back from 2026-12-31: ten years before is 2016-12-31? Let's compute exactly: From 2026-12-31 back 10 years = 2016-12-31. A ten-year window measured back from 2026-12-31 would be 2016-12-31? Wait this is crucial. The spec says: "by the look-back window measured back from 2026-12-31: ... N5. Colonoscopy during 2026 or the nine years prior (ten-year window)." It explicitly says "during 2026 or the nine years prior" i.e., calendar years 2026 and the nine previous calendar years (2017-2025). That is ten calendar years: 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026. That window starts 2017-01-01. But if interpreted as a rolling 10-year period back from 2026-12-3json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 12,799 tokens
We need answer a JSON block with measure population for QM-CRC. We must analyze 26 members. Need determine eligibility (age, continuous enrolment), exclusions, numerator.
Let's restate measure:
Measurement year: 2026-01-01 through 2026-12-31.
ELIGIBLE POPULATION (denominator)
- Age: 46 through 75 years as of 2026-12-31 (i.e., age 46,47,...75 inclusive). So age >=46 and <=75 on Dec 31 2026.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
Interpretation of continuous enrolment: "the full measurement year with no more than one gap of up to 45 days." Means they must be enrolled for the entire year 2026 except possibly one gap of <=45 days. If not enrolled at all before some date (i.e., starts mid-year) then they missed more than 45 days? Wait the enrolment description says "continuous enrolment: the full measurement year". Need parse: "the full measurement year with no more than one gap of up to 45 days." Typically HEDIS measure: continuous enrollment for the measurement year, allowing one gap of up to 45 days. But it also may allow enrollment less than full year? No, continuous enrollment means enrolled from Jan 1 to Dec 31, with no more than one gap of up to 45 days. If not enrolled before a date, then gap from Jan 1 to start date. For example Member 71111: Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. That's a gap from Jan 1 to Apr 30, which is 120 days (Jan 31+Feb 28+Mar31+Apr30=120). That's >45 days gap, and also not enrolled for full year. So not continuously enrolled. Likewise Member 71122: enrolment 2026-03-22 through 2026-12-31, not enrolled before 2026-03-22. Gap Jan1-Mar21 = 80 days? Jan (31)+Feb(28)+Mar21=80 days, >45. Not eligible. 71126: enrolment 2026-03-17 through 2026-12-31, not before: gap Jan1-Mar16=74 days. Not eligible. 71130: enrolment 2026-05-16 through 2026-12-31, not before: gap Jan1-May15=135 days. Not eligible. 71131: enrolment 2026-04-12 through 2026-12-31, not before: gap Jan1-Apr11=101 days. Not eligible. 71132: enrolment 2026-01-01 through 2026-04-19; 2026-05-26 through 2026-12-31. One gap of 36 days. This is continuous enrolment? It has a gap from Apr20 to May25 inclusive? Let's compute: enrolment period 1: Jan1-Apr19. Period 2: May26-Dec31. Gap: Apr20 through May25. Number of days: Apr20-30: 11 days (20,21,22,23,24,25,26,27,28,29,30) = 11. May1-25: 25 days. Total 36 days. This is one gap of 36 days <=45, so continuous enrolment OK (full year with one gap up to 45 days). If there are two gaps, fail. If one gap >45, fail.
Need check each member's enrolment.
Also note member 71121: Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days. That's two gaps. Not allowed (no more than one gap). So not continuously enrolled. Wait gap1: Mar22-Apr18 =? Actually period1 ends Mar21, period2 starts Apr19. Gap days = Mar22-Apr18 inclusive: Mar22-31 =10 days? Let's count Mar22,23,24,25,26,27,28,29,30,31 =10; Apr1-18 =18; total 28. Yes. Gap2: Jul7-Jul21 =15 days (7-21 inclusive =15). So two gaps, regardless of length, fails continuous enrolment (only one gap of up to 45 days allowed). So not eligible.
Member 71123: Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days. Two gaps -> fails (more than one gap). Not eligible.
Member 71115: Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Gap Jul17-Aug20 inclusive? Jul17-31=15, Aug1-20=20, total 35. OK.
Member 71116: Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days. Gap Mar17-Apr20 inclusive: Mar17-31=15, Apr1-20=20 =>35. OK.
Member 71117: Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days. Gap Jun3-Jul17 inclusive? Jun3-30=28 (3 to 30 inclusive =28? Let's count: 30-3+1 =28), Jul1-17=17, total 45. This is one gap of exactly 45 days. Allowed? "no more than one gap of up to 45 days." Up to 45 days inclusive. Yes, 45 days allowed. So continuous enrolment OK.
Member 71118: Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days. Gap Jun15-Jul26 inclusive: Jun15-30=16, Jul1-26=26, total 42. OK.
Member 71127: Enrolment: 2026-01-01 through 2026-06-25; 2026-07-20 through 2026-12-31. One gap of 24 days. Gap Jun26-Jul19 inclusive: Jun26-30=5, Jul1-19=19 total 24. OK.
Member 71136: Enrolment: 2026-01-01 through 2026-07-01; 2026-08-11 through 2026-12-31. One gap of 40 days. Gap Jul2-Aug10 inclusive: Jul2-31=30, Aug1-10=10 total 40. OK.
Members with continuous no gaps: 71112, 71113, 71114, 71119, 71120, 71124, 71125, 71128, 71129, 71133, 71134, 71135. Also check 71111, 71122, 71126, 71130, 71131 are mid-year start, so not full year. 71132 has gap. Let's list all 26 and assign.
First, age eligibility. Age 46-75 as of 2026-12-31.
Compute age from DOB to 2026-12-31.
Let's list each member DOB and stated age:
71111 DOB 1971-04-18 -> 55. Eligible age (46-75). Yes.
71112 DOB 1954-02-14 -> 72. Yes.
71113 DOB 1979-02-27 -> 47. Yes.
71114 DOB 1951-11-18 -> 75. Yes (75 inclusive).
71115 DOB 1979-09-19 -> 47. Yes.
71116 DOB 1976-01-11 -> 50. Yes.
71117 DOB 1963-09-02 -> 63. Yes.
71118 DOB 1979-03-23 -> 47. Yes.
71119 DOB 1950-03-25 -> 76. No (too old). Age 76 >75.
71120 DOB 1951-03-21 -> 75. Yes.
71121 DOB 1971-08-17 -> 55. Yes.
71122 DOB 1954-09-15 -> 72. Yes.
71123 DOB 1959-03-08 -> 67. Yes.
71124 DOB 1960-08-15 -> 66. Yes.
71125 DOB 1950-05-08 -> 76. No (age 76).
71126 DOB 1981-12-20 -> 45. No (age 45 <46).
71127 DOB 1981-01-14 -> 45. No (too young).
71128 DOB 1951-12-10 -> 75. Yes.
71129 DOB 1959-07-23 -> 67. Yes.
71130 DOB 1981-09-13 -> 45. No (age 45).
71131 DOB 1950-05-05 -> 76. No (age 76).
71132 DOB 1950-02-01 -> 76. No (age 76).
71133 DOB 1967-01-22 -> 59. Yes.
71134 DOB 1981-09-26 -> 45. No (age 45).
71135 DOB 1971-08-26 -> 55. Yes.
71136 DOB 1981-11-11 -> 45. No (age 45).
So not_eligible due to age: 71119 (76), 71125 (76), 71126 (45), 71127 (45), 71130 (45), 71131 (76), 71132 (76), 71134 (45), 71136 (45). Wait 71132 age 76, yes not eligible by age. Also 71130 age 45 not eligible. 71134 age 45 not eligible. 71136 age 45 not eligible.
Double-check 71125: 1950-05-08, on 2026-12-31 age = 76 (turned 76 in May 2026). Yes >75. 71131: 1950-05-05 turns 76 in May 2026, so 76. 71132: 1950-02-01 turns 76 in Feb 2026, age 76. 71119: 1950-03-25 turns 76 in Mar 2026. Good.
Now check enrolment not eligible (either age fail or enrolment fail). We'll classify not_eligible if age fail OR enrolment fail (not continuous). The spec says: "never enters the eligible population (age, event, or enrolment)". Continuous enrolment is enrolment requirement. So if age okay but enrolment fails (e.g., not enrolled full year with allowed gap), they are not_eligible. Also if age fails, not_eligible regardless of enrolment.
Let's list enrolment status for each member (full year with no more than one gap <=45 days). Need check all.
I'll create table:
Member / Age elig? / Enrolment description / Enrolment eligible? / Overall eligible? (if age yes and enrol yes) / then exclusions / numerator.
1. 71111: Age 55 yes. Enrol: 2026-05-01 through 12-31, not enrolled before 05-01. This is not full year: gap Jan1-Apr30 = 120 days. One gap >45, and not enrolled at start. Does continuous enrolment require enrollment beginning Jan 1? The definition: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Since not enrolled from Jan 1 to Apr 30, that is a gap of 120 days before enrollment starts. There is no enrollment before, so gap is from start of year to start date. It's a gap of 120 days >45. So fails. Not eligible due to enrolment (and also not full year). So not_eligible. (Even though age yes). Also has frailty but age <66, so no exclusion E4. No CRC, colectomy, hospice not mentioned. But since not_eligible, done.
2. 71112: Age 72 yes. Enrol: full year no gaps. Eligible (in denominator before exclusions). Exclusions? No CRC, no colectomy, no hospice, no frailty/advanced illness. So none. Numerator? Screening history: No colorectal screening on record. So does not meet numerator. Status: non_compliant. (In denominator, not excluded, doesn't meet numerator). Wait denominator includes eligible after exclusions. Yes.
3. 71113: Age 47 yes. Enrol: full year no gaps. Eligible. Exclusions: Other history: 2025-07-17 Diagnosis C18.7 malignant neoplasm of sigmoid colon, which is colorectal cancer (C18-C21) any time on or before 2026-12-31. Date 2025-07-17 is before 2026-12-31. So meets E1 colorectal cancer. Therefore excluded. Even though had screening (CT 2020, flex sig 2025), exclusion evaluated before numerator. So excluded. Status excluded.
4. 71114: Age 75 yes. Enrol: full year no gaps. Eligible. Exclusions: Other history: 2026-12-17 Frailty documented (gait abnormality). 2026-05-05 Advanced illness documented (heart failure). Age 66 or older as of 2026-12-31? Age 75, yes. AND both frailty and advanced illness documented during measurement year (2026). Frailty date 2026-12-17 during MY, advanced illness 2026-05-05 during MY. Both documented during measurement year. So meets E4. Therefore excluded. Screening: 2021 CT colonography. But excluded status. So excluded.
5. 71115: Age 47 yes. Enrol: 2026-01-01 through 2026-07-16; 2026-08-21 through 12-31. One gap of 35 days (Jul17-Aug20). Allowed. Eligible (enrolment ok). Exclusions? Other history: 2026-07-07 Frailty documented. 2026-02-06 Advanced illness documented (heart failure). Age 47, not 66 or older. E4 requires age 66+. So not excluded by E4. No CRC/colectomy/hospice. None of E1-E4. Numerator: Screening history: 2016-12-23 Colonoscopy. N5 Colonoscopy during 2026 or the nine years prior (ten-year window). Look-back from 2026-12-31: ten-year window means colonoscopy during 2026 or the nine years prior. The nine years prior to 2026 are 2017,2018,2019,2020,2021,2022,2023,2024,2025? Wait careful: "during 2026 or the nine years prior (ten-year window)". Measurement year is 2026. The nine years prior to 2026 are 2017 through 2025 inclusive? Let's count: If we are in 2026, the prior nine years are 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. That's nine years. Plus 2026 = ten-year window (2017-2026). Actually 2017 to 2026 inclusive is 10 years (2017,2018,2019,2020,2021,2022,2023,2024,2025,2026). Yes. Colonoscopy date 2016-12-23. Is 2016 within 2017-2026? No, 2016 is ten years prior? Let's count: 2026 minus 9 = 2017. The window includes 2017-2026. 2016 is before 2017, so outside window. Wait is 2016 in the "nine years prior"? Let's compute: If measurement year end 2026-12-31. A colonoscopy during 2026 or the nine years prior. The nine years prior to 2026 are the years 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025. That is nine years. 2016 is the tenth year prior, not included. Sometimes HEDIS colonoscopy window is 10 years (i.e., every 10 years), look back 9 years plus current year: so procedure must be in the past 10 years inclusive of current year: 2017-2026. Yes. Thus 2016-12-23 is more than 9 years prior? Date Dec 23, 2016 to Dec 31, 2026 is 10 years and 8 days. Since it's before Jan 1, 2017, it's outside. So colonoscopy does NOT meet N5. Any other screening? Only colonoscopy 2016. No FOBT/FIT in 2026, no stool DNA, no sigmoidoscopy/CT. So does not meet numerator. Status: non_compliant.
Wait need check exact window: N5. Colonoscopy during 2026 or the nine years prior (ten-year window). The nine years prior to 2026: 2025 (1), 2024 (2), 2023 (3), 2022 (4), 2021 (5), 2020 (6), 2019 (7), 2018 (8), 2017 (9). So 2017 is nine years prior. 2016 is ten years prior, not included. Yes. So 2016 colonoscopy too old. Non-compliant.
6. 71116: Age 50 yes. Enrol: Jan1-Mar16; Apr21-Dec31. One gap of 35 days (Mar17-Apr20). Allowed. Eligible. Exclusions: none (no CRC, colectomy, hospice, frailty/adv). Numerator: Screening: 2023-01-09 Stool DNA test. N2 Stool DNA test during 2026 or the two years prior (three-year window). Window: 2026 or two years prior: years 2024 and 2025? Let's compute: two years prior to 2026 are 2025 and 2024. Plus 2026 = three-year window 2024, 2025, 2026. Wait "during 2026 or the two years prior" means 2026, 2025, 2024. Yes. 2023-01-09 is in 2023, which is three years prior, outside window. So stool DNA in 2023 does not meet. No other screening. Does not meet numerator. Status: non_compliant.
7. 71117: Age 63 yes. Enrol: Jan1-Jun2; Jul18-Dec31. One gap of 45 days (Jun3-Jul17). Allowed (up to 45). Eligible. Exclusions: none. Numerator: Screening: 2026-01-11 Stool DNA test. N2: Stool DNA during 2026? Yes, 2026-01-11 is during 2026. Meets N2. Also any? So compliant. Status compliant.
8. 71118: Age 47 yes. Enrol: Jan1-Jun14; Jul27-Dec31. One gap of 42 days. Allowed. Eligible. Exclusions: none. Numerator: Screening: 2021-11-12 Flexible sigmoidoscopy; 2022-07-04 Flexible sigmoidoscopy. N3 Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Window: 2026 plus four years prior: 2025,2024,2023,2022. So 2022-2026. Also is 2021 included? Four years prior to 2026: 2025 (1), 2024 (2), 2023 (3), 2022 (4). So window is 2022-2026. 2021 is five years prior, outside. The 2022-07-04 flexible sigmoidoscopy is within 2022, thus within window (five-year window). So meets N3. (Even one in 2022 qualifies; 2021 one is too old but 2022 qualifies). Status compliant.
9. 71119: Age 76 -> not_eligible. (Enrol full year, but age fail). Not_eligible. No need evaluate further. But check: Screening 2023 flexible sigmoidoscopy would meet numerator? 2023 within N3 window (2022-2026) yes. But not eligible due to age. So not_eligible.
10. 71120: Age 75 yes. Enrol full year. Eligible. Exclusions: Other history: 2026-02-01 Advanced illness documented (heart failure). No frailty documented? It says "Other history: 2026-02-01 Advanced illness documented". No frailty. Age 75 >=66, but E4 requires BOTH frailty and advanced illness. Frailty alone does not exclude, advanced illness alone does not exclude. Here only advanced illness, no frailty. So not excluded. No CRC/colectomy/hospice. None. Numerator: Screening history: No colorectal screening on record. So does not meet numerator. Status: non_compliant.
11. 71121: Age 55 yes. Enrol: periods with two gaps (28 and 15 days). Continuous enrolment requires no more than one gap. Two gaps -> fails enrolment. So not_eligible (enrolment). Screening: 2026-02-22 CT colonography. N4 CT colonography during 2026 or four years prior (2022-2026). 2026 meets. But not eligible. So not_eligible.
12. 71122: Age 72 yes. Enrol: 2026-03-22 through 12-31, not enrolled before 03-22. Gap Jan1-Mar21 = 80 days. More than 45, not full year. Fails enrolment. Not_eligible. Other history: frailty 2026-10-08, advanced illness 2026-01-13. Age 72, but enrolment fails, so not_eligible. (If evaluated, meets E4 because both frailty and advanced illness during MY and age>=66, so excluded, but not_eligible overrides? Wait spec: "A member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So 71122 fails enrolment, so not_eligible, not excluded. Correct.)
13. 71123: Age 67 yes. Enrol: two gaps (13 and 25 days). Fails (more than one gap). Not_eligible. Screening none. Not_eligible.
14. 71124: Age 66 yes. Enrol full year. Eligible. Exclusions: none (no frailty/advanced? none documented). Numerator: Screening: 2026-04-15 Flexible sigmoidoscopy. N3 flexible sigmoidoscopy during 2026 or four years prior. 2026 meets. So compliant. Status compliant.
15. 71125: Age 76 -> not_eligible (age). Enrol full year. Screening: 2026-04-02 Faecal immunochemical test (FIT). N1 FOBT or FIT during 2026. Meets numerator. But not eligible due to age 76. So not_eligible.
16. 71126: Age 45 -> not_eligible. Enrol 2026-03-17 through 12-31 not before: gap Jan1-Mar16 = 74 days, also fails enrolment. Age fail too. Not_eligible.
17. 71127: Age 45 -> not_eligible. Enrol: Jan1-Jun25; Jul20-Dec31 one gap 24 days (enrolment OK), but age fail. Not_eligible. Screening 2024-12-13 Stool DNA. N2 window 2024-2026, 2024 meets, so would be compliant if age eligible. But age 45, not_eligible.
18. 71128: Age 75 yes. Enrol full year. Eligible. Exclusions: none. Numerator: Screening: 2020-02-10 CT colonography; 2026-08-17 Stool DNA test. Check N2 Stool DNA during 2026 or two years prior: 2026-08-17 is in 2026, meets N2. Also CT colonography 2020: N4 window 2022-2026, 2020 outside. But stool DNA meets. So compliant. Status compliant.
19. 71129: Age 67 yes. Enrol full year. Eligible. Exclusions: none. Numerator: Screening: 2023-07-08 Flexible sigmoidoscopy; 2023-09-13 CT colonography. N3 flex sig during 2026 or four years prior: window 2022-2026. 2023-07-08 is within, meets N3. Also CT colonography 2023 within N4 window (2022-2026). So meets numerator via N3 or N4. Compliant. Status compliant.
20. 71130: Age 45 -> not_eligible. Enrol 2026-05-16 through 12-31 not before: gap >45, fails enrolment too. Not_eligible. Other history: Diagnosis C18.7 in 2024 (colorectal cancer). Meets E1, but age/enrol fail -> not_eligible. Screening: 2020 CT (outside N4?), 2026-12-08 FIT (would meet N1). Not eligible.
21. 71131: Age 76 -> not_eligible. Enrol 2026-04-12 through 12-31 not before: gap >45, fails enrolment. Not_eligible. Screening: 2026-09-20 CT colonography (meets N4 if eligible). Not eligible.
22. 71132: Age 76 -> not_eligible (age). Enrol: Jan1-Apr19; May26-Dec31 one gap 36 days (enrolment OK), but age fail. Not_eligible. Other history: 2019-11-07 Diagnosis C18.7 colorectal cancer (meets E1), but age fail. Screening: 2026-11-15 FIT (meets N1). Not eligible.
23. 71133: Age 59 yes. Enrol full year. Eligible. Exclusions: none. Numerator: Screening: 2021-04-12 CT colonography; 2021-09-09 CT colonography. N4 CT colonography during 2026 or four years prior: window 2022-2026. 2021 is five years prior? Let's compute: four years prior to 2026 are 2025,2024,2023,2022. So window 2022-2026. 2021 is outside (2021 is five years prior). Thus CT colonography in 2021 does NOT meet N4. No other screening (no FOBT, stool DNA, flex sig, colonoscopy). Wait colonoscopy? No. So does not meet numerator. Status: non_compliant.
Double-check: N4 is CT colonography during 2026 or the four years prior (five-year window). Years: 2026, 2025, 2024, 2023, 2022. Yes, 2022 through 2026. 2021 not included. So 71133 non_compliant.
24. 71134: Age 45 -> not_eligible (age). Enrol full year. Other history: 2023-04-23 Total colectomy. Meets E2 (total colectomy any time on or before 2026-12-31). But age fail -> not_eligible. Screening: 2023-10-21 flexible sigmoidoscopy (N3 window 2022-2026, meets), but not eligible due to age. So not_eligible.
25. 71135: Age 55 yes. Enrol full year. Eligible. Exclusions: none. Numerator: Screening: 2016-11-12 Colonoscopy. N5 colonoscopy during 2026 or nine years prior: window 2017-2026. 2016 is outside (like 71115). So does not meet. Any other screening? No. Status: non_compliant.
Wait check 71135: DOB 1971-08-26 age 55, enrolment continuous. Only colonoscopy 2016-11-12. 2016 is before 2017, so outside ten-year window. Non-compliant. Yes.
26. 71136: Age 45 -> not_eligible (age). Enrol: Jan1-Jul1; Aug11-Dec31 one gap 40 days (enrolment OK), but age fail. Not_eligible. Other history: 2026-03-06 Advanced illness documented. Age 45, so E4 not (age<66). No exclusion. Screening: 2026-02-13 Flexible sigmoidoscopy (N3 meets), but age not eligible. So not_eligible.
Now compile lists.
Let's ensure we haven't missed any member with exclusion among eligible.
Eligible members (age 46-75 and continuous enrolment):
From above, check each:
71111 - enrol fail -> not_eligible.
71112 - eligible.
71113 - eligible but excluded (E1).
71114 - eligible but excluded (E4).
71115 - eligible, non_compliant.
71116 - elijson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 15,218 tokens
We need answer exactly one fenced JSON code block. Task: MEASURE QM-CRC. We have roster of 26 members (71111 to 71136 inclusive = 26 members? Let's count: 71111 through 71136 = 26 members: 71111-71136 inclusive is 26. Yes.)
We need classify each member: eligible population after exclusions (denominator = compliant + non_compliant), numerator = compliant members, excluded = count and members, not_eligible = count and members, rate = numerator/denominator*100 rounded half up to one decimal place.
Keys required: denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members. Need counts equal lengths. Member IDs strings.
Need be careful with age, continuous enrollment, exclusions, numerator criteria.
Let's restate specification:
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population (denominator):
- Age: 46 through 75 years as of 2026-12-31. Means age must be >=46 and <=75 on 2026-12-31. Age computed as of date; DOB given and "so X years old on 2026-12-31". We'll trust given ages? They gave ages. Need check boundaries: 46 through 75 inclusive. So age 45 not eligible, age 76 not eligible. Ages given: 55,72,47,75,47,50,63,47,76,75,55,72,67,66,76,45,45,75,67,45,76,76,59,45,55,45. Wait check each.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days. Means enrolled for full measurement year (Jan 1 - Dec 31) but allowed max one gap up to 45 days. If not enrolled before some date in 2026 (i.e. enrolment starts later), that's a gap? Actually "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Typically denominator requires continuous enrollment for the measurement year, allowing one gap of up to 45 days. If enrolled starting later (e.g., 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01), then they have a gap from Jan 1 to Apr 30 = 120 days? Actually not enrolled before 2026-05-01 means not enrolled Jan 1 - Apr 30. That's a gap of 120 days (more than 45). So fails continuous enrolment? Wait they say "Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01." Measurement year is full year. If not enrolled Jan 1-Apr 30, that's a gap of 120 days before enrollment start. Does that count as a gap? The continuous enrollment criteria for full measurement year generally requires coverage on Jan 1 and continuous except allowed gap. If they start 2026-05-01, there is a gap from Jan 1 to May 1 (120 days) which is more than 45, so not eligible. However let's parse: "the full measurement year with no more than one gap of up to 45 days." A member who is not enrolled before 2026-05-01 has a period of no enrollment from 2026-01-01 to 2026-04-30 (inclusive) of 120 days. That's a gap >45 days, so fails. Also they are not enrolled for the full measurement year because missing first 4 months. The allowed gap is a break in coverage during the year, but if they start later, they are not continuously enrolled for the full year; the gap from Jan 1 to start date is a gap. Since it's >45 days, not eligible. Similarly enrolment starting 2026-03-22 means gap Jan 1 - Mar 21 = 80 days? Let's compute: Jan 1 to Mar 21 inclusive? Actually if enrolled from 2026-03-22, prior non-enrollment Jan 1 - Mar 21 = 31 (Jan) + 28 (Feb 2026? 2026 not leap, Feb 28) + 21 (Mar 1-21?) Wait Mar 22 start, so Mar 1-21 = 21 days, total 31+28+21=80 days. >45, not eligible. So members with "Enrolment: [date] through 2026-12-31, continuous from that date. Not enrolled before [date]." Should be not_eligible due to enrollment (unless gap from Jan 1 to start date is <=45? Let's check: if start 2026-02-15? Not present. For start 2026-03-17: gap Jan 1 - Mar 16 = 31+28+16=75 days >45. Start 2026-03-22: 80 >45. Start 2026-04-12: gap Jan 1 - Apr 11 = 31+28+31+11 = 101 >45. Start 2026-05-01: Jan-Apr = 31+28+31+30 = 120 >45. Start 2026-05-16: Jan 1-May15 = 31+28+31+30+15=135 >45. So all "continuous from that date, not enrolled before" are not eligible for enrollment. Wait member 71122: enrolment 2026-03-22 through 2026-12-31 continuous from that date. Not enrolled before 2026-03-22. Gap 80 days -> not eligible. Member 71126: 2026-03-17, 75 days -> not eligible. Member 71130: 2026-05-16, 135 days -> not eligible. Member 71131: 2026-04-12, 101 days -> not eligible. Member 71111: 2026-05-01, 120 days -> not eligible. Are there any others? Let's list all:
- 71111: enrolment 2026-05-01 through 2026-12-31, not before. -> not eligible (age 55 would be OK but enrollment fails). So not_eligible. But wait need check exclusions? not_eligible even if exclusion documented. So 71111 not_eligible.
- 71112: full year continuous, age 72 (46-75). Eligible unless exclusion. No screening -> numerator? No. Exclusions? None (no CRC, colectomy, hospice, no frailty/advanced). Age 72, but E4 requires age >=66 AND both frailty and advanced illness. No frailty/advanced. So denominator (non_compliant).
- 71113: DOB 1979-02-27, age 47. Enrolment full year continuous. Screening: CT colonography 2020-07-03 (N4: during 2026 or four years prior = 2022-2026? Wait measurement year 2026, look-back back from 2026-12-31. For CT colonography: during 2026 or the four years prior (five-year window). The four years prior to 2026 are 2022, 2023, 2024, 2025? Let's define: "during 2026 or the four years prior (five-year window)" Means services in 2026, 2025, 2024, 2023, 2022? Actually if measurement year is 2026, "2026 or the four years prior" = years 2026, 2025, 2024, 2023, 2022. That's five years inclusive. A test on 2020-07-03 is in 2020, which is six years prior? Let's count: 2026 minus 2020 = 6 years ago. The window is 2022-2026 (if four years prior means 2022, 2023, 2024, 2025 plus 2026). So 2020 is outside (not within five-year window). Flexible sigmoidoscopy 2025-11-08: N3 flexible sigmoidoscopy during 2026 or four years prior (five-year window): 2022-2026. 2025 is inside, so meets N3! But wait member has Other history: 2025-07-17 Diagnosis C18.7 malignant neoplasm of sigmoid colon. That's colorectal cancer (C18-C21) any time on or before 2026-12-31. C18.7 is C18, so E1 exclusion. Exclusion evaluated before numerator, so member is excluded (since in eligible population: age 47, enrollment full year). Even though they meet numerator (flex sig 2025) and maybe CT outside, exclusion E1 applies. So 71113 -> excluded.
- 71114: DOB 1951-11-18, age 75 (in 46-75 inclusive). Enrolment full year continuous. Screening: CT colonography 2021-12-07 (N4 window 2022-2026? 2021 is outside (five-year window 2022-2026). So no N4. No other screening. Numerator? No. Exclusions: Frailty documented 2026-12-17, Advanced illness documented 2026-05-05 (heart failure). Age 66 or older as of 2026-12-31? Age is 75, so yes >=66. Both frailty and advanced illness documented during measurement year (2026). So E4 exclusion applies. So 71114 -> excluded. (Even though non_compliant otherwise). Need note: frailty alone no, advanced alone no; both present and age>=66 -> excluded.
- 71115: DOB 1979-09-19, age 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Need verify gap: from 2026-07-17 to 2026-08-20 inclusive? They said one gap of 35 days. Allowed: no more than one gap of up to 45 days. So enrolment OK (one gap 35 <=45). Age 47 OK. Eligible population. Screening: 2016-12-23 Colonoscopy. N5 colonoscopy during 2026 or nine years prior (ten-year window): years 2017-2026? Wait 2026 or nine years prior = 2017,2018,...2026? Let's count: nine years prior to 2026 are 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025 plus 2026 = ten-year window 2017-2026. A colonoscopy on 2016-12-23 is in 2016, which is ten years prior? Let's compute: from 2026-12-31 back ten years is 2016-12-31. The window is "during 2026 or the nine years prior (ten-year window)". If measured back from 2026-12-31, services on or after 2016-12-31? Actually the look-back window measured back from 2026-12-31. For colonoscopy: "during 2026 or the nine years prior (ten-year window)". The nine years prior to 2026 are 2017 through 2025? Wait if year is 2026, the prior nine years are 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. Plus 2026 gives 2017-2026. A test on 2016-12-23 is before 2017, so outside the ten-year window if window is 2017-2026. But is it within ten years back from 2026-12-31? 2026-12-31 minus 10 years = 2016-12-31. A service on 2016-12-23 is 10 years and 8 days before 2026-12-31, so it is just outside a 10-year lookback (must be on or after 2016-12-31). Since date is 2016-12-23, it's 8 days too early, so not in window. Thus no colonoscopy numerator. No other screening. So numerator not met. Exclusions: Frailty documented 2026-07-07, Advanced illness documented 2026-02-06. Age 47, not >=66, so E4 does not apply (needs age 66+). No CRC, no colectomy, no hospice. So member is in denominator, non_compliant. Wait check enrolment: gap 35 days, one gap allowed up to 45, so continuous enrolment satisfied. So 71115 -> non_compliant.
- 71116: DOB 1976-01-11, age 50. Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days (Mar 17-Apr 20? They say one gap of 35 days; allowed <=45). Age 50 eligible. Enrollment OK. Screening: 2023-01-09 Stool DNA test. N2 stool DNA during 2026 or two years prior (three-year window): years 2024-2026? Wait "during 2026 or the two years prior (three-year window)". Two years prior to 2026 are 2024 and 2025? Actually prior years: 2025 (1 year prior), 2024 (2 years prior). So window = 2024, 2025, 2026. A test in 2023-01-09 is outside (not in 2024-2026). So no N2. No other screening. No exclusions. So non_compliant? Wait no screening meets numerator. Yes non_compliant. Check: 2023 is three years prior? If window is 2024-2026, 2023 is 3 years prior, not included. Specification: "during 2026 or the two years prior (three-year window)" means 2026 + prior two years = 2024 and 2025? Let's be precise: If current year is 2026, "the two years prior" are 2025 and 2024. Yes. So 2023 is not included. So non_compliant.
- 71117: DOB 1963-09-02, age 63. Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days. Allowed: no more than one gap of up to 45 days. Gap is exactly 45 days, so allowed (up to 45 inclusive). Age 63 eligible. Enrollment OK. Screening: 2026-01-11 Stool DNA test. N2 stool DNA during 2026 -> yes meets numerator. No exclusions. So compliant.
- 71118: DOB 1979-03-23, age 47. Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap of 42 days (allowed). Age 47 eligible. Screening: Flexible sigmoidoscopy on 2021-11-12 and 2022-07-04. N3 flex sig during 2026 or four years prior (five-year window): 2022-2026. The 2022-07-04 test is inside (2022). The 2021-11-12 is outside (2021 not in 2022-2026). At least one meets N3. So numerator met. No exclusions. Compliant.
- 71119: DOB 1950-03-25, age 76. Age >75, not eligible (age 76). So not_eligible regardless. Screening etc irrelevant. 71119 not_eligible.
- 71120: DOB 1951-03-21, age 75 (in 46-75 inclusive). Enrolment full year continuous. Screening: none. Exclusions: Advanced illness documented 2026-02-01 (heart failure). No frailty documented. Age 75 >=66, but E4 requires BOTH frailty and advanced illness. Only advanced illness, no frailty, so E4 not met. No CRC, no colectomy, no hospice. So denominator, non_compliant.
- 71121: DOB 1971-08-17, age 55. Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days. That's TWO gaps. Requirement: no more than one gap of up to 45 days. Two gaps -> fails continuous enrolment. So not_eligible (enrollment). Wait need verify: continuous enrolment: full measurement year with no more than one gap of up to 45 days. If two gaps, not allowed. So 71121 not_eligible. (Even if age 55 OK). Check: gap1 Mar22-Apr18 = 28 days; gap2 Jul7-Jul21 = 15 days. Yes two gaps. So not_eligible. (If they had one gap of 45 and another? no.)
- 71122: DOB 1954-09-15, age 72. Enrolment 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-22. Gap from Jan 1 to Mar 21 = 80 days >45, so fails continuous enrolment (not enrolled full year, one gap >45). Also effectively two? It's one continuous non-enrollment gap of 80 days before start. Since >45, not eligible. So not_eligible. Note: has frailty and advanced illness, age 72, but not eligible due enrollment, so not_eligible not excluded. Also no screening. not_eligible.
- 71123: DOB 1959-03-08, age 67. Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days. That's TWO gaps. So fails (no more than one gap). Not_eligible. (Age 67 OK, no screening). So not_eligible.
- 71124: DOB 1960-08-15, age 66 (in 46-75). Enrolment full year continuous. Screening: 2026-04-15 Flexible sigmoidoscopy. N3 flex sig during 2026 -> meets numerator. Exclusions: none (no CRC, colectomy, hospice, no frailty/advanced). Age 66 but no frailty/advanced. So compliant. (Even if age 66, E4 needs both; none). Compliant.
- 71125: DOB 1950-05-08, age 76. Age >75, not eligible. not_eligible.
- 71126: DOB 1981-12-20, age 45. Age <46, not eligible. Also enrolment start 2026-03-17 not full year. not_eligible. (No screening either). not_eligible.
- 71127: DOB 1981-01-14, age 45. Age <46, not eligible. (Enrolment one gap 24 days, but age fails). not_eligible.
- 71128: DOB 1951-12-10, age 75 (in range). Enrolment full year continuous. Screening: CT colonography 2020-02-10 (N4 window 2022-2026; 2020 outside). Stool DNA test 2026-08-17 (N2 during 2026 -> meets). So numerator met. Exclusions: none. Compliant. (Age 75, no frailty/advanced illness, so no E4). Compliant.
- 71129: DOB 1959-07-23, age 67. Enrolment full year continuous. Screening: Flexible sigmoidoscopy 2023-07-08. N3 flex sig during 2026 or four years prior (2022-2026). 2023 is inside -> meets N3. CT colonography 2023-09-13: N4 window 2022-2026, 2023 inside -> also meets N4. At least one. No exclusions. Compliant.
- 71130: DOB 1981-09-13, age 45. Age <46, not eligible. Also enrolment start 2026-05-16 not full year, gap >45. Also has CRC diagnosis C18.7 in 2024 (exclusion if eligible). But not_eligible due age and enrollment. not_eligible.
- 71131: DOB 1950-05-05, age 76. Age >75, not eligible. Also enrolment start 2026-04-12. not_eligible.
- 71132: DOB 1950-02-01, age 76. Age >75, not eligible. Also enrolment gap 36 days but age fails. Also CRC diagnosis 2019-11-07 (exclusion if eligible). not_eligible.
- 71133: DOB 1967-01-22, age 59. Enrolment full year continuous. Screening: CT colonography 2021-04-12 and 2021-09-09. N4 CT colonography window: during 2026 or four years prior = 2022-2026. Both 2021 (April, Sept) are outside (2021 not in window). No other screening. So numerator not met. Exclusions none. So non_compliant. Wait check CT colonography dates: 2021 is five years prior? 2026-2021=5. The window is "2026 or the four years prior (five-year window)" means 2022-2026 inclusive. 2021 is the fifth year prior? Let's list: 2026 (current), 2025 (1 prior), 2024 (2), 2023 (3), 2022 (4). That's four years prior. So 2021 is five years prior, outside. Yes outside. No other tests. So non_compliant.
- 71134: DOB 1981-09-26, age 45. Age <46, not eligible. Also total colectomy 2023-04-23 (exclusion if eligible). not_eligible.
- 71135: DOB 1971-08-26, age 55. Enrolment full year continuous. Screening: Colonoscopy 2016-11-12. N5 colonoscopy window: during 2026 or nine years prior (ten-year window) = 2017-2026? Let's check: current 2026, prior nine years: 2025,2024,2023,2022,2021,2020,2019,2018,2017. Window = 2017-2026. Colonoscopy 2016-11-12 is before 2017, so outside. (Similar to 71115 but 2016-11-12 even earlier than Dec 23). So no numerator. No exclusions. non_compliant.
- 71136: DOB 1981-11-11, age 45. Age <46, not eligible. Enrolment gap 40 days (one gap <=45 actually, but age fails). Also advanced illness 2026-03-06 (no frailty). not_eligible due age. Not eligible.
Now we need ensure ages: member 71114 is 75, inclusive. 71120 age 75, 71128 age 75. All eligible. Member 71119 76 not eligible, 71125 76, 71131 76, 71132 76. Member 71126 45, 71127 45, 71130 45, 71134 45, 71136 45. Age <46 not eligible.
Now check member 71111 again: age 55, but enrolment 2026-05-01 through 2026-12-31, not enrolled before 2026-05-01. This is a gap from Jan 1 to Apr 30 of 120 days. Continuous enrolment: full measurement year with no more than one gap of up to 45 days. The member is not enrolled for Jan-Apr, which is a gap of 120 days, greater than 45, so fails. Also not enrolled for full measurement year (missing beginning). So not_eligible. Yes.
But need to consider: Does "continuous enrolment: the full measurement year with no more than one gap of up to 45 days" mean the member must be enrolled on Jan 1 and Dec 31, and any gap (including at start?) counts? Typically HEDIS continuous enrollment allows one gap of up to 45 days during the measurement year, but the member must be enrolled on the last day of the year? Actually for measurement year, continuous enrollment without gaps means enrolled from Jan 1 to Dec 31, but a gap of up to 45 days is allowed. If they start May 1, they were not enrolled Jan 1-Apr 30, which is a gap of 120 days, so not eligible. If they start Feb 1, gap 31 days? Wait Jan 1-Jan 31 = 31 days gap, allowed if <=45? But then they'd be enrolled Feb 1-Dec 31 with one gap of 31 days. Would that satisfy? The gap is before enrollment start, but it's still a gap in the measurement year. In our roster, all late starts have gaps >45. Member 71130 starts May 16 (135 days). 71131 Apr 12 (101). 71126 Mar 17 (75). 71122 Mar 22 (80). 71111 May 1 (120). None <=45. So all not eligible. Good.
Now check member 71121 and 71123 with two gaps: not eligible due two gaps. Even if each gap <=45, "no more than one gap" means maximum count of gaps is one. So two gaps -> not eligible. Good.
Now member 71115: enrolment 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. Allowed. So eligible. Age 47. Good.
Member 71116: one gap 35 days. Eligible. Age 50.
Member 71117: one gap of 45 days. "up to 45 days" includes 45. Eligible. Age 63.
Member 71118: one gap 42 days. Eligible.
Now check screening windows carefully for each eligible member to determine numerator.
Let's list all members, their status, and classification. We'll go one by one from 71111 to 71136.
I'll create table:
ID | DOB age (as of 2026-12-31) | Enrolment meets? | Eligible? (age+enroll) | Exclusions? | Numerator meet? | Final status
71111: Age 55 (OK). Enrol: start May 1, gap Jan1-Apr30=120 >45 -> Enroll FAIL. Not eligible. Status not_eligible. (Has frailty 2026-10-27, but not eligible; no matter.)
71112: Age 72 OK. Enrol full year continuous OK. Eligible. Exclusions: none (no CRC, colectomy, hospice, no frailty/adv; age72 but no frailty/adv). Numerator: No screening on record. So non_compliant.
71113: Age 47 OK. Enrol full OK. Eligible. Exclusions: Diagnosis C18.7 on 2025-07-17 = colorectal cancer (C18-C21) any time on or before 2026-12-31. E1 met. So excluded. (Numerator: flex sig 2025-11-08 meets N3, but exclusion overrides; also CT 2020 outside). Status excluded.
71114: Age 75 OK (<=75). Enrol full OK. Eligible. Exclusions: Frailty 2026-12-17, Advanced illness 2026-05-05, age 75 >=66, both documented during MY -> E4 met. Excluded. (Screening CT 2021 outside; no numerator, but excluded anyway). Status excluded.
71115: Age 47 OK. Enrol: one gap 35 days OK. Eligible. Exclusions: Frailty 2026-07-07, Adv illness 2026-02-06, but age 47 <66, so E4 not met. No CRC, colectomy, hospice. So no exclusion. Numerator: Colonoscopy 2016-12-23. N5 window 2017-2026; 2016 outside. No other screening. So does NOT meet numerator. Status non_compliant.
71116: Age 50 OKjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Flash · Alibaba108.2s · 7,141 out | 88.7s · 8,395 out | 124.5s · 13,547 out
Reasoning · 6,798 tokens
We need answer JSON only. Need evaluate 26 members against measure. Need carefully classify each as compliant, non_compliant, excluded, not_eligible.
Let's parse spec:
Measurement year 2026-01-01 through 2026-12-31.
Eligible population denominator:
- Age 46 through 75 years as of 2026-12-31.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Interpretation: Need enrolled full measurement year? "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Means member must have enrolment covering Jan 1 to Dec 31 except at most one gap <=45 days? Or if not enrolled before date then not full measurement year -> not eligible. In HEDIS, continuous enrollment: full measurement year, may have one gap up to 45 days. If new enrollment mid-year not eligible unless gap? Actually continuous enrollment full MY. If not enrolled from Jan1? Typically eligible if enrolled 12 months of measurement year (with gap up to 45 days). If enrolled 2026-05-01 through 12-31, not full year. Not eligible. Need treat not_enrolled_before Jan1 or discontinues before Dec31 as not eligible unless gap? The phrase "the full measurement year with no more than one gap of up to 45 days" implies start must be Jan1 and end Dec31 with possible one interior gap <=45 days. Records say continuous from date; not enrolled before date => not eligible if start after Jan1. If end before Dec31? none? Some start after. If gaps: one gap of 35 etc qualifies if Jan1-Dec31 except interior gap. Need also if multiple gaps? "no more than one gap of up to 45 days" -> two gaps, even each <=45, not eligible. Need check if gap exactly 45 allowed? up to 45 includes 45. gap 46 not. Need maybe calculate gaps from listed.
Exclusions evaluated before numerator only for eligible: E1 colorectal cancer C18-C21 any time on/before 2026-12-31. If member has cancer diagnosis -> excluded if eligible; if not eligible then not_eligible even exclusion documented. E2 total colectomy any time on/before 2026-12-31. E3 hospice during MY. E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone or advanced illness alone no. Both must be during measurement year? "documented during the measurement year." So if one outside MY? Need only if both during MY. Need age 66+.
Numerator windows measured back from 2026-12-31:
N1 FOBT/FIT during 2026. FIT = faecal immunochemical test. 2026 dates.
N2 Stool DNA during 2026 or two years prior (three-year window). Dates 2024-2026? "during 2026 or the two years prior" -> 2024,2025,2026 inclusive? For dates on 2024-? window measured back from 2026-12-31: 3-year window likely 2024-01-01 through 2026-12-31? HEDIS usually CY 2024 for 2026? But wording: during 2026 or the two years prior (three-year window). If event date 2023-11-04? Is 2023 included? No. But date 2024-01-01? Could be in two years prior. Need maybe exact date back 3 years? "during 2026 or the two years prior" could mean 2024, 2025, 2026 calendar years. For dates: 2023-11-04 not; 2023-10-21 not. 2024-12-13 is included (within two years prior). 2025-11-08 not stool DNA. Need use calendar year? It says by look-back window measured back from 2026-12-31. "during 2026 or the two years prior (three-year window)." So date >= 2024-01-01? Could also be >= 2024-01-01? Since measured back from Dec31 three-year window means 2024-01-01 through 2026-12-31 inclusive if calendar years. Need inspect test cases. For N3 five-year: during 2026 or four years prior -> 2022-2026? N4 five-year CT colonography -> 2022-2026? N5 colonoscopy 2017-2026? Need see members with boundary: 2021-11-12 flexible sigmoidoscopy for 71118: If five-year window measured from 2026-12-31 exactly back 5 years: 2022-01-01? 2021-11-12 outside. If calendar 2022-2026, 2021 outside. likely non-compliant. 2021-12-07 CT for 71114 age75 frailty+AI? excluded anyway. 2021-04/09 CT for 71133 outside if five-year 2022-2026 -> noncompliant. Need if exactly? none 2022. Colonoscopy 2016-12-23 outside if ten-year 2017-2026; 2016-11-12 outside. Stool DNA 2023-11-04 outside if 2024-2026; 2023-01-09 outside; 2023-10-21? not stool dna. FIT 2026 qualifies. Stool DNA 2026-08-17 qualifies.
Need classify all 26.
Let's list each.
Definitions IDs strings after MEMBER.
Age: as of 2026-12-31 given. Eligible age 46-75 inclusive. 76 not eligible; 45 not eligible. 75 eligible, 46? none maybe.
Enrolment:
- 71111: DOB age 55 eligible. Enrolment 2026-05-01 through 2026-12-31 continuous from that date, not enrolled before. Does not have full measurement year. Not eligible. Even screening? not_eligible. Note one might consider gap from 2026-01-01 to 04-30 is >45 days? Not eligible.
- 71112: age72 eligible; enrolment Jan-Dec continuous no gaps -> eligible. No screening -> numerator no. Exclusions none. non_compliant.
- 71113: age47 eligible; Jan-Dec continuous eligible. Screening: 2020-07 CT outside, 2025-11 flex sig within five-year? flexible sigmoidoscopy 2025 yes N3 numerator. But diagnosis C18.7 2025-07-17 -> E1 excluded. Excluded evaluated before numerator: excluded. not compliant. Age/enrol yes. excluded.
- 71114: age75 eligible; continuous eligible. Screening 2021-12 CT outside five-year? If 2022-2026 no. Other history: frailty 2026-12-17 and advanced illness 2026-05-05, both during MY, age 66+ -> E4 excluded. Excluded. Even numerator? no. Excluded.
- 71115: age47 eligible? Yes 47. Enrolment Jan-Jul 16 gap Aug21-Dec31 one gap 35 days. If Jan1-Dec31 except one gap <=45 qualifies. Screening colonoscopy 2016-12-23 outside 10-year (2017-2026) -> no numerator. Other history: frailty 2026-07-07, advanced illness 2026-02-06, both during MY, age66? Age 47, E4 requires age66+, so not exclude. No cancer/colectomy/hospice. non_compliant.
- 71116: age50 eligible. Enrolment Jan-Mar16 gap Apr21-Dec31 gap 35 qualifies. Screening stool DNA 2023-01-09. Three-year window 2024-2026? outside. No numerator. No exclusions. non_compliant.
- 71117: age63 eligible. Enrolment Jan-Jun2 gap Jul18-Dec31 gap 45? Need count gap. They state one gap of 45 days. Up to 45 allowed. qualifies. Screening stool DNA 2026-01-11 within window -> numerator. No exclusions. compliant.
- 71118: age47 eligible. Enrolment Jan-Jun14 gap Jul27-Dec31 gap 42 qualifies. Screening flexible sigmoidoscopy 2021-11-12 and 2022-07-04. Five-year window? If 2022-2026, 2022-07-04 qualifies. If exact back 5 years 2021-12-31? 2022 qualifies too. numerator compliant. No exclusions. compliant.
- 71119: age76 on 2026-12-31 -> not eligible despite screening flex 2023. not_eligible.
- 71120: age75 eligible; continuous eligible. No screening -> numerator no. Advanced illness during MY 2026-02-01 but no frailty -> no E4. no cancer/colectomy/hospice. non_compliant.
- 71121: age55 eligible; enrolment Jan-Mar21 gap Apr19-Jul6 gap Jul22-Dec31: two gaps of 28 and 15. Spec no more than one gap -> not eligible. Even screening CT 2026. Not eligible.
- 71122: age72 eligible by age. Enrolment 2026-03-22 through 12-31 continuous from date, not enrolled before -> not full measurement year. Not eligible. Other history: advanced illness 2026-01-13 before enrolment? frailty 2026-10-08. E4 both during measurement year? Yes both in 2026 calendar, but not eligible due enrolment; not_eligible. Important rule: a member who fails age,event,enrolment is not_eligible even if exclusion also documented.
- 71123: age67 eligible. Enrolment Jan-Feb23 gap Mar9-Jun27 gap Jul23-Dec31: two gaps 13 and 25. More than one gap -> not eligible. No exclusion. not_eligible. (Even if no screening.) Need if full year with two gaps? no.
- 71124: age66 eligible. Continuous. Screening flexible sigmoidoscopy 2026-04-15 -> N3 compliant. No exclusions. compliant.
- 71125: age76 not eligible. Continuous, FIT 2026. not_eligible.
- 71126: age45 not eligible. not_eligible.
- 71127: age45 not eligible. not_eligible.
- 71128: age75 eligible. Continuous. Screening stool DNA 2026-08-17 -> numerator. CT 2020 outside. No exclusions. compliant.
- 71129: age67 eligible. Continuous. Screening flexible sigmoidoscopy 2023-07-08 within five-year -> numerator. CT 2023-09-13 within. No exclusions. compliant.
- 71130: age45 not eligible (DOB 1981-09-13 => 45). Also enrolment starts 05-16. Has cancer diagnosis 2024 excluded if eligible but not. not_eligible.
- 71131: age76 not eligible. Continuous from 04-12, also age. not_eligible.
- 71132: age76 not eligible. Has cancer diagnosis 2019, FIT 2026. not_eligible.
- 71133: age59 eligible; continuous. Screening CT colonography 2021-04-12 and 2021-09-09. Need 5-year window: likely 2022-2026, outside. No numerator. non_compliant.
- 71134: age45 not eligible. Total colectomy 2023 would exclude if eligible. not_eligible.
- 71135: age55 eligible; continuous. Colonoscopy 2016-11-12 outside 10-year (2017-2026? If measured back from 2026-12-31 exactly 10 years: 2016-12-31 to 2026-12-31? 2016-11-12 outside. If calendar 2017-2026 outside). non_compliant.
- 71136: age45 not eligible. Has flex sig 2026 and AI. not_eligible.
Need ensure if 71111: start 05-01, gap >? Not eligible.
Need maybe check 71115 colonoscopy 2016-12-23. Ten-year window: "during 2026 or the nine years prior (ten-year window)." If date 2016-12-23, 2016 not in nine years prior? Let's calculate: 2026 and nine years prior = 2017 through 2025? Ten-year window? Hmm phrase: "during 2026 or the nine years prior (ten-year window)." If including 2026 and 2025,2024,2023,2022,2021,2020,2019,2018,2017 => 10 years? Wait count: 2026 plus nine prior years = 2017-2026 (10 calendar years). So 2016 outside. If exact lookback 10 years from 2026-12-31 includes 2016-12-31? Actually dates on/after 2017-01-01? Let's see. The phrase says during 2026 or nine years prior: nine years prior calendar years to 2026 = 2017,2018,...2025? plus 2026 = 10. 2016 outside. For five-year: during 2026 or four years prior -> 2022-2026. For three: 2024-2026. Good.
Need consider "as of 2026-12-31" age: 71114 DOB 1951-11-18: 75 (turns 75 in Nov 2026) eligible. 71118 DOB 1979-03-23 age 47. Good.
Potential ambiguity: Exclusion E1 colorectal cancer C18-C21 any time on or before 2026-12-31. If diagnosis date 2025, excluded. 71113 yes. 71130 not eligible. 71132 not eligible. Need if C18.7 in record is "diagnosis" and C18-C21 yes. Need exclude if eligible. Good.
Potential nuance: E4 age 66 or older AND both frailty and advanced illness documented during the measurement year. For 71115 age47 no. For 71122 not eligible, but if not eligible, don't apply exclusion. For 71114 excluded. For 71120 age75 advanced illness only, not exclude. For 71112 no. For 71123 age67 no frailty/AI. For 71124 age66 no frailty/AI. For 71129 no. For 71136 age45 advanced illness but not eligible anyway.
Need ensure counts and arrays.
Let's classify each in arrays:
71111 not_eligible
71112 non_compliant
71113 excluded
71114 excluded
71115 non_compliant
71116 non_compliant
71117 compliant
71118 compliant
71119 not_eligible
71120 non_compliant
71121 not_eligible
71122 not_eligible
71123 not_eligible
71124 compliant
71125 not_eligible
71126 not_eligible
71127 not_eligible
71128 compliant
71129 compliant
71130 not_eligible
71131 not_eligible
71132 not_eligible
71133 non_compliant
71134 not_eligible
71135 non_compliant
71136 not_eligible
Let's count:
Compliant: 71117, 71118, 71124, 71128, 71129 = 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6.
Excluded: 71113, 71114 = 2.
Not eligible: total 26 -13 =13. Let's list count: 71111(1), 71119(2), 71121(3), 71122(4), 71123(5), 71125(6), 71126(7), 71127(8), 71130(9), 71131(10), 71132(11), 71134(12), 71136(13). Yes.
Denominator = compliant + non_compliant = 11. Or eligible population after exclusions removed. Eligible after age/enrol? Let's calculate eligible before exclusions: 71112,71113,71114,71115,71116,71117,71118,71120,71124,71128,71129,71133,71135 = 13. Excluded 2 -> denominator 11. Numerator 5. rate = 5/11*100 = 45.4545 -> rounded half up to one decimal: 45.5. Need output number 45.5.
Check each eligible numerator:
71112 no -> NC
71113 excluded -> not in denom (despite maybe colonoscopy 2025 numerator? colonoscopy in ten-year yes but excluded)
71114 excluded
71115 colonoscopy 2016 no -> NC
71116 stool DNA 2023 no -> NC
71117 stool DNA 2026 yes -> C
71118 flexible sigmoidoscopy 2022 yes -> C
71120 no -> NC
71124 flexible sigmoidoscopy 2026 yes -> C
71128 stool DNA 2026 yes -> C
71129 flexible sigmoidoscopy 2023 yes -> C
71133 CT 2021 no -> NC
71135 colonoscopy 2016 no -> NC
C=5, NC=6. Good.
Need check if 71114's CT colonography 2021-12-07 maybe within five-year if measured back from 2026-12-31 inclusive: date >= 2022-01-01? outside; if exact 5 years before 2026-12-31 = 2021-12-31 to 2026-12-31? 2021-12-07 outside. no anyway.
Potential issue: Exclusion E4 requires age 66+ and both frailty and advanced illness documented during measurement year. 71115 has both during MY but age 47, no. 71136 has AI but age45 not eligible. 71122: age72, both during MY, enrolment starts 3/22. Not eligible. What if continuous enrollment with gap: if starts Mar22, the absence Jan1-Mar21 is 79 days? Not eligible. Good.
Potential issue: "full measurement year with no more than one gap of up to 45 days" could allow enrollment not starting Jan1 if total gap (pre-enrolment) up to 45 days? Example 71122 starts Mar22: Jan1-Mar21 79 days -> not eligible. 71131 starts Apr12: 101 days. 71111 starts May1. 71126 starts Mar17: 75 days. 71130 starts May16. none within 45 except? 71122? no. 71131? no. 71111 no. So same.
Need output exactly fenced JSON block. Ensure string IDs. counts.
Double-check member IDs after MEMBER. Use 71111 etc.
Need maybe "rate" as number; one decimal maybe 45.5. If 5/11*100 = 45.454545, half up to one decimal => 45.5. If 6? no.
Let's consider if denominator includes members eligible and not excluded, regardless numerator. Yes.
Let's consider if "not_eligible never enters eligible population (age, event, or enrolment)" and "Exclusions evaluated before numerator, and only for members who are in eligible population: a member who fails age, event, or enrolment is not_eligible even if exclusion also documented." We applied. "Event" maybe screening? Hmm event? But measure eligible event? It's age/enrolment, not event. We used not_eligible for age/enrol.
Need maybe member 71111 has frailty 2026-10-27, age55 no AI. If eligible? no. But if enrolled 2026-05-01, not eligible.
Need maybe member 71113 diagnosis C18.7: If diagnosis "malignant neoplasm of sigmoid colon" on 2025-07-17; E1 any time on or before 2026-12-31. Excluded. What if colorectal cancer diagnosis is itself event? But exclusions only after eligible. Good.
Need maybe 71130 cancer diagnosis before MY but age45 not eligible. Good.
Need maybe 71132 cancer diagnosis any time on/before MY but age76 not eligible. Good.
Need maybe 71134 total colectomy on 2023 and age45 not eligible. If age 45, not eligible. But event? no.
Potential hidden test: For 71129 flexible sigmoidoscopy during 2023 qualifies within five-year. Yes.
Let's think of date windows exact. "by the look-back window measured back from 2026-12-31" Could mean if colonoscopy during 2026 or nine years prior: dates on/after 2017-01-01? Or 2016-12-31? If exact back from 2026-12-31 for nine years = 2017-01-01? In HEDIS, colonoscopy completion 10 years prior to measurement year end; for MY2026, colonoscopy on/after 2017-01-01? Actually HEDIS COL: colonoscopy in the measurement year or 10 years before measurement year? The completion 10 years prior to end of measurement year, e.g. for 2026, 2017-2026? Yes. Flexible sigmoidoscopy completion 5 years prior (2022-2026). Stool DNA 3 years prior (2024-2026). FIT 2026. If exact calendar: colonoscopy 2016-12-31? If window "during 2026 or the nine years prior" -> nine prior years = 2017-2025, plus 2026. If date 2016-12-23 outside. Good.
Could "the four years prior" for flexible sigmoidoscopy include 2021? Measurement year 2026, four years prior = 2022,2023,2024,2025? No 2021 would be five years prior. 71118 2021 no, but 2022 yes. 71113 no need.
Potential issue: For 71133 CT colonography on 2021-04-12 and 2021-09-09. If five-year window includes 2021? No, "2026 or four years prior" = 2022-2026, not 2021. If exact from 2026-12-31 back 5 years = 2021-12-31? 2021-09 outside. Non.
Need maybe 71116 stool DNA 2023-01-09. If three-year window exact from 2026-12-31 back 3 years = 2024-01-01? 2023 outside. Non. If 36 months back includes 2024-01? no.
Could 71113 flexible sigmoidoscopy 2025-11-08 would be numerator but excluded due cancer. Exclusion before numerator. Good.
Need ensure JSON valid. Only one fenced block. No extra.
Let's prepare final JSON:
{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117","71118","71124","71128","71129"],
"non_compliant_members": ["71112","71115","71116","71120","71133","71135"],
"excluded_members": ["71113","71114"],
"not_eligible_members": ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
}
Double-check arrays total 26: 5+6+2+13=26. IDs unique.
Need perhaps order any. Good.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 8,052 tokens
We need answer JSON only. Need classify 26 members according to measure. Need be very careful with age, enrolment, exclusions before numerator, only eligible population first. Need produce required keys. Need reason thoroughly.
Let's restate rules.
Measurement year 2026-01-01 to 2026-12-31.
Eligible population/denominator: Age 46 through 75 years as of 2026-12-31. Continuous enrolment: full measurement year with no more than one gap of up to 45 days.
Numerator any one lookback from 2026-12-31:
N1 FOBT/FIT during 2026.
N2 Stool DNA during 2026 or two years prior (three-year window). Need determine window: by look-back window measured back from 2026-12-31. "during 2026 or the two years prior" likely 2024,2025,2026 calendar years? Since N1 says during 2026. For N3 five-year window: during 2026 or four years prior (2022-2026). N4 2022-2026. N5 2017-2026? "during 2026 or the nine years prior" likely 2017-2026 calendar year windows. Need check if dates like 2016-12-23 are outside ten-year? If exactly nine years prior from 2026-12-31 maybe date on or after 2017-01-01? If date 2016-12-23, outside by 8 days. HEDIS typically uses date of screening during measurement year or lookback period in full years? E.g colonoscopy in measurement year or nine years prior means dates in 2017-2026? Or if on/after 2017-01-01. 2016-12-23 not numerator. Need see if any ambiguous. N5 2016-11-12 definitely outside if 10-year window 2017-2026, but if exact 10 years from 2026-12-31 -> 2016-12-31, also outside? 2016-11-12 outside. 2016-12-23 outside if 10 years prior date cutoff 2016-12-31? outside. Good.
Required exclusions:
E1 colorectal cancer C18-C21 any time on/before 2026-12-31.
E2 total colectomy any time on/before 2026-12-31.
E3 hospice any time during measurement year.
E4 Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
Exclusions evaluated before numerator, and only for members in eligible population. A member who fails age/event/enrolment is not_eligible even if exclusion documented.
Status:
compliant denominator not excluded meets numerator
non_compliant denom not excluded not numerator
excluded eligible + required exclusion
not_eligible never enters eligible.
Need classify each member.
Need define enrolment: full measurement year with no more than one gap of up to 45 days. Continuous means no more than one gap, gap length <=45 days. If start after Jan 1 not continuous? It says full measurement year with no more than one gap of up to 45 days. If not enrolled before date? A gap before enrollment from 1/1 to start counts as gap? If start > 045 days after 1/1? Need likely not eligible if start after Jan 1 unless within first 45 days? Let's parse: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Usually measure requires enrollment 2025 and 2026 full year? Here only full measurement year with no more than one gap up to 45 days. If enrolled from 2026-05-01, gap from Jan 1 to Apr 30 120 days -> fail. If start 2026-01-01 continuous. Gaps: 71115 one gap 35 days OK. 71116 gap 35 OK. 71117 gap 45 OK. 71118 gap 42 OK. 71121 two gaps of 28 and 15 -> more than one gap -> fail, even if each <=45. 71123 two gaps -> fail. 71124 continuous. 71125 continuous. 71122 start 3/22 gap 80 days -> fail. 71126 start 3/17 75 days -> fail. 71129 continuous. 71130 start 5/16 >45 -> fail (also age 45 fail). 71131 start 4/12 gap 101 -> fail (also age 76). 71132 gap 36 OK (age 76 fail). 71133 continuous. 71134 continuous. 71135 continuous. 71136 gap 40 OK? Age 45 fail.
Need check gap calculation? Given records include "One gap of X days" and dates maybe consistent? We can use provided gap? Need maybe calculate? For enrolment "full measurement year with no more than one gap of up to 45 days". For 71117: 2026-01-01 through 2026-06-02; 2026-07-18 through ... gap dates 6/3 to 7/17 inclusive? Days: June 3-30 = 28, July 1-17=17, total 45. Provided 45. OK. If gap up to 45 days inclusive. 71115 gap July17-Aug20? July 17-31=15, Aug1-20=20 total35? OK.
71122 start 2026-03-22, gap Jan1-Mar21? Jan31+Feb28+Mar21=80? fail.
71126 start Mar17 gap Jan1-Mar16 75? fail.
71131 start Apr12 gap Jan1-Apr11 101 fail.
Age: 46 through 75 as of 2026-12-31. Ages provided. Need note 76 -> not eligible. 45 -> not eligible. 75 eligible. 46? none. 71119 76 not eligible, 71125 76 not eligible, 71131 76, 71132 76. Also 71126/27/30/34/36 45 not eligible. 71113 47, etc.
Need evaluate exclusions for eligible only. But note if member fails eligibility due to enrolment but has exclusion, status not_eligible. e.g 71121 two gaps -> not eligible, no exclusion. 71123 two gaps -> not eligible. 71130 age fail -> not eligible even cancer history? Age 45. 71126 age 45 fail. 71136 age45 fail but also stool? N3? Flexible sigmoidoscopy 2026-02-13 would numerator if eligible, but not eligible.
Let's classify each.
MEMBER 71111: age55. Enrolment: 2026-05-01 through 12-31 continuous from that date, not enrolled before. That's a gap from 1/1 to 4/30 ~120 days, not no more than one gap up to 45. So not_eligible due to enrolment. Age OK. Has frailty only, not exclusion. Screening outside but irrelevant. Not eligible.
71112: age72, continuous eligible. No screening. No exclusion. Not numerator -> non_compliant.
71113: age47, continuous eligible. Has diagnosis C18.7 on 2025-07-17 -> E1 colorectal cancer on/before 2026 -> excluded. Even numerator? flexible sigmoidoscopy 2025-11-08 within 5-year; stool no. Excluded. Not numerator status irrelevant.
71114: age75 eligible continuous. Has frailty 2026-12-17 and advanced illness 2026-05-05, age 66+ -> E4 both documented during measurement year -> excluded. CT colonography 2021-12-07? N4 window 2022-2026? 2021 outside if 5 years (maybe 2021-12-31?). But excluded anyway. Excluded.
71115: age47 eligible? Enrolment: Jan1-Jul16, Aug21-Dec31 one gap 35 days. Age 47. Has frailty and advanced illness during measurement year but age 47 not 66+, so E4 does not apply. No other exclusions. Screening: colonoscopy 2016-12-23. N5 ten-year window during 2026 or nine years prior. Need decide if 2016-12-23 within ten years? If ten-year window from 2017-01-01 to 2026-12-31? outside. If from 2016-12-31 to 2026-12-31? outside (2016-12-23 before). If "nine years prior" maybe 2017, 2018, 2019, 2020, 2021, 2022, 2023, 2024, 2025 plus 2026 = 2017-2026. Outside. Not numerator. No other screening. So non_compliant? Need age 47 colonoscopy old no. Enrolment OK. Not excluded. Status non_compliant. Check frailty/advanced illness age not 66 -> not exclusion. Good.
71116: age50 eligible? One gap 35, continuous OK. Screening stool DNA 2023-01-09. N2 three-year window: during 2026 or two years prior (2024,2025,2026) -> 2023 outside. If exact date window from 2024-01-01? outside. No other screening. No exclusion. non_compliant. Wait stool DNA 2023 might be outside. Status non_compliant.
71117: age63 eligible (gap 45 OK). Stool DNA 2026-01-11 N2 numerator. No exclusion. compliant.
71118: age47 eligible (gap 42 OK). Flexible sigmoidoscopy 2021-11-12 and 2022-07-04. N3 five-year window: during 2026 or four years prior = 2022-2026? If exact years, 2021 maybe outside, 2022 inside. If from 2022-01-01 to 2026-12-31, 2022-07-04 numerator. If exact 5 years from 2021-12-31? 2021-11-12 outside but 2022 inside. Numerator compliant. No exclusion. Need check 2021 maybe if 2026 minus 4 years = 2022; outside. 2022-07 inside. compliant.
71119: age76 as of Dec31 -> not eligible. continuous and screening but age fail. Not eligible. Note age 76 not through 75. Exclusions irrelevant. Not eligible.
71120: age75 eligible continuous. Advanced illness only, no frailty -> E4 not both. No screening. No exclusion. non_compliant.
71121: age55 but two gaps (28 and 15) -> more than one gap -> not eligible. CT colonography 2026 would numerator if eligible, but not. Not eligible.
71122: age72 but start Mar22, gap >45 -> not eligible. Frailty and advanced illness during measurement year? frailty 2026-10-08, advanced illness 2026-01-13; age66+ and both, would exclusion if eligible, but fails enrolment. Rule: member who fails enrolment is not_eligible even if exclusion documented. Not eligible.
71123: age67 but two gaps -> not eligible. no screening. Not eligible.
71124: age66 eligible continuous. Flexible sigmoidoscopy 2026-04-15 -> N3 numerator. No exclusion. compliant. Age 66 but no frailty/advanced. Good.
71125: age76 not eligible. FIT 2026 but age fail. Not eligible.
71126: age45 not eligible; start Mar17. Not eligible.
71127: age45 not eligible (even though gap 24 OK and stool DNA 2024 outside if eligible). Not eligible.
71128: age75 eligible continuous. CT colonography 2020-02-10 outside N4, but Stool DNA 2026-08-17 N2 numerator. No exclusion. compliant.
71129: age67 eligible continuous. Flexible sigmoidoscopy 2023-07-08 and CT colonography 2023-09-13. N3/N4 2022-2026 inside -> numerator. compliant.
71130: age45 not eligible (also cancer history). Not eligible. Note cancer on 2024 and FIT 2026 but age fail. Not eligible.
71131: age76 not eligible (start Apr12). Not eligible.
71132: age76 not eligible (gap OK but age fail; cancer history). Not eligible.
71133: age59 eligible continuous. CT colonography 2021-04-12, 2021-09-09. N4 five-year window: 2022-2026 if calendar years -> outside. If exact from 2021-12-31? outside. Need check CT colonography during 2026 or the four years prior: four years prior are 2022,2023,2024,2025. So 2021 outside. No other. No exclusion. non_compliant. Need note if 2021 maybe within 5 years if date 2021-09-09 to 2026-12-31 is >5 years? outside. non.
71134: age45 not eligible. Total colectomy exclusion but age fail. Not eligible. Flexible sigmoidoscopy 2023 also irrelevant. Not eligible.
71135: age55 eligible continuous. Colonoscopy 2016-11-12. N5 ten-year window: 2017-2026? outside. If exact date 2016-11-12 to 2026-11-12? ten years? Need from 2026-12-31 back nine years? If ten-year window: "during 2026 or the nine years prior" => years 2017-2026. 2016 outside. If date-based ten years from 2026-12-31 = 2016-12-31, outside. No numerator. non_compliant. No exclusion. Check age OK. Non.
71136: age45 not eligible (gap 40 OK but age fail). Flexible sigmoidoscopy 2026 would numerator, advanced illness only, no frailty. Not eligible.
Now need ensure counts: Let's list categories.
Excluded: 71113, 71114 => 2.
Compliant: 71117, 71118, 71124, 71128, 71129 => 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 => 6? Also check any other eligible not numerator: 711?? Let's compile all statuses.
All members:
71111 NE
71112 NC
71113 EX
71114 EX
71115 NC
71116 NC
71117 C
71118 C
71119 NE
71120 NC
71121 NE
71122 NE
71123 NE
71124 C
71125 NE
71126 NE
71127 NE
71128 C
71129 C
71130 NE
71131 NE
71132 NE
71133 NC
71134 NE
71135 NC
71136 NE
Counts: C=5, NC=6, EX=2, denominator=11 (C+NC) (not including excluded), rate=5/11*100=45.4545 -> 45.5. NE=15? Total 26. 5+6+2=13, NE=13? Wait 26-13=13. I counted NE list: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 = 13. Yes. Denom=11. total=26. Good.
Need check if any eligible member should be excluded due to E1 if cancer documented any time before Dec31 even if age? Only eligible. 71113 excluded. 71130 and 71132 not eligible, not excluded. Good.
E4: age66 or older AND both frailty and advanced illness documented during measurement year. Check 71114 excluded. 71115 age47 no. 71122 age72 but not eligible enrolment, not excluded. 71136 age45 no. 71120 advanced only. 71111 frailty only age55. 71116 none. 71124 no frailty/advanced. Good.
Need verify enrolment of 71111: "Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01." Does "full measurement year with no more than one gap of up to 45 days" maybe allows partial year? No, full measurement year no more than one gap. Starting May1 is a gap of 120 days. Not eligible. Good.
Need maybe gap count if start not Jan1: The initial missing coverage is a gap. Yes.
Need maybe 71122 age72 with gap start Mar22, one gap of 80 days >45 -> not eligible. Good.
Need maybe 71119 age76: age is "46 through 75 years as of 2026-12-31". Age given 76. Not eligible.
Need maybe 71125 76; 71131 76; 71132 76. Good.
Need consider numerator windows in more exact date terms. The text says "by the look-back window measured back from 2026-12-31" and lists N1 "during 2026", N2 "during 2026 or the two years prior (three-year window)", N3 "during 2026 or the four years prior (five-year window)", N4 same, N5 "during 2026 or the nine years prior (ten-year window)." This likely means calendar-year lookback: if in measurement year or previous full years. But if a test was on 2023 for stool DNA: 2026 or two years prior (2024, 2025) -> 2023 outside. If they meant date back 3 years from 2026-12-31 -> 2024-01-01 to 2026-12-31 or 2023-12-31? Need examine dates around cutoffs to see potential deliberate traps. We have 71116 stool DNA 2023-01-09; clearly outside even exact 3-year. 71118 flex sig 2021-11-12 and 2022-07-04; if 5-year exact from 2021-12-31? 2021-11 outside but 2022 inside; if calendar years 2022 inside. compliant. 71133 CT colonography 2021-09; if exact 5-year from 2021-12-31? outside; if 5 years from 2026-12-31 = 2021-12-31, 2021-09 outside. non. If "four years prior" might include 2021? Measurement year 2026, four years prior: 2025,2024,2023,2022. Not 2021. non. 71135 colonoscopy 2016-11-12; if ten years from 2026-12-31 = 2016-12-31? 2016-11 before; if "nine years prior" years 2017-2025, 2016 outside. non. 71115 colonoscopy 2016-12-23: if exact ten years from 2026-12-31 = 2016-12-31? 2016-12-23 outside; if "nine years prior" includes 2017 only. non. Good.
But check HEDIS COL: numerator dates are measurement year or prior 9 years for colonoscopy? For CY 2026, date from 2017-01-01 to 2026-12-31. If exact 10 years, from 2016-12-31 to 2026-12-31? Usually lookback is 10 calendar years? Actually HEDIS COL numerator: Colonoscopy done during measurement year or 9 years prior. The date cutoff is January 1, 2017 for MY 2026? Or 2016-12-31? HEDIS defines "during measurement year or the 9 years prior" maybe date after 10 years? If exact from 2026-12-31 back 10 years = 2016-12-31? Hmm need consider if 2016-12-23 could be within 10 years if back from 2026-12-31: Date difference from 2016-12-23 to 2026-12-31 is 10 years and 8 days, outside. So not numerator. 2016-11-12 outside. Good.
Need maybe age "46 through 75 years as of 2026-12-31". If DOB 1950-05-08 -> 76; 1951-11-18 -> 75; 1951-03-21 -> 75; 1954-02-14 -> 72; 1963 -> 63; 1959 -> 67; 1981-12-20 -> 45; 1981-01-14 -> 45; 1981-09-13 -> 45; 1981-09-26 ->45; 1981-11-11 ->45. Good.
Need think if not enrolled before 2026-05-01 but continuous from that date maybe they mean enrolment is continuous but only for part of year? The phrase says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So no.
Could there be issue with 71123: gaps 13 and 25 -> more than one gap. Not eligible. Yes.
Could there be issue with 71121: gaps 28 and 15 -> more than one. Not eligible.
Could a gap of 0 if continuous? OK.
Need maybe include all member IDs strings. Output JSON only with keys. Need ensure rate number maybe 45.5.
Need maybe validate total members 26: compliant_members 5, non_compliant_members 6, excluded_members 2, not_eligible_members 13 -> lengths match. Denominator integer = 11. Numerator=5. Excluded=2. Not_eligible=13.
Potential edge: Are excluded members removed from denominator? Yes denominator in eligible after exclusions (compliant+noncompliant), count 11. Excluded count 2 but not included denominator. Good.
Potential ambiguity: If member excluded due to E4 and also numerator, excluded. We have 71114 CT outside, no numerator anyway. 71113 has numerator but excluded.
Potential ambiguity: E1 colorectal cancer any time on/before 2026-12-31. Includes 2025 and 2019 etc. Only eligible: 71113. 71130, 71132 not eligible. If age fail but cancer, not eligible. Good.
Potential ambiguity: 71115 age47 has frailty and advanced illness both during year. E4 requires age66 or older AND both. Does not exclude. Good.
Potential ambiguity: 71122 age72 has frailty/advanced but start Mar22 -> not eligible. Rule says a member who fails age, event, or enrolment is not_eligible even if exclusion documented. Good.
Potential issue with date of advanced illness 2026-01-13 for 71122 before enrolment (not enrolled until Mar22). "documented during measurement year" only, not necessarily during enrollment. But not eligible anyway.
Potential issue: Continuous enrolment gap maybe if start not Jan1 but gap of 80, not eligible. What if gap is not considered if not enrolled at all before start? It says not enrolled before start. The period before start is a gap. Fail.
Potential issue: "no more than one gap of up to 45 days" could mean within enrollment episodes only, not initial or terminal gaps? But "full measurement year" implies from Jan1 to Dec31; initial not enrolled before 2026-05-01 means not enrolled full year. They deliberately note "continuous from that date. Not enrolled before". Should be ineligible. Need ensure 71111 not eligible not perhaps denominator with numerator from 2025 colonoscopy? If enrolment partial, no.
Potential issue: gap of 45: 71117 one gap of 45 days OK. Numerator stool DNA 2026 compliant. If gap calculation inclusive? Given says one gap of 45 days. "up to 45 days" includes 45. Good.
Potential issue: N2 stool DNA during 2026 or two years prior. If stool DNA 2023-01-09 for 71116: outside if two prior calendar years; outside if exact 3 years from 2023-12-31. If exact date 2023-12-31 to 2026-12-31, 2023-01 outside. Good.
Potential issue: 71127 stool DNA 2024-12-13 if age45 not eligible. If age eligible, N2 would numerator. But not.
Potential issue: 71113 flexible sigmoidoscopy 2025-11-08 numerator but cancer excludes. Good.
Potential issue: 71111 enrolment fail despite colonoscopy 2025 and stool DNA 2023? 2025 colonoscopy would numerator if eligible. not. Good.
Potential issue: 71130 age45 but colon cancer history and FIT 2026. Not eligible. Good.
Potential issue: 71136 age45 but flex sig 2026 and gap 40. Not eligible. Good.
Potential issue: 71128 CT 2020 outside but stool DNA 2026 numerator. compliant.
Potential issue: 71132 cancer history and age 76. Not eligible. If age fail, even though cancer exclusion? not eligible. Good.
Need output valid JSON. Maybe keys order irrelevant. Need exactly one fenced JSON block and nothing else.
Let's construct:
{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117","71118","71124","71128","71129"],
"non_compliant_members": ["71112","71115","71116","71120","71133","71135"],
"excluded_members": ["71113","71114"],
"not_eligible_members": ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
}
Double-check lengths: not eligible list 13. Count: 71111(1),71119(2),71121(3),71122(4),71123(5),71125(6),71126(7),71127(8),71130(9),71131(10),71132(11),71134(12),71136(13). Good.
Need maybe denominator = compliant + noncompliant only, excluding excluded. Yes 5+6=11. Numerator=5.
Potential alternative: Some measure population tasks include exclusions count in denominator? No: required definitions says denominator members in eligible after exclusions removed (compliant + non_compliant), excluded members removed. Good.
Potential alternative: Age 75 includes if turns 76 after Dec31? Provided ages as of Dec31. OK.
Need think if "continuous enrolment: the full measurement year with no more than one gap of up to 45 days" maybe means if start after Jan1 but no more than one gap (the initial gap) up to 45? e.g enrolled 2026-01-01? no start 2026-01-01. 71111 start May -> gap too long. 71122 start Mar22 gap >45. 71126 start Mar17 gajson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 13,204 tokens
We need answer JSON only. Need analyze carefully. Task: measure population QM-CRC. Roster 26 members 71111-71136? Count 26 yes (111 to 136 inclusive). Need determine each member status: not_eligible (age/enrolment fails), excluded (in eligible pop but exclusion), compliant (denominator after exclusions and meets numerator), non_compliant (denominator after exclusions and not numerator). Need compute counts lists, rate.
Need evaluate age: 46 through 75 years as of 2026-12-31. Given ages. Continuous enrolment: full measurement year with no more than one gap of up to 45 days. Important: "not enrolled before" start means gap at beginning? Full measurement year 2026-01-01 to 2026-12-31. Continuous enrolment with no more than one gap of up to 45 days. If not enrolled Jan 1-Mar etc: is that a gap before year? They are not enrolled for measurement year portion; likely not eligible because not continuous full measurement year? The phrase: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Usually HEDIS continuous enrollment 24 months? But here says full measurement year with no more than one gap up to 45 days. If start 2026-05-01, that's a gap from Jan 1 to Apr 30 (long) and not full year, not_eligible. Need treat gaps of 28/15 multiple? "no more than one gap of up to 45 days" means at most one gap <=45. Member 71121 has two gaps (28 and 15) -> not eligible. Member 71123 two gaps -> not eligible. Members with gap <=45 one: 71115, 71116, 71117, 71118 eligible if age. Need be careful gap days as stated. "One gap of 45 days" allowed up to 45. "35", "42" allowed. Multiple gaps not allowed even if sum <=45. Need count not eligible by age >75 or <46. Also enrolment starting later than Jan 1: "not enrolled before date". Is that a gap? The measurement year start is Jan 1, not enrolled Jan-Mar, >45, fails continuous full year. Even if start later but gap less than 45? e.g. if not enrolled Feb? But all start later are >45 except 71122 starts Mar 22 gap 80; not_eligible. 71131 starts Apr 12. 71130 starts May 16. 71126 Mar 17. Also age some. Need not eligible.
Exclusions evaluated before numerator, only for eligible population. Need apply required exclusions to members that are eligible (age & enrolment). Need determine eligibility first? Yes. If fails age/event/enrolment not eligible even if exclusion. Then excluded if eligible and meets E1-E4. E1 colorectal cancer any time on or before 2026-12-31: diagnosis C18-C21. E2 total colectomy any time. E3 hospice during measurement year. E4 age 66 or older AND both frailty and advanced illness documented during measurement year. For E4, note "documented during the measurement year" = 2026-01-01 through 2026-12-31? Measurement year yes. Frailty and advanced illness documented during measurement year. Age 66 or older as of 2026-12-31. Need consider if frailty/advanced illness documented before measurement year not count. Also if not enrolled full year? But eligible requires enrolment. For E4 need both during measurement year. Need maybe if advanced illness documented 2026-01-13 but not enrolled until 2026-03-22? Member not eligible due enrolment anyway. If eligible and docs outside? Only measurement year. Need careful for E1/E2/E3 any time.
Numerator: any one by look-back measured back from 2026-12-31.
N1 FOBT or FIT during 2026. So date between 2026-01-01 and 2026-12-31? yes.
N2 Stool DNA during 2026 or two years prior (three-year window). Need interpret inclusive: 2024-01-01? "during 2026 or the two years prior (three-year window)" measured back from 2026-12-31 maybe exactly 3 years: 2024-01-01 through 2026-12-31? Or date 2023-11-04 not in 3-year window if three years prior from Dec 31 is Dec 31 2023. Usually HEDIS stool DNA in past 3 years, e.g. 2023? Need be consistent. For 2026 measurement year, three-year window might include 2024, 2025, 2026? But wording: "during 2026 or the two years prior (three-year window)." The two years prior = 2024 and 2025? Actually if calendar years, during 2026 or two years prior = 2024, 2025, 2026. But measured back from 2026-12-31? It says look-back window measured back from 2026-12-31. Could include dates >= 2023-12-31? For N3/N4 "during 2026 or the four years prior (five-year window)" Could mean calendar years 2022-2026? But measured back from Dec 31: five years includes Dec 31 2021? We need infer from examples? Dates likely constructed to test thresholds: e.g. 71113 CT 2020-07-03 (6 years) no; flex sig 2025-11-08 yes. 71111 stool DNA 2023-11-04, colonoscopy 2025-01-02 yes. 71116 stool DNA 2023-01-09? If calendar three-year window 2024-2026 no; if exact 3 years back from 2026-12-31 includes 2023-11-04? Wait 2023-11-04 is > 2023-12-31? No, it's earlier than Dec 31, so not included if exact. If calendar years two prior: 2023 is one prior? Let's parse.
Numerator says: "by the look-back window measured back from 2026-12-31: N1 ... during 2026. N2 ... during 2026 or the two years prior (three-year window). N3 ... during 2026 or the four years prior (five-year window). N4 ... during 2026 or the four years prior (five-year window). N5 ... during 2026 or the nine years prior (ten-year window)."
This seems to define windows in calendar-year-ish language but measured back from 2026-12-31. HEDIS often: "in the measurement year or two years prior" means any date within 3 years before end of measurement year. For 2026, a 3-year lookback includes dates from 2024-01-01 through 2026-12-31? Actually HEDIS lookback dates are often specified by date ranges: For 2026 MY, 3-year lookback: 2024-01-01 through 2026-12-31 (three calendar years), or 2023-12-31? The phrase "during 2026 or the two years prior" means 2026, 2025, 2024. Yes calendar years. "measured back from 2026-12-31" maybe just for window length, but examples? Need identify critical dates:
- 71111: Stool DNA 2023-11-04 and Colonoscopy 2025-01-02. Colonoscopy 2025 is within 10 years regardless. So N5 yes. Stool DNA 2023 doesn't matter.
- 71116: Stool DNA 2023-01-09. If 3-year window = 2024-2026 no; if exact 3 years = from 2023-12-31? no; if "two years prior" calendar = 2024,2025 no. Non-compliant? Age 50, enrolment one gap 35. If 2023 stool DNA were considered? Let's check date: 2023-01-09 is more than 3 years before 2026-12-31? Exact 3-year lookback from Dec 31 2026 is Dec 31 2023; 2023-01-09 outside. If calendar 3-year = Jan 1 2024; outside. So no either way. Why included? maybe to test no stool DNA if older than 3 years. 71111 stool DNA 2023-11-04: exact 3-year from 2023-12-31? outside by ~57 days. Calendar three-year includes 2023? Hmm if "two years prior" to 2026 = 2024 and 2025? Wait if measurement year 2026, during 2026 or the two years prior: prior years = 2025 and 2024, not 2023. So 2023-11-04 outside. If 3-year window measured back from 2026-12-31: includes 2024-2026, outside. If HEDIS 3-year lookback for 2026 might include 2023? Let's think: For 2026 measurement year, a 3-year lookback period often includes the measurement year plus two prior years: 2023, 2024, 2025? No, if prior to measurement year: measurement year = 2026, two years prior = 2024 and 2025. Three years total = 2024, 2025, 2026. But HEDIS sometimes lookback is 3 years inclusive of measurement year and 2 years before, e.g., for 2020: 2018-2020. Yes. Then 2023 is four years prior? So 71111 stool DNA 2023 not numerator, but colonoscopy 2025 is. 71116 2023 not. 71127 45 not eligible. 71128 stool DNA 2026 yes.
Need determine all members.
Let's systematically evaluate each member. Need output lists. Member IDs strings after MEMBER: "71111" etc.
General definitions:
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.
If fail -> not_eligible. Note age 45 not eligible even if enrolment good. Age 76 not eligible. Age 75 eligible. Age 46 eligible. Given ages maybe some DOB make 45 exactly as of 12/31 but 46 later? 71126 DOB 1981-12-20 -> 45 on 2026-12-31, not eligible. 71127 1981-01-14 ->45, not eligible. 71130 1981-09-13 ->45, not eligible. 71134 1981-09-26 ->45, not eligible. 71136 1981-11-11 ->45, not eligible.
Enrolment: full measurement year with no more than one gap up to 45 days.
Members with continuous 1/1-12/31: eligible (if age).
Members with one gap: 71115 age 47, enrolment gap 35 => eligible. 71116 age 50 gap 35 => eligible. 71117 age 63 gap 45 => eligible. 71118 age 47 gap 42 => eligible.
Members with multiple gaps: 71121 two gaps -> not_eligible. 71123 two gaps -> not_eligible.
Members not enrolled before start date: 71111 starts 5/1, not enrolled Jan-Apr (gap long? >45) -> not_eligible. 71122 starts 3/22 gap Jan-Mar 80 -> not_eligible. 71126 starts 3/17, also age 45 not_eligible. 71130 starts 5/16, age 45. 71131 starts 4/12, age 76. 71132 starts? 1/1 to 4/19; 5/26 to 12/31 one gap 36, but age 76 -> not_eligible. Actually enrolment ok. 71119/120? continuous age? Need list.
Potential edge: "no more than one gap of up to 45 days" could allow one gap of up to 45 days anywhere, including initial non-enrolment before eligible? If start 2026-05-01, that's a gap of 120 days >45, fails. If start 2026-11-15 gap 60 fail. OK.
Now exclusions among eligible:
List eligible initially by age/enrolment:
71112 age72 continuous eligible. No exclusions, no screening -> non_compliant.
71113 age47 continuous eligible, diagnosis C18.7 2025-07-17 -> E1 colorectal cancer -> excluded. (Also flex sig numerator? excluded before numerator, status excluded).
71114 age75 continuous eligible. Frailty 2026-12-17 and advanced illness 2026-05-05, age 66+ => E4 excluded. CT 2021? 5-year window maybe if 2021-12-07? exact 5-year from 2021-12-31? 2021-12-07 outside; calendar 2022-2026 outside. But excluded anyway.
71115 age47 one gap eligible. Frailty 2026-07-07, advanced illness 2026-02-06. Age 47, E4 requires age 66+ -> not exclude. Colonoscopy 2016-12-23: ten-year window? 2016 maybe if exact from 2016-12-31? date before -> outside; calendar 10-year includes 2017-2026? 2016-12-23 outside (or if "nine years prior" includes 2017? yes no). Need likely non_compliant. Could date 2016-12-23 be within 10-year window measured back from 2026-12-31? Exactly 10 years is 2016-12-31? No, if inclusive of date one day? Wait "during 2026 or the nine years prior (ten-year window)". Nine years prior to 2026 calendar years: 2017-2026 (10 calendar years) if measurement year 2026 and nine prior years = 2017 through 2025 plus 2026? That's 2017-2026, not 2016. But if lookback date from 2026-12-31 to 2016-12-31? Ten-year period: 2016-12-31? Usually dates on or after 2016-12-31? If date 2016-12-23 is just 8 days before 10-year exact, outside. Why 2016-12-23? Probably intentionally outside. If date 2016-12-31 maybe boundary? So non_compliant.
71116 age50 one gap eligible. No exclusions. Stool DNA 2023-01-09 outside 3-year -> non_compliant.
71117 age63 one gap eligible. Stool DNA 2026-01-11 -> N2 (also 2026) compliant.
71118 age47 one gap eligible. Flex sig 2021-11-12, 2022-07-04. Five-year window: 2022-07-04 is within 5 years (2022-2026 if calendar; exact from 2021-12-31? 2022 within). 2021-11-12 outside if exact 5-year but irrelevant. compliant.
71119 age76 -> not_eligible.
71120 age75 continuous eligible. Advanced illness only -> not exclude (frailty required). No screening -> non_compliant.
71122 age72 but enrolment start 3/22 (gap >45) -> not_eligible, even though age/frailty advanced.
71123 age67 multiple gaps -> not_eligible.
71124 age66 continuous eligible. Flex sig 2026-04-15 -> N3 compliant. No exclusions. Note age 66+ but no frailty/advanced.
71125 age76 -> not_eligible, even screening/exclusion no.
71126 age45 and enrolment start -> not_eligible.
71127 age45 -> not_eligible.
71128 age75 continuous eligible. Stool DNA 2026-08-17 -> compliant. CT 2020 maybe not.
71129 age67 continuous eligible. Flex sig 2023-07-08, CT 2023-09-13. Five-year window includes 2023 (2022-2026 or exact 2021-12-31) -> compliant. Need check age not exclude.
71130 age45 not_eligible, also cancer/exclusions irrelevant.
71131 age76 not_eligible.
71132 age76 not_eligible (gap ok but age fail). Also cancer E1 but not eligible.
71133 age59 continuous eligible. CT 2021-04-12, 2021-09-09. Five-year window? If calendar 2022-2026 excludes 2021. If exact from 2021-12-31 excludes 2021-09-09. So non_compliant. Why 2021-09? outside. Need consider if five-year window measured back from 2026-12-31 includes 2021? Let's examine. "during 2026 or the four years prior (five-year window)" Could be interpreted as measurement year 2026 plus four prior calendar years = 2022, 2023, 2024, 2025, 2026. That excludes all 2021. But HEDIS lookback for 2026 five years would often include 2022? Actually if 5-year lookback from 2026-12-31, include 2022-2026? Yes. What about 2021-12-31? If exact date 2021-12-31 might be included? But "four years prior" to 2026 = 2022-2025? Wait four years prior: 2022, 2023, 2024, 2025? Four calendar years before measurement year? If measurement year 2026, prior years are 2025, 2024, 2023, 2022 (four years). Plus measurement year => 5 years: 2022-2026. Yes.
But there are dates:
71114 CT 2021-12-07 outside.
71118 flex sig 2021-11-12 and 2022-07-04: 2022 inside.
71129 flex sig 2023 and CT 2023 inside.
71133 CT 2021 outside. Could be a trick for exact date window: If measured back exactly 5 years from 2026-12-31 includes 2021-12-31? Then 2021-09 outside; still outside. If five years includes 2021 full calendar? Then CT 2021 would be inside? But wording says four years prior (five-year window). Some might include 2021? Let's analyze all test dates for ambiguity.
HEDIS colorectal cancer screening 2024? Numerator includes:
- Fecal occult blood test in the measurement year.
- Flexible sigmoidoscopy in the measurement year or up to four years prior.
- CT colonography in the measurement year or up to four years prior.
- Colonoscopy in the measurement year or up to nine years prior.
- Stool DNA in measurement year or up to two years prior.
Often HEDIS uses "measurement year or up to X years prior" meaning calendar years: e.g. 2024 measurement year, flexible sigmoidoscopy during 2020-2024? Yes because up to four years prior includes 2020? Wait measurement year 2024; up to four years prior = 2020? Let's see: If 2024 is year 0, 2023 is 1 year prior, 2022=2, 2021=3, 2020=4. That's five calendar years: 2020-2024. But if prior years to 2024 are 2023, 2022, 2021, 2020 = four. Yes. Earlier I used prior years as 2025-2022; that's four years prior to 2026 (2025 one, 2024 two, 2023 three, 2022 four). Include 2022. Then for colonoscopy nine years prior includes 2017 through 2025 plus 2026 = 2017-2026. That matches calendar 10 years? Let's count: 2017-2026 inclusive 10 years. So for 2026, flex sig CT 2022-2026; colonoscopy 2017-2026; stool DNA 2024-2026. This is one interpretation. "during 2026 or the four years prior" could mean 2026, 2025, 2024, 2023, 2022 (five years), not just 2026 + four prior *within measurement period?* Yes.
But there's another exact date interpretation: from 2026-12-31 minus 5 years = 2021-12-31. If date 2021-12-07 would be outside; if 2021-12-31 maybe inside. For HEDIS often lookback includes date within measurement year or up to X years prior by dates, so for colonoscopy 10 years: dates 2016-12-31? Wait HEDIS 2024: colonoscopy on or after 2015? Let's recall: For 2024, colonoscopy lookback is dates from 2015? I think HEDIS 10-year lookback includes 2015 through 2024? For 2024 measurement year: 10-year period is 2015-01-01 through 2024-12-31? Or 2014-12-31? Need recall. HEDIS numerator: "Colonoscopy during the measurement year or nine years prior" often dates 2015-2024 for 2024. So includes full calendar years. The measure spec text here explicitly says measured back from 2026-12-31, which might imply date-based windows not calendar full years? It says "by the look-back window measured back from 2026-12-31". This likely means:
- during 2026 = 2026-01-01 through 2026-12-31.
- three-year window measured back from 2026-12-31 = 2024-01-01? or 2023-12-31? They specify "during 2026 or the two years prior (three-year window)." If measured back from end date, 2026 plus prior 2 years could be 2024, 2025, 2026 calendar.
But the phrase "measured back from 2026-12-31" is included likely to remove ambiguity of exact lookback from end date. It might mean: N2: dates on or after 2023-12-31? Let's inspect: three-year window measured back from 2026-12-31 -> if you count three years back, start 2023-12-31 (or 2024-01-01?). Example: a 3-year lookback from Dec 31 2026 includes Dec 31 2025, Dec 31 2024, Dec 31 2023? Not calendar full. But they also say "during 2026 or the two years prior." The two years prior as dates before measurement year: 2024 and 2025 if prior calendar years. Hmm.
Need infer intended from dates: They gave many screening dates near window boundaries:
- 71111: Stool DNA 2023-11-04. If exact 3 years from Dec 31 2026 includes Dec 31 2023 to Dec 31 2026, 2023-11-04 outside. If calendar 2024-2026, outside. If "2026 or two years prior" could mean 2023, 2024, 2025? Wait if prior years = years before 2026? No.
- 71113: CT colonography 2020-07-03 (outside 5), flex sig 2025-11-08 inside, also cancer.
- 71114: CT 2021-12-07, excluded by age/frailty. If non-excluded would be inside 5-year? If exact date window includes 2021-12-31, 2021-12-07 outside; if calendar five years includes 2022, outside; if "four years prior" includes 2021 (since 2026-04? no). So maybe not matter.
- 71115: Colonoscopy 2016-12-23. Ten-year exact from Dec 31 2016? outside by 8 days. Calendar 10-year 2017-2026 outside. If "nine years prior" to 2026 = 2017-2025? outside. So likely non_compliant. Why near Dec 31? To test exact date boundary? 2016-12-23 is just 8 days outside a 10-year exact window from Dec 31 2026? Actually exact 10 years back from Dec 31 2026 is Dec 31 2016. If inclusive start Dec 31 2016, date Dec 23 2016 is outside. If full calendar 10 years = Jan 1 2017-Dec31 2026, outside. If "nine years prior" = 2017, outside. So non_compliant.
- 71135: Colonoscopy 2016-11-12, non_compliant outside. Similar.
- 71136 age45 not eligible despite flex sig 2026-02-13.
- 71133 CT 2021-09-09. Five-year exact start Dec 31 2021? date Sep 2021 outside; calendar 2022 outside; if "four years prior" includes 2021? Let's count if measurement year 2026, four years prior could be 2022 (four years prior), but 2021 is five years prior. So outside. Maybe non_compliant.
- 71129 flex/CT 2023: inside.
- 71118 flex sig 2022-07-04: inside? If five-year exact start Dec 31 2021, yes. Calendar 2022 yes. 2021-11-12 outside exact? inside if calendar? Not matter.
Potential edge: For E4, member 71114 has frailty 2026-12-17, advanced illness 2026-05-05. Both during measurement year. Age 75. Excluded. Member 71120 advanced illness 2026 only but no frailty, non_compliant. Member 71115 both but age 47 no. Member 71136 age45 no.
Hospice none. Colectomy 71134 but age45 not eligible -> not_eligible even if exclusion. Cancer 71113 eligible excluded; 71130 not eligible; 71132 not eligible due age. 71113 also flex sig 2025 but excluded.
Need decide compliant list:
Eligible and no exclusions and numerator:
- 71117: stool DNA 2026-01-11 yes.
- 71118: flex sig 2022-07-04 yes (within 5).
- 71124: flex sig 2026 yes.
- 71128: stool DNA 2026 yes.
- 71129: flex sig/CT 2023 yes.
- 71112 no.
- 71115 no colonoscopy outside? maybe non_compliant.
- 71116 stool DNA 2023 outside? non_compliant.
- 71120 no.
- 71133 CT 2021 outside? non_compliant.
- 71135 colonoscopy 2016 outside? non_compliant.
What about 71111 not eligible due start 5/1; but colonoscopy 2025 would numerator but not eligible.
What about 71119,125,131,132 age76 not eligible despite screening.
71122 not eligible due gap, despite advanced/frailty no numerator.
71123 not eligible multiple gaps, no screening.
71121 not eligible multiple gaps despite CT 2026.
71126/71127/71130/71134/71136 age45 notjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K2.6 · Moonshot42.5s · 9,806 out | 341.8s · 13,450 out | 389.1s · 8,359 out
Reasoning · 7,135 tokens
We need to produce a JSON output with counts and lists for measure QM-CRC. Let's evaluate each of the 26 members.
First, understand the measure:
Eligible population (denominator):
- Age 46 through 75 years as of 2026-12-31.
- Continuous enrollment: full measurement year (2026-01-01 to 2026-12-31) with no more than one gap of up to 45 days.
Numerator (any one of N1-N5 by look-back from 2026-12-31):
N1. FOBT or FIT during 2026.
N2. Stool DNA test during 2026 or the two years prior (i.e., 2024-01-01 through 2026-12-31).
N3. Flexible sigmoidoscopy during 2026 or the four years prior (i.e., 2022-01-01 through 2026-12-31).
N4. CT colonography during 2026 or the four years prior (i.e., 2022-01-01 through 2026-12-31).
N5. Colonoscopy during 2026 or the nine years prior (i.e., 2017-01-01 through 2026-12-31).
Required Exclusions (only evaluated if 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 measurement year (2026).
E4. Age >=66 as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Need both frailty and advanced illness during 2026.
Important: Exclusions are evaluated before numerator. If a member meets exclusion, they are excluded even if they also meet numerator.
Status definitions:
- not_eligible: fails age, event (screening?), or enrollment. Actually "age, event, or enrollment". Event likely means something else? The measure says eligible population is defined by age and continuous enrollment. I think "event" might refer to something else but in the context of eligible population it's age, enrollment. The definition says: "never enters the eligible population (age, event, or enrolment)". For CRC, the eligible population is based on age and enrollment; there is no event required to enter. So not_eligible is due to age or enrollment.
- excluded: in eligible population but meets a required exclusion.
- compliant: in denominator (eligible + not excluded), meets numerator.
- non_compliant: in denominator, does not meet numerator.
Now evaluate each member.
Member 71111:
DOB 1971-04-18, age 55 as of 12/31/2026. Age 46-75: Yes.
Enrollment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. That means they are missing 2026-01-01 to 2026-04-30. That's a gap of 120 days? Wait the member is not enrolled before 5/1. Continuous from 5/1 onward. The requirement is continuous enrollment full measurement year with no more than one gap up to 45 days. Since they only start on 5/1, they are missing Jan-April (4 months). That's >45 days. So not eligible due to enrollment.
Screening history: Stool DNA 2023-11-04 (outside N2 window? N2 is 2024-2026, so no). Colonoscopy 2025-01-02: N5 window is 2017-2026, so yes. But they are not eligible. Also frailty 2026-10-27.
Since not eligible, they go to not_eligible. Check age qualifies, enrollment fails. So status: not_eligible.
Member 71112:
DOB 1954-02-14, age 72. Yes.
Enrollment: continuous full year. Yes.
Screening: none.
Exclusions: No cancer, no colectomy, no hospice, no frailty or advanced illness.
Age <66? No, age 72. But frailty+advanced illness needed for E4. Neither present.
So eligible. Denominator. Numerator? No screening. So non_compliant.
Member 71113:
DOB 1979-02-27, age 47. Yes.
Enrollment: continuous full year.
Screening: CT colonography 2020-07-03 (outside N4 window 2022-2026). Flexible sigmoidoscopy 2025-11-08: N3 window is 2022-2026. Yes, 2025 is within window. So numerator met.
But exclusions: Diagnosis C18.7 on 2025-07-17. C18 is colorectal cancer. E1 applies any time on or before 2026-12-31. So E1 met.
Since exclusion met, and exclusion evaluated before numerator, status = excluded.
Member 71114:
DOB 1951-11-18, age 75. Yes.
Enrollment: continuous full year.
Screening: CT colonography 2021-12-07. N4 window is 2022-2026. 2021 is outside. So no numerator.
Exclusions: Frailty 2026-12-17, advanced illness 2026-05-05. Age 75 >=66. Both frailty and advanced illness documented during measurement year. So E4 met. Excluded.
Member 71115:
DOB 1979-09-19, age 47. Yes.
Enrollment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap from 7/17 to 8/20 inclusive? Let's calculate gap days. The gap starts after 7/16 and before 8/21. So days missing: July 17-31 = 15 days, August 1-20 = 20 days, total 35 days. Yes, one gap of 35 days <=45. So enrollment satisfies.
Screening: Colonoscopy 2016-12-23. N5 window is 2017-2026. 2016-12-23 is before 2017. So does not meet N5. No other screening.
Exclusions: Frailty 2026-07-07 and advanced illness 2026-02-06. Age 47 <66, so E4 does not apply (requires age >=66). No cancer, no colectomy, no hospice.
So eligible, denominator. Numerator? None. Non_compliant.
Member 71116:
DOB 1976-01-11, age 50. Yes.
Enrollment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. Gap from 3/17 to 4/20. March 17-31 = 15 days, April 1-20 = 20 days, total 35 days. One gap <=45. OK.
Screening: Stool DNA 2023-01-09. N2 window is 2024-2026. 2023 is outside. No numerator.
Exclusions: none.
So eligible, denominator, non_compliant.
Member 71117:
DOB 1963-09-02, age 63. Yes.
Enrollment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap from 6/3 to 7/17. June 3-30 = 28 days, July 1-17 = 17 days, total 45 days. The spec says no more than one gap of up to 45 days. Is a gap of exactly 45 days allowed? "up to 45 days" usually includes 45. Let's assume yes. So eligible.
Screening: Stool DNA 2026-01-11. N2: during 2026 or two years prior (2024-2026). 2026-01-11 is within. So numerator met.
Exclusions: none.
So compliant.
Member 71118:
DOB 1979-03-23, age 47. Yes.
Enrollment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. Gap from 6/15 to 7/26. June 15-30 = 16 days, July 1-26 = 26 days, total 42 days. One gap <=45. OK.
Screening: Flexible sigmoidoscopy 2021-11-12 (outside N3 window 2022-2026), 2022-07-04 (inside N3 window 2022-2026). So numerator met.
Exclusions: none.
So compliant.
Member 71119:
DOB 1950-03-25, age 76. Age range is 46 through 75. 76 > 75. So not eligible due to age. Also enrollment is continuous. But age fails. Since age fails, they are not_eligible regardless of other factors. Let's confirm: "Age: 46 through 75 years as of 2026-12-31." So 76 is out.
Screening history present but irrelevant.
Status: not_eligible.
Member 71120:
DOB 1951-03-21, age 75. Yes.
Enrollment: continuous full year.
Screening: none.
Exclusions: Advanced illness documented 2026-02-01. Age 75 >=66. But need both frailty and advanced illness for E4. Only advanced illness present. No cancer, no colectomy, no hospice.
So eligible, denominator, non_compliant.
Member 71121:
DOB 1971-08-17, age 55. Yes.
Enrollment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps: 3/22-4/18 = 28 days; 7/7-7/21 = 15 days. Two gaps, both <=45, but spec allows "no more than one gap of up to 45 days". Two gaps means fails continuous enrollment. So not eligible due to enrollment.
Even though CT colonography 2026-02-22 (counts for N4? N4 is CT colonography during 2026 or four years prior (2022-2026). Yes, in 2026). But enrollment fails.
Status: not_eligible.
Member 71122:
DOB 1954-09-15, age 72. Yes.
Enrollment: 2026-03-22 through 2026-12-31. Not enrolled before 3/22. Missing Jan 1 - Mar 21. That's 80 days. So not eligible due to enrollment.
Exclusions: Frailty and advanced illness both in 2026. Age >=66. But since not eligible, status is not_eligible.
Status: not_eligible.
Member 71123:
DOB 1959-03-08, age 67. Yes.
Enrollment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps: 2/24-3/8 = 13 days; 6/28-7/22 = 25 days. Two gaps. Fails enrollment (only one gap allowed). So not eligible.
No exclusions considered.
Status: not_eligible.
Member 71124:
DOB 1960-08-15, age 66. Yes.
Enrollment: continuous full year.
Screening: Flexible sigmoidoscopy 2026-04-15. N3 window includes 2026. So numerator met.
Exclusions: none.
Compliant.
Member 71125:
DOB 1950-05-08, age 76. >75. Not eligible due to age.
Status: not_eligible.
Member 71126:
DOB 1981-12-20, age 45 on 2026-12-31? Let's calculate: 2026-12-31 minus 1981-12-20 = 45 years, 11 days. Age is 45. Measure requires 46 through 75. So age 45: not eligible.
Status: not_eligible.
Member 71127:
DOB 1981-01-14, age 45 on 2026-12-31? 2026-12-31 minus 1981-01-14 = 45 years, 11 months, 17 days. So age 45. Not eligible (must be 46+).
Enrollment has one gap of 24 days, but age fails anyway.
Status: not_eligible.
Member 71128:
DOB 1951-12-10, age 75. Yes.
Enrollment: continuous full year.
Screening: CT colonography 2020-02-10 (outside N4 window 2022-2026). Stool DNA 2026-08-17 (inside N2 window 2024-2026). So numerator met.
Exclusions: none.
Compliant.
Member 71129:
DOB 1959-07-23, age 67. Yes.
Enrollment: continuous full year.
Screening: Flexible sigmoidoscopy 2023-07-08 (N3 window 2022-2026). CT colonography 2023-09-13 (N4 window 2022-2026). So numerator met.
Exclusions: none.
Compliant.
Member 71130:
DOB 1981-09-13, age 45 on 2026-12-31? 2026-09-13 would be 45th birthday. As of 2026-12-31, age is 45. Not eligible because age <46.
Wait: 2026-12-31 minus 1981-09-13 = 45 years, 3 months, 18 days. Yes, 45. So not eligible.
However, let's double-check the age calculation for borderline cases. Age on a date is usually computed as year difference minus 1 if the birthday hasn't occurred yet. Here birthday is 09-13. On 12-31-2026, birthday has occurred (09-13-2026). So age = 2026 - 1981 = 45. So 45. Not eligible.
Even if they had a FIT in 2026 and cancer diagnosis, age fails so not_eligible.
Status: not_eligible.
Member 71131:
DOB 1950-05-05, age 76. >75. Not eligible due to age.
Status: not_eligible.
Member 71132:
DOB 1950-02-01, age 76. >75. Not eligible due to age. Wait, but enrollment gap and cancer? Age 76 means not eligible.
Let's verify: 2026-12-31 - 1950-02-01 = 76 years, 10 months, 30 days. So age 76. Not eligible.
Status: not_eligible.
Wait, let me double check all ages. Sometimes I might miscalculate.
71111: 1971-04-18 -> 2026-12-31: 55. correct.
71112: 1954-02-14 -> 72. correct.
71113: 1979-02-27 -> 47. correct.
71114: 1951-11-18 -> 75. correct.
71115: 1979-09-19 -> 47. correct.
71116: 1976-01-11 -> 50. correct.
71117: 1963-09-02 -> 63. correct.
71118: 1979-03-23 -> 47. correct.
71119: 1950-03-25 -> 76. correct.
71120: 1951-03-21 -> 75. correct.
71121: 1971-08-17 -> 55. correct.
71122: 1954-09-15 -> 72. correct.
71123: 1959-03-08 -> 67. correct.
71124: 1960-08-15 -> 66. correct.
71125: 1950-05-08 -> 76. correct.
71126: 1981-12-20 -> 45. correct (2026-12-20 is 45th bday, so on 12/31 is 45).
71127: 1981-01-14 -> 45. Wait: 2026-01-14 is 45th birthday. On 2026-12-31, they are 45. correct.
71128: 1951-12-10 -> 75. correct (2026-12-10 is 75th, on 12/31 still 75).
71129: 1959-07-23 -> 67. correct.
71130: 1981-09-13 -> 45. correct (2026-09-13 is 45th, on 12/31 is 45).
71131: 1950-05-05 -> 76. correct.
71132: 1950-02-01 -> 76. correct.
71133: 1967-01-22 -> 59. correct.
71134: 1981-09-26 -> 45. correct (2026-09-26 is 45th bday; on 12/31 45).
71135: 1971-08-26 -> 55. correct.
71136: 1981-11-11 -> 45. correct (2026-11-11 is 45th bday; on 12/31 45).
So age not eligible members: 71119 (76), 71125 (76), 71126 (45), 71127 (45), 71130 (45), 71131 (76), 71132 (76), 71134 (45), 71136 (45). That's 9 members.
Enrollment not eligible members (age eligible but enrollment fails): 71111, 71121, 71122, 71123. Let's verify.
71111: enrolled 5/1/2026 to 12/31/2026. Missing Jan1-Apr30. That's a single gap? Actually the measure says "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If they are not enrolled before 2026-05-01, the gap is from 2026-01-01 to 2026-04-30. That's 120 days. So fails.
71121: two gaps (28 and 15 days). Fails.
71122: enrolled 3/22/2026 to 12/31/2026. Missing Jan1-Mar21. That's 80 days. Fails.
71123: two gaps (13 and 25 days). Fails.
Wait, are there any others with enrollment issues? Let's check all.
71112: continuous, no gaps. OK.
71113: continuous, no gaps. OK.
71114: continuous, no gaps. OK.
71115: gap 35 days. OK.
71116: gap 35 days. OK.
71117: gap 45 days. Exactly 45? Let's count carefully. Enrollment 2026-01-01 through 2026-06-02. Next 2026-07-18 through 2026-12-31. Gap from 2026-06-03 to 2026-07-17 inclusive? The prompt says "One gap of 45 days." So we trust it's up to 45. OK.
71118: gap 42 days. OK.
71119: continuous. OK.
71120: continuous. OK.
71124: continuous. OK.
71128: continuous. OK.
71129: continuous. OK.
71133: continuous. OK.
71135: continuous. OK.
So enrollment fails for 4 members.
Now, any overlaps between age fail and enrollment fail? Let's see: 71122 age 72 but enrollment fails. 71111 age 55 but enrollment fails. 71121 age 55 but enrollment fails. 71123 age 67 but enrollment fails. So the not_eligible set is the union of age-fails and enrollment-fails. No overlap in those two groups? Let's check:
Age fails: 71119, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136.
Enrollment fails: 71111, 71121, 71122, 71123.
No overlap. So total not_eligible = 9 + 4 = 13.
Now, among the remaining 13 members, we need to evaluate exclusions and numerator.
Remaining members:
71112, 71113, 71114, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135.
Let's evaluate each:
71112: age 72, continuous. No exclusions. No screening. -> non_compliant.
71113: age 47, continuous. Exclusion E1: C18.7 diagnosis on 2025-07-17. CRC any time on or before 2026-12-31. Yes. Excluded.
71114: age 75, continuous. Exclusion E4: age >=66 AND both frailty and advanced illness during measurement year. Frailty 2026-12-17, advanced illness 2026-05-05. Both in 2026. So excluded.
71115: age 47, continuous (one gap 35d). Exclusions: frailty 2026-07-07, advanced illness 2026-02-06. Age 47 <66, so E4 does NOT apply. No other exclusions. Numerator: colonoscopy 2016-12-23. N5 window: 2017-01-01 through 2026-12-31. 2016-12-23 is outside. No other screening. -> non_compliant.
Wait, could colonoscopy on 2016-12-23 be considered in the ten-year window? The look-back is measured back from 2026-12-31: "Colonoscopy during 2026 or the nine years prior (ten-year window)." Nine years prior from 2026-12-31 would be 2017-12-31? "during 2026 or the nine years prior (ten-year window)" - Typically a ten-year window ending 12/31/2026 would start 1/1/2017. Actually "during 2026 or the nine years prior" means 2026 and the 9 years before it, i.e., 2017 through 2026 inclusive. 2016-12-23 is in 2016, before 2017. So outside. non_compliant.
71116: age 50, continuous (gap 35d). No exclusions. Numerator: stool DNA 2023-01-09. N2 window: 2024-2026. 2023 is outside. No other screening. -> non_compliant.
71117: age 63, continuous (gap 45d). No exclusions. Numerator: stool DNA 2026-01-11. In 2026, so N2 met. -> compliant.
71118: age 47, continuous (gap 42d). No exclusions. Numerator: flex sig 2022-07-04. N3 window: 2022-2026. Yes. -> compliant.
71120: age 75, continuous. Exclusions: advanced illness 2026-02-01. Age >=66 but no frailty. So E4 not met. No other exclusions. Numerator: no screening. -> non_compliant.
71124: age 66, continuous. No exclusions. Numerator: flex sig 2026-04-15. in 2026. N3 met. -> compliant.
71128: age 75, continuous. No exclusions. Numerator: stool DNA 2026-08-17. in 2026. N2 met. -> compliant.
71129: age 67, continuous. No exclusions. Numerator: flex sig 2023-07-08 (N3 window 2022-2026) or CT colonography 2023-09-13 (N4 window 2022-2026). Either qualifies. -> compliant.
71133: age 59, continuous. No exclusions. Numerator: CT colonography 2021-04-12 and 2021-09-09. N4 window is 2022-2026. 2021 is outside. No other tests. -> non_compliant.
71135: age 55, continuous. No exclusions. Numerator: colonoscopy 2016-11-12. N5 window 2017-2026. 2016 outside. No other screening. -> non_compliant.
So among the 13 eligible:
Excluded: 71113, 71114. (2)
Compliant: 71117, 71118, 71124, 71128, 71129. (5)
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. (6)
Check total: 2 + 5 + 6 = 13. Correct.
Denominator = eligible after exclusions = compliant + non_compliant = 11.
Numerator = 5.
Excluded = 2.
Not_eligible = 13.
Rate = 5 / 11 * 100 = 45.4545... round half up to one decimal: 45.5.
Let's verify compliant_members: ["71117","71118","71124","71128","71129"]
Non_compliant: ["71112","71115","71116","71120","71133","71135"]
Excluded: ["71113","71114"]
Not_eligible: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Wait, any borderline cases?
Member 71126: DOB 1981-12-20. On 2026-12-31, age is exactly 45 years and 11 days. Since measure says 46 through 75, 45 is too young.
Member 71130: DOB 1981-09-13. On 2026-12-31, age is 45 years, 3 months, 18 days. Too young.
Member 71134: DOB 1981-09-26. Age 45. Too young.
Member 71136: DOB 1981-11-11. Age 45. Too young.
Now double-check member 71113: excluded due to CRC. But they also had flex sig in 2025 which would be numerator. Exclusion takes precedence. Correct.
71114: age 75, frailty 12/17/2026, advanced illness 5/5/2026. E4 requires both during measurement year. Both are present. Excluded. They had CT colonography 2021 but it's outside N4 window (2022-2026). Even if inside, exclusion first.
71115: Age 47. Frailty and advanced illness documented, but age <66. Not excluded. No numerator. non_compliant.
71120: Age 75. Advanced illness but no frailty. Not excluded.
71122: Age 72. Enrollment fails. Not eligible. However, they have frailty and advanced illness. But age/enrollment fail first.
71133: Age 59. CT colonography in 2021. N4 window is "during 2026 or the four years prior (five-year window)". Four years prior from 2026 would be 2022. 2021 is outside. So non_compliant.
71135: Age 55. Colonoscopy 2016. N5 window is 2026 or nine years prior (ten-year window). Nine years prior from 2026 is 2017. 2016 is outside. non_compliant.
Now check if any members had hospice. None mentioned.
Check total colectomy: 71134 had total colectomy 2023-04-23. But 71134 is age 45, not eligible. Since not eligible, they are not_eligible, not excluded. Correct. Exclusions are only evaluated for eligible population.
Similarly, CRC on 71130 (C18.7 on 2024-11-25). But 71130 is age 45, not eligible. So not_eligible.
CRC on 71132 (C18.7 on 2019-11-07). Age 76, not eligible. So not_eligible.
Now, one nuance: Member 71111 has frailty. Age 55. Not eligible due to enrollment. So not_eligible.
Member 71127: age 45. Stool DNA 2024-12-13. N2 window is 2024-2026. If eligible, they'd be compliant. But age fails.
Rate calculation: numerator=5, denominator=11. 5/11=0.454545... *100 = 45.4545... Round half up to one decimal place. 45.5. Correct.
Wait, is there any chance member 71117's gap is considered >45? The prompt says "One gap of 45 days." The spec says "up to 45 days". Since the input explicitly says one gap of 45 days, we should treat it as satisfying.
Similarly, 71118 one gap of 42 days. OK.
71115 gap of 35 days. OK.
71116 gap of 35 days. OK.
71121: gaps of 28 and 15 days. Two gaps. Fails. The spec says "no more than one gap". So yes, fails.
71123: gaps of 13 and 25 days. Two gaps. Fails.
Now, need to output exactly one JSON code block with required keys. Sorting of member IDs in arrays: "in any order". So we can output in any order, but sorted ascending might be best.
Counts:
denominator: 11
numerator: 5
excluded: 2
not_eligible: 13
rate: 45.5
Arrays:
compliant_members: ["71117","71118","71124","71128","71129"]
non_compliant_members: ["71112","71115","71116","71120","71133","71135"]
excluded_members: ["71113","71114"]
not_eligible_members: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Double-check we have all 26 members.
Compliantjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 10,520 tokens
We need to parse each member record against QM-CRC measure spec. Output counts and lists.
Let's restate spec:
Measurement year 2026-01-01 through 2026-12-31.
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.
That means "Enrolment: the full measurement year with no more than one gap of up to 45 days." So they need to be enrolled for the measurement year, but allowed one gap of <=45 days.
Interpretation: If a member is missing coverage at the start or end, they are not in continuous enrollment for the full year unless the gap is within the year and <=45 days. If they are not enrolled at start (e.g., starts 2026-05-01), then they are missing the first portion of the year; does that count as one gap? The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
In typical measures, "continuous enrollment for the full measurement year" means they have coverage for the entire year, allowing a gap of up to 45 days. A member who starts mid-year is not enrolled for the full measurement year. The examples likely treat not enrolled before a start date as missing the initial part; that is a gap? Actually the standard HEDIS language: "No more than one gap in enrollment of up to 45 days during the measurement year." Starting coverage after the start of the year means there is a gap from 1/1 to start date; if that's >45 days, fails. But in many implementations, you must have coverage for each month of the year, allowing gaps of up to 45 days total? Let's interpret carefully.
Given the member records, we see ones like 71111: enrolment 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. That's a gap from 2026-01-01 to 2026-04-30: 120 days (Jan 31+Feb28+Mar31+Apr30 = 120). That's more than one gap of up to 45 days. So likely not eligible.
71122: enrolment 2026-03-22 through 2026-12-31. Not enrolled before. Gap from Jan 1 to Mar 21 = 80 days (31+28+21 = 80). >45 days, not eligible.
71126: enrolment 2026-03-17 through 2026-12-31. Gap Jan 1 to Mar 16 = 75 days. >45, not eligible.
71130: enrolment 2026-05-16 through 2026-12-31. Gap Jan 1 to May 15 = 135 days. >45, not eligible.
71131: enrolment 2026-04-12 through 2026-12-31. Gap Jan 1 to Apr 11 = 101 days. >45, not eligible.
What about 71127: enrolment 2026-01-01 through 2026-06-25; 2026-07-20 through 2026-12-31. One gap of 24 days (June 26 to July 19 inclusive? Let's count days). Let's compute later. That is one gap <=45 days, so eligible if age qualifies.
Important: The definition says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That means any periods without enrollment are allowed only if total number of gaps <=1 and gap duration <=45. Gaps can be at the start or within the year? Usually the full measurement year requirement means they must be enrolled from Jan 1 to Dec 31, but a gap up to 45 days is forgiven. Starting after Jan 1 would be a gap at the beginning; since it's one gap, but if >45 days, fails. So we must calculate gap durations for those not enrolled at start. The examples of 71111 etc are likely not eligible due to age? Age 55, but enrollment gap >45. So not eligible.
Also, 71121 has two gaps (28 and 15 days). The spec says "no more than one gap". So fails continuous enrollment. Indeed "Gaps of 28 and 15 days." That is two gaps, so not eligible.
71123: gaps of 13 and 25 days = two gaps, not eligible.
71132: gap of 36 days (one gap), but need to ensure it's within the full measurement year. Enrolled 2026-01-01 through 2026-04-19, then 2026-05-26 through 2026-12-31. That is one gap of 36 days. Age 76, so not eligible due to age anyway. But we evaluate age first, enrollment later? Not_eligible if fails any of age, event, or enrollment. So 71132 not_eligible.
71136: gap of 40 days. One gap. Age 45 (not 46-75), so not eligible anyway.
71115: one gap of 35 days. Age 47. Eligible age, enrollment okay.
71116: one gap of 35 days. Age 50. Eligible.
71117: one gap of 45 days. Age 63. Eligible if gap <=45. Need to check exact count: enrolled 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap from 06-03 to 07-17 inclusive? Usually gap is days without coverage. Let's compute later. The record says one gap of 45 days, so we accept as given. So eligible.
71118: one gap of 42 days. Age 47. Eligible.
So need to compute age accurately as of 2026-12-31. Since DOB given, age = 2026 - birth year, adjusted if birthday after Dec 31. Actually 2026-12-31 minus DOB year. Let's compute each.
Members:
1. 71111 DOB 1971-04-18. Age 2026-1971 = 55 (birthday before 12/31). So 55. Age eligible (46-75).
Enrollment: 2026-05-01 to 2026-12-31. Not full year, gap from Jan 1 to Apr 30: Jan 31, Feb 28, Mar 31, Apr 30 = 120 days. So not eligible due to enrollment.
Exclusion? E4 maybe? Age <66. So no exclusion. Not_eligible due to enrollment.
2. 71112 DOB 1954-02-14. Age 72. Eligible age. Enrollment continuous Jan 1-Dec 31. No gaps. So eligible.
Screening: none. So denominator, non-compliant unless excluded.
Exclusions: no cancer, no colectomy, no hospice, no frailty/advanced illness. So non_compliant.
3. 71113 DOB 1979-02-27. Age 47. Eligible age. Enrollment continuous Jan 1-Dec 31.
Screening: 2020-07-03 CT colonography (5-year window: 2022-01-01 to 2026-12-31? Wait N4: CT colonography during 2026 or the four years prior (five-year window). That window is 2022-01-01 to 2026-12-31). 2020-07-03 is outside window. 2025-11-08 flexible sigmoidoscopy (five-year window: 2022-01-01 to 2026-12-31). 2025-11-08 is within window (N3). So numerator? Wait exclusions first.
Other history: 2025-07-17 Diagnosis C18.7. That's colorectal cancer (C18-C21) any time on or before 2026-12-31. So exclusion E1 applies. Since exclusion is evaluated before numerator, and the member is in eligible population (age and enrollment), they are excluded. Note: The cancer diagnosis is before end of 2026. So excluded.
4. 71114 DOB 1951-11-18. Age 75. Eligible age (46-75 inclusive). Enrollment continuous. Eligible.
Screening: 2021-12-07 CT colonography. Window for CT colonography: 2022-01-01 to 2026-12-31 (5-year). 2021-12-07 is outside window. So no numerator screening.
Other history: 2026-12-17 frailty, 2026-05-05 advanced illness. Age 66+ as of 2026-12-31? Age 75, so yes. Both frailty and advanced illness documented during measurement year. So exclusion E4 applies. Excluded.
5. 71115 DOB 1979-09-19. Age 47. Eligible age.
Enrollment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days. So eligible.
Screening: 2016-12-23 colonoscopy. Window for colonoscopy: 2017-01-01? Wait N5: during 2026 or the nine years prior (ten-year window). That is 2017-01-01 to 2026-12-31? Let's compute: 2026-12-31 minus 9 years = 2017-12-31? No, "nine years prior" from 2026 includes 2026-12-31 back to 2017-01-01? Actually "during 2026 or the nine years prior (ten-year window)" means 10-year window ending 2026-12-31, i.e., 2017-01-01 to 2026-12-31. However, if inclusive, 2026 minus 9 = 2017. So 2017-2026 inclusive is 10 years. 2016-12-23 is outside. So no numerator.
Exclusions: frailty documented 2026-07-07, advanced illness documented 2026-02-06. Age 47 <66. E4 only applies if age >=66. So E4 not applicable. No cancer, no colectomy, no hospice. So not excluded. Non_compliant.
But wait: Is frailty alone or advanced illness alone excluding? E4 requires both AND age >=66. Since age <66, not excluded.
6. 71116 DOB 1976-01-11. Age 50. Eligible.
Enrollment: Jan 1 - Mar 16; Apr 21 - Dec 31. One gap of 35 days. Eligible.
Screening: 2023-01-09 stool DNA test. Window for stool DNA (N2): 2024-2026? Wait N2: Stool DNA during 2026 or the two years prior (three-year window). That is 2024-01-01 to 2026-12-31. 2023-01-09 is outside. So no numerator.
No exclusions. Non_compliant.
7. 71117 DOB 1963-09-02. Age 63. Eligible age.
Enrollment: Jan 1 - Jun 2; Jul 18 - Dec 31. One gap. Record says gap of 45 days. Let's verify: Jun 3 to Jul 17 inclusive = how many days? June has 30 days, so June 3-30 = 28 days; July 1-17 = 17 days; total = 45. Yes. So eligible.
Screening: 2026-01-11 stool DNA test. Window for stool DNA: three-year window 2024-01-01 to 2026-12-31. 2026-01-11 is within. So numerator N2 met. Compliant.
Exclusions: none.
8. 71118 DOB 1979-03-23. Age 47. Eligible.
Enrollment: Jan 1 - Jun 14; Jul 27 - Dec 31. One gap of 42 days. Eligible.
Screening: 2021-11-12 flexible sigmoidoscopy (5-year window: 2022-01-01 to 2026-12-31). Outside. 2022-07-04 flexible sigmoidoscopy. Also outside? 2022-07-04 is within 2022-2026? Yes, 2022-07-04 is on or after 2022-01-01 and on or before 2026-12-31. N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). 2022-07-04 is within the five-year window (2017? Let's compute: 2026 minus 4 years = 2022. So window is 2022-01-01 to 2026-12-31). 2022-07-04 falls inside. So compliant via N3.
No exclusions. Compliant.
9. 71119 DOB 1950-03-25. Age 76. Not eligible (age >75). Not_eligible.
Even if they had screening, age fails. Enrollment continuous. But not_eligible due to age.
10. 71120 DOB 1951-03-21. Age 75. Eligible age.
Enrollment continuous. Eligible.
Screening: none.
Other history: 2026-02-01 advanced illness (heart failure, I50.22). Age >=66. But frailty is not documented. E4 requires BOTH frailty and advanced illness. Advanced illness alone does not exclude. So E4 NOT met. No other exclusions. So non_compliant.
11. 71121 DOB 1971-08-17. Age 55. Eligible age.
Enrollment: Jan 1 - Mar 21; Apr 19 - Jul 6; Jul 22 - Dec 31. Gaps of 28 and 15 days. That's two gaps. Spec says no more than one gap. So not eligible due to enrollment.
Screening: 2026-02-22 CT colonography. But not eligible anyway.
Other: none. not_eligible.
12. 71122 DOB 1954-09-15. Age 72. Eligible age.
Enrollment: Mar 22 - Dec 31 continuous. Not enrolled before Mar 22. Gap Jan 1 - Mar 21 = 80 days. >45 days. Not eligible.
Other: frailty + advanced illness. Age >=66. But not in eligible population due to enrollment. So not_eligible.
13. 71123 DOB 1959-03-08. Age 67. Eligible age.
Enrollment: Jan 1 - Feb 23; Mar 9 - Jun 27; Jul 23 - Dec 31. Gaps of 13 and 25 days. Two gaps. Not eligible.
Other: none. not_eligible.
14. 71124 DOB 1960-08-15. Age 66. Eligible age.
Enrollment continuous. Eligible.
Screening: 2026-04-15 flexible sigmoidoscopy. N3: within 2026. So compliant.
Exclusions: none. Compliant.
15. 71125 DOB 1950-05-08. Age 76. Not eligible due to age.
Enrollment continuous.
Screening: 2026-04-02 FIT. Not eligible anyway.
not_eligible.
16. 71126 DOB 1981-12-20. Age 45 on 2026-12-31? Let's compute: 2026-12-31 minus 1981-12-20 = 45 years, 11 days. Age 45. Not eligible (must be 46-75). Not_eligible.
Enrollment: Mar 17 - Dec 31. Not full year anyway.
not_eligible.
17. 71127 DOB 1981-01-14. Age 45. 2026-1981 = 45 (birthday Jan 14 before Dec 31). Age 45. Not eligible.
Enrollment: Jan 1 - Jun 25; Jul 20 - Dec 31. One gap of 24 days. But age <46. Not_eligible.
Screening: 2024-12-13 stool DNA test. Not eligible anyway.
18. 71128 DOB 1951-12-10. Age 75. Eligible age.
Enrollment continuous. Eligible.
Screening: 2020-02-10 CT colonography (outside 5-year window 2022-2026). 2026-08-17 stool DNA test (within three-year window 2024-2026). So compliant via N2.
Exclusions: none. Compliant.
19. 71129 DOB 1959-07-23. Age 67. Eligible age.
Enrollment continuous. Eligible.
Screening: 2023-07-08 flexible sigmoidoscopy (within 5-year window 2022-2026). 2023-09-13 CT colonography (also within 5-year). So compliant via N3 or N4.
Exclusions: none. Compliant.
20. 71130 DOB 1981-09-13. Age 45 on 2026-12-31? 2026-1981=45. Born Sep 13, before Dec 31, so age 45. Not eligible due to age.
Enrollment: May 16 - Dec 31. Not eligible.
Other: 2024-11-25 diagnosis C18.7. But not eligible anyway. not_eligible.
21. 71131 DOB 1950-05-05. Age 76. Not eligible.
Enrollment: Apr 12 - Dec 31. Not eligible anyway.
Screening: 2026-09-20 CT colonography. Not eligible. not_eligible.
22. 71132 DOB 1950-02-01. Age 76. Not eligible.
Enrollment Jan 1 - Apr 19; May 26 - Dec 31. One gap of 36 days. Age >75. not_eligible.
Other: 2019 C18.7 cancer. But not eligible anyway.
23. 71133 DOB 1967-01-22. Age 59. Eligible.
Enrollment continuous. Eligible.
Screening: 2021-04-12 CT colonography (outside 5-year window 2022-2026). 2021-09-09 CT colonography (also outside). So no numerator.
Exclusions: none. Non_compliant.
24. 71134 DOB 1981-09-26. Age 45. Not eligible.
Enrollment continuous. But age <46. not_eligible.
Other: 2023-04-23 total colectomy. Not eligible anyway.
25. 71135 DOB 1971-08-26. Age 55. Eligible.
Enrollment continuous. Eligible.
Screening: 2016-11-12 colonoscopy. Ten-year window: 2017-01-01 to 2026-12-31. 2016-11-12 outside. No numerator.
Exclusions: none. Non_compliant.
26. 71136 DOB 1981-11-11. Age 45. Not eligible.
Enrollment: Jan 1 - Jul 1; Aug 11 - Dec 31. One gap 40 days. Age <46. not_eligible.
Other: advanced illness. But not eligible anyway.
Now we need to double-check everything. Let's ensure ages are correct.
Age as of 2026-12-31:
71111: 1971 -> 55. Good.
71112: 1954 -> 72. Good.
71113: 1979 -> 47. Good.
71114: 1951 -> 75. Good.
71115: 1979 -> 47. Good.
71116: 1976 -> 50. Good.
71117: 1963 -> 63. Good.
71118: 1979 -> 47. Good.
71119: 1950 -> 76. Good.
71120: 1951 -> 75. Good.
71121: 1971 -> 55. Good.
71122: 1954 -> 72. Good.
71123: 1959 -> 67. Good.
71124: 1960 -> 66. Good.
71125: 1950 -> 76. Good.
71126: 1981 -> 45. Good.
71127: 1981 -> 45. Good.
71128: 1951 -> 75. Good.
71129: 1959 -> 67. Good.
71130: 1981 -> 45. Good.
71131: 1950 -> 76. Good.
71132: 1950 -> 76. Good.
71133: 1967 -> 59. Good.
71134: 1981 -> 45. Good.
71135: 1971 -> 55. Good.
71136: 1981 -> 45. Good.
Now enrollment:
Continuous enrollment: full measurement year with no more than one gap of up to 45 days.
For those with enrollment periods given as "2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01." That means the gap is from 2026-01-01 to 2026-04-30 inclusive? Let's count days. 2026 is not a leap year. Jan 31, Feb 28, Mar 31, Apr 30 = 120 days. So definitely not eligible. So 71111, 71122, 71126, 71130, 71131 are all not eligible due to enrollment gap >45. Many also fail age anyway.
Wait 71126 age 45, both fail. 71130 age 45 and gap. 71131 age 76 and gap.
Now 71127: enrollment Jan 1 - Jun 25; Jul 20 - Dec 31. One gap of 24 days. Age 45, fails age. Not eligible.
71136: age 45, fails age anyway.
71121: two gaps. Not eligible.
71123: two gaps. Not eligible.
71132: age 76 fails age.
71115: one gap 35 days. Good.
71116: one gap 35 days. Good.
71117: one gap 45 days. Good.
71118: one gap 42 days. Good.
Now we need to ensure the exact dates of screenings for numerator windows. Let's carefully compute each eligible member.
Eligible members: those in age 46-75 and continuous enrollment.
List of members potentially eligible:
71111 age 55 but enrollment gap >45. Not eligible.
71112 age 72, continuous. Eligible.
71113 age 47, continuous. Eligible. (Excluded due to cancer.)
71114 age 75, continuous. Eligible. (Excluded due to E4.)
71115 age 47, one gap 35. Eligible.
71116 age 50, one gap 35. Eligible.
71117 age 63, one gap 45. Eligible.
71118 age 47, one gap 42. Eligible.
71119 age 76. Not eligible.
71120 age 75, continuous. Eligible.
71121 two gaps. Not eligible.
71122 age 72, enrollment gap >45. Not eligible.
71123 two gaps. Not eligible.
71124 age 66, continuous. Eligible.
71125 age 76. Not eligible.
71126 age 45, gap. Not eligible.
71127 age 45, gap. Not eligible.
71128 age 75, continuous. Eligible.
71129 age 67, continuous. Eligible.
71130 age 45, gap. Not eligible.
71131 age 76, gap. Not eligible.
71132 age 76, gap. Not eligible.
71133 age 59, continuous. Eligible.
71134 age 45. Not eligible.
71135 age 55, continuous. Eligible.
71136 age 45, gap. Not eligible.
So eligible population (denominator before exclusions) = members: 71112, 71113, 71114, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135. That's 13 members.
Wait, did we miss any? Let's check all 26.
1. 71111 not_eligible.
2. 71112 eligible.
3. 71113 eligible.
4. 71114 eligible.
5. 71115 eligible.
6. 71116 eligible.
7. 71117 eligible.
8. 71118 eligible.
9. 71119 not_eligible (age).
10. 71120 eligible.
11. 71121 not_eligible (2 gaps).
12. 71122 not_eligible (gap too big).
13. 71123 not_eligible (2 gaps).
14. 71124 eligible.
15. 71125 not_eligible (age).
16. 71126 not_eligible (age + gap).
17. 71127 not_eligible (age).
18. 71128 eligible.
19. 71129 eligible.
20. 71130 not_eligible (age + gap).
21. 71131 not_eligible (age + gap).
22. 71132 not_eligible (age + gap).
23. 71133 eligible.
24. 71134 not_eligible (age).
25. 71135 eligible.
26. 71136 not_eligible (age + gap).
Count eligible = 13. Denominator = eligible minus exclusions.
Now exclusions among eligible:
E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31.
- 71113 has diagnosis C18.7 on 2025-07-17. So excluded.
- Any others? 71132 has C18.7 but not eligible. 71130 has C18.7 but not eligible. So among eligible, only 71113.
E2: Total colectomy any time on or before 2026-12-31.
- 71134 has total colectomy but not eligible. No eligible members have colectomy. So none.
E3: Hospice at any time during measurement year.
- None.
E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
- 71114: age 75, frailty documented 2026-12-17, advanced illness documented 2026-05-05. Both during measurement year. So excluded.
- 71120: age 75, advanced illness documented 2026-02-01, but no frailty. Not excluded.
- 71124: age 66, no frailty or advanced illness.
- 71128: age 75, no frailty or advanced illness.
- 71129: age 67, no frailty or advanced illness.
- 71122: not eligible. But if eligible, has both frailty and advanced illness and age 72. But enrollment gap, so not eligible.
- 71115: age 47 <66. Not relevant.
Any other eligible members with both? 71112 no. 71115 no. 71116 no. 71117 no. 71118 no. 71133 no. 71135 no.
So exclusions among eligible: 71113 (E1), 71114 (E4). Total excluded = 2.
Therefore denominator = 13 - 2 = 11.
Now numerator among denominator (eligible, not excluded). Need to check if any exclusion member also has numerator; but spec says if meets both exclusion and numerator, excluded, not compliant. So we count only compliant members among denominator.
Denominator members = eligible not excluded:
From eligible list remove 71113 and 71114.
Remaining: 71112, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135.
Now check numerator for each:
N1. FIT or FOBT during 2026.
N2. Stool DNA during 2026 or two years prior (2024-01-01 to 2026-12-31).
N3. Flexible sigmoidoscopy during 2026 or four years prior (2022-01-01 to 2026-12-31).
N4. CT colonography during 2026 or four years prior (2022-01-01 to 2026-12-31).
N5. Colonoscopy during 2026 or nine years prior (2017-01-01 to 2026-12-31).
71112: no screening. Non_compliant.
71115: colonoscopy 2016-12-23. Outside 2017-01-01+ window. No other screening. Non_compliant.
71116: stool DNA 2023-01-09. Outside N2 window (starts 2024-01-01). Non_compliant.
71117: stool DNA 2026-01-11. Within N2 (2026). Compliant.
71118: flexible sigmoidoscopy 2021-11-12 (outside 2022 window). flexible sigmoidoscopy 2022-07-04 (within N3 window). Compliant.
71120: no screening. Non_compliant.
71124: flexible sigmoidoscopy 2026-04-15. Within N3. Compliant.
71128: CT colonography 2020-02-10 (outside 2022 window). Stool DNA 2026-08-17 (within N2). Compliant.
71129: flexible sigmoidoscopy 2023-07-08 (within N3). CT colonography 2023-09-13 (within N4). Compliant.
71133: CT colonography 2021-04-12 (outside 2022). 2021-09-09 (outside). No other. Non_compliant.
71135: colonoscopy 2016-11-12 (outside 2017-01-01 window). Nojson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,031 tokens
We need to evaluate each member against QM-CRC measure for 2026.
Spec:
- 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 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 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).
- Exclusions (E1-E4), evaluated only for members in eligible population (i.e., meet age and enrollment). A member not eligible is not_eligible even if exclusion criteria also met. A member who meets both exclusion and numerator is excluded.
- 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 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year (2026). Both must be present in 2026.
Let's evaluate each member.
Member 71111:
- DOB 1971-04-18. Age on 2026-12-31 = 55. (Eligible age 46-75: yes).
- Enrollment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. This means not enrolled for Jan-Apr 2026. The requirement is continuous enrollment for full measurement year with no more than one gap up to 45 days. Here there is a gap from 2026-01-01 to 2026-04-30 (approx 120 days). That's >45 days, and also not continuous from start. Also "continuous from that date" but there is a prior gap of >45 days. Not continuous for full year. So not eligible due to enrollment.
- Since not eligible, not_eligible regardless of other factors. Let's confirm: age meets, enrollment fails. So not_eligible.
- No need to check exclusions or numerator. But for completeness: screening history: 2023-11-04 Stool DNA (outside N2 window? N2 is 2024-2026, so 2023 no). 2025-01-02 Colonoscopy (N5 window 2017-2026, yes). But not eligible.
- Not eligible.
Member 71112:
- DOB 1954-02-14. Age 72. Yes.
- Enrollment: continuous full year, no gaps. Yes.
- Exclusions: No CRC, no colectomy, no hospice, no frailty/illness. No exclusions.
- Numerator: No screening on record. So no numerator.
- Thus eligible, denominator, non_compliant.
Member 71113:
- DOB 1979-02-27. Age 47. Yes.
- Enrollment: continuous full year, no gaps. Yes.
- Exclusions: Diagnosis C18.7 on 2025-07-17. E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. Yes, C18.7 qualifies.
- So excluded (E1). Even though there are screenings (CT colonography 2020 outside N4 window (2022-2026); flexible sigmoidoscopy 2025-11-08 within N3 window (2022-2026). But excluded takes precedence. Excluded.
Member 71114:
- DOB 1951-11-18. Age 75. Yes.
- Enrollment: continuous full year.
- Exclusions: Age 66+ (75). Frailty documented 2026-12-17 (gait abnormality). Advanced illness documented 2026-05-05 (heart failure, I50.22). Both documented during measurement year 2026. So E4 applies.
- So excluded (E4).
- Numerator: 2021-12-07 CT colonography (outside N4 window 2022-2026). So not numerator anyway. But excluded.
Member 71115:
- DOB 1979-09-19. Age 47. Yes.
- Enrollment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. Gap: 2026-07-17 to 2026-08-20 inclusive? Let's compute days. Start of gap is day after 07-16 = 07-17. End of gap is day before 08-21 = 08-20. Number of days in gap: from July 17 to August 20 inclusive? The spec says gap of up to 45 days. Usually gap is measured as days between enrollment segments. Let's calculate precisely.
The first segment ends 2026-07-16. The next starts 2026-08-21. The gap in days = (start date of next - end date of previous - 1). So 2026-08-21 minus 2026-07-16 = 36 days. Then minus 1 = 35 days? Actually if you are enrolled through 07-16 and then from 08-21, the days not enrolled are 07-17, 07-18, ..., 08-20. Let's count: July has 31 days. July 17-31 = 15 days (17,18,19,20,21,22,23,24,25,26,27,28,29,30,31) = 15. August 1-20 = 20 days. Total = 35 days. So gap is 35 days. That is ≤45 days. The requirement is full measurement year with no more than one gap of up to 45 days. The first gap is the only gap, and starts at beginning? Wait, is there a gap at the beginning? The member is enrolled from 2026-01-01. So no gap at start. The gap is 35 days. So enrollment qualifies.
Wait: the spec says "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 measurement year, but can have a single gap up to 45 days. So 35-day gap is okay.
Thus eligible.
- Exclusions: Frailty documented 2026-07-07. Advanced illness documented 2026-02-06 (heart failure). Age is 47, which is <66. So E4 requires age 66+. Thus E4 does NOT apply. No CRC, no colectomy, no hospice.
- Numerator: Colonoscopy 2016-12-23. N5 window: 2017-01-01 to 2026-12-31. 2016-12-23 is just before 2017-01-01. So it's outside the ten-year window. No other screening. So does not meet numerator.
- Thus non_compliant.
Member 71116:
- DOB 1976-01-11. Age 50. Yes.
- Enrollment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. Gap: 03-17 to 04-20. Count days: March 17-31 = 15 days. April 1-20 = 20 days. Total = 35 days. ≤45. Only one gap. So eligible.
- Exclusions: None.
- Numerator: 2023-01-09 Stool DNA test. N2 window: 2024-01-01 to 2026-12-31. 2023 is outside. No other screening. So no numerator.
- Thus non_compliant.
Member 71117:
- DOB 1963-09-02. Age 63. Yes.
- Enrollment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap: 06-03 to 07-17. June 3-30 = 28 days. July 1-17 = 17 days. Total = 45 days. ≤45. Only one gap. So eligible.
- Exclusions: None.
- Numerator: 2026-01-11 Stool DNA test. N2 window includes 2026. So meets N2.
- Thus compliant.
Member 71118:
- DOB 1979-03-23. Age 47. Yes.
- Enrollment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. Gap: 06-15 to 07-26. June 15-30 = 16 days. July 1-26 = 26 days. Total = 42 days. ≤45. Only one gap. So eligible.
- Exclusions: None.
- Numerator: Flexible sigmoidoscopy 2021-11-12 and 2022-07-04. N3 window: 2022-01-01 to 2026-12-31. 2021-11-12 is outside. 2022-07-04 is inside. So meets N3.
- Thus compliant.
Member 71119:
- DOB 1950-03-25. Age 76. Age must be 46-75 as of 2026-12-31. 76 > 75. So not eligible.
- Enrollment: continuous full year. But age fails.
- Not eligible.
Member 71120:
- DOB 1951-03-21. Age 75. Yes.
- Enrollment: continuous full year.
- Exclusions: Advanced illness documented 2026-02-01 (heart failure). Age 75 (≥66). But E4 requires both frailty AND advanced illness during measurement year. Only advanced illness, no frailty. So E4 does not apply. No CRC, no colectomy, no hospice.
- Numerator: No colorectal screening on record. So non_compliant.
Member 71121:
- DOB 1971-08-17. Age 55. Yes.
- Enrollment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps: 03-22 to 04-18 (28 days), and 07-07 to 07-21 (15 days). Two gaps. Requirement: no more than one gap of up to 45 days. Two gaps > not eligible.
- Not eligible.
- (Even if eligible, has CT colonography 2026-02-22 which is in N4 window, but enrollment fails.)
Member 71122:
- DOB 1954-09-15. Age 72. Yes.
- Enrollment: 2026-03-22 through 2026-12-31. Not enrolled before 2026-03-22. So gap from 01-01 to 03-21. That's 80 days (Jan 1-31 = 31, Feb 1-28 = 28, Mar 1-21 = 21 => 80). >45 days. Not full measurement year enrollment. Not eligible.
- Not eligible.
Member 71123:
- DOB 1959-03-08. Age 67. Yes.
- Enrollment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps: 02-24 to 03-08 (13 days), 06-28 to 07-22 (25 days). Two gaps. Not eligible.
- Not eligible.
Member 71124:
- DOB 1960-08-15. Age 66. Yes.
- Enrollment: continuous full year, no gaps. Yes.
- Exclusions: None.
- Numerator: 2026-04-15 Flexible sigmoidoscopy. N3 window includes 2026. So compliant.
Member 71125:
- DOB 1950-05-08. Age 76. >75. Not eligible.
- Not eligible.
Member 71126:
- DOB 1981-12-20. Age 45. <46. Not eligible.
- Not eligible.
Member 71127:
- DOB 1981-01-14. Age 45. <46. Not eligible.
- Not eligible.
Member 71128:
- DOB 1951-12-10. Age 75. Yes.
- Enrollment: continuous full year.
- Exclusions: None.
- Numerator: 2026-08-17 Stool DNA test. N2 window includes 2026. So compliant.
- Also CT colonography 2020-02-10 outside N4 window.
Member 71129:
- DOB 1959-07-23. Age 67. Yes.
- Enrollment: continuous full year.
- Exclusions: None.
- Numerator: 2023-07-08 Flexible sigmoidoscopy. N3 window: 2022-01-01 to 2026-12-31. Yes, within. 2023-09-13 CT colonography also within N4. So compliant.
Member 71130:
- DOB 1981-09-13. Age 45. <46. Not eligible.
- Not eligible.
- (Even though enrollment from 2026-05-16, age fails.)
Member 71131:
- DOB 1950-05-05. Age 76. >75. Not eligible.
- Enrollment from 2026-04-12. Both age and enrollment fail. But age alone makes not eligible. Not eligible.
Member 71132:
- DOB 1950-02-01. Age 76. >75. Not eligible.
- Enrollment: 2026-01-01 through 2026-04-19; 2026-05-26 through 2026-12-31. One gap of 36 days. But age >75. So not eligible.
- Not eligible.
Member 71133:
- DOB 1967-01-22. Age 59. Yes.
- Enrollment: continuous full year.
- Exclusions: None.
- Numerator: CT colonography 2021-04-12 and 2021-09-09. N4 window: 2022-01-01 to 2026-12-31. Both are in 2021, before window. No other screening. So no numerator.
- Non_compliant.
Member 71134:
- DOB 1981-09-26. Age 45. <46. Not eligible. Enrolled full year.
- Not eligible.
- Note: Total colectomy 2023-04-23 (E2). Since not eligible, status not_eligible.
Member 71135:
- DOB 1971-08-26. Age 55. Yes.
- Enrollment: continuous full year.
- Exclusions: None.
- Numerator: 2016-11-12 Colonoscopy. N5 window: 2017-01-01 to 2026-12-31. 2016-11-12 is outside. No other screening. So non_compliant.
Member 71136:
- DOB 1981-11-11. Age 45. <46. Not eligible.
- Enrollment: 2026-01-01 through 2026-07-01; 2026-08-11 through 2026-12-31. One gap of 40 days (July 2 to August 10). But age is 45 (<46). So not eligible.
- Not eligible.
Now let's compile counts.
List all members:
71111: not_eligible
71112: non_compliant
71113: excluded
71114: excluded
71115: non_compliant
71116: non_compliant
71117: compliant
71118: compliant
71119: not_eligible
71120: non_compliant
71121: not_eligible
71122: not_eligible
71123: not_eligible
71124: compliant
71125: not_eligible
71126: not_eligible
71127: not_eligible
71128: compliant
71129: compliant
71130: not_eligible
71131: not_eligible
71132: not_eligible
71133: non_compliant
71134: not_eligible
71135: non_compliant
71136: not_eligible
Now count:
Compliant (numerator): 71117, 71118, 71124, 71128, 71129 = 5 members.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6 members.
Excluded: 71113, 71114 = 2 members.
Not_eligible: the rest. Let's count: 71111,71119,71121,71122,71123,71125,71126,71127,71130,71131,71132,71134,71136. That's 13 members.
Check total: 5+6+2+13 = 26. Correct.
Denominator = compliant + non_compliant = 5 + 6 = 11.
Numerator = 5.
Excluded = 2.
Not_eligible = 13.
Rate = numerator / denominator * 100 = 5 / 11 * 100 = 45.4545... Round half up to one decimal place: 45.5.
Wait, is 5/11 = 0.454545... times 100 = 45.4545... The second decimal is 5, so round up the first decimal from 4 to 5. 45.5. Yes.
Now double-check each ambiguous member carefully.
Member 71111: Enrolled 2026-05-01 to 2026-12-31. The spec says continuous enrollment for the full measurement year with no more than one gap of up to 45 days. Since not enrolled before 2026-05-01, the gap from 01-01 to 04-30 is 120 days. This is not "no more than one gap of up to 45 days". So fails. Not eligible.
Member 71113: Excluded due to C18.7 on 2025-07-17. E1 says "Colorectal cancer (C18-C21) any time on or before 2026-12-31." Yes. So excluded. Good.
Member 71114: Age 75 (>=66). Frailty 2026-12-17. Advanced illness 2026-05-05. Both in measurement year. So E4. Excluded.
Member 71115: Age 47 (<66), so E4 doesn't apply. Gap of 35 days. Eligible. Colonoscopy 2016-12-23. N5 window: 2017-01-01 through 2026-12-31. So 2016-12-23 is outside. Non-compliant.
Member 71116: Age 50. Gap 35 days. Eligible. Stool DNA 2023-01-09. N2 window: 2024-01-01 to 2026-12-31. Outside. Non-compliant.
Member 71117: Age 63. Gap 45 days (06-03 to 07-17). Let's recount: June 3 to June 30: 28 days (3,4,...,30). July 1 to July 17: 17 days. 28+17 = 45. Exactly 45, which is allowed. Eligible. Stool DNA 2026-01-11. Compliant.
Member 71118: Gap 42 days. Eligible. Flexible sigmoidoscopy 2022-07-04. N3 window is 2022-01-01 to 2026-12-31. Yes. Compliant.
Member 71119: Age 76. Not eligible.
Member 71120: Age 75. Advanced illness only, no frailty. No exclusion. No screening. Non-compliant.
Member 71121: Two gaps: 28 days and 15 days. Not eligible.
Member 71122: Enrollment starts 2026-03-22. Gap from 01-01 to 03-21. That's 80 days. Not eligible.
Member 71123: Two gaps: 13 days and 25 days. Not eligible.
Member 71124: Age 66. FIT? No, flexible sigmoidoscopy 2026-04-15. Compliant.
Member 71125: Age 76. Not eligible.
Member 71126: Age 45. Not eligible.
Member 71127: Age 45. Not eligible.
Member 71128: Age 75. Stool DNA 2026-08-17. Compliant.
Member 71129: Age 67. Flexible sigmoidoscopy 2023-07-08. Compliant.
Member 71130: Age 45. Not eligible.
Member 71131: Age 76. Not eligible.
Member 71132: Age 76. Not eligible.
Member 71133: Age 59. CT colonography 2021 (both). N4 window starts 2022. So no numerator. Non-compliant.
Member 71134: Age 45. Not eligible.
Member 71135: Age 55. Colonoscopy 2016-11-12. N5 window starts 2017-01-01. Outside. Non-compliant.
Member 71136: Age 45. Not eligible.
Now check if any member with age >=66 has both frailty and advanced illness:
- 71114: yes (excluded).
- 71115: age 47, no.
- 71122: age 72, has both frailty (2026-10-08) and advanced illness (2026-01-13). But 71122 is not eligible due to enrollment. Since not eligible, we don't evaluate exclusions. Not_eligible.
- 71124: age 66, no frailty/illness.
- 71128: age 75, no frailty/illness.
- 71129: age 67, no.
- 71120: age 75, only advanced illness.
- 71125: age 76, not eligible anyway.
Check E3 (hospice during measurement year): No member has hospice.
Check E2 (total colectomy any time on or before 2026-12-31): 71134 has total colectomy 2023-04-23. But 71134 is age 45, not eligible. So not_eligible.
Check E1 (CRC): 71113 and 71130 and 71132.
- 71113: excluded.
- 71130: age 45, not eligible. Not_eligible.
- 71132: age 76, not eligible. Not_eligible.
All good.
Now verify compliant count:
71117 (Stool DNA 2026)
71118 (Flex sig 2022)
71124 (Flex sig 2026)
71128 (Stool DNA 2026)
71129 (Flex sig 2023)
That's 5.
Non-compliant:
71112 (age 72, no screening)
71115 (age 47, colonoscopy 2016 too old)
71116 (age 50, stool DNA 2023 too old)
71120 (age 75, no screening)
71133 (age 59, CT colonography 2021 too old)
71135 (age 55, colonoscopy 2016 too old)
That's 6.
Excluded:
71113 (CRC)
71114 (frailty+advanced illness age 75)
That's 2.
Not_eligible:
71111 (enrollment gap too large)
71119 (age 76)
71121 (two gaps)
71122 (enrollment gap too large)
71123 (two gaps)
71125 (age 76)
71126 (age 45)
71127 (age 45)
71130 (age 45)
71131 (age 76)
71132 (age 76)
71134 (age 45)
71136 (age 45)
That's 13.
Total 26.
Denominator = 11.
Rate = 5/11*100 = 45.4545... -> 45.5.
Let's format as JSON.
Keys:
"denominator": 11
"numerator": 5
"excluded": 2
"not_eligible": 13
"rate": 45.5
"compliant_members": ["71117","71118","71124","71128","71129"]
"non_compliant_members": ["71112","71115","71116","71120","71133","71135"]
"excluded_members": ["71113","71114"]
"not_eligible_members": ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Should we sort? Not required, but any order is fine. I'll list them in ascending order to be safe.
Double-check date math for 71115 gap:
Enrolled through 2026-07-16. Next starts 2026-08-21. Gap days = (2026-08-21) - (2026-07-16) - 1 = 36 - 1? Actually difference in days between Aug 21 and July 16 is 36 days. Wait, July 16 to Aug 21:
July 16 to July 31 = 15 days (including 17? Let's compute simpler: Aug 21 is the 233rd day of year, July 16 is the 197th day. Difference = 36 days. Then gap days = 36 - 1 = 35 days. Yes.
71116: March 16 to April 21. Mar 16 is day 75. Apr 21 is day 111. Diff = 36. Gap = 35.
71117: June 2 to July 18. June 2 is day 153. July 18 is day 199. Diff = 46. Gap = 45. (Because June 2 enrolled, so off starting June 3. July 18 enrolled, so off through July 17. Count: June has 30 days, so June 3-30 = 28 days. July 1-17 = 17 days. 28+17 = 45. Yes.)
71118: June 14 to July 27. June 14 is day 165. July 27 is day 208. Diff = 43. Gap = 42.
71121: Two gaps.
First: March 21 to April 19. Mar 21 is day 80. Apr 19 is day 109. Diff = 29. Gap = 28.
Second: July 6 to July 22. July 6 is day 187. July 22 is day 203. Diff = 16. Gap = 15.
Two gaps. Not eligible.
71123: Feb 23 to Mar 9. Feb 23 is day 54. Mar 9 is day 68. Diff = 14. Gap = 13.
June 27 to July 23. June 27 is day 178. July 23 is day 204. Diff = 26. Gap = 25.
Two gaps. Not eligible.
71132: Apr 19 to May 26. Apr 19 is day 109. May 26 is day 146. Diff = 37. Gap = 36.
But age 76, so not eligible anyway.
Now, check if any age calculation is off by one? Age as of 2026-12-31.
Formula: 2026 - year of birth, then adjust if month/day after Dec 31. Since it's exactly Dec 31, if DOB is on or before Dec 31, age = 2026 - year. If DOB is after Dec 31 (impossible). So age = 2026 - birth year.
71111: 2026-1971 = 55.
71112: 2026-1954 = 72.
71113: 2026-1979 = 47.
71114: 2026-1951 = 75.
71115: 2026-1979 = 47.
71116: 2026-1976 = 50.
71117: 2026-1963 = 63.
71118: 2026-1979 = 47.
71119: 2026-1950 = 76.
71120: 2026-1951 = 75.
71121: 2026-1971 = 55.
71122: 2026-1954 = 72.
71123: 2026-1959 = 67.
71124: 2026-1960 = 66.
71125: 2026-1950 = 76.
71126: 2026-1981 = 45.
71127: 2026-1981 = 45.
71128: 2026-1951 = 75.
71129: 2026-1959 = 67.
71130: 2026-1981 = 45.
71131: 2026-1950 = 76.
71132: 2026-1950 = 76.
71133: 2026-1967 = 59.
71134: 2026-1981 = 45.
71135: 2026-1971 = 55.
71136: 2026-1981 = 45.
Correct.
Now, any chance that enrollment "continuous from that date" implies that prior gap is not considered? No, the spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So being enrolled starting later in the year is a gap from start of year. That's a gap >45 days (or at least more than allowed). So not eligible.
Wait, for 71111: "Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01." This clearly means not full year.
71122: "Enrolment: 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-22." Not full year.
71126: "Enrolment: 2026-03-17 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-17." Age 45, but also enrollment gap. Not eligible.
71130: "Enrolment: 2026-05-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-16." Age 45, not eligible.
71131: "Enrolment: 2026-04-12 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-12." Age 76, not eligible.
71132: Age 76. Not eligible.
Now, is there any nuance about the "look-back window measured back from 2026-12-31"? N2: Stool DNA test during 2026 or the two years prior (three-year window). That means 2024, 2025, 2026. So 2024-01-01 to 2026-12-31. 71116's test is 2023-01-09, outside. Correct.
N3: Flexible sigmoidoscopy during 2026 or the four years prjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100DeepSeek V4 Flash · DeepSeek16.8s · 6,101 out | 45.1s · 11,622 out | 22.3s · 4,721 out
Reasoning · 4,597 tokens
We need answer JSON only. Need compute measure population. Need be careful. Need place each member. Let's restate spec.
Measure QM-CRC, 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 of up to 45 days. Need interpret "full measurement year with no more than one gap of up to 45 days." Members not enrolled before start? Need continuous enrolment full year means enrolled 2026-01-01 through 2026-12-31 with no more than one gap <=45 days. If first enrolment later, not continuous full year, so not eligible. Need identify.
Numerator: any one by look-back from 2026-12-31:
N1 FIT/FOBT during 2026 (calendar year 2026)
N2 stool DNA during 2026 or two years prior = 2024-01-01 through 2026-12-31? "during 2026 or the two years prior (three-year window)" likely from 2024-01-01 to 2026-12-31.
N3 flex sig during 2026 or four years prior = 2022-01-01 through 2026-12-31 (five-year window).
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 (ten-year window).
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 measurement year.
E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone does not exclude, advanced alone does not exclude.
Need classify each. Let's make table.
Need know age as of 2026-12-31. Use DOB. Age = year difference? Need exact. For date 2026-12-31, age is 2026 - birth year if birthday occurred on or before Dec 31? Actually if DOB Dec 20, 1981, on Dec 31 2026 turned 45. For DOB Dec 10 1951, turned 75. For DOB Feb 1 1950, turned 76. Good.
Eligible age 46-75 inclusive. So 45 not eligible, 76 not eligible.
Continuous enrolment: Need define "full measurement year with no more than one gap of up to 45 days." We need count gaps. If enrolled from later date, not full year; not eligible. If has one gap <=45 days and otherwise continuous from Jan 1 to Dec 31, eligible. If multiple gaps? Spec says no more than one gap of up to 45 days. If two gaps, not eligible (unless? no). Need identify.
Let's go member by member.
MEMBER 71111. DOB 1971-04-18 -> 55. Enrolment 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. Not continuous full year -> not_eligible. Screening irrelevant. So not_eligible.
MEMBER 71112. DOB 1954-02-14 -> 72. Enrolment full continuous. No screening. No exclusions. Age 72, no frailty/advanced. Eligible, non_compliant. Need E4? no both. So non_compliant.
MEMBER 71113. DOB 1979-02-27 -> 47. Enrolment full continuous. Screening: 2020 CT colonography (outside 5-year window? window 2022-2026, so no), 2025-11-08 flex sig (within 2022-2026, yes numerator N3). Other: 2025-07-17 diagnosis C18.7 colorectal cancer (E1). Exclusion before numerator; member in eligible population meets E1, so excluded, not compliant. Even though numerator met, excluded. So excluded.
MEMBER 71114. DOB 1951-11-18 -> 75. Enrolment full continuous. Screening: 2021-12-07 CT colonography (outside window 2022-2026? Actually 2021-12-07 before 2022, not in five-year window; no). Other: 2026-12-17 frailty, 2026-05-05 advanced illness. Age 75 >=66, both frailty and advanced illness documented during measurement year -> E4 exclusion. Eligible, excluded. Even if no numerator. Excluded.
MEMBER 71115. DOB 1979-09-19 -> 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap 35 days (July 17 to Aug 20 inclusive? 35 days). Continuous full year except one gap <=45 -> eligible. Screening: 2016-12-23 colonoscopy. Look-back for colonoscopy ten-year window 2017-01-01 through 2026-12-31. 2016-12-23 is before 2017, so not numerator. Other: frailty 2026-07-07, advanced illness 2026-02-06. Age 47 <66, so E4 not apply. No colorectal cancer/colectomy/hospice. So eligible, non_compliant. Need check colonoscopy date 2016-12-23: "during 2026 or the nine years prior" from 2026-12-31 back 9 years = 2017-12-31? Wait careful! Need parse look-back windows. "during 2026 or the nine years prior (ten-year window)" measured back from 2026-12-31. Ten-year window: 2017-01-01 through 2026-12-31? Let's think. If measurement date is 2026-12-31, ten years prior = 2016-12-31? Actually "during 2026 or the nine years prior" means calendar years 2026, 2025, ..., 2017? Nine years prior to 2026 are 2017 through 2025 inclusive. So window 2017-01-01 to 2026-12-31. Yes. 2016-12-23 outside. Good.
MEMBER 71116. DOB 1976-01-11 -> 50. Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap 35 days (Mar17-Apr20). Eligible. Screening: 2023-01-09 stool DNA. Stool DNA window: 2024-01-01 through 2026-12-31? Wait "during 2026 or the two years prior (three-year window)" = 2024-2026. 2023-01-09 outside. No other. No exclusions. Non_compliant.
MEMBER 71117. DOB 1963-09-02 -> 63. Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap 45 days (June 3 to July 17 inclusive? Let's count: June 3-30 = 28 days, July 1-17 = 17 days, total 45). Eligible. Screening: 2026-01-11 stool DNA. Stool DNA during 2026 -> numerator N2. No exclusions. Compliant.
MEMBER 71118. DOB 1979-03-23 -> 47. Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap 42 days (June15-July26). Eligible. Screening: 2021-11-12 flex sig, 2022-07-04 flex sig. Flex sig window 2022-2026. 2022-07-04 qualifies. No exclusions. Compliant.
MEMBER 71119. DOB 1950-03-25 -> 76. Age 76, not eligible (age out). Even if continuous and screening, not_eligible. Need note no exclusions. So not_eligible.
MEMBER 71120. DOB 1951-03-21 -> 75. Enrolment full continuous. Screening none. Other: advanced illness only 2026-02-01. Age 75, but E4 requires both frailty and advanced illness. Frailty absent, so no exclusion. No cancer/colectomy/hospice. Eligible, non_compliant.
MEMBER 71121. DOB 1971-08-17 -> 55. Enrolment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days. That's two gaps. Spec: no more than one gap. So not continuous eligible. Not_eligible. Screening 2026-02-22 CT colonography qualifies but doesn't matter. Not_eligible.
MEMBER 71122. DOB 1954-09-15 -> 72. Enrolment: 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before. Not full year -> not_eligible. Other frailty/advanced irrelevant. Not_eligible.
MEMBER 71123. DOB 1959-03-08 -> 67. Enrolment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days. Two gaps -> not eligible? Need "no more than one gap" so two gaps disqualifies. Not_eligible. Screening none. Not_eligible.
MEMBER 71124. DOB 1960-08-15 -> 66. Enrolment full continuous. Screening: 2026-04-15 flex sig within 2026 -> numerator. No exclusions. Compliant. Age 66 but no frailty/advanced. Compliant.
MEMBER 71125. DOB 1950-05-08 -> 76. Age 76, not eligible. Even though FIT 2026. Not_eligible.
MEMBER 71126. DOB 1981-12-20 -> 45. Age 45, not eligible. Enrolment later anyway. Not_eligible.
MEMBER 71127. DOB 1981-01-14 -> 45. Age 45, not eligible. Enrolment one gap 24 days but age fails. Not_eligible.
MEMBER 71128. DOB 1951-12-10 -> 75. Enrolment full continuous. Screening: 2020-02-10 CT colonography outside window; 2026-08-17 stool DNA within 2026 -> numerator. No exclusions. Compliant.
MEMBER 71129. DOB 1959-07-23 -> 67. Enrolment full continuous. Screening: 2023-07-08 flex sig (within 2022-2026), 2023-09-13 CT colonography (within). Numerator. No exclusions. Compliant.
MEMBER 71130. DOB 1981-09-13 -> 45. Age 45, not eligible. Also cancer, but age fails. Not_eligible.
MEMBER 71131. DOB 1950-05-05 -> 76. Age 76, not eligible. Enrolment later. Not_eligible.
MEMBER 71132. DOB 1950-02-01 -> 76. Age 76, not eligible. Enrolment one gap 36 days but age fails. Not_eligible.
MEMBER 71133. DOB 1967-01-22 -> 59. Enrolment full continuous. Screening: 2021-04-12 CT colonography, 2021-09-09 CT colonography. CT window 2022-2026, both outside. No exclusions. Non_compliant.
MEMBER 71134. DOB 1981-09-26 -> 45. Age 45, not eligible. Also total colectomy 2023, but age fails. Not_eligible.
MEMBER 71135. DOB 1971-08-26 -> 55. Enrolment full continuous. Screening: 2016-11-12 colonoscopy. Colonoscopy window 2017-2026, outside. No exclusions. Non_compliant.
MEMBER 71136. DOB 1981-11-11 -> 45. Age 45, not eligible. Enrolment one gap 40 days but age fails. Not_eligible.
Need check if any member with age 46? No. Need maybe age as of Dec 31 2026 for DOB 1981-12-20: 45th birthday on 2026-12-20, so age 45. Correct.
Need count categories. Let's list all 26 with classifications.
71111 not_eligible
71112 non_compliant
71113 excluded
71114 excluded
71115 non_compliant
71116 non_compliant
71117 compliant
71118 compliant
71119 not_eligible
71120 non_compliant
71121 not_eligible
71122 not_eligible
71123 not_eligible
71124 compliant
71125 not_eligible
71126 not_eligible
71127 not_eligible
71128 compliant
71129 compliant
71130 not_eligible
71131 not_eligible
71132 not_eligible
71133 non_compliant
71134 not_eligible
71135 non_compliant
71136 not_eligible
Need verify 71115: age 47, one gap 35 days, eligible. Screening colonoscopy 2016-12-23 outside. Frailty+advanced but age <66, so no exclusion. non_compliant. Good.
Need verify 71116: one gap 35 days, eligible. Stool DNA 2023-01-09 outside three-year window? Let's precisely define "during 2026 or the two years prior (three-year window)" measured back from 2026-12-31. Could be 2024-01-01 through 2026-12-31. Yes. 2023 not. non_compliant.
Need verify 71117: one gap 45 days, eligible. Stool DNA 2026-01-11 qualifies. compliant.
Need verify 71118: one gap 42 days, eligible. Flex sig 2022-07-04 qualifies. compliant.
Need verify 71121: two gaps, not eligible. Even though one gap 28 and one 15, total? Spec "no more than one gap of up to 45 days" means at most one gap. Two gaps -> not continuous. not_eligible. Good.
Need verify 71123: two gaps, not eligible. Good.
Need verify 71124: age 66, flex sig 2026 qualifies, no E4. compliant.
Need verify 71128: age 75, stool DNA 2026 qualifies. compliant.
Need verify 71129: age 67, flex sig 2023 qualifies. compliant.
Need verify 71133: CT 2021 outside. non_compliant.
Need verify 71135: colonoscopy 2016-11-12 outside 10-year window. non_compliant.
Need verify 71113: flex sig 2025 qualifies but cancer exclusion. excluded. Good.
Need verify 71114: age 75, frailty and advanced illness both documented in 2026 -> excluded. CT 2021 outside anyway. Good.
Need verify 71120: advanced illness only -> not excluded, no screening -> non_compliant. Good.
Need verify 71112: age 72, no screening, no exclusion -> non_compliant.
Need verify 71122: not enrolled full year -> not_eligible. Good.
Need verify 71111: not enrolled full year -> not_eligible. Good.
Need verify 71119, 71125, 71131, 71132: age 76 -> not_eligible. Good.
Need verify 71126, 71127, 71130, 71134, 71136: age 45 -> not_eligible. Good.
Need count.
Let's count compliant: 71117, 71118, 71124, 71128, 71129 = 5. Check 71113 excluded not compliant. 71114 excluded. So numerator 5.
Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135 = 6. Let's ensure 71115 non_compliant yes. 71116 non_compliant yes. 71120 non_compliant yes. 71133 non_compliant yes. 71135 non_compliant yes. 71112 yes. Total 6.
Excluded: 71113, 71114 = 2.
Not_eligible: all others. 26 - 5 - 6 - 2 = 13. Let's list not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Count 13. Also 71119, 71125, 71131, 71132 age 76; 71126, 71127, 71130, 71134, 71136 age 45; 71111, 71122 enrolment; 71121, 71123 multiple gaps. Total 4+5+2+2=13. Good.
Denominator = compliant + non_compliant = 5+6 = 11. After exclusions removed. Eligible population before exclusions = denominator + excluded = 13. But not_eligible 13. Total 26. Denominator 11.
Rate = numerator / denominator * 100 = 5/11 *100 = 45.454545... round half up to one decimal = 45.5. Need output number 45.5.
Need arrays with member IDs as strings. Any order. Need include all members in exactly one list. Let's ensure no duplicates.
Compliant_members: ["71117","71118","71124","71128","71129"]
Non_compliant_members: ["71112","71115","71116","71120","71133","71135"]
Excluded_members: ["71113","71114"]
Not_eligible_members: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Need maybe include 71115 in non_compliant? Let's re-evaluate 71115's colonoscopy date 2016-12-23. If ten-year window from 2026-12-31 back 10 years inclusive might be 2016-12-31? Wait "during 2026 or the nine years prior (ten-year window)" measured back from 2026-12-31. If "nine years prior" to 2026 means years 2017-2025. But if measured back from 2026-12-31 by 10 years, that's 2016-12-31. However the phrase "during 2026 or the nine years prior" strongly indicates calendar years: 2026 plus 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017 = ten calendar years? Wait count: 2026 (1), 2025 (2), 2024 (3), 2023 (4), 2022 (5), 2021 (6), 2020 (7), 2019 (8), 2018 (9), 2017 (10). Yes window 2017-01-01 through 2026-12-31. 2016-12-23 outside. Good.
For stool DNA: "during 2026 or the two years prior (three-year window)" = 2026, 2025, 2024. 2023 outside. Good.
For flex sig/CT: "during 2026 or the four years prior (five-year window)" = 2026, 2025, 2024, 2023, 2022. 2021 outside. Good.
Need maybe N1 "Faecal occult blood test or faecal immunochemical test during 2026" only calendar 2026. Good.
Need think about continuous enrolment "full measurement year with no more than one gap of up to 45 days." For members with one gap, the gap is "up to 45 days" inclusive. 71117 gap 45 days qualifies. 71115 35 qualifies. 71116 35 qualifies. 71118 42 qualifies. 71132 36 qualifies but age fails. 71136 40 but age fails. 71127 24 but age fails. Good.
Need think about "continuous from that date" for 71111, 71122, 71126, 71130, 71131: not enrolled before start. Not full year. Not eligible. Even if 71131 age 76 anyway. Good.
Need think about exclusions evaluated before numerator and only for eligible population. For 71113 and 71114 excluded. For 71130 and 71134 not_eligible despite cancer/colectomy. Good.
Need think about E4: age 66 or older AND both frailty and advanced illness documented during measurement year. For 71114 age 75, frailty 2026-12-17, advanced 2026-05-05 -> excluded. For 71122 age 72, frailty 2026-10-08, advanced 2026-01-13, but not eligible due to enrolment. For 71115 age 47, both but age <66. For 71120 age 75, only advanced. For 71112 no. Good.
Need maybe 71124 age 66 exactly, no frailty/advanced. Not excluded. Good.
Need maybe 71129 age 67, no frailty/advanced. Good.
Need output JSON with required keys exactly. No extra keys. Need ensure "rate" number 45.5 not string. "denominator" integer 11, "numerator" 5, "excluded" 2, "not_eligible" 13.
Need maybe "denominator" after exclusions removed? Definition says denominator = members in eligible population after exclusions removed (compliant + non_compliant). Yes 11.
Need maybe "eligible population" includes excluded? The task says denominator after exclusions removed. So denominator 11.
Let's double-check all member IDs are strings with leading? IDs are "71111" etc. Use strings.
Need perhaps include 71113 in excluded_members even though numerator met. Yes.
Need perhaps include 71114 in excluded_members. Yes.
Need maybe 71115 non_compliant because colonoscopy 2016-12-23 not within 10-year window. But wait if "ten-year window" measured back from 2026-12-31 is 2016-12-31 to 2026-12-31, then 2016-12-23 is outside by 8 days. Still outside. Good.
Need maybe 71135 colonoscopy 2016-11-12 outside. Good.
Need maybe 71133 CT colonography 2021-04-12 and 2021-09-09 outside. Good.
Need maybe 71116 stool DNA 2023-01-09 outside. Good.
Need maybe 71118 flex sig 2021-11-12 outside, 2022-07-04 inside. Good.
Need maybe 71113 flex sig 2025-11-08 inside but excluded. Good.
Need maybe 71128 CT 2020 outside, stool DNA 2026 inside. Good.
Need maybe 71129 flex sig 2023-07-08 inside. Good.
Need maybe 71124 flex sig 2026-04-15 inside. Good.
Need maybe 71117 stool DNA 2026-01-11 inside. Good.
Need think if "Faecal immunochemical test" in N1 counts as "faecal occult blood test or faecal immunochemical test" yes. 71125 FIT 2026 but age 76 not eligible. 71132 FIT 2026 but age 76 not eligible. 71130 FIT 2026 but age 45 not eligible. Good.
Need maybe 71111 age 55, no screening, but not eligible. Good.
Need maybe 71121 CT colonography 2026-02-22 qualifies, but two gaps -> not eligible. Good.
Need maybe 71123 no screening, two gaps -> not eligible. Good.
Need maybe 71126 no screening, age 45 -> not eligible. Good.
Need maybe 71127 stool DNA 2024-12-13 within 2024-2026, but age 45 -> not eligible. Good.
Need maybe 71134 flex sig 2023-10-21 within, but age 45 and colectomy -> not eligible. Good.
Need maybe 71136 flex sig 2026-02-13 within, but age 45 -> not eligible. Good.
Need maybe 71119 flex sig 2023-03-04 within, but age 76 -> not eligible. Good.
Need maybe 71131 CT 2026-09-20 within, but age 76 -> not eligible. Good.
Need maybe 71132 FIT 2026-11-15 within, but age 76 -> not eligible. Good.
Need maybe 71125 FIT 2026-04-02 within, but age 76 -> not eligible. Good.
Need maybe 71130 CT 2020 outside, FIT 2026 within, but age 45 -> not eligible. Good.
Need maybe 71122 no screening, not eligible. Good.
Need maybe 71111 no screening, not eligible. Good.
Everything consistent.
Need output exactly one fenced JSON code block and nothing else. Use JSON. Need no comments. Let's craft.
Need ensure "rate" 45.5. 5/11 = 0.454545 *100 = 45.4545, round half up to one decimal = 45.5. Good.
Need maybe "rate" number with one decimal 45.5. Good.
Need arrays in any order. We'll output.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 11,437 tokens
We need answer JSON only. Need compute measure population. Need carefully apply spec. Need no extra text. Let's parse task.
We have measure QM-CRC, 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.
Need for each member: check age as of 2026-12-31 (date of birth to that date). Enrolment continuous no more than one gap <=45 days. Need not_eligible if fails age or enrolment. Exclusions only for eligible population. Exclusions: E1 colorectal cancer C18-C21 any time on/before 2026-12-31. E2 total colectomy any time. E3 hospice at any time during measurement year. E4 age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty alone no; advanced illness alone no. Need note if advanced illness on 2026-01-13 before enrolment? For E4 "documented during measurement year", regardless enrolment? For eligible continuous enrolment? But if enrolment gap/or partial maybe not eligible. Need include.
Numerator: any one by look-back window measured back from 2026-12-31:
N1 FOBT/FIT during 2026 (calendar 2026-01-01 to 2026-12-31? "during 2026").
N2 Stool DNA during 2026 or two years prior (three-year window). So dates from 2024-01-01? Let's think "during 2026 or two years prior (three-year window)" measured back from 2026-12-31. A three-year window likely 2024-01-01 through 2026-12-31? If measured back from end, window = 2024-01-01 to 2026-12-31 inclusive? Actually "during 2026 or the two years prior" means service date Jan 1 2024 through Dec 31 2026, inclusive (three calendar years). For colonoscopy "during 2026 or the nine years prior (ten-year window)" = 2017-01-01 through 2026-12-31? But examples? Need interpret look-back measured back from 2026-12-31. If exact 10 years back from 2026-12-31 would be 2016-12-31 to 2026-12-31, but phrase "during 2026 or the nine years prior" is calendar years: 2026 plus prior 9 calendar years = 2017-2026. Hmm they mention look-back window measured back from 2026-12-31; N5 colonoscopy during 2026 or the nine years prior (ten-year window). For 2023-11-04 stool DNA (not in N1? N1 2026 only; N2 2026 or two years prior => 2024-2026? So 2023 not within N2). Need apply using likely calendar-year ranges: N1 2026; N2 2024-2026; N3 2022-2026? Wait flexible sigmoidoscopy during 2026 or four years prior = 2022-2026 (5-year window). CT colonography same. N5 colonoscopy 2017-2026. But "measured back from 2026-12-31" suggests if service exactly 2017-01-01 is not 10 years back? Let's check: colonoscopy on 2016-12-23: if ten-year window measured back from 2026-12-31 would include 2016-12-23 (within 10 years prior), but "during 2026 or nine years prior" approximates calendar years 2017-2026, excluding 2016. Need determine intended. In HEDIS measure? Colorectal cancer screening typically look-back: colonoscopy during the measurement year or the previous 9 years; flexible sigmoidoscopy in measurement year or previous 4 years; FIT in measurement year; gFOBT in measurement year; FIT-DNA in measurement year or previous 2 years. They use "during 2026 or the X years prior" not exact date, likely calendar-year windows. We should use calendar-year windows: N1 2026; N2 2024-2026; N3 2022-2026; N4 2022-2026; N5 2017-2026. But maybe because age as of end year. Need be careful with members with dates in 2020 etc. But mostly exclusions. We'll determine.
Need categorize every member. Let's create table.
Member list 71111-71136 (26). Need IDs.
I'll process.
Let's define age as of 2026-12-31: age at end. Need age 46-75 inclusive. Compute with birth date.
71111 DOB 1971-04-18 -> 2026-12-31 age 55 (before birthday? born Apr; age 55 yes). enrol 2026-05-01 through 2026-12-31 continuous. Not enrolled before 05/01, so not full measurement year; gap? Actually first enrolment 2026-05-01; not eligible continuous full year. no more than one gap? There is gap from Jan 1-Apr 30? Could be considered gap >45? They say continuous from that date, not enrolled before. Fails continuous enrolment. Not_eligible. Even if screening history includes colonization etc. not relevant.
71112 DOB 1954-02-14 -> age 72 (eligible, 46-75). Enrol continuous full year no gaps. No screening. Need check exclusions: no colorectal cancer, no colectomy, no hospice, no frailty/advanced illness. Not excluded. Numerator no screening => non_compliant. But age 72, E4 requires both frailty and advanced illness; none => no.
71113 1979-02-27 age 47 eligible. Continuous full. Screening: 2020 CT, 2025 flex sig. Diagnosis C18.7 2025-07-17. Exclusion E1 colorectal cancer yes any time on/before 2026-12-31. Since eligible and meets exclusion, excluded even if numerator? Does she meet numerator? Need maybe CT 2020 not in window? "CT colonography during 2026 or four years prior" = 2022-2026, so 2020 no. Flexible sig 2025-11-08 within 2022-2026 yes could meet N3. But exclusion E1 => excluded. Status excluded. Need if exclusion before numerator; correct.
71114 1951-11-18 age 75 eligible. Continuous. Screening CT colonography 2021-12-07. Is it within 2022-2026? No, 2021 not. No other. Exclusions: Age 75, frailty documented 2026-12-17 and advanced illness documented 2026-05-05 during measurement year. Both documented. E4 requires age >=66 AND both frailty and advanced illness documented during MY. Yes. Excluded. Need note E3 none, E1 no. So excluded due E4 even though no numerator maybe. Actually E4 exclusion yes.
71115 1979-09-19 age 47. Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap 35 days (07-17 to 08-20 inclusive? 2026-07-17 to 2026-08-20 = 35? Let's compute: July 17-31 =15 days inclusive? Actually gap excludes 07/16 and 08/21. Days not enrolled: Jul 17,18,...31 (15), Aug 1-20 (20) total 35). Enrolment continuous? Full year with one gap <=45 yes eligible? The spec says continuous enrolment full measurement year with no more than one gap up to 45 days. Two enrolment segments plus one gap of 35: yes, eligible. Screening: colonoscopy 2016-12-23. For N5 window 2017-2026, no. no other. Exclusions: Frailty 2026-07-07 and advanced illness 2026-02-06, but age 47, E4 requires age >=66, so not excluded. E1/E2/E3 no. Numerator no eligible, so non_compliant. Note if colonoscopy from 2016 within 10 years from 2026-12-31 (exact 10 years back) maybe 2016-12-23 is less than 10 years from 2026-12-31? Actually 2016-12-23 to 2026-12-31 = 10 years +8 days? Hmm if "measured back from 2026-12-31", colonoscopy in prior 9? The window "ten-year" would include 2016-12-23 but phrase "during 2026 or the nine years prior" excludes 2016? Need decide. If countable, this member would be numerator compliant. Need evaluate intended. It says look-back window measured back from 2026-12-31. N5: Colonoscopy during 2026 or the nine years prior (ten-year window). Ten-year window ending 2026-12-31 begins 2016-12-31. A service on 2016-12-23 is before 2016-12-31? Wait "prior" perhaps includes all services through 2026-12-31; if exact ten years before is 2016-12-31. Since 2016-12-23 is before 2016-12-31 by 8 days, so outside. Absolute. So no. Good.
71116 1976-01-11 age 50. Enrolment: 2026-01-01 through 03-16; 04-21 through 12-31. Gap 35 days? From 03-17 to 04-20 includes 35? Mar17-31=15, Apr1-20=20 total 35. One gap <=45: eligible. Screening 2023-01-09 stool DNA. N2 window 2024-2026? no. (2023 outside). Exclusions none. Numerator no => non_compliant.
71117 1963-09-02 age 63. Enrolment: 2026-01-01 through 06-02; 07-18 through 12-31. Gap 45 days? Jun3-Jul17: Jun 3-30 28 + Jul1-17 17 =45. Eligible (one gap 45). Screening 2026-01-11 stool DNA -> N2? Stool DNA during 2026 yes. Also N1 FIT? Actually "Stool DNA test" not FIT/FOBT. N1 includes FOBT or FIT; no. N2 yes. So numerator met. Exclusions none. Eligible and compliant. Need note stool DNA not "faecal immunochemical". Yes.
71118 1979-03-23 age 47. Enrolment: 01-01 through 06-14; 07-27 through 12-31. Gap 42 days (Jun15-Jul26: Jun15-30 16 + Jul1-26 26 =42) eligible. Screening: 2021-11-12 flexible sig; 2022-07-04 flexible sig. N3 window 2022-2026 includes 2022-07-04, yes. Exclusions none. Compliant.
71119 1950-03-25 age 76. Age >75, not_eligible. Even continuous. Screening flex sig 2023; but age fails. Not_eligible.
71120 1951-03-21 age 75. Enrol eligible. Screening none. Other: advanced illness 2026-02-01 only. As age >=66 but only advanced illness, not both, not E4. Other exclusions no. Numerator no -> non_compliant.
71121 1971-08-17 age 55. Enrolment: 1/1-3/21; 4/19-7/6; 7/22-12/31. Gaps 28 and 15 days. Need continuous enrolment full measurement year with no more than one gap of up to 45 days. This has two gaps (one gap? Actually two gaps). Specification says "no more than one gap of up to 45 days" so two gaps even each under 45 not allowed. Thus not eligible. Need not_eligible. Wait the definition from task says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That means at most one gap total. So 71121 fails due two gaps. Could there be "no more than one gap" means only one gap, so not_eligible. Yes. Screening CT 2026-02-22 qualifies but fails age/enrol? age okay but enrollment fails. not_eligible.
71122 1954-09-15 age 72. Enrolment: 2026-03-22 through 12/31, not enrolled before. Missing Jan1-Mar21; not full, not eligible. Could gap at start >? Since no coverage first 80 days, not eligible. Screening none. Frailty 2026-10-08, advanced illness 2026-01-13. But not eligible due enrollment. Not_eligible even though exclusions. Need status not_eligible because fails continuous enrolment. Good.
71123 1959-03-08 age 67. Enrolment: 1/1-2/23; 3/9-6/27; 7/23-12/31. Gaps 13 and 25 = two gaps, so not eligible. Also screening none. Not_eligible due enrollment. We'll note, despite age. Yes.
71124 1960-08-15 age 66. Enrolment continuous full. Screening 2026-04-15 Flexible sigmoidoscopy. Exclusions no. Need E4? age 66; no frailty or advanced illness. Compliant.
71125 1950-05-08 age 76. Age fails >75, not eligible even FIT 2026. Not eligible.
71126 1981-12-20 age 45 (as of 2026-12-31 exactly? Born Dec 20, 1981, turns 45 on Dec 20; eligible if age through 45? Age 45 is below age 46? Eligible age 46-75 as of date, so 45 not eligible). Enrolment from 03/17, not full. Not eligible for two reasons. Screening none. not_eligible.
71127 1981-01-14 age 45. Age fail (45, below 46). Enrolment: one gap 24 days. Even if age fails, not eligible. Screening 2024-12-13 stool DNA not relevant. not_eligible.
71128 1951-12-10 age 75. Enrolment continuous. Screening: 2020-02-10 CT colonography; 2026-08-17 stool DNA test. Need check 2026 stool DNA yes N2. Exclusions none. Compliant.
71129 1959-07-23 age 67. Continuous. Screening 2023-07-08 flexible sig; 2023-09-13 CT colonography. Are they in window? N3/N4 2022-2026 yes both 2023. Compliant. No exclusions.
71130 1981-09-13 age 45. Age fail, not eligible. Enrolment only May 16-Dec 31 also fails. Screening FIT but not eligible. Colorectal C18.7 2024-11-25 would be exclusions but not eligible -> not_eligible. Note E1 actual but not used.
71131 1950-05-05 age 76. Age fail >75. Enrolment not full. Screening CT 2026-09-20, but not eligible. not_eligible.
71132 1950-02-01 age 76. Age fail. Enrolment 01/01-04/19 + 05/26-12/31 gap 36 days one gap, actually eligible? Age fails anyway. Diagnosis C18.7 2019. Not_eligible because age. Need status not_eligible regardless exclusion. yes.
71133 1967-01-22 age 59. Continuous. Screening 2021-04-12 CT and 2021-09-09 CT. N4 window 2022-2026? No, 2021 outside. Does "four years prior" to 2026 maybe includes 2021 if exact? Need decide. If using 5-year window measured back from 2026-12-31, 2021-04-12 is within 5 years (less than 5 years 8.6 months). Actually "during 2026 or the four years prior (five-year window)" calendar range would 2022-2026, but measured back from 2026-12-31 exact five years back = 2021-12-31. A CT colonography on 2021-09-09 falls within 2021-12-31? Wait date 2021-09-09 is before 2021-12-31, so if start 2021-12-31, not including dates before. A service date 2021-09-09 is >5 years prior? From 2026-12-31 back 5 years is 2021-12-31; 2021-09-09 is before that, so 5.3 years, not within. So no. If "five-year window" includes prior 5 calendar years? 2022-2026, no. Thus 71133 non_compliant. Need consider if "during 2026 or the four years prior" includes 2021? "four years prior" to "2026"? 2022-2026 (4 years prior are 2022,2023,2024,2025, plus 2026 = 5 years). The phrase: "2026 or the two years prior (three-year window)" 2024, 2025, 2026. "four years prior" = 2022, 2023, 2024, 2025, plus 2026. So 2021 outside. Yes.
71134 1981-09-26 age 45. Age fail below 46. Enrolment continuous. Screening 2023-10-21 flexible sigmoidoscopy (within 2022-2026 if eligible) but age fail. Other history 2023-04-23 total colectomy. But excluded? Not eligible due age, so not_eligible. Need not exclude. Good.
71135 1971-08-26 age 55. Continuous. Screening 2016-11-12 colonoscopy. N5 window 2017-2026; 2016 outside. No exclusions. Non_compliant.
71136 1981-11-11 age 45. Age fail. Enrolment has gap 40. Screening 2026-02-13 flex sig. Advanced illness only. not_eligible due age.
Need summary counts. Let's list thoroughly.
Need ensure member ID strings "71111" etc.
Let's create table:
71111 not_eligible
71112 non_compliant
71113 excluded
71114 excluded
71115 non_compliant (maybe? Need check age 47. Enrollment with one gap 35 qualifies). yes.
71116 non_compliant
71117 compliant
71118 compliant
71119 not_eligible
71120 non_compliant
71121 not_eligible
71122 not_eligible
71123 not_eligible
71124 compliant
71125 not_eligible
71126 not_eligible
71127 not_eligible
71128 compliant
71129 compliant
71130 not_eligible
71131 not_eligible
71132 not_eligible
71133 non_compliant
71134 not_eligible
71135 non_compliant
71136 not_eligible
Need ensure any eligible exclusions missed: members age eligible continuous:
71112 eligible no exclusion -> non_compliant.
71113 age 47 continuous full -> E1 exclusion.
71114 age75 continuous full -> E4 exclusion.
71115 age47 one gap 35 -> eligible. Frailty and advanced illness but age <66, not exclusion. Colonoscopy 2016-12-23 not in window. Non_compliant.
71116 age50 one gap 35 -> eligible. Stool DNA 2023 outside N2? Let's check if "stool DNA 2023-01-09" and current 2026-12-31, is 3 years 11.7 months; N2 three-year window would start 2024? Yes outside if calendar. But if measured back from 2026-12-31 by 3 years = 2023-12-31, 2023-01-09 outside. Noncompliant. Correct.
71117 eligible colonoscopy? Actually Stool DNA 2026-01-11, N2 yes. compliant.
71118 yes.
71120 eligible non (no screening, only adv illness)
71124 eligible compliant.
71128 eligible compliant.
71129 eligible compliant.
71133 eligible non-compliant. Wait 71133 is age 59, continuous. We decided no screening in window because 2021. Need if "5-year window measured back from 2026-12-31" might include 2021? Let's calculate exact five-year prior date: 2021-12-31 if measurement period ends 2026-12-31. CT 2021-09-09 is before prior date, so outside. But wait if 5 years prior from end date includes 2021 portion after Dec 31? No. If measurement year 2026 and prior four years = 2022-2025, so no. So non.
71135 colonoscopy 2016-11-12 outside N5. Non.
71120 age75, no eligible? only advanced illness, no frailty. noncompliant.
71124 flexible 2026-04-15 compliant.
71128 stool DNA 2026-08-17, CT 2020 not. compliant.
71129 flexible/colonography 2023, within. compliant.
Need count arrays.
Let's count by status.
Compliant IDs: 71117, 71118, 71124, 71128, 71129. Also maybe? 71113 excluded despite sig 2025; no. 71130 not eligible. 71134 not eligible. So 5 compliant.
Non-compliant IDs:
71112, 71115, 71116, 71120, 71133, 71135. Also? 71114 excluded or? Let's check 71114 has CT 2021-12-07; if window 2022-26 no. But exclusion E4 so excluded, yes. Good. 71115 non. 71116 non. 71120 non. 71133 non. 71135 non. Eligible also 711? Did we have any eligible members with no screening not listed? 71129 no, 71128. 71117. Count: eligible (denominator after exclusions) = 5+6=11. Excluded eligible = 71113, 71114. Also any 71120 with advanced only no; no. Total eligible population (denominator before exclusions) = non_ex? Actually eligible population includes exclusions 13? Let's count: eligible after exclusions = denom 11; excluded = 2; eligible population before exclusions = 13. Let's verify total members by list:
Compliant 5
Non 6
Excluded 2
Not_eligible 13? Total 26. 5+6+2 =13 so not_eligible 13. Does that match? Let's list not eligible by member:
71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Count 13.
Let's check 711? Total 26 members 71111-71136 inclusive? 71111,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36. Yes 26. Not eligible:
71111 (not continuous)
71119 (age 76)
71121 (two gaps)
71122 (not continuous)
71123 (two gaps)
71125 (age 76)
71126 (age 45)
71127 (age 45)
71130 (age 45)
71131 (age 76)
71132 (age76)
71134 (age45)
71136 (age45) = 13. Also 711? 770 15 not. Good.
But wait 71111 is age 55, not enrolled before May; if "continuous enrolment: full measurement year with no more than one gap up to 45 days" Could one argue coverage from 2026-05-01 through 2026-12-31 continuous from that date, not enrolled before. This is absence from Jan-Apr (121 days) one gap >45, fails. yes.
Need validate if one gap with covered start Jan 1 and end Dec31 is considered continuous. For 71115/16/17/18, yes. But one gap count: Need confirm gap "of up to 45 days" includes exactly 45. 71117 has 45 exactly yes. Need compute: 2026-06-02 through 2026-07-18? Wait status: "Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days." They tell us one gap of 45 days; allow "up to 45 days" so yes. But if gap includes endpoints, they said. Use given.
Need inspect 71122: Advanced illness date 2026-01-13, but member not enrolled until 2026-03-22. If not eligible, no need. But if continuous enrolment missing maybe not excluded. We correctly not_eligible.
Need ensure "Age: 46 through 75 years as of 2026-12-31." For member 71126 DOB 1981-12-20, age on 2026-12-31 = 45. Yes. For 71127 DOB 1981-01-14 = 45. For 71130 DOB 1981-09-13 = 45. For 71134 DOB 1981-09-26 = 45. For 71136 DOB 1981-11-11 = 45. Not eligible. Good.
But wait 71111 DOB 1971-04-18. In Dec 2026, days before birthday? Since birthday April, after, age 55. Good.
71115 1979-09-19, age 47.
71116 1976-01-11, age 50.
71117 1963-09-02, age 63.
71133 1967-01-22, age 59.
71135 1971-08-26, age 55. Good.
Need count rate = numerator / denominator *100 to one decimal. Numerator 5, denominator 11. Rate = 45.4545..., rounded half up to one decimal: 45.5. Need confirm if numerator=5? If 71115 might be compliant due colonoscopy 10-year "look-back" exact? Need scrutinize lookback window nuance. This could change rate. Let's examine all near-window cases:
- 71115 colonoscopy 2016-12-23. N5 window "during 2026 or the bonus nine years prior (ten-year window)." If exact 10-year look-back from 2026-12-31 includes dates on/after 2016-12-31. 2016-12-23 is before, so no. But phrase "nine years prior" from 2026-12-31? Let's parse exactly "by the look-back window measured back from 2026-12-31: N5. Colonoscopy during 2026 or the nine years prior (ten-year window)." They explicitly say measured back from 2026-12-31. The window should be [2016-12-31, 2026-12-31]. But then "during 2026 or the nine years prior" is a simplification but not necessarily exact calendar-year boundaries: If end date is Dec 31, the preceding nine years from end date would be 2018? Wait careful:
"Nine years prior" to 2026-12-31? A date 9 years prior is 2017-12-31, not 2017-01-01. A ten-year window includes 2017 through 2026 plus one day? Let's think: If a service is "within the past 10 years" on 2026-12-31, you'd include service datjson{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
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"fabricated": false,
"abstained": false
}Reasoning · 4,535 tokens
We need to evaluate each member against QM-CRC measure. Need to determine eligibility, exclusions, numerator.
Age as of 2026-12-31: 46 through 75 inclusive. So members 45 are not eligible.
Enrolment: continuous full measurement year with no more than one gap of up to 45 days. Need to check each member's enrolment.
Numerator: any of the screening tests with look-back.
Exclusions: E1 colorectal cancer (C18-C21) any time on/before 2026-12-31; E2 total colectomy; E3 hospice during measurement year; E4 age 66+ AND both frailty and advanced illness documented during 2026.
Also note: exclusions evaluated before numerator, but only for eligible population. If member fails age/event/enrolment, not_eligible even if exclusion.
Let's go through each member.
Member 71111: DOB 1971-04-18 → age 55 on 2026-12-31. Within 46-75. Enrolment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before 2026-05-01. So missing Jan-Apr. Not full-year continuous enrolment. So fails continuous enrolment? The measure requires full measurement year with no more than one gap up to 45 days. This member not enrolled for part before 2026-05-01, that's a gap? Actually enrolment pattern: not enrolled before 2026-05-01. That's a gap from Jan 1 to Apr 30 (maybe >45 days). Actually continuous enrolment means enrolled the full year; or with no more than one gap up to 45 days. This member has a gap from Jan 1 to Apr 30 ~ 120 days. Not eligible for enrolment. So not_eligible. Even though they have screening. Also frailty only, no advanced illness, so E4 not met anyway (only age 55, not 66+). But not eligible due to enrolment.
MEMBER 71112: age 72, continuous enrolment no gaps. No screening. No exclusions documented. So eligible, no numerator, non_compliant. But check E4? Age 72, frailty and advanced illness both needed. Documented? "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So no exclusion. So non_compliant.
MEMBER 71113: age 47 (DOB 1979-02-27), eligible. Enrolment continuous. History: CT colonography 2020-07-03, flexible sigmoidoscopy 2025-11-08. Also diagnosis C18.7 in 2025-07-17. E1: colorectal cancer any time on or before 2026-12-31. Diagnosis C18.7 (malignant neoplasm sigmoid colon) is colorectal cancer. So excluded. Even if numerator? The sigmoidoscopy within 5 years (2025-11-08 within 2021-12-31 through 2026-12-31? Actually look-back window: N3 flexible sigmoidoscopy during 2026 or four years prior, so 2022-01-01 through 2026-12-31? Wait measurement year 2026, and four years prior means 2022-2025? Need interpret look-back: "during 2026 or the four years prior" means from 2022-01-01 through 2026-12-31 (five-year window). Actually N3: "Flexible sigmoidoscopy during 2026 or the four years prior (five-year window)" So the window is 2022-01-01 to 2026-12-31? Or the "prior" years would be 2022-2025? Usually look-back measured back from 2026-12-31: five-year window means 2022-01-01 through 2026-12-31? Need to interpret. The numerator says "by the look-back window measured back from 2026-12-31". For five-year window: 2021-12-31 back five years? Actually "during 2026 or the four years prior" suggests the service could be in 2026 or in 2022-2025? Let's parse: if measurement year 2026, "the four years prior" are 2022, 2023, 2024, 2025. So the window is 2022-01-01 through 2026-12-31. That's the look-back window of five years (2022-2026). Similarly, colonoscopy ten-year window means 2017-2026. So yes.
Thus flexible sigmoidoscopy 2025-11-08 is within 2022-2026, so would meet numerator N3. But E1 exclusion applies (colorectal cancer), so excluded, not numerator. So excluded.
MEMBER 71114: age 75 (DOB 1951-11-18). 46-75 inclusive, so eligible. Enrolment continuous. Screening: CT colonography 2021-12-07. Is that within five-year window (2022-2026)? 2021-12-07 is outside, so not numerator. History: Frailty documented 2026-12-17; advanced illness documented 2026-05-05. Age 75 is ≥66. Both frailty and advanced illness documented during 2026. So E4 exclusion applies. So excluded.
MEMBER 71115: age 47 (DOB 1979-09-19). Enrolment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap of 35 days (July 17 to Aug 20 inclusive? Actually break from Jul 17? End of first period Jul 16, start second Aug 21, gap Jul 17-Aug 20 = 35 days). That is allowed (up to 45 days). So continuous enrolment satisfied? The criterion: full measurement year with no more than one gap of up to 45 days. Yes, one gap of 35. So eligible. Screening: colonoscopy 2016-12-23. Look-back for colonoscopy ten-year window: 2017-2026? Actually ten years prior from 2026-12-31? The wording "during 2026 or the nine years prior (ten-year window)". The nine years prior to 2026 are 2017-2025, so window 2017-01-01 through 2026-12-31. 2016-12-23 is outside, so no. Other history: Frailty documented 2026-07-07; advanced illness 2026-02-06. Age 47, not 66+. So E4 not apply (needs age ≥66). So no exclusion. No numerator, non-compliant.
MEMBER 71116: age 50. Enrolment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap of 35 days (Mar 17-Apr 20). Allowed. Eligible. Screening: stool DNA 2023-01-09. Stool DNA test window: three-year window (2026 or two years prior = 2024-2025? Actually two years prior to 2026 are 2024, 2025, so window 2024-01-01 through 2026-12-31). 2023-01-09 is outside. So no numerator. No exclusions. Non-compliant.
MEMBER 71117: age 63 (DOB 1963-09-02). Enrolment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. Gap from Jun 3 to Jul 17 = 45 days? Let's count: Jun 3 through Jul 17 inclusive? Actually first period ends Jun 2, second begins Jul 18. Gap includes Jun 3,4,... Jul 17. Number of days: June has 30 days, so Jun 3-30 28 days, Jul 1-17 17 days = 45 days. Allowed (up to 45). So eligible. Screening: stool DNA 2026-01-11. Within 2026, meets N2. No exclusions. So compliant.
MEMBER 71118: age 47. Enrolment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. Gap from Jun 15 to Jul 26 = 42 days. Allowed. Screening: flexible sigmoidoscopy 2021-11-12 and 2022-07-04. N3 window: 2022-2026? 2022-07-04 is within (2022-01-01 through 2026-12-31). So meets N3. No exclusions. Compliant.
MEMBER 71119: age 76 (DOB 1950-03-25). Age 76, above 75. So not_eligible. Even though screening etc. Age fails. Not_eligible.
MEMBER 71120: age 75 (DOB 1951-03-21). Eligible. Enrolment continuous. No screening. History: Advanced illness documented 2026-02-01. Frailty? No frailty documented. E4 requires both frailty and advanced illness. Only advanced illness. So no exclusion. Non-compliant.
MEMBER 71121: age 55. Enrolment: 2026-01-01 through 03-21; 04-19 through 07-06; 07-22 through 12-31. Gaps of 28 and 15 days. Two gaps. Criterion: no more than one gap of up to 45 days. Two gaps, even though each <=45, fails because "no more than one gap". So not eligible for enrolment. Also, the total? Not allowed. So not_eligible.
MEMBER 71122: age 72. Enrolment: 2026-03-22 through 2026-12-31, not enrolled before 03-22. That's a gap from Jan 1 to Mar 21, longer than 45 days? Actually 80 days. So fails continuous enrolment. Also history: Frailty documented 2026-10-08; advanced illness 2026-01-13. But advanced illness documented during measurement year? Yes, 2026-01-13. Frailty 2026-10-08. Age 72. E4 both present. But enrolment fails, so not_eligible anyway. Exclusions are evaluated only for eligible population, but here not eligible due to enrolment. So not_eligible.
MEMBER 71123: age 67 (DOB 1959-03-08) so 67, within 46-75. Enrolment: 2026-01-01 through 02-23; 03-09 through 06-27; 07-23 through 12-31. Gaps of 13 and 25 days. Two gaps. Fails no more than one gap. Not_eligible.
MEMBER 71124: age 66 (DOB 1960-08-15). Eligible. Enrolment continuous. Screening: flexible sigmoidoscopy 2026-04-15. Within window (2022-2026). Meets N3. No exclusions. Compliant.
MEMBER 71125: age 76 (DOB 1950-05-08). Age >75. Not_eligible.
MEMBER 71126: age 45 (DOB 1981-12-20). Age 45 as of 2026-12-31? Yes 45. Not eligible (below 46). Not_eligible.
MEMBER 71127: age 45 (DOB 1981-01-14). Age 45. Not eligible. Also enrolment has a gap of 24 days but age fails. Not_eligible.
MEMBER 71128: age 75 (DOB 1951-12-10). Eligible. Enrolment continuous. Screening: CT colonography 2020-02-10, stool DNA 2026-08-17. Stool DNA within 2026 (N2? Actually stool DNA test N2 three-year window includes 2026). So meets N2. No exclusions. Compliant.
MEMBER 71129: age 67 (DOB 1959-07-23). Eligible. Enrolment continuous. Screening: flexible sigmoidoscopy 2023-07-08, CT colonography 2023-09-13. Both within 2022-2026 five-year window. Meets N3 or N4. No exclusions. Compliant.
MEMBER 71130: age 45 (DOB 1981-09-13). Age 45. Not eligible. Also history: C18.7 2024 diagnosis, and FIT 2026-12-08, but age fails first. Not_eligible.
MEMBER 71131: age 76 (DOB 1950-05-05). Age 76. Not_eligible.
MEMBER 71132: age 76 (DOB 1950-02-01). Age 76. Not_eligible.
MEMBER 71133: age 59 (DOB 1967-01-22). Eligible. Enrolment continuous. Screening: CT colonography 2021-04-12 and 2021-09-09. Five-year window: need 2022-01-01 through 2026-12-31. Both in 2021, not within. So no numerator. No exclusions. Non-compliant.
MEMBER 71134: age 45 (DOB 1981-09-26). Age 45. Not_eligible. Even with colectomy. Not_eligible.
MEMBER 71135: age 55 (DOB 1971-08-26). Eligible. Enrolment continuous. Screening: colonoscopy 2016-11-12. Ten-year window: 2017-2026. 2016-11-12 is before 2017, so not within. No other screening. No exclusions. Non-compliant.
MEMBER 71136: age 45 (DOB 1981-11-11). Age 45. Not_eligible. Even with advanced illness (no frailty anyway) and sigmoidoscopy. Not_eligible.
Now count.
Let's list members and statuses:
71111: not_eligible
71112: non_compliant
71113: excluded (E1)
71114: excluded (E4)
71115: non_compliant
71116: non_compliant
71117: compliant
71118: compliant
71119: not_eligible (age 76)
71120: non_compliant
71121: not_eligible (enrolment gap 2)
71122: not_eligible (enrolment gap)
71123: not_eligible (enrolment gap 2)
71124: compliant
71125: not_eligible
71126: not_eligible
71127: not_eligible
71128: compliant
71129: compliant
71130: not_eligible
71131: not_eligible
71132: not_eligible
71133: non_compliant
71134: not_eligible
71135: non_compliant
71136: not_eligible
Now counts:
Compliant: 71117, 71118, 71124, 71128, 71129 -> that's 5.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135 -> that's 6.
Excluded: 71113 (E1), 71114 (E4) -> 2.
Not eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Let's list: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136 -> that's 13.
Check total: 5+6+2+13=26. Good.
Denominator = compliant + non_compliant = 5+6=11.
Numerator = 5.
Rate = 5/11 * 100 = 45.4545... round half up to one decimal: 45.5 (since 45.45 -> 45.5? Actually 45.4545 rounds to 45.5 because hundredth is 5? The rule: round half up to one decimal? They said round half up to one decimal, e.g. 62.5. So we take 45.454545... to one decimal: 45.5). Let's compute precisely: 5/11 = 0.454545... *100 = 45.454545... -> at one decimal, the digit after 45.4 is 5, so round up to 45.5. Yes.
Need to verify numerator - check each compliant:
- 71117: stool DNA 2026-01-11 -> N2 (stool DNA during 2026 or two years prior, yes within 2026) - correct.
- 71118: flexible sigmoidoscopy 2022-07-04 -> within five-year window (2022-2026) - yes.
- 71124: flexible sigmoidoscopy 2026-04-15 -> yes.
- 71128: stool DNA 2026-08-17 -> yes. Also CT colonography 2020-02-10 outside.
- 71129: flexible sigmoidoscopy 2023-07-08 or CT colonography 2023-09-13 -> yes.
Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135. Check:
-1 71112: no screening - correct non_compliant.
-71115: colonoscopy 2016 outside, no other - non_compliant.
-71116: stool DNA 2023 outside three-year (2024-2026). non.
-71120: no screening.
-71133: CT 2021 outside.
-71135: colonoscopy 2016 outside.
Excluded: 71113 E1, 71114 E4. Check 71113 65? Actually 71113 age 47, but colorectal cancer, so excluded. 71114 age 75, frailty+advanced illness -> E4.
Not eligible: check each:
-71111: age 55 but not enrolled full year - not_eligible.
-71119: 76.
-71121: two gaps.
-71122: not enrolled before Mar 22 - actually do we count gap as from Jan1 to Mar21 = 81 days? But they say "Not enrolled before 2026-03-22" - that is a gap >45, so fails.
-71123: two gaps.
-71125: 76.
-71126: 45.
-71127: 45.
-71130: 45.
-71131: 76.
-71132: 76.
-71134: 45.
-71136: 45.
Yes.
Now need output JSON with arrays of member IDs strings. All IDs as strings "71111" etc.
Need to ensure member IDs are the numbers after "MEMBER" in each record, as strings.
So required keys.
Denominator integer: 11
numerator: 5
excluded: 2
not_eligible: 13
rate: 45.5
Compliant_members: ["71117","71118","71124","71128","71129"]
Non_compliant_members: ["71112","71115","71116","71120","71133","71135"]
Excluded_members: ["71113","71114"]
Not_eligible_members: list all 13: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Let's double-check count: 13 is correct.
Now output JSON. Important: no extra keys.
Check if member 71112 is 72, no screening, not excluded. yes non_compliant.
Also check E3 hospice: for eligible members, none have hospice. So fine.
Now write JSON.
Make sure rate is 45.5 not 45.454.
Also ensure list order doesn't matter.
Let's output.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}67DeepSeek V4 Pro · DeepSeek84.5s · 3,825 out | 127.3s · 6,590 out | 90.1s · 4,318 out
Reasoning · 3,639 tokens
We are asked to evaluate a roster of 26 members against measure QM-CRC for colorectal cancer screening. We must classify each member into compliant, non_compliant, excluded, or not_eligible, and then provide counts and rate.
Let's go through each member systematically, checking eligibility, exclusions, then numerator.
Eligibility: Age 46-75 as of 2026-12-31. Continuous enrollment in measurement year (2026) with no more than one gap of up to 45 days.
Numerator: any of the listed screenings within look-back windows from 2026-12-31.
Exclusions: E1 colorectal cancer (C18-C21) 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 documented during measurement year.
We'll process each:
Member 71111: DOB 1971-04-18 => age 55 on 2026-12-31. Enrolled 2026-05-01 to 12-31. Not continuous full year; gap before May 1. That's a single period from May to Dec, but it's not a "gap" because they started late. The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." They must be enrolled for the full year, with at most one gap of <=45 days. If they weren't enrolled at all before May, that's essentially a gap from Jan 1 to Apr 30? That's not a "gap" within the year; it's a lack of enrollment for the first part. The requirement is to be continuously enrolled for the full year, except allowed one gap of up to 45 days. So the member must have coverage from Jan 1 onward, but can have a single gap up to 45 days. If they had no coverage before May 1, that's a gap of 120 days (Jan 1 - Apr 30), which exceeds 45 days. So not eligible. They are not enrolled for the full year with only a small gap. So not_eligible. Screening history: 2023 stool DNA, 2025 colonoscopy, but not needed. Frailty documented in 2026 but not relevant because not eligible. So not_eligible.
Member 71112: DOB 1954-02-14 => age 72. Enrolled full year, no gaps. No screening. No exclusion conditions (no cancer, colectomy, hospice, no frailty/advanced illness). So in denominator, no numerator => non_compliant. Check E4: age 66+ but no frailty and advanced illness both. So not excluded. So non_compliant.
Member 71113: DOB 1979-02-27 => age 47. Enrolled full year. Screening: 2020 CT colonography (that is 2019-2020? CT colonography window is 2026, 2025, 2024, 2023, 2022: five-year window, so 2020 is outside? Actually: N4: CT colonography during 2026 or the four years prior (five-year window). From 2026-12-31, look back five years: 2022, 2023, 2024, 2025, 2026. 2020 is outside. 2025-11-08 flexible sigmoidoscopy: N3: during 2026 or the four years prior (five-year window). So 2025 is within five years? Yes, 2025 is within 2022-2026 window. So numerator met. But check exclusions: 2025-07-17 diagnosis C18.7 (colorectal cancer) any time on or before 2026-12-31. That's exclusion E1. So excluded. Not numerator. So excluded.
Member 71114: DOB 1951-11-18 => age 75. Enrolled full year. Screening: 2021-12-07 CT colonography (within 2022-2026? 2021 is outside). So no numerator, unless other screening. But check exclusions: frailty documented 2026-12-17, advanced illness documented 2026-05-05. Age 75 >=66, both conditions documented during measurement year. So E4 applies. So excluded. Not numerator.
Member 71115: DOB 1979-09-19 => age 47. Enrollment: 2026-01-01 to 07-16, then 08-21 to 12-31. Gap from 07-17 to 08-20? Total 35 days gap. That's one gap of 35 days, <=45 days. Eligible. Screening: 2016-12-23 colonoscopy. Colonoscopy window: 2017-2026 (10-year window). 2016 is outside. So not numerator. Check exclusions: frailty 2026-07-07, advanced illness 2026-02-06. Age 47, not >=66, so E4 doesn't apply. No cancer, colectomy, hospice. So not excluded. So non_compliant.
Member 71116: DOB 1976-01-11 => age 50. Enrollment: 2026-01-01 to 03-16, 04-21 to 12-31. Gap 03-17 to 04-20, 35 days. Eligible. Screening: 2023-01-09 stool DNA test. Stool DNA window: 2026, 2025, 2024, 2023, 2022. So 2023 is within. Numerator N2 satisfied. No exclusions. So compliant.
Member 71117: DOB 1963-09-02 => age 63. Enrollment: 2026-01-01 to 06-02, 07-18 to 12-31. Gap 06-03 to 07-17, 45 days exactly. Eligible. Screening: 2026-01-11 stool DNA test within measurement year (2026). N2 satisfied. No exclusions. Compliant.
Member 71118: DOB 1979-03-23 => age 47. Enrollment: 2026-01-01 to 06-14, 07-27 to 12-31. Gap 06-15 to 07-26, 42 days. Eligible. Screening: 2021-11-12 flexible sigmoidoscopy (2022-2026 window? 2021 is outside), 2022-07-04 flexible sigmoidoscopy (2022 is within five-year window? Yes, 2022-2026, so inside). N3 satisfied. No exclusions. Compliant.
Member 71119: DOB 1950-03-25 => age 76. Not in age range (46-75). So not_eligible. Even if screening, age out. So not_eligible.
Member 71120: DOB 1951-03-21 => age 75. Enrolled full year. No screening. But check exclusions: advanced illness documented 2026-02-01. Age 75 >=66. Need both frailty and advanced illness. Only advanced illness, no frailty. So not excluded. She has no screening, so non_compliant.
Member 71121: DOB 1971-08-17 => age 55. Enrollment: 2026-01-01 to 03-21, 04-19 to 07-06, 07-22 to 12-31. Gaps: 03-22 to 04-18 (28 days) and 07-07 to 07-21 (15 days). Two gaps. Rule says no more than one gap. So more than one gap? Two gaps, both <=45 days but it's more than one gap. So not eligible. So not_eligible.
Member 71122: DOB 1954-09-15 => age 72. Enrollment: 2026-03-22 to 12-31, not before. Not full year; gap from Jan 1 to Mar 21 (80 days), exceeds 45 days. So not_eligible. (Even if we treat it as a gap, it's too large.) So not_eligible. Even age in range, but enrollment fails.
Member 71123: DOB 1959-03-08 => age 67. Enrollment: 2026-01-01 to 02-23, 03-09 to 06-27, 07-23 to 12-31. Gaps: 02-24 to 03-08 (13 days) and 06-28 to 07-22 (25 days). Two gaps, not allowed. So not_eligible.
Member 71124: DOB 1960-08-15 => age 66. Enrolled full year. Screening: 2026-04-15 flexible sigmoidoscopy, in measurement year, N3 satisfied. No exclusions. Compliant.
Member 71125: DOB 1950-05-08 => age 76. Not in age range. Not_eligible.
Member 71126: DOB 1981-12-20 => age 45 on 12-31 (just turned 45? Actually birth 1981-12-20, on 2026-12-31 she is exactly 45 years old. The age requirement is 46 through 75. So she is not 46. So not_eligible. No need to check enrollment.
Member 71127: DOB 1981-01-14 => age 45 on 12-31? 2026 - 1981 = 45, birthday Jan 14, so she turned 45 in Jan 2026, but on Dec 31 she is still 45 (since birthday is Jan, she already had it, age 45). Wait, as of 2026-12-31, she is 45 years old (2026 - 1981 = 45, birthday already passed)? Let's calculate: Born Jan 14, 1981. On Dec 31, 2026, she turned 45 earlier in the year (Jan 14). So her age is 45. Not 46. So not eligible. So not_eligible. (Check: Age 46 through 75, so 45 is excluded). Not_eligible.
Member 71128: DOB 1951-12-10 => age 75 (birthday Dec 10, so on Dec 31, she is 75). Enrolled full year. Screening: 2020-02-10 CT colonography (outside window), 2026-08-17 stool DNA test (within measurement year, N2). So numerator satisfied. No exclusions. So compliant.
Member 71129: DOB 1959-07-23 => age 67. Enrolled full year. Screening: 2023-07-08 flexible sigmoidoscopy (2023 within five-year window? yes, 2022-2026 includes 2023), N3. So numerator satisfied. No exclusions. Compliant.
Member 71130: DOB 1981-09-13 => age 45 (like 71127, age 45 on 12/31). Not age 46. So not_eligible.
Member 71131: DOB 1950-05-05 => age 76. Not in age range. Not_eligible.
Member 71132: DOB 1950-02-01 => age 76. Not in age range. Not_eligible. (Even if age 76, not eligible.)
Member 71133: DOB 1967-01-22 => age 59. Enrolled full year. Screening: 2021-04-12 CT colonography (outside 2022-2026, so not numerator), 2021-09-09 CT colonography also outside. No other screening. So no numerator. No exclusions. Non_compliant.
Member 71134: DOB 1981-09-26 => age 45. Again age 45, not eligible. So not_eligible.
Member 71135: DOB 1971-08-26 => age 55. Enrolled full year. Screening: 2016-11-12 colonoscopy. Colonoscopy window: 2017-2026. 2016 is outside. So no numerator. No exclusions. Non_compliant.
Member 71136: DOB 1981-11-11 => age 45. Not age 46. So not_eligible. Even if he has screening and exclusions, age fails. So not_eligible.
Now, let's list and count.
Eligible (age, enrollment OK) and not excluded:
- 71112: non_compliant
- 71115: non_compliant (age 47, enrollment OK, no exclusion)
- 71116: compliant
- 71117: compliant
- 71118: compliant
- 71120: non_compliant (no screening, no exclusion)
- 71124: compliant
- 71128: compliant
- 71129: compliant
- 71133: non_compliant (no screening)
- 71135: non_compliant (no screening)
Also, check 71114: excluded (E4), so not in denominator. 71113: excluded (cancer). So those are excluded.
Others are not eligible due to age or enrollment.
Thus, denominator members: 71112, 71115, 71116, 71117, 71118, 71120, 71124, 71128, 71129, 71133, 71135. That's 11 members.
Numerator (compliant): 71116, 71117, 71118, 71124, 71128, 71129. That's 6.
Non_compliant: 71112, 71115, 71120, 71133, 71135 (5). 11-6=5, good.
Excluded members: 71113, 71114 (2). No other exclusions found from roster. (Checked: 71113 cancer, 71114 E4). No one had colectomy or hospice besides those. 71134 had colectomy but age not eligible, so not eligible, not excluded. Exclusion only applies if in eligible population (age, enrollment). 71134 age 45, not eligible. So excluded count is 2.
Not eligible: all others: 71111 (enrollment gap >45 days), 71119 (age 76), 71121 (two gaps), 71122 (enrollment gap large), 71123 (two gaps), 71125 (age 76), 71126 (age 45), 71127 (age 45), 71130 (age 45), 71131 (age 76), 71132 (age 76), 71134 (age 45), 71136 (age 45). That's a total of: let's list: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. That's 13 members. The total roster 26, so 13 not eligible, 2 excluded, 11 denominator (6+5). 13+2+11 = 26, correct.
Rate = numerator/denominator * 100 = 6/11 * 100 = 54.5454... Round half up to one decimal place: 54.5 (since 54.545 rounds to 54.5? Actually 6/11 = 0.545454..., 54.5454... So one decimal: 54.5. The third decimal is 5, but we round half up: 54.545, the digit after the first decimal is 4, so 54.5. Wait: 6/11 = 54.545454...%. To one decimal, we look at the second decimal (4), so 54.5. Exactly half would be 54.55 to 54.6 rounding half up, but here it's 54.54..., so round down. So 54.5.
Now build the arrays.
Compliant: ["71116","71117","71118","71124","71128","71129"]
Non_compliant: ["71112","71115","71120","71133","71135"]
Excluded: ["71113","71114"]
Not_eligible: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"]
Check order any order is fine.
Output JSON.json{
"denominator": 11,
"numerator": 6,
"excluded": 2,
"not_eligible": 13,
"rate": 54.5,
"compliant_members": ["71116", "71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": [
"71111", "71119", "71121", "71122", "71123", "71125", "71126",
"71127", "71130", "71131", "71132", "71134", "71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 6,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 54.5,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71116",
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71120",
"71133",
"71135"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": true,
"abstained": false
}Reasoning · 6,404 tokens
We are asked to classify 26 members according to the measure QM-CRC for measurement year 2026. We need to assign each member to compliant, non_compliant, excluded, or not_eligible. Then compute denominator (compliant + non_compliant), numerator (compliant), excluded, not_eligible, and rate (numerator/denominator * 100, one decimal place). Also provide arrays of member IDs.
Let's go through each member systematically.
First, define eligible population:
- Age 46-75 as of 2026-12-31 (i.e., born between 1951-01-01 and 1980-12-31? Actually: age 46 means born on or after 1951-01-01? Let's calculate: If age is 46 on 2026-12-31, then birth year = 2026 - 46 = 1980. If birthday exactly 2026-12-31? Age is calendar year difference? Typically measure age as of measurement year end. So age = 2026 - birth year, ignoring exact date? Usually measure specification says "Age as of December 31 of the measurement year." So we compute integer age = 2026 - year of birth. So if born in 1980, age 46; if born in 1951, age 75. So eligible birth years: 1951 to 1980 inclusive. However, some measures use "46 through 75 years as of 2026-12-31" meaning age 46 to 75. So birth years 1980 (age 46) down to 1951 (age 75). So if born in 1950, age 76, not eligible. If born in 1981, age 45, not eligible. Check: 2026-1950=76; 2026-1981=45. So eligible birth years: 1951-1980.
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days. Enrolment must be continuous from 2026-01-01 to 2026-12-31? The spec: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So the member must be enrolled during the entire measurement year (2026), but allowed one gap of up to 45 days. If there are multiple gaps, or a gap >45 days, not eligible. Also, if the member is not enrolled at all during some period at the start or end? It says "full measurement year" meaning they must be enrolled in the plan for the entire year, but can have one gap. So they must have enrolment covering January 1 to December 31, except for at most one continuous gap of missing enrolment <=45 days. So if they have enrolment starting after Jan 1, that's a gap of days before enrolment that is not considered a gap? Wait, typical continuous enrollment criterion: member must be continuously enrolled throughout the measurement year with no more than one break of up to 45 days. Usually, if the member enrolls mid-year, they are not continuously enrolled for the full year; they need to be enrolled from at least the start of the year with allowable gaps. But the wording "full measurement year" implies that the member must be enrolled for the entire year, but they can have one short gap. So members who are not enrolled as of Jan 1 are not eligible unless their non-enrollment period before enrollment is considered a gap? Actually, many plans consider a member continuously enrolled if they were enrolled at the beginning and end of the year, with no more than one break. But the spec says "full measurement year with no more than one gap of up to 45 days." I interpret that as: the member's enrollment period(s) must cover Jan 1 through Dec 31, with at most one gap of <=45 days. If a member is not enrolled at all on Jan 1, then they are missing days from the beginning, which is essentially a gap from Jan 1 to enrollment start. But that gap could be >45 days. The spec doesn't explicitly say the gap must be during the year; it's a gap in enrollment during the year. So if a member enrolls on May 1, they have a gap from Jan 1 to Apr 30 of 120 days, which is >45 days and constitutes a break. So they are not continuously enrolled for the full year. Thus, to be eligible, the member must have enrollment covering the entire year, except for at most one gap of up to 45 days. So if they have a gap at the beginning or end, it counts as a gap. So members whose enrollment starts after Jan 1 + 45 days? Actually, any gap exceeding 45 days disqualifies. So if they have a gap of 120 days at the start, that's >45, so not eligible. Members who are enrolled as of Jan 1 but then have a mid-year gap that's <=45 days and then re-enroll and stay enrolled through Dec 31 are eligible. Members with enrollment from Feb 1 (31 days missing) might be okay if that gap is 31 days and they have no other gaps? But is that gap considered a gap? The total enrollment period is from Feb 1 to Dec 31, which does not cover Jan 1 to Jan 31. So that's a 31-day gap at the beginning. So the member has one gap of 31 days, which is ≤45 days, so that might be allowed. However, typical continuous enrollment criteria often require enrollment from the first day of the year through the last, with a gap of up to 45 days, but the gap can be at any point. So if a member enrolls on Feb 1 and stays enrolled, they have a 31-day gap (Jan 1-31). That's one gap <=45 days, so they might be considered continuously enrolled. But many measures define continuous enrollment as being enrolled for the entire measurement year with no more than one gap in enrollment of up to 45 days. The gap can be anywhere, including at the beginning, as long as the total days not enrolled do not exceed 45 and there is only one gap. So if a member has enrollment from Feb 1 to Dec 31, that's 31 days missing, one gap, ≤45, so eligible. But if a member has enrollment from Mar 22 to Dec 31, that's 80 days missing (Jan 1 to Mar 21 = 80 days), >45, so not eligible. So we need to compute the total gap days for each member's enrollment pattern.
We need to check each member's enrollment details and see if they have enrollment from Jan 1 to Dec 31 with at most one gap ≤45 days.
Now, exclusions: E1 colorectal cancer diagnosis C18-C21 at any time before or on 2026-12-31. E2 total colectomy any time before or on 2026-12-31. E3 hospice during measurement year. E4 age 66+ AND both frailty and advanced illness documented during measurement year.
So first, check age for each member.
If age not in 46-75, not_eligible. Then check continuous enrollment. If fails, not_eligible. Then check exclusions. If any exclusion applies, member is excluded. Then check numerator: if any of N1-N5 criteria met, compliant; else non_compliant.
We'll process each member:
MEMBER 71111. DOB 1971-04-18, age on 2026-12-31: 2026-1971=55. Within 46-75. Eligible age. Enrollment: 2026-05-01 through 2026-12-31, continuous from that date. Not enrolled before. So missing Jan 1 to Apr 30 = 120 days? Actually, from Jan 1 to Apr 30 inclusive is 120 days? Let's compute: Jan 1 to Apr 30: January 31, February 28 (2026 is not a leap year? 2026 is not divisible by 4, so Feb 28), March 31, April 30. Total 31+28+31+30=120 days. That's >45 days. So not continuously enrolled. Therefore not_eligible. (No need to check exclusions or numerator). So 71111 is not_eligible.
MEMBER 71112. DOB 1954-02-14, age 72. Eligible age. Enrollment: 2026-01-01 through 2026-12-31, continuous, no gaps. Eligible enrollment. Check exclusions: No colorectal cancer, no colectomy, no hospice, no frailty/advanced illness. So no exclusion. Check numerator: No colorectal screening on record. So no N1-N5. Non_compliant. So 71112 is non_compliant.
MEMBER 71113. DOB 1979-02-27, age 47. Eligible age. Enrollment: full year, continuous, no gaps. Eligible enrollment. Check exclusions: Has diagnosis C18.7 on 2025-07-17, that's colorectal cancer (C18.7 is in C18-C21) any time before 2026-12-31. So E1 applies. Therefore excluded. So 71113 is excluded.
MEMBER 71114. DOB 1951-11-18, age 75 (2026-1951=75). Eligible age. Enrollment: full year, continuous. Eligible enrollment. Check exclusions: E1? No cancer. E2? No colectomy. E3? No hospice. E4: Age 66+ (75 is 66+), and frailty documented (2026-12-17) and advanced illness documented (2026-05-05) both during measurement year. So E4 applies. Therefore excluded. So 71114 is excluded.
MEMBER 71115. DOB 1979-09-19, age 47. Eligible age. Enrollment: 2026-01-01 through 2026-07-16; 2026-08-21 through 2026-12-31. One gap from 2026-07-17 to 2026-08-20. How many days? July: 17 to 31 is 15 days? Actually, gap is from July 17 (first missing day) through August 20 (last missing day). Then re-enroll on Aug 21. Let's compute: July 17-31: 15 days (31-17+1=15? 31-17=14, +1=15). August 1-20: 20 days. Total gap = 15+20 = 35 days. That's ≤45 days, and only one gap. So continuous enrollment is met. (Check: enrollment started Jan 1, ended July 16, then gap 35 days, then resumed Aug 21 to end of year. So total coverage spans year with one gap 35 days). So eligible enrollment. Check exclusions: Has frailty documented (2026-07-07) and advanced illness (2026-02-06) during measurement year. Age 47, not 66+, so E4 doesn't apply. No E1, E2, E3. So no exclusions. Check numerator: Colonoscopy on 2016-12-23. That is within 9 years prior (10-year window from 2026-12-31). 2026 minus 9 years = 2017. So 2016 is before the window? The window is "during 2026 or the nine years prior". That means any time from 2017-01-01? Actually, "2026 or the nine years prior" - the look-back window measured back from 2026-12-31. So 2026 is current year, and the prior years: 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. That's exactly nine years prior. So the window is 2017-01-01 through 2026-12-31. Colonoscopy date 2016-12-23 is before 2017-01-01, so not within window. So not N5. Any other screening? No. So non_compliant. So 71115 is non_compliant.
MEMBER 71116. DOB 1976-01-11, age 50. Eligible age. Enrollment: 2026-01-01 through 2026-03-16; 2026-04-21 through 2026-12-31. One gap from 2026-03-17 to 2026-04-20. Count days: March 17-31: 31-17+1=15? Actually, 31-17=14, +1=15? Let's verify: 17,18,...,31 inclusive is 15 days (31-16=15). April 1-20: 20 days. Total 35 days. Gap=35 days, one gap, so eligible enrollment. Check exclusions: no cancer, no colectomy, no hospice, no frailty/illness, age 50 so E4 not applicable. No exclusions. Check numerator: Stool DNA test on 2023-01-09. Stool DNA test: N2 says during 2026 or the two years prior (three-year window). So lookback: 2026, 2025, 2024. So window is 2024-01-01 to 2026-12-31. 2023-01-09 is before 2024, so not in window. So no numerator. Non_compliant. So 71116 is non_compliant.
MEMBER 71117. DOB 1963-09-02, age 63. Eligible age. Enrollment: 2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap from 2026-06-03 to 2026-07-17. Count days: June 3-30: 30-3+1=28 days (June has 30 days). July 1-17: 17 days. Total gap = 28+17=45 days. Exactly 45, so eligible (no more than 45 days). Check exclusions: none. Numerator: Stool DNA test on 2026-01-11. That's during measurement year 2026. N2 requires stool DNA test during 2026 or two prior years. 2026-01-11 is in 2026, so N2 is met. Compliant. So 71117 is compliant.
MEMBER 71118. DOB 1979-03-23, age 47. Eligible age. Enrollment: 2026-01-01 through 2026-06-14; 2026-07-27 through 2026-12-31. One gap from 2026-06-15 to 2026-07-26. Count days: June 15-30: 16 days (30-15+1=16? June 15 to 30 inclusive is 16 days: 15,16,...,30 = 16 days. 30-15=15, +1=16). July 1-26: 26 days. Total gap = 42 days. ≤45, so eligible. Check exclusions: none. Numerator: Flexible sigmoidoscopy on 2021-11-12 and 2022-07-04. N3: flexible sigmoidoscopy during 2026 or the four years prior (five-year window). So window: 2022-01-01 to 2026-12-31? Let's compute: 2026 and four prior years: 2025, 2024, 2023, 2022. So the five-year window is 2022-01-01 through 2026-12-31. The 2021 date is outside. 2022-07-04 is within window. So N3 satisfied. Compliant. So 71118 is compliant.
MEMBER 71119. DOB 1950-03-25, age 76. Not eligible age (76 > 75). So not_eligible. No need for anything else. So 71119 is not_eligible.
MEMBER 71120. DOB 1951-03-21, age 75. Eligible age. Enrollment: full year continuous. Check exclusions: E1? no cancer. E2? no colectomy. E3? no hospice. E4: age 75, 66+, but only advanced illness documented (2026-02-01), no frailty documented. So E4 requires both frailty and advanced illness. So no exclusion. Numerator: No colorectal screening on record. So non_compliant. So 71120 is non_compliant.
MEMBER 71121. DOB 1971-08-17, age 55. Eligible age. Enrollment: 2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Two gaps: first gap from 2026-03-22 to 2026-04-18 (since re-enroll 04-19, so gap 03-22 to 04-18). Let's count: March 22-31: 10 days (31-22+1=10). April 1-18: 18 days. Total first gap = 28 days. Second gap from 2026-07-07 to 2026-07-21: July 7-21: 15 days (21-7+1=15). So two gaps, total gaps = 2, which is more than one gap allowed. So fails continuous enrollment. Not eligible. So 71121 not_eligible. Even though each gap ≤45, the spec says "no more than one gap". So two gaps disqualifies. So 71121 is not_eligible.
MEMBER 71122. DOB 1954-09-15, age 72. Eligible age. Enrollment: 2026-03-22 through 2026-12-31, continuous from that date. Not enrolled before. That's a gap from Jan 1 to Mar 21. Count days: Jan 1 - Mar 21. January 31, February 28, March 1-21: 21 days. Total 31+28+21=80 days. Gap is 80 days >45. So not eligible. So 71122 not_eligible.
MEMBER 71123. DOB 1959-03-08, age 67. Eligible age. Enrollment: 2026-01-01 through 2026-02-23; 2026-03-09 through 2026-06-27; 2026-07-23 through 2026-12-31. Gaps: Gap 1: 2026-02-24 to 2026-03-08. Count: February 24-28: 5 days (28-24+1=5). March 1-8: 8 days. Total 13 days. Gap 2: 2026-06-28 to 2026-07-22. Count: June 28-30: 3 days (30-28+1=3? 28,29,30 = 3 days). July 1-22: 22 days. Total 25 days. So two gaps, both ≤45 but two gaps. So fails continuous enrollment (more than one gap). Not eligible. So 71123 not_eligible. (Note: she is age 67, no exclusions, but not eligible)
MEMBER 71124. DOB 1960-08-15, age 66. Eligible age. Enrollment: full year continuous. Exclusions: no E1-3. E4: age 66+, so need both frailty and advanced illness. No frailty documented, no advanced illness documented. So no exclusion. Numerator: Flexible sigmoidoscopy on 2026-04-15, which is in 2026. N3 satisfied. Compliant. So 71124 compliant.
MEMBER 71125. DOB 1950-05-08, age 76. Not eligible age. So not_eligible. 71125 not_eligible.
MEMBER 71126. DOB 1981-12-20, age 2026-1981=45. Age 45 as of 2026-12-31. Eligible age range is 46-75, so 45 is not eligible. Not_eligible. So 71126 not_eligible.
MEMBER 71127. DOB 1981-01-14, age 45 (2026-1981=45). Not eligible age. So not_eligible. 71127 not_eligible.
MEMBER 71128. DOB 1951-12-10, age 75. Eligible age. Enrollment: full year continuous. Exclusions: none (no cancer, no colectomy, no hospice, age 75 but E4 requires both frailty and advanced illness; none documented). Numerator: Stool DNA test on 2026-08-17, which is 2026, so N2 satisfied. Also CT colonography 2020-02-10: N4 requires 2026 or four years prior (2022-2026 window?), but 2020 is outside five-year window (2021? Actually five-year window from 2026-12-31 includes 2022-2026? The window is 2026 and four years prior = 2025, 2024, 2023, 2022. So 2020 is not within. But the stool DNA 2026 is within, so compliant. So 71128 compliant.
MEMBER 71129. DOB 1959-07-23, age 67. Eligible age. Enrollment: full year continuous. Exclusions: none. Numerator: Flexible sigmoidoscopy on 2023-07-08. N3 window: 2022-2026 (2026 and four years prior). 2023 is within 2022-2026, so N3 met. Compliant. So 71129 compliant.
MEMBER 71130. DOB 1981-09-13, age 45. Not eligible age. So not_eligible. Even though he has diagnosis C18.7 and screening, age disqualifies first. So not_eligible. 71130 not_eligible.
MEMBER 71131. DOB 1950-05-05, age 76. Not eligible age. Not_eligible. 71131 not_eligible.
MEMBER 71132. DOB 1950-02-01, age 76. Not eligible age. Not_eligible. 71132 not_eligible.
MEMBER 71133. DOB 1967-01-22, age 59. Eligible age. Enrollment: full year continuous. Exclusions: none. Numerator: CT colonography on 2021-04-12 and 2021-09-09. N4 window: 2022-2026 (2026 and four years prior). 2021 is not within (2022 is the earliest). So no numerator event. Non_compliant. 71133 non_compliant.
MEMBER 71134. DOB 1981-09-26, age 45. Not eligible age. Not_eligible. 71134 not_eligible.
MEMBER 71135. DOB 1971-08-26, age 55. Eligible age. Enrollment: full year continuous. Exclusions: none. Numerator: Colonoscopy on 2016-11-12. Colonoscopy window: 2026 or nine years prior (2017-2026). 2016 is outside. So non_compliant. 71135 non_compliant.
MEMBER 71136. DOB 1981-11-11, age 45. Not eligible age. Not_eligible. 71136 not_eligible.
Now, let's compile lists.
First, not_eligible due to age: 71119 (76), 71125 (76), 71126 (45), 71127 (45), 71130 (45), 71131 (76), 71132 (76), 71134 (45), 71136 (45). Also 71111 was not eligible due to enrollment gap >45 days. 71121 not eligible due to two gaps. 71122 not eligible due to enrollment gap >45 days. 71123 not eligible due to two gaps. So total not_eligible: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Count them: 13 members.
Excluded: 71113 (colorectal cancer), 71114 (age 66+ with both frailty and advanced illness). Any others? Check E1-E4 on remaining eligible members. 71115 had frailty and advanced illness but age 47, so E4 not apply. So only 71113 and 71114 excluded. So excluded: 71113, 71114. Count 2.
Now remaining members are those with eligible age and enrollment and no exclusions. They are either compliant or non_compliant.
List all members we haven't classified: 71112 (non_c), 71115 (non_c), 71116 (non_c), 71117 (c), 71118 (c), 71120 (non_c), 71124 (c), 71128 (c), 71129 (c), 71133 (non_c), 71135 (non_c). Wait, we missed a few: Did we handle 71116? Yes, non_c. 71120 non_c. 71124 c. 71128 c. 71129 c. 71133 non_c. 71135 non_c. Also 71115 non_c. 71112 non_c. 71117 c. 71118 c. So compliant: 71117, 71118, 71124, 71128, 71129. That's 5. Non_compliant: 71112, 71115, 71116, 71120, 71133, 71135. That's 6. And we have 5+6=11 members eligible and not excluded. Denominator = 11. Numerator = 5. Rate = 5/11 * 100 = 45.4545... rounded half up to one decimal place: 45.5? 45.4545 -> nearest tenth is 45.5 because 45.45 rounds up? Wait, 45.4545: the hundredth digit is 5? Actually, 5/11=0.454545... Multiply by 100 = 45.4545%. The tenth is the first decimal. The hundredth is 5, so we round up the tenth from 4 to 5? Round half up: if the next digit is 5 or more, round up. So 45.45... the hundredth digit is 5 (since 45.4545, tenth=4, hundredth=5). So round up tenth from 4 to 5, giving 45.5. Yes.
Check all members to ensure every member appears exactly once. Roster 26 members. We classified 13 not_eligible, 2 excluded, 5 compliant, 6 non_compliant. Total 13+2+5+6=26. Correct.
Now produce JSON. Compliant_members: ["71117", "71118", "71124", "71128", "71129"] (sorted or any order). Non_compliant: ["71112", "71115", "71116", "71120", "71133", "71135"]. Excluded: ["71113", "71114"]. Not_eligible: ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]. Double-check: 71136 is 45, not eligible. Yes. 71134 45, not eligible. 71132 76, not eligible. 71131 76, not eligible. 71130 45, not eligible. 71127 45, not eligible. 71126 45, not eligible. 71125 76, not eligible. 71123 enrollment gap, not eligible. 71122 enrollment gap, not eligible. 71121 two gaps, not eligible. 71119 76, not eligible. 71111 enrollment gap, not eligible. So all accounted. Ensure no member ID is missing: 71111-71136 sequentially? Roster has 71111-71136 inclusive, but note 71136 is the last. Check if any missing: 71111 to 71136 should be 26 members (36-11+1=26). Yes, all present.
Now compute denominator = 11, numerator = 5, excluded = 2, not_eligible = 13, rate = 45.5.
Json structure: keys "denominator": 11, "numerator": 5, "excluded": 2, "not_eligible": 13, "rate": 45.5, "compliant_members": [...], "non_compliant_members": [...], "excluded_members": [...], "not_eligible_members": [...].
I'll output the JSON directly.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,094 tokens
We are asked to evaluate each member against the QM-CRC measure for measurement year 2026. We need to produce the final JSON with counts and member IDs classified.
Let's go through each member systematically.
First, recall:
- Eligible population: age 46-75 as of 2026-12-31; continuous enrollment full year with no more than one gap up to 45 days.
- Exclusions: colorectal cancer (C18-C21) any time on or before 2026-12-31; total colectomy any time; hospice any time during measurement year; age 66+ AND both frailty and advanced illness documented during the year.
- Numerator: various screening tests within specified windows back from 2026-12-31.
Note that exclusions are applied only to those in the eligible population (i.e., meet age and enrollment criteria). If a member fails age or enrollment, they are not_eligible regardless of exclusions. If they meet age and enrollment but have an exclusion, they are excluded even if they also meet numerator.
Now, process each member.
MEMBER 71111:
- DOB 1971-04-18 => age 55 on 2026-12-31. In range.
- Enrollment: 2026-05-01 through 2026-12-31. Not full year; missing Jan-Apr. That's a gap > 45 days from start. So not continuous full year. Enrolment doesn't meet requirement (must be full measurement year with no more than one gap up to 45 days, but here the member is not enrolled from Jan 1 to Apr 30). So does not meet continuous enrollment criteria.
- Not eligible.
Status: not_eligible.
MEMBER 71112:
- DOB 1954-02-14 => age 72 on 2026-12-31. In range.
- Enrollment: full year, continuous, no gaps.
- Screening: none.
- No exclusions documented: no cancer, no colectomy, no hospice, no frailty/advanced illness. Since age 66+, check E4: requires both frailty and advanced illness. None documented, so not excluded.
Eligible, no exclusion. Numerator: no screening. So non_compliant.
MEMBER 71113:
- DOB 1979-02-27 => age 47. In range.
- Enrollment: full year, continuous.
- Screening history: CT colonography 2020-07-03 (outside 5-year window, window is 2026+4 prior = 2022-2026, 2020 is before 2022). Flexible sigmoidoscopy 2025-11-08: window is 2026+4 prior = 2022-2026. 2025 is within. So that's a numerator hit (N3).
- But check exclusions: has diagnosis C18.7 on 2025-07-17. That is colorectal cancer (C18-C21) any time on or before 2026-12-31. So exclusion E1 applies.
So this member is excluded.
MEMBER 71114:
- DOB 1951-11-18 => age 75 on 2026-12-31. In range.
- Enrollment: full year, continuous.
- Screening: CT colonography 2021-12-07. Window: 2026+4 = 2022-2026. 2021 is before 2022. So not within 5-year window. No other screening.
- Exclusions: age 66+ (75) AND both frailty (2026-12-17) and advanced illness (2026-05-05) documented during measurement year. So E4 applies.
Thus, excluded.
MEMBER 71115:
- DOB 1979-09-19 => age 47. In range.
- Enrollment: two segments: 2026-01-01 to 2026-07-16; 2026-08-21 to 2026-12-31. One gap from 07-17 to 08-20, which is 35 days (July 17 to Aug 20 inclusive? Let's compute: July has 31 days, so 17-31 is 15 days (31-17+1=15), plus Aug 1-20 is 20 days, total 15+20=35. Actually 7/17-7/31 is 15 days (31-17+1 = 15), 8/1-8/20 is 20 days, total 35 days. So one gap of 35 days, which is <=45. So continuous enrollment met (full year with one gap ≤45 days). Check: is enrollment from Jan 1 to Dec 31? Yes, first segment starts Jan 1, ends Dec 31 after gap. So yes, continuous enrollment met.
- Screening: colonoscopy 2016-12-23. Window for colonoscopy: 2026+9 prior = 2017-2026. 2016 is before 2017. So not within 10-year window. No other screening.
- Exclusions: age not 66+ (47), so E4 does not apply. No cancer, no colectomy, no hospice. But member has frailty and advanced illness documented, but not age 66+. So not excluded.
Eligible, no exclusion. Numerator: no qualifying screening. So non_compliant.
MEMBER 71116:
- DOB 1976-01-11 => age 50. In range.
- Enrollment: two segments: 2026-01-01 to 2026-03-16; 2026-04-21 to 2026-12-31. One gap: 3/17 to 4/20. That's from March 17 to April 20 inclusive: March 17-31 is 15 days, April 1-20 is 20 days, total 35. So 35 days gap. Another? Only one gap. So continuous enrollment met.
- Screening: stool DNA test 2023-01-09. Window for stool DNA: 2026 or the two years prior (3-year window: 2024, 2025, 2026). 2023 is outside (three-year window means 2026, 2025, 2024). So not within. No other.
- No exclusions.
So non_compliant.
MEMBER 71117:
- DOB 1963-09-02 => age 63. In range.
- Enrollment: segments: 2026-01-01 to 2026-06-02; 2026-07-18 to 2026-12-31. One gap: 6/3 to 7/17. June 3 to 30: 28 days? June has 30 days, so 3-30=28 days (30-3+1=28), July 1-17 = 17 days, total 45. So gap of 45 days, which is allowed (up to 45). So enrollment met.
- Screening: stool DNA test 2026-01-11. That is in 2026, so numerator N2? Stool DNA test in 2026 counts for N2 (three-year window, 2026 included). So numerator hit.
- No exclusions.
Compliant.
MEMBER 71118:
- DOB 1979-03-23 => age 47. In range.
- Enrollment: 2026-01-01 to 2026-06-14; 2026-07-27 to 2026-12-31. One gap: 6/15 to 7/26. June 15-30: 16 days (30-15+1=16), July 1-26: 26 days, total 42 days. Okay.
- Screening: flexible sigmoidoscopy 2021-11-12 and 2022-07-04. Window: 2026+4 prior = 2022-2026. So 2022-07-04 is within the window (2022 is first year of window). So numerator N3 hit.
- No exclusions.
Compliant.
MEMBER 71119:
- DOB 1950-03-25 => age 76 on 2026-12-31. Out of age range (46-75). So not eligible.
Status: not_eligible. (Note: even though screening found, age disqualifies.)
MEMBER 71120:
- DOB 1951-03-21 => age 75. In range.
- Enrollment: full year, continuous.
- Screening: none.
- Exclusions: age 66+, so check E4: has advanced illness (2026-02-01) but no frailty. E4 requires both, so not excluded. No other exclusions.
So eligible, no numerator. Non_compliant.
MEMBER 71121:
- DOB 1971-08-17 => age 55. In range.
- Enrollment: three segments: 2026-01-01 to 2026-03-21; 2026-04-19 to 2026-07-06; 2026-07-22 to 2026-12-31. Gaps: first gap 3/22 to 4/18: March 22-31 (10 days), April 1-18 (18 days) total 28. Second gap 7/7 to 7/21: July 7-21: 15 days (21-7+1=15). So two gaps. The rule: "no more than one gap of up to 45 days." Two gaps, so fails enrollment. So not eligible.
Status: not_eligible.
MEMBER 71122:
- DOB 1954-09-15 => age 72. In range.
- Enrollment: 2026-03-22 through 2026-12-31. Not enrolled from Jan 1 to Mar 21. That's a gap from start >45 days? Missing Jan 1 - Mar 21, about 2 months 20 days, over 45 days. So not continuous full year. Not eligible.
Status: not_eligible.
MEMBER 71123:
- DOB 1959-03-08 => age 67. In range.
- Enrollment: three segments: 2026-01-01 to 2026-02-23; 2026-03-09 to 2026-06-27; 2026-07-23 to 2026-12-31. Gaps: first: 2/24 to 3/8 (Feb 24-28 maybe leap year? 2026 is not leap year, so Feb has 28 days. So 2/24-28 = 5 days, March 1-8 = 8 days, total 13). Second: 6/28 to 7/22: June 28-30 = 3 days, July 1-22 = 22 days, total 25 days. So two gaps. Fails enrollment.
Status: not_eligible.
MEMBER 71124:
- DOB 1960-08-15 => age 66. In range.
- Enrollment: full year, continuous.
- Screening: flexible sigmoidoscopy 2026-04-15. Window: 2026+4 = 2022-2026, so yes.
- Exclusions: age 66, so check E4: no frailty, no advanced illness. Not excluded.
Compliant.
MEMBER 71125:
- DOB 1950-05-08 => age 76. Out of range. not_eligible.
MEMBER 71126:
- DOB 1981-12-20 => age 45 on 2026-12-31. Out of range (46-75). Not eligible.
MEMBER 71127:
- DOB 1981-01-14 => age 45 (turns 45 on Jan 14, 2026, but on Dec 31, 2026, she's 45? Actually born Jan 14 1981, as of 2026-12-31, age = 2026-1980? Let's compute: born Jan 14, 1981. Date: 2026-12-31. Age = 45 if birthday has already passed in 2026? Birthday Jan 14, so yes, turned 45 in Jan 2026. So age 45. Age range is 46-75, so not eligible. Not eligible.
Status: not_eligible.
MEMBER 71128:
- DOB 1951-12-10 => age 75 on 2026-12-31. In range.
- Enrollment: full year, continuous.
- Screening: CT colonography 2020-02-10: outside 5-year window. Stool DNA test 2026-08-17: within 2026, so numerator hit (N2).
- No exclusions: no cancer, no colectomy, no hospice, no frailty/advanced illness. So compliant.
MEMBER 71129:
- DOB 1959-07-23 => age 67. In range.
- Enrollment: full year, continuous.
- Screening: flexible sigmoidoscopy 2023-07-08: window 2022-2026, yes. So numerator N3. Also CT colonography 2023-09-13, same window, but one is enough.
- No exclusions: age 66+, check E4: no frailty or advanced illness. Not excluded.
Compliant.
MEMBER 71130:
- DOB 1981-09-13 => age 45 (turned 45 in Sep 2026). Not in range. Not eligible.
Status: not_eligible.
MEMBER 71131:
- DOB 1950-05-05 => age 76. Not eligible.
MEMBER 71132:
- DOB 1950-02-01 => age 76. Not eligible.
MEMBER 71133:
- DOB 1967-01-22 => age 59. In range.
- Enrollment: full year, continuous.
- Screening: CT colonography 2021-04-12 and 2021-09-09. Both outside 5-year window (2022-2026). So no numerator.
- No exclusions.
Non_compliant.
MEMBER 71134:
- DOB 1981-09-26 => age 45. Not eligible. (But check: age 45, not in 46-75 range, so not eligible. Total colectomy exclusion irrelevant since not in denominator.)
MEMBER 71135:
- DOB 1971-08-26 => age 55. In range.
- Enrollment: full year, continuous.
- Screening: colonoscopy 2016-11-12. Window for colonoscopy: 2017-2026. 2016 is before 2017. So not qualifying. No other screening.
- No exclusions.
Non_compliant.
MEMBER 71136:
- DOB 1981-11-11 => age 45. Not eligible.
Now compile lists.
Compliant members: from above: 71117, 71118, 71124, 71128, 71129. That's 5.
Non_compliant members: 71112, 71115, 71116, 71120, 71133, 71135. That's 6.
Excluded members: 71113 (cancer), 71114 (E4). Also check: any others? 71113 and 71114. That's 2.
Not_eligible: all others: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Counting: 13 members? Total 26 members: 5+6+2+13=26. Let's list:
Not_eligible IDs: 71111, 71119, 71121, 71122, 71123, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136. Yes, 13.
Thus denominator = compliant + non_compliant = 11. Numerator = 5. Excluded = 2. Not_eligible = 13. Rate = 5/11 *100 = 45.4545... rounded half up to one decimal place: 45.5.
Check for any misclassifications.
Member 71115: I said non_compliant. Age 47, enrollment segments: Jan 1 to Jul 16, Aug 21 to Dec 31. One gap 35 days, that's fine. No qualifying screening, no exclusion. So non_compliant correct.
Member 71133: non_compliant, no screening in window. Correct.
Member 71135: colonoscopy 2016-11-12, out of 10-year window. Correct.
Member 71113: excluded due to cancer. She had screening (flex sig 2025-11-08) but excluded. Correct.
Member 71114: excluded E4. Had frailty and advanced illness and age 75. Correct.
Member 71120: age 75, only advanced illness, no frailty, so not excluded. Non_compliant. Correct.
Member 71121: enrollment gaps: 28 and 15 days, two gaps, so not eligible. Correct.
Member 71122: enrollment starts 2026-03-22, not full year, not eligible. Correct.
Member 71123: two gaps (13 and 25), not eligible. Correct.
Member 71127: age 45, not eligible. Correct.
Member 71136: age 45, not eligible.
Member 71134: age 45, not eligible (even with colectomy).
Member 71130: age 45, not eligible (even with cancer).
Member 71125: age 76, not eligible.
Member 71131: age 76, not eligible.
Member 71132: age 76, not eligible, even with cancer.
Member 71119: age 76, not eligible.
Member 71126: age 45, not eligible.
So tally stands.
Now compile answer.
denominator: 11, numerator: 5, excluded: 2, not_eligible: 13, rate: 45.5, compliant_members: ["71117","71118","71124","71128","71129"], non_compliant_members: ["71112","71115","71116","71120","71133","71135"], excluded_members: ["71113","71114"], not_eligible_members: ["71111","71119","71121","71122","71123","71125","71126","71127","71130","71131","71132","71134","71136"].
Check ordering: any order is fine.
I'll output the JSON.json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}67Claude Haiku 4.5 · Anthropic160.4s · 18,717 out | 96.9s · 11,236 out | 80.4s · 12,921 out
Reasoning · 18,520 tokens
Let me work through each member systematically against the QM-CRC measure specification.
**Measure Parameters:**
- Measurement year: 2026-01-01 through 2026-12-31
- Eligible population (denominator):
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days
- Numerator (at least one):
- 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 (2022-2026)
- N4: CT colonography during 2026 or four years prior (2022-2026)
- N5: Colonoscopy during 2026 or nine years prior (2016-2026)
- Required Exclusions:
- E1: Colorectal cancer (C18-C21) on or before 2026-12-31
- E2: Total colectomy on or before 2026-12-31
- E3: Hospice during the measurement year (2026)
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year
Let me go through each member:
**MEMBER 71111:**
- DOB: 1971-04-18, age 55 on 2026-12-31 ✓ (in 46-75 range)
- Enrolment: 2026-05-01 through 2026-12-31. Not enrolled before 2026-05-01. This is NOT the full measurement year.
The gap from 2026-01-01 to 2026-05-01 exceeds 45 days, so this member fails continuous enrolment. **not_eligible**
**MEMBER 71112:**
- DOB: 1954-02-14, age 72 on 2026-12-31 ✓ (in 46-75 range)
- Enrolment: 2026-01-01 through 2026-12-31, continuous ✓
- No colorectal screening documented anywhere
- No exclusions apply (no cancer, colectomy, hospice, or frailty/advanced illness combo)
- Meets denominator but lacks numerator compliance — **noncompliant**
**MEMBER 71113:**
- DOB: 1979-02-27, age 47 ✓, continuous enrolment ✓
- Screening: 2020 CT colonography, 2025 flexible sigmoidoscopy
- Diagnosis 2025-07-17: C18.7, malignant neoplasm of sigmoid colon — active colorectal cancer triggers E1 exclusion
- **excluded**
**MEMBER 71114:**
- DOB: 1951-11-18, age 75 ✓, checking enrolment continuity starting 2026-01-01...
2026-12-31, continuous ✓
- Screening: 2021 CT colonography, outside the 4-year lookback
- Age 66+: yes; frailty documented 2026-12-17; advanced illness (heart failure) 2026-05-05
- Both frailty and advanced illness present with age 66+ → E4 exclusion: **excluded**
**MEMBER 71115:**
- DOB: 1979-09-19, age 47 ✓
- Enrolment split with a gap around mid-2026, need to check gap duration against continuity threshold
Gap of 35 days ✓ within limit
- Screening: 2016 colonoscopy within 10-year window
- No exclusions apply; age under 66
- N5 satisfied via colonoscopy → **compliant**
**MEMBER 71116:**
- DOB: 1976-01-11, age 50 ✓
- Enrolment gap of 35 days ✓
- Screening: 2023 stool DNA test within 3-year window
Reconsidering the window - it's the current year plus two priors (2024-2026), not three years back from 2026. So 2023-01-09 falls outside this window.
No other qualifying screening exists. **non_compliant**
**MEMBER 71117:**
- DOB: 1963-09-02, age 63 ✓
- Checking enrolment...
✓
- Screening history: two flexible sigmoidoscopies (2021-11-12, 2022-07-04), both within the 5-year lookback
- Exclusions: None; meets N3
- **compliant**
**MEMBER 71119:**
- DOB 1950-03-25, turns 76 by year-end — exceeds age range
- **not_eligible**
**MEMBER 71120:**
- DOB 1951-03-21, age 75 ✓, continuous enrollment all year ✓
- No screening history found
Advanced illness flagged 2026-02-01, but frailty isn't documented — E4 needs both criteria together, so it doesn't apply here.
- No exclusions apply
- No screening in numerator
- **non_compliant**
**MEMBER 71121:**
- DOB 1971-08-17, age 55 ✓
- Enrollment has small gaps (28 and 15 days) but stays compliant ✓
- Found a CT colonography dated 2026-02-22
No exclusions. This satisfies N4.
- **compliant**
**MEMBER 71122:**
- DOB 1954-09-15, age 72 ✓
- Coverage doesn't start until 2026-03-22, leaving an ~80 day gap from Jan 1 — well over the 45-day threshold
- **not_eligible**
**MEMBER 71123:**
- DOB 1959-03-08, age 67 ✓
- Enrollment periods: 2026-01-01 to 2026-02-23, then 2026-03-09 to 2026-06-27
; 2026-07-23 through 2026-12-31. Gaps of 13 and 25 days ✓
- No colorectal screening found
- No exclusions
- **non_compliant**
**MEMBER 71124:**
- DOB 1960-08-15, age 66 ✓
- Continuously enrolled all year
- Flexible sigmoidoscopy on 2026-04-15 satisfies N3
- **compliant**
**MEMBER 71125:**
- DOB 1950-05-08, age 76 — exceeds upper age limit
- **not_eligible**
**MEMBER 71126:**
- DOB 1981-12-20, age 45 — below lower age limit
**not_eligible**
**MEMBER 71127:**
- DOB 1981-01-14, age 45 — also under 46
- **not_eligible**
**MEMBER 71128:**
- DOB 1951-12-10, age 75 ✓, fully enrolled
- Stool DNA test 2026-08-17 meets N2 (CT colonography from 2020 too old)
- **compliant**
**MEMBER 71129:**
- DOB 1959-07-23, age 67 ✓, enrolled continuously
- Checking screening record starting 2023-07-08...
Flexible sigmoidoscopy 2023-09-13 and CT colonography, both within their respective 5-year windows through 2026 — satisfies N3/N4. No exclusions.
- **compliant**
**MEMBER 71130:**
- DOB 1981-09-13, age 45 — fails age threshold regardless of cancer history
- **not_eligible**
**MEMBER 71131:**
- DOB 1950-05-05, age 76 — exceeds upper age limit
- **not_eligible**
**MEMBER 71132:**
- DOB 1950-02-01, age 76 — same issue, screening history irrelevant here
- **not_eligible**
**MEMBER 71133:**
- DOB 1967-01-22, age 59, checking next...
Age 59 falls in range, enrolment continuous all year. Two CT colonography screenings in 2021 both land within the 2022-2026 window — meets N4. No exclusions.
- **compliant**
**MEMBER 71134:**
Age 45 — below threshold.
- **not_eligible**
**MEMBER 71135:**
Age 55, continuous enrolment, colonoscopy from 2016 falls within the 10-year lookback (2016-2026) — meets N5.
- **compliant**
**MEMBER 71136:**
DOB 1981-11-11, checking age...
Wait, 71122 should be not_eligible due to enrollment, not excluded. Let me re-examine: enrolled status determines that classification.
For the gap calculation: 2026-01-01 to 2026-03-22 spans Jan (31) + Feb (28) + Mar 22 = 81 days, exceeding the 45-day threshold, confirming not_eligible.
Excluded members are those meeting exclusion criteria within the eligible population: 71113 (colorectal cancer) and 71114 (age 66+ with frailty and advanced illness).
Total roster count: 26.
Breaking down eligibility: 10 members are not_eligible, leaving 16 potentially eligible. Removing the two exclusions (71113, 71114) gives a denominator of 14.
Checking compliance status for the numerator: 71112 non-compliant (no screening), 71115 compliant (colonoscopy within 10 years), 71116 non-compliant (stool DNA test from 2023-01-09, outside the 3-year window), 71117 compliant (stool DNA test in 2026), 71118 compliant (flexible sigmoidoscopy within 5 years), 71120 non-compliant (no screening), 71121 compliant (CT colonography in 2026), and continuing to check 71123.
71123 turns out non-compliant (no screening). Then 71124 compliant (flexible sigmoidoscopy in 2026), 71128 compliant (stool DNA test in 2026), 71129 compliant (flexible sigmoidoscopy plus CT colonography within 5 years), 71133 compliant (CT colonography within 5 years), 71135 compliant (colonoscopy within 10 years).
That gives 8 compliant members, so non-compliant should be 14 - 8 = 6, but I'm only finding 4 non-compliant IDs (71112, 71116, 71120, 71123). I need to go back and verify the full denominator list to find the discrepancy — starting with 71112, 71115, 71116, 71117, 71118, 71120, and continuing.
Working through each candidate: 71113 and 71114 excluded, 71119 not eligible by age, 71120 makes denominator with advanced illness alone not triggering exclusion, and 71121 qualifies too with enrollment gaps of 28 and 15 days falling within allowed limits.
- 71122: not_eligible (gap too large)
- 71123: age 67, gaps of 13 and 25 days, no exclusions → denominator
- 71124: age 66, full year enrolled, clean → denominator
- 71125-71127: not_eligible on age
- 71128: age 75, full year, clean → denominator
- 71129: age 67, full year, clean → denominator
- 71130: not_eligible (age)
- 71131: not_eligible (age)
Rounding out with 71132-71136: excluding age 76's, catching 71133 (age 59, full year, clean → denominator) and 71135 (age 55, full year, clean → denominator).
Final denominator set: 71112, 71115-71118, 71120-71121, 71123-71124, 71128-71129, 71133, 71135 = 13 members.
Now checking compliance - 71115 has colonoscopy 2016-12-23, falls within the 10-year lookback, satisfies screening. 71117 has a stool DNA test scheduled for 2026, need to verify this counts within the measurement period.
2025, 2026 - so 2023-01-09 falls outside, confirming non-compliant.
Final tally: non-compliant are 71112, 71116, 71120, 71123 (4 total).
Numerator = 9, Denominator = 13, Rate = 9/13 × 100 ≈ 69.2%
Excluded = 2 (71113, 71114)
Checking not_eligible members for enrollment gaps:
- 71111: enrolled 2026-05-01 to 2026-12-31, gap Jan-Apr = 120 days, exceeds 45 → not_eligible confirmed
- 71122: enrolled 2026-03-22 to 2026-12-31, gap Jan 1 to Mar 22 = 81 days, exceeds 45 → not_eligible confirmed
not_eligible = 11: 71111, 71119, 71122, 71125, 71126, 71127, 71130, 71131, 71132, 71134, 71136
Totals: 26 members, 2 excluded, 11 not eligible, denominator 13, 9 compliant, 4 non-compliant. Checks: 2+11+13=26 ✓, 9+4=13 ✓
Reconsidering 71111 against the continuous enrollment rule (full year, ≤45 day single gap) — measurement year runs 2026-01-01 to 2026-
12-31. Someone enrolled only from 2026-05-01 onward is missing Jan-Apr, a 120-day absence before enrollment even starts, not a mid-year gap.
The phrasing "full measurement year with no more than one gap of up to 45 days" likely means enrollment must span essentially the whole year, allowing just one interruption of ≤45 days — not that any random enrollment window under 45 days total absence counts. Under this reading, starting coverage in May clearly fails since the missing time far exceeds the 45-day allowance.
Same logic applies to 71122, who starts 2026-03-22 — about 80 days missing, also over the limit, making them not_eligible too.
Reviewing all members' statuses:
1. 71111 — not_eligible (missing ~120 days at start)
2. 71112 — denominator, non_compliant (age 72, full-year enrollment, no screening)
3. 71113 — excluded (C18.7 colorectal cancer)
4. 71114 — excluded (age 75, frailty + advanced illness in 2026)
5. 71115 — denominator, compliant (colonoscopy 2016-12-23, within 10-year window)
6. 71116 — denominator, non_compliant (stool DNA 2023-01-09 too old; nothing else qualifies)
7. 71117 — denominator, compliant (stool DNA 2026-01-11)
8. 71118 — denominator, compliant
1131: not_eligible (age 76, exceeds 75)
22. 71132: not_eligible (age 76, exceeds 75)
23. 71133: denominator, compliant (CT colonography twice in 2021 within 5-year window)
24. 71134: not_eligible (age 45, below 46)
25. 71135: denominator, compliant (colonoscopy 2016-11-12 within 10-year window)
26. 71136: continuing evaluation
Tallying results: 13 in denominator, 9 compliant/numerator, 4 non-compliant, 2 excluded, 11 not_eligible, summing to 20 patients total.
Rate = 9/13 × 100 = 69.230769... → rounds to 69.2%
Rechecking 71116's stool DNA test dated 2023-01-09 against the three-year window (2024-2026, since "two years prior" to 2026 means 2024-2025). That test falls outside the window entirely, so it doesn't count toward compliance.
Confirming N5's phrasing follows the same logic - "nine years prior" gives a 2016-2026 window - which validates my interpretation for N2. 2023-01-09 stays outside the 2024-2026 window, so 71116 remains non_compliant with no other screening on record.
through 2026-12-31.
N5's window (colonoscopy in 2026 or nine years prior) stretches back roughly to 2016-2017, giving a full ten-year span. Checking dates: 2016-12-23 for 71115 and 2016-11-12 for 71135 both fall within this range, confirming they count.
both fall right at the boundary. Given the ambiguity, tests from 2016-01-01 onward likely satisfy a 10-year lookback from 2026, so these colonoscopies should count as compliant.
is getting overly technical. The reasonable interpretation: a "10-year window" covers 2016 through 2026, so tests from early 2016 should count. I'll treat 71115 and 71135 as compliant.
Same logic applies to the 5-year window (N3/N4): 2026-12-31 minus 5 years = 2021-12-31, so 2021-2026. For the 3-year window (N2): 2026-12-31 minus 3 years puts the boundary around 2023-12-31.
But this conflicts with an earlier read where "two years prior" to 2026 meant just 2024-2025, not 2023-2025. Similarly "four years prior" would mean 2022-2025, not include 2026 itself.
The ambiguity is whether "years prior" means the calendar years immediately preceding 2026, or a rolling period from N years ago to now. These give different windows.
Since the spec explicitly calls it a "three-year window" for "2026 or two years prior," that confirms interpretation 2: current year plus the two full years before it = 2024, 2025, 2026 = 3 years total.
Applying the same logic, "2026 or the four years prior (five-year window)" = 2022, 2023, 2024, 2025, 2026 = 5 years.
So 2023-01-09 falls inside the five-year window but outside the three-year window.
And "2026 or the nine years prior (ten-year window)" = 2017 through 2026.
Colonoscopies dated 2016 would fall just outside this ten-year window — worth double-checking against the exact anchor date, since the spec measures from 2026-12-31, meaning the ten-year cutoff might actually be 2016-12-31, which would make 2016 borderline compliant.
are included.
- Tests during 2024 are included.
- This continues back to 2017 (nine years prior).
So the full window spans 2017-2026, meaning 10 calendar years. But this creates a problem: tests from 2016 (which would be 10 years prior) fall outside the window, so 71115 and 71135 with their 2016 dates get excluded.
Actually checking the math again: if 2026 is year 0, then 2017 is 9 years back and 2016 is 10 years back. "Nine years prior" should mean 2017-2025, combined with 2026 itself giving a 10-year span from 2017-2026.
But if I take the "ten-year window" label literally as spanning exactly 10 years back from 2026-12-31, that would be 2016-12-31 to 2026-12-31 - which would include some of late 2016.
I'll go with the exact-years-back interpretation for all windows:
- 10-year: 2016-12-31 to 2026-12-31
- 5-year: 2021-12-31 to 2026-12-31
- 3-year: 2023-12-31 to 2026-12-31
Under this reading, 2016-12-23 falls just before the cutoff, making 71115 non_compliant.
year window)" means 2026 itself plus the 9 years immediately preceding it: 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017. That gives a window of 2017-2026, not 2016-2026.
But taking "ten-year window" literally, a full 10 calendar years would need to include 2016. Since the measurement end date is 2026-12-31, looking back 10 years lands on 2016-12-31, so tests from 2016 onward should count.
Going with this reading: 71115 (colonoscopy 2016-12-23) and 71135 (colonoscopy 2016-11-12) both fall within the 10-year window and are compliant.
Numerator: 9 — 71115, 71117, 71118, 71121, 71124
or after 2016-12-31 counts, so 2016-12-23 and 2016-11-12 both fall short and are excluded. Whether "nine years prior" means 2017-2025 combined with 2026, the outcome is the same—2016 dates don't qualify.
That reclassifies 71115 and 71135 as non_compliant rather than compliant, since their colonoscopies fall outside the 10-year window.
Compliant: 71117, 71118, 71121, 71124, 71128, 71129, 71133 = 7
Non_compliant: 71112, 71115, 71116, 71120, 71123, 71135 = 6
Numerator: 7, Denominator: 13, Rate: 7/13 × 100 ≈ 53.8%
But I should double-check the "ten-year window" phrasing once more—going back exactly 10 years from 2026-12-31 lands on 2016-12-31, which could change how the boundary is drawn.
"Colonoscopy during 2026 or the nine years prior (ten-year window)" seems to mean 2026 plus 9 prior years = 2017-2026, a 10 calendar-year span that excludes 2016. If instead "10 years" were meant literally as a rolling period, 2016 might barely qualify. I'll go with the calendar-year interpretation: window is 2017-2026, so any test from 2016 or earlier doesn't count.
2026 inclusive, meaning 10 calendar years total: 2017-2026. So 2016 dates fall outside this window.
This confirms 71115 and 71135 are non_compliant since their dates (2016-12-23, 2016-11-12) predate the 2017-2026 window.
Final tally: Numerator 7, Denominator 13, Rate 53.8%.
I should verify the five-year window logic for N3/N4 similarly - "2026 or four years prior" means 2022-2026.
Checking cases:
- 71118: 2021-11-12 falls outside the window, but 2022-07-04 falls inside. Compliant.
- 71129: both 2023-07-08 and 2023-09-13 fall within 2022-2026. Compliant.
- 71133: 2021-04-12 needs checking against the window boundaries too.
71133 has both dates outside the window → non_compliant, not compliant as I had it.
Now checking the 3-year window similarly: N2 covers stool DNA tests within 2024-2026. 71116's 2023-01-09 falls outside this window → non_compliant. 71117's 2026-01-11 is inside → compliant.
Applying the corrected windows (3-year: 2024-2026, 5-year: 2022-2026, 10-year: 2017-2026):
- 71115: colonoscopy 2016-12-23 falls outside the 10-year window → non_compliant
- 71118: has one date outside (2021-11-12) but one inside (2022-07-04) → compliant since only one is needed
- 71129: both dates (2023-07-08, 2023-09-13) fall inside → compliant
- 71133: both dates fall outside the window → non_compliant
Recounting: numerator becomes 71117, 71118, 71121, 71124, 71128, 71129 = 6 compliant; non_compliant totals 7 (71112, 71115, 71116, 71120, 71123, 71133, 71135). With denominator 13, rate = 6/13 ≈ 46.2%.
Still uncertain about the window boundaries though — need to reconfirm what "nine years prior" actually means for N5.
"Colonoscopy during 2026 or the nine years prior" likely means the ten-year span covering 2017 through 2026 (nine years before 2026 plus 2026 itself). So a colonoscopy anytime from 2017-01-01 through 2026-12-31 should count as compliant.
Following that logic, "four years prior" gives a 5-year window (2022-2026), and "two years prior" gives a 3-year window (2024-2026).
Checking each patient:
- 71115: colonoscopy on 2016-12-23 falls outside 2017-2026 → non_compliant
- 71118: sigmoidoscopy on 2021-11-12 is outside 2022-2026, but 2022-07-04 falls inside → compliant
- 71129: both sigmoidoscopy (2023-07-08) and CT colonography (2023-09-13) fall inside 2022-2026 → compliant
- 71133: both CT colonography dates (2021-04-12, 2021-09-09) fall outside
- 71135: colonoscopy 2016-11-12 outside 2017-2026 → non_compliant
Tallying: numerator (71117, 71118, 71121, 71124, 71128, 71129) = 6, non-compliant (71112, 71115, 71116, 71120, 71123, 71133, 71135) = 7, denominator = 13. Rate = 6/13 ≈ 46.2%.
Double-checking 71118 - the 2021-11-12 sigmoidoscopy predates the 2022-2026 window,
11-12 and 2022-07-04. The 5-year window for a 2026 measurement year is 2022-2026, so 2022-07-04 falls right within it and satisfies the screening requirement. The 42-day enrollment gap is also within the 45-day allowance, so 71118 stays compliant.
Now checking N1's wording carefully - it only mentions FOBT/FIT during 2026, not stool DNA tests. Need to see if 71117's stool DNA test on 2026-01-11 actually qualifies under a different criterion since it isn't the same test type as N1 specifies.
Since N2 covers stool DNA tests within 2026 or the two prior years (2024-2026), and 71117's test falls on 2026-01-11, this satisfies N2's window directly. So 71117 is compliant via N2, not N1.
Rechecking all numerator members:
- 71117: Stool DNA test 2026-01-11 → N2 (2024-2026) → compliant
- 71118: Flexible sigmoidoscopy 2022-07-04 → N3 (2022-2026) → compliant
- 71121: CT colonography 2026-02-22 → N4 (2022-2026) → compliant
- 71124: Flexible sigmoidoscopy 2026-04-15 → N3 (2022-2026) → compliant
- 71128: Stool DNA test 2026-08-17 → N2 (20json{
"denominator": 13,
"numerator": 6,
"excluded": 2,
"not_eligible": 11,
"rate": 46.2,
"compliant_members": ["71117", "71118", "71121", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71123", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71122", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 13,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 6,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 11,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 46.2,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71121",
"71124",
"71128",
"71129"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71123",
"71133",
"71135"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71122",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}Reasoning · 11,039 tokens
Let me work through each member systematically against the measure specification QM-CRC.
**Measure requirements:**
- Measurement year: 2026-01-01 through 2026-12-31
- Eligible population (denominator):
- 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 (any one of):
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or prior two years (3-year window)
- N3: Flexible sigmoidoscopy during 2026 or prior four years (5-year window)
- N4: CT colonography during 2026 or prior four years (5-year window)
- N5: Colonoscopy during 2026 or prior nine years (10-year window)
- Exclusions (only evaluated for eligible members):
- 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
Let me evaluate each member:
**MEMBER 71111**
- DOB: 1971-04-18, age 55 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: 2026-05-01 through 2026-12-31. Started 2026-05-01, so enrolled for ~7 months. Did not enroll for 2026-01-01 to 2026-04-30, which is 120 days.
This exceeds the allowed single gap of up to 45 days. ✗ NOT ELIGIBLE — fails continuous enrolment.
- Status: not_eligible
**MEMBER 71112**
- DOB: 1954-02-14, age 72 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Eligible population: YES (denominator)
- Exclusions:
- E1: No colorectal cancer documented
Colectomy, hospice, and frailty/advanced illness exclusions also not met — none of E2-E4 apply, so member remains in denominator. Checking numerator: no FOBT/FIT, Stool DNA, flex sig, CT colonography, or colonoscopy on record in any applicable lookback window. Status: non_compliant.
**MEMBER 71113**
- DOB: 1979-02-27, age 47 on 2026-12-31 ✓ (in range 46-75)
Continuous enrollment 2026-01-01 through 2026-12-31, no gaps — denominator eligible. Checking exclusions: diagnosis C18.7 (malignant neoplasm, sigmoid colon) dated 2025-07-17 triggers E1 colorectal cancer exclusion.
- Status: excluded
**MEMBER 71114**
- DOB: 1951-11-18, age 75 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Eligible population: YES (denominator)
- Exclusions:
- E1: No colorectal cancer documented ✓
- E2: No colectomy documented ✓
- E3: No hospice documented ✓
- E4: Age 75 (66+), frailty documented —
Frailty on 2026-12-17 plus advanced illness on 2026-05-05, both within measurement year, triggers E4. EXCLUDED ✗
- Status: excluded
**MEMBER 71115**
- DOB: 1979-09-19, age 47 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: continuous with one 35-day gap (2026-07-16 to 2026-08-21), within allowed threshold ✓
- Eligible population: YES (denominator)
- Exclusions:
- E1, E2, E3: none documented ✓
- E4: Age 47, doesn't apply ✓
- Numerator: no FOBT/FIT, stool DNA, flexible sigmoidoscopy, or CT colonography documented for the qualifying periods so far — checking remaining tests.
**MEMBER 71116**
- DOB: 1976-01-11, age 50 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: one 35-day gap, acceptable ✓
- Eligible population: YES (denominator)
- Exclusions: E1-E3 none documented, E4 doesn't apply at age 50 ✓
- Numerator: N1 no FOBT/FIT in 2026 ✗. N2 stool DNA test dated 2023-01-09 — checking whether this falls within the 3-year look-back window (2023-12-31 cutoff).
Re-reading the criteria: "during 2026 or the two years prior" means the window covers 2024, 2025, and 2026 only. So 2023-01-09 falls outside the window and does not satisfy N2. ✗
ool DNA test on 2023-01-09 falls outside this window. ✗
None of N3-N5 satisfy either — no flex sig, no CT colonography, no colonoscopy in their respective lookback periods. Status: non_compliant.
**MEMBER 71117**
DOB 1963-09-02, age 63 ✓. Enrollment: 2026-01-01 to 2026-06-02, then 2026-07-18 to 2026-12-31 — single gap of exactly 45 days ✓. Qualifies for denominator. Checking E1 exclusion for colorectal conditions.
✓
- Numerator:
- N1: No FOBT/FIT in 2026 ✗
- N2: No Stool DNA test in 2026 or prior two years ✗
- N3: Flex sig dates 2021-11-12 and 2022-07-04. Window needed is 2022-2026 (during 2026 or four years prior). The 2021 date falls outside this window, before 2022 starts.
2022-07-04 falls within the window ✓
- compliant
**MEMBER 71119**
- Age 76 on 2026-12-31, exceeds upper bound of 75 ✗
- not_eligible
**MEMBER 71120**
- Age 75 on 2026-12-31, within range ✓
- Enrolled full year, no gaps ✓
- Denominator: YES
- Exclusions:
- No colorectal cancer ✓
- Checking colectomy exclusion
-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Two gaps: 28 days and 15 days. Two gaps means this fails continuous enrolment (only one gap allowed). ✗
- Status: not_eligible
**MEMBER 71122**
- DOB: 1954-09-15, age 72
Age checks out for member 71122. Enrollment starts 2026-03-22, leaving a 79-day gap from Jan 1 - exceeds the single-gap rule, so not eligible.
**MEMBER 71123**
- Age 67 fits range. Enrollment has two gaps (13 days and a second period) - checking if this also fails the single-gap requirement.
**MEMBER 71124**
- Age 66, continuous enrollment all year - qualifies for denominator.
- Exclusions clear: no colorectal cancer, no colectomy, no hospice. Age 66+ requires checking frailty/advanced illness documentation - none found, so not excluded.
- Checking numerator: no FOBT/FIT recorded in 2026 so far.
026-12-31 ✗ (outside range 46-75; must be ≥46)
- Status: not_eligible
**MEMBER 71128**
- DOB: 1951-12-10, age 75 on 2026-12-31 ✓ (in range 46-75)
- Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps ✓
- Eligible population: YES (denominator)
- Exclusions:
- E1: No colorectal cancer documented ✓
- E2: No colectomy documented ✓
- E3: No hospice documented ✓
- E4: Age 75, no frailty or advanced illness documented, not excluded ✓
- Numerator:
- N1: No FOBT/FIT in 2026 ✗
- N2: Stool DNA test 2026-
08-17, within 2026 ✓
- Status: compliant
**MEMBER 71129**
- DOB: 1959-07-23, age 67 on 2026-12-31 ✓ (in range)
- Enrolment continuous through 2026 ✓
- Denominator: YES
- Exclusions: no cancer, no colectomy, no hospice, age 67 with no frailty/advanced illness documented ✓ all clear
- Numerator: N1 FOBT/FIT ✗, N2 Stool DNA ✗, N3 flexible sigmoidoscopy 2023-07-08 falls within 2022-2026 window ✓
- Status: compliant
**MEMBER 71130**
- DOB: 1981-09-13, age 45 on 2026-12-31 ✗ (must be
Members 71131 and 71132 both age 76, exceeding the 75 upper limit, so both not_eligible.
**MEMBER 71133**
- DOB: 1967-01-22, age 59 ✓ in range
- Enrolment continuous ✓, denominator YES
- Exclusions all clear, E4 not applicable since under 66
- Numerator: N1 ✗, N2 ✗, N3 ✗, checking N4 CT colonography
CT colonography dates 2021-04-12 and 2021-09-09 fall outside the required window (2022-2026), so N4 ✗. N5 colonoscopy also ✗. Status: non_compliant.
**MEMBER 71134**
- Age 45, below the 46 minimum → not_eligible
**MEMBER 71135**
- DOB 1971-08-26, age 55 ✓, enrollment continuous, denominator YES, checking exclusions starting with E1.
DOB 1981-11-11 makes them 45 on 2026-12-31, below the required 46-75 range — not_eligible.
Now compiling results, only 71117 qualifies as compliant so far.
Continuing the compliance check: 71118 had a flexible sigmoidoscopy 2022-07-04, 71124 in 2026-04-15, 71128 stool DNA test 2026-08-17, 71129 sigmoidoscopy 2023-07-08. That brings compliant count to 5.
Non-compliant members lacking any qualifying screening: 71112, 71115, 71116, 71120, 71133, 71135.
Excluded: 71113 has colorectal cancer diagnosis, 71114 is 66+ with frailty and advanced illness both present — total 2 excluded.
Not eligible: 71111 has enrollment gap over 45 days (120-day gap starting 2026-05-01); 71119 age 76; 71121 has two gaps, disqualifying since only one gap ≤45 days is allowed; 71122 gap of 79 days; 71123 also has two gaps; 71125 age 76; 71126, 71127, 71130 all age 45.
Continuing: 71131 age 76; 71132 age 76; 71134 age 45; 71136 age 45.
Total not eligible: 13.
Tallying: denominator 11, numerator 5, excluded 2, not eligible 13, sums to 26 which matches total records.
Rate calculation: 5/11 × 100 ≈ 45.5%
Now verifying my exclusion for 71111 — enrollment starts 2026-05-01, so the gap from Jan 1 to May 1 spans 120 days (31+28+31...).
Confirming 71114 meets E4: age 75 satisfies the ≥66 threshold, and both frailty (12-17) and advanced illness (05-05) fall within 2026, so both conditions documented — correctly excluded.
Checking 71115: age 47 fails the age criterion for exclusion.
No cancer, colectomy, or hospice indicators found, placing this member in the denominator. The lone colonoscopy dates to 2016-12-23. Recalculating the 10-year screening window: from 2026 back through the nine prior years spans 2017-2026, meaning 2016 falls just outside — non-compliant.
**71117**: Gap is
June 3 through July 17 marks the gap — 28 days in June plus 17 in July equals 45 days total, matching the spec's stated gap.
**71118**: Age 47, gap of 42 days meets the ≤45 day threshold. Checking flexible sigmoidoscopy dates (2021-11-12, 2022-07-04) against the look-back window of 2022-2026 — 2022-07-04 qualifies. Compliant ✓
**71119**: Age 76 on 2026-12-31, exceeds the 75-year cap. Not eligible ✓
**71120**: Advanced illness alone doesn't trigger E4 exclusion since it requires frailty too. Falls into denominator, no screening found — non-compliant ✓
**71121**: Two gaps (28 and 15 days) violates the single-gap rule. Not eligible ✓
**71122**: Enrollment gap from Jan 1 to Mar 21 totals 79 days, well past the 45-day limit. Not eligible ✓
**71123**: Checking for multiple gaps here too —
gaps of 13 and 25 days again break the single-gap allowance. Not eligible ✓
**71124**: Age 66, no exclusions, flexible sigmoidoscopy done 2026-04-15 — compliant ✓
**71128**: Stool DNA test in 2026 satisfies screening for this 75-year-old — compliant ✓
**71129**: Sigmoidoscopy from 2023-07-08 falls within the 2022-2026 lookback window — compliant ✓
**71133**: CT colonography dates (2021) fall outside the required 2022-2026 window, so this doesn't count toward compliance.
**71135**: Colonoscopy from 2016 falls outside the required 2017-2026 ten-year window (nine years prior to 2026 plus 2026 itself). No other qualifying test exists — non-compliant ✓
Double-checking window math: for flex sig, "2026 or the four years prior" spans 2022-2026 (five years total). For colonoscopy, "2026 or the nine years prior" spans 2017-2026 (ten years total).
For stool DNA, "2026 or the two years prior" spans 2024-2026 (three years total).
**71116 recheck**: Stool DNA test from 2023-01-09 falls outside the 2024-2026 window — non-compliant ✓
**71127**: Age 45, falls outside the eligible age range.
Tallying up:
- Compliant: 71117, 71118, 71124, 71128, 71129 (5)
- Non-compliant: 71112, 71115, 71116, 71120, 71133, 71135 (6)
- Excluded: 71113, 71114 (2)
- Not eligible: 71111, 71119, 71121-71123, 71125-71127, 71130-71131
Total check: 11+2+13=26 ✓
Rate = 5/11 × 100 = 45.45... → 45.5 rounded
Double-checking age criteria: 46-75 as of 2026-12-31. Age 45 excluded, age 76 excluded. Verifying my classifications against this range confirms the tallies above.
✗
- 71132: 76 ✗
- 71133: 59 ✓
- 71134: 45 ✗
- 71135: 55 ✓
- 71136: 45 ✗
Now checking 71121's enrolment gaps against the spec: "2026-01-01 through 2026-03-21; 2026-04-19 through 2026-07-06; 2026-07-22 through 2026-12-31. Gaps of 28 and 15 days."
Gap 1 spans end of 2026-03-21 to start of 2026-04-19 — March 22-31 (10 days) plus April 1-18 (18 days).
Total = 28 days ✓
Gap 2 spans end of 2026-07-06 to start of 2026-07-22 — July 7-21 = 15 days ✓
Since two gaps exist and the spec allows "no more than one gap of up to 45 days," this member fails the enrolment requirement. ✓
Verifying 71117's gap: "2026-01-01 through 2026-06-02; 2026-07-18 through 2026-12-31. One gap of 45 days." Gap spans end of 2026-06-02 to start of 2026-07-18 — June 3-30 (28 days) plus July 1-17 (17 days), totaling 45 days ✓
This matches the spec's claim, confirming this member meets the enrolment requirement.
Now checking N4 windows for 71114: DOB 1951-11-18 (age 75), CT colonography on 2021-12-07. The N4 window is 2022-2026, and the exam predates this range, so it doesn't satisfy N4.
Checking E4 exclusion instead: age 75 qualifies (66+), frailty documented 2026-12-17, advanced illness documented 2026-05-05 — both within the measurement year. E4 applies, excluding this member.
For 71113: DOB 1979-02-27 (age 47), continuous enrolment throughout 2026 confirms eligibility. But diagnosis of C18.7 (colorectal cancer) on 2025-07-17 triggers E1 exclusion.
Compiling final results into JSON with denominator 11, numerator 5, excluded 2, not_eligible 13, rate 45.5%, and listing compliant member IDs.
Double-checking the look-back windows since errors often hide there. N2 (stool DNA test) uses a three-year window - during 2026 or the two years prior - meaning any test from Jan 1, 2024 through Dec 31, 2026 counts.
Dates in 2023 or earlier fall outside this window.
For N3 (flexible sigmoidoscopy) and N4 (CT colonography), both use "2026 or the four years prior" — a five-year window spanning 2022-01-01 through 2026-12-31.
For N5 (colonoscopy), the window is "2026 or the nine years prior" — a ten-year span, so I need to work out that start date next.
11-12 is before the window, but 2022-07-04 falls within it, so 71118 qualifies.
71127 has stool DNA 2024-12-13 within window but is age 45 - not eligible due to age.
71129's flexible sig 2023-07-08 falls within the N3 window - qualifies.
Checking 71133's CT colonography dates against the N4 window next.
```
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
```
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 12,724 tokens
Let me work through each member systematically against the QM-CRC colorectal cancer screening measure specification.
The measurement year is 2026-01-01 through 2026-12-31.
**ELIGIBLE POPULATION (denominator) criteria:**
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrollment: the full measurement year with no more than one gap of up to 45 days
**NUMERATOR** — any one of:
- 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: 2024-2026)
- N3. Flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-2026)
- 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: 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
- 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 71111**
- DOB 1971-04-18, age 55 on 2026-12-31 ✓ (in range 46-75)
- Enrollment starts 2026-05-01, leaving Jan-Apr uncovered (120 days), well beyond the 45-day allowance
- Fails continuous enrollment ✗
- Status: NOT_ELIGIBLE
---
**MEMBER 71112**
- DOB 1954-02-14, age 72 on 2026-12-31 ✓ (in range 46-75)
-
Enrolled continuously 2026-01-01 through 2026-12-31, no gaps ✓
- Exclusions all clear: no colorectal cancer, no colectomy, no hospice, age 72 without frailty/advanced illness documentation ✓
- Denominator eligible
- Checking numerator screenings: no FOBT/FIT, no stool DNA test, no flex sig, no CT colonography, no colonoscopy in any lookback window ✗
- Status: NON_COMPLIANT
---
**MEMBER 71113**
- Age 47 on 2026-12-31, meets range ✓
- Continuous enrollment all year ✓
- Diagnosis C18.7 (sigmoid colon malignancy) from 2025-07-17 triggers exclusion ✗
- Status
EXCLUDED
---
**MEMBER 71114**
- Age 75, within range ✓
- Continuously enrolled ✓
- No cancer, colectomy, or hospice, but both frailty (2026-12-17) and advanced illness (2026-05-05) documented for this ≥66 member — meets dual exclusion criteria ✗
- Status: EXCLUDED
---
**MEMBER 71115**
- Age 47, within range ✓
- Enrollment split 2026-01-01 to 2026-07-16 and 2026-08-21 to 2026-12-31, gap of 35 days, within 45-day allowance ✓
- No cancer, colectomy, hospice; age under 66 ✓
- Denominator eligible
- Numerator: no FOBT/FIT, no stool DNA, no flex sig, no CT colonography, but colonoscopy dated 20
16-12-23 falls in the 2017-2026 window, satisfying the numerator.
- Status: COMPLIANT
---
**MEMBER 71116**
- Age 50, within range ✓
- Enrollment gap of 35 days (2026-03-17 to 2026-04-20), within tolerance ✓
- No exclusion triggers; age under 66
- Denominator eligible
- Numerator: no current-year FOBT/FIT, stool DNA test from 2023-01-09 too old for the 2024-2026 window, no sigmoidoscopy, no CT colonography, no colonoscopy in range — no test satisfies numerator
- Status: NON_COMPLIANT
---
**MEMBER 71117**
- Age 63, within range ✓
- Enrollment gap exactly 45 days (2026-06-03 to 2026-07-17), still within allowance ✓
- No cancer, colectomy, hospice; checking age-related exclusion next
---
**MEMBER 71117 (continued)**
- Age 63 confirmed under 66, no exclusions apply
- Denominator eligible
- No FOBT/FIT in 2026, but stool DNA test on 2026-01-11 satisfies numerator ✓
- Status: COMPLIANT
---
**MEMBER 71118**
- Age 47, within range ✓
- Enrollment gap 42 days, acceptable ✓
- No exclusions triggered
- Denominator eligible
- No FIT/FOBT or stool DNA in window, but flexible sigmoidoscopies from 2021 and 2022 fall within the 2022-2026 timeframe, satisfying numerator ✓
- Status: COMPLIANT
---
**MEMBER 71119**
- Age 76 exceeds upper bound of 75
- Status: NOT_ELIGIBLE
---
**MEMBER 71120**
- Age 75, at upper boundary of range ✓
- Continuous enrollment all year, no gaps ✓
- Checking exclusions next
ons:
- E1: No colorectal cancer ✓
- E2: No colectomy ✓
- E3: No hospice ✓
- E4: Age 75 (≥66), advanced illness documented 2026-02-01, but no frailty documented
- Only one condition (advanced illness), not both ✓
- In denominator
- No screening tests found across any of the accepted modalities (FOBT, stool DNA, sigmoidoscopy, CT colonography, colonoscopy) in their respective windows
- Status: NON_COMPLIANT
---
**MEMBER 71121**
- Age 55, within range ✓
- Two separate enrollment gaps (28 days and 15 days) - exceeds allowed limit of one gap
- Status: NOT_ELIGIBLE
---
**MEMBER 71122**
- Age 72, within range ✓
- Enrollment starting 2026-03-22 through year-end, checking continuity
Missing 80 days at the start (2026-01-01 to 2026-03-21), so continuous enrollment fails. Status: NOT_ELIGIBLE.
---
**MEMBER 71123**
- Age 67, within range ✓
- Two enrollment gaps (13 days and 25 days) - violates single-gap rule
- Status: NOT_ELIGIBLE
---
**MEMBER 71124**
- Age 66, within range ✓
- Full continuous enrollment all year, no gaps
- Exclusions all cleared (no cancer, no colectomy, no hospice, no dual frailty+advanced illness)
- Denominator: yes
- Checking numerator - no FOBT, no stool DNA, moving to check sigmoidoscopy history
Flexible sigmoidoscopy on 2026-04-15 satisfies numerator. Status: COMPLIANT
---
**MEMBER 71125**
- Age 76, exceeds upper bound. Status: NOT_ELIGIBLE
**MEMBER 71126**
- Age 45, below lower bound. Status: NOT_ELIGIBLE
**MEMBER 71127**
- Age 45, below lower bound. Status: NOT_ELIGIBLE
---
**MEMBER 71128**
- Age 75, within range ✓, full continuous enrollment
- All exclusions clear, enters denominator
- No FOBT, but stool DNA test 2026-08-17 satisfies numerator
- Status: COMPLIANT
---
**MEMBER 71129**
- Age 67, within range ✓, checking enrollment continuity next
3: No hospice ✓
- E4: Age 59 (<66) ✓
- In denominator
- Numerator: no faecal test, no stool DNA, no sigmoidoscopy in window; CT colonography 2021-04-12/09-09 falls outside 2022-2026 window; no colonoscopy 2017-2026
- Status: NON_COMPLIANT
---
**MEMBER 71134**
- DOB 1981-09-26, age 45 on 2026-12-31 ✗ (too young)
- Status: NOT_ELIGIBLE
---
**MEMBER 71135**
- DOB 1971-08-26, age 55 ✓
- Enrollment 2026-01-01–12-31, continuous ✓
- Exclusions: no cancer, no colectomy, no hospice, age <66 ✓
- In denominator
- Numerator: no faecal test, no stool DNA, checking sigmoidoscopy next
**MEMBER 71135 (cont.)**
- No sigmoidoscopy 2022-2026, no CT colonography 2022-2026
- Colonoscopy 2016-11-12 falls just outside the 2017-2026 window ✗
- Status: NON_COMPLIANT
---
**MEMBER 71136**
- DOB 1981-11-11, age 45 ✗ (too young)
- Status: NOT_ELIGIBLE
---
Compiling final results:
**COMPLIANT:** 71115, 71117, 71118, 71124, 71128, 71129
**NON_COMPLIANT:** 71112, 71116, 71120, 71133, 71135
**EXCLUDED:** 71113 (colorectal cancer), 71114 (age 75, frailty/advanced illness)
**NOT_ELIGIBLE:** 71111 (enrollment gap likely), plus checking remaining members
For 71119, 71121, 71122, 71123, 71125-71127, 71130-71132, 71134, 71136 - need to verify each against age range (46-75) and enrollment continuity (max one gap ≤45 days across the year).
Counting: 6 compliant + 5 non-compliant + 2 excluded should leave 13 not-eligible if total is 26.
Denominator = 6+5 = 11, Numerator = 6, Rate = 6/11 × 100 = 54.5%
Double-checking enrollment gaps: a member "not enrolled before" some date means a gap exists from 2026-01-01 to that date.
71111: gap 2026-01-01 to 04-30 (~120 days) — exceeds 45, NOT_ELIGIBLE.
71122: gap 01-01 to 03-21 = 31+28+21 = 80 days — exceeds 45, NOT_ELIGIBLE.
71126: enrollment gap only 75 days but age 45 (below 46-75 range) — NOT_ELIGIBLE due to age.
71130: age 45 also disqualifies regardless of enrollment dates — NOT_ELIGIBLE.
71131: age 76 exceeds upper bound — NOT_ELIGIBLE.
For numerator N5 (colonoscopy), the ten-year window is 2017-2026. Member 71135's colonoscopy from 2016-11-12 falls outside this window, so N5 not met.
For N4 (CT colonography), the five-year window is 2022-2026. Member 71133's exams from 2021 fall outside, so N4 not met.
Checking 71115's colonoscopy date of 2016-12-23 against the 2017-2026 window — need to confirm if this falls just outside the boundary.
ten-year window spans 2017-01-01 through 2026-12-31.
Under this reading, a colonoscopy on 2016-12-23 falls just outside the window since it's in 2016, not 2017. So 71115 doesn't satisfy N5 after all — I'll need to flag this as a discrepancy from my earlier compliant marking and revisit that member's status.
For 71118: sigmoidoscopy dates are 2021-11-12 and 2022-07-04, and the five-year N3 window is 2022-2026. The first date misses the window, but 2022-07-04 falls inside it, so 71118 satisfies N3 and counts compliant.
Similarly for 71129: a single sigmoidoscopy on 2023-07-08 lands within the 2022-2026 window, satisfying N3.
Double-checking the year-count logic for N3/N4 (four years prior) versus N5 (nine years prior) — both follow the same pattern of current year plus N prior years, giving five-year and ten-year windows respectively.
Applying the corrected N5 window (2017-2026) to 71115's colonoscopy from 2016-12-23 shows it falls outside the window, so this member fails N5 and should be marked NON_COMPLIANT rather than compliant.
Final tally:
- COMPLIANT: 71117, 71118, 71124, 71128, 71129
- NON_COMPLIANT: 71112, 71115, 71116, 71120, 71133, 71135
- EXCLUDED: 71113 (colorectal cancer diagnosis), 71114 (age 75 with frailty and advanced illness)
- NOT_ELIGIBLE: 71111
Verifying enrollment gaps for edge cases - 71117's 45-day gap is exactly at the allowed maximum, so it counts as eligible. 71121 and 71123 both have two separate gaps each, exceeding the "no more than one gap" rule, correctly placing them in NOT_ELIGIBLE.
Going through each compliant member's numerator: 71117 (stool DNA 2026-01-11, N2), 71118 (sigmoidoscopy 2022-07-04, N3), 71124 (sigmoidoscopy 2026-04-15, N3), 71128 (stool DNA 2026-08-17, N2), 71129 (sigmoidoscopy 2023-07-08, N3) - all confirmed within their respective windows.
Checking non-compliant members: 71112 and 71120 have no screening history at all. 71115 and 71135 both have colonoscopies from 2016, outside the N5 window. 71116's stool DNA test (2023) predates the N2 three-year window. 71133's CT colonography tests (2021) fall outside the N4 five-year window.
Excluded members confirmed: 71113 has C18.7 diagnosis meeting E1, 71114 has both frailty and advanced illness documentation meeting E4.
Working through not-eligible members: 71111 has a ~120-day enrollment gap from January to April. 71119, 71125, 71131, 71132 are all age 76, exceeding the 46-75 range. 71126, 71127, 71130 are age 45, below the range. 71122 has an ~80-day gap at the start of the year.
Totals check out: 5 compliant + 6 non-compliant + 2 excluded + 13 not-eligible = 26 members total.
Denominator = 11, Numerator = 5, Rate = 5/11 × 100 = 45.4545... → rounds to 45.5.
json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": ["71117", "71118", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 45.5,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}33GPT-5.6 Terra · OpenAI7.7s · 693 out | 8.6s · 698 out | 8.0s · 680 out
json{
"denominator": 11,
"numerator": 4,
"excluded": 2,
"not_eligible": 13,
"rate": 36.4,
"compliant_members": ["71117", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71118", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 4,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 36.4,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
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],
"got": [
"71117",
"71124",
"71128",
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],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71118",
"71120",
"71133",
"71135"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
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"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 11,
"numerator": 4,
"excluded": 2,
"not_eligible": 13,
"rate": 36.4,
"compliant_members": ["71117", "71124", "71128", "71129"],
"non_compliant_members": ["71112", "71115", "71116", "71118", "71120", "71133", "71135"],
"excluded_members": ["71113", "71114"],
"not_eligible_members": ["71111", "71119", "71121", "71122", "71123", "71125", "71126", "71127", "71130", "71131", "71132", "71134", "71136"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 4,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 2,
"got": 2,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 13,
"got": 13,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 45.5,
"got": 36.4,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"got": [
"71117",
"71124",
"71128",
"71129"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"got": [
"71112",
"71115",
"71116",
"71118",
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],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71113",
"71114"
],
"got": [
"71113",
"71114"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"got": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
],
"ok": true,
"present": true
}
],
"fabricated": true,
"abstained": false
}json{
"denominator": 11,
"numerator": 5,
"excluded": 2,
"not_eligible": 13,
"rate": 45.5,
"compliant_members": [
"71117",
"71118",
"71124",
"71128",
"71129"
],
"non_compliant_members": [
"71112",
"71115",
"71116",
"71120",
"71133",
"71135"
],
"excluded_members": [
"71113",
"71114"
],
"not_eligible_members": [
"71111",
"71119",
"71121",
"71122",
"71123",
"71125",
"71126",
"71127",
"71130",
"71131",
"71132",
"71134",
"71136"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 5,
"got": 5,
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