Colorectal screening, twenty members
Roster generated from a seeded stream (seed 2108) 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
89.3
across 28 models
Models scoring 100
24
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 — 20 members
MEMBER 71081. Date of birth 1951-10-15, so 75 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days.
Screening history:
2025-10-03 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71082. Date of birth 1981-09-15, so 45 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:
2026-11-13 Frailty documented (gait abnormality, R26.2).
2026-06-12 Advanced illness documented (heart failure, I50.22).
MEMBER 71083. Date of birth 1971-06-11, so 55 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-08-02 CT colonography.
2026-09-02 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71084. Date of birth 1967-02-19, so 59 years old on 2026-12-31. Male.
Enrolment: 2026-04-15 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-15.
Screening history:
2021-05-09 Flexible sigmoidoscopy.
Other history:
2026-03-11 Frailty documented (gait abnormality, R26.2).
MEMBER 71085. Date of birth 1959-01-11, so 67 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
No colorectal screening on record.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71086. Date of birth 1951-02-07, so 75 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2020-08-11 CT colonography.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71087. Date of birth 1967-06-23, so 59 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days.
Screening history:
2021-04-28 CT colonography.
Other history:
2026-05-25 Frailty documented (gait abnormality, R26.2).
2026-06-21 Advanced illness documented (heart failure, I50.22).
MEMBER 71088. Date of birth 1976-06-16, so 50 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days.
Screening history:
2021-07-01 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71089. Date of birth 1967-11-24, so 59 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
No colorectal screening on record.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71090. Date of birth 1950-05-28, so 76 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-05-27; 2026-06-25 through 2026-12-31. One gap of 28 days.
Screening history:
2026-06-02 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71091. Date of birth 1950-07-12, so 76 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-04-24; 2026-06-03 through 2026-12-31. One gap of 39 days.
Screening history:
2026-02-09 Faecal immunochemical test.
2026-05-24 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71092. Date of birth 1971-06-21, so 55 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-02-25 Stool DNA test.
Other history:
2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon.
MEMBER 71093. Date of birth 1976-11-04, so 50 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-07-02 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71094. Date of birth 1981-12-09, so 45 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-04-24; 2026-06-15 through 2026-12-31. One gap of 51 days.
Screening history:
2026-06-06 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71095. Date of birth 1979-11-11, so 47 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-05-26 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71096. Date of birth 1967-03-27, so 59 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2026-03-13 Colonoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71097. Date of birth 1951-08-03, so 75 years old on 2026-12-31. Female.
Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days.
Screening history:
2026-10-11 Faecal immunochemical test.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71098. Date of birth 1954-09-24, so 72 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-12-31, continuous, no gaps.
Screening history:
2023-04-14 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71099. Date of birth 1979-09-26, so 47 years old on 2026-12-31. Male.
Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days.
Screening history:
2025-01-25 Flexible sigmoidoscopy.
No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented.
MEMBER 71100. Date of birth 1979-01-17, so 47 years old on 2026-12-31. Male.
Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16.
Screening history:
2020-11-17 CT colonography.
Other history:
2026-01-23 Advanced illness documented (heart failure, I50.22).json{
"kind": "fields",
"fields": {
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
}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 · Anthropic11.5s · 1,015 out | 10.9s · 939 out | 16.2s · 933 out
Reasoning · 824 tokens
[omitted]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 748 tokens
[omitted]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 742 tokens
[omitted]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.7 Flash · Google20.0s · 3,008 out | 20.5s · 3,552 out | 17.1s · 2,472 out
Reasoning · 2,726 tokens
**Evaluating CRC Screening Eligibility**
I'm currently focusing on identifying the eligible population for Measure QM-CRC for the 2026 measurement year. My current progress involves filtering for individuals aged 46 to 75 as of January 1, 2026, ensuring we capture the correct cohort for colorectal cancer screening evaluation.
**Refining Eligibility Criteria**
I'm now refining the continuous enrollment rules, specifically focusing on the "no more than one gap of up to 45 days" condition. I've already evaluated patient 71081 against this and other criteria, determining their ineligibility due to multiple enrollment gaps. Patient 71082 was excluded based on age, and patient 71083 is confirmed as eligible.
**Processing Patient Data**
I've processed several more patient records. Patient 71083 was confirmed eligible. I've now evaluated patients 71084 through 71087, determining their eligibility based on age, enrollment continuity, exclusions, and recent screening data. This continues our refinement of the eligible cohort.
**Continuing Patient Assessment**
I've assessed patients 71088 through 71095. Patient 71088 failed enrollment continuity, while 71089 is non-compliant due to lack of screening. Patients 71090, 71091, and 71094 were ineligible due to age. Patient 71092 is excluded due to a colorectal cancer diagnosis. Patients 71093 and 71095 are compliant.
**Processing More Patients**
I have assessed patients 71096 through 71100. Patients 71096, 71097, 71098, and 71099 meet all criteria and are compliant, with their screening dates falling within the required windows. Patient 71100, however, was deemed not eligible due to a significant enrollment gap exceeding 45 days.
**Continuing Patient Tally**
I've assessed patients 71082 through 71100. My tally now shows 7 compliant, 4 non-compliant, 1 excluded, and 8 not eligible individuals, based on age, screening recency, and enrollment continuity.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,270 tokens
**Analyzing QM-CRC Members**
I'm currently scrutinizing each member's eligibility against the QM-CRC specifications. This involves a close look at age parameters, ensuring they fall within the 46-75 range by the end of 2026. I'm also verifying continuous enrollment throughout 2026, allowing for a single gap no exceeding 45 days.
**Evaluating Member Eligibility**
My focus has shifted to meticulously checking individual member criteria. I've confirmed age and enrollment requirements, and am now cross-referencing them against the specific numerator and exclusion rules for QM-CRC qualification.
**Processing Member Data**
I've processed several members, identifying issues with enrollment gaps and screening timing. One individual failed the age requirement outright. My current effort involves consolidating these findings and preparing to flag them appropriately.
**Reviewing Specific Cases**
I'm currently examining individual member data. I've identified that member 71092 is excluded due to a colorectal cancer diagnosis, and member 71094 failed both age and enrollment criteria. The rest, including 71093, 71095, 71096, 71097, 71098, and 71099, appear compliant with all reviewed conditions.
**Validating Additional Members**
I've now reviewed member 71100, finding them ineligible due to an enrollment gap exceeding 45 days. My comprehensive re-evaluation confirms the compliance status of all previously checked members.
**Calculating Final Rate**
I have now finalized the counts for all 20 members, categorizing them as compliant, non-compliant, excluded, or not eligible. I've calculated the final QM-CRC rate at 63.6% by dividing the compliant members by the sum of compliant and non-compliant members.
**Verifying Member Classifications**
I have confirmed the final classifications for the remaining members. This includes a detailed check of age, enrollment continuity, screening dates, and any relevant diagnoses against the established QM-CRC criteria. The comprehensive review is complete.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
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],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,190 tokens
**Focusing on Eligibility**
I'm currently zeroing in on the 20 members for Measure QM-CRC. My focus is on identifying those eligible for the 2026 measurement year, specifically those between 46 and 75 years old by the end of 2026. This involves meticulously checking their dates of birth against the 1951-1980 range.
**Reviewing Enrolment and Age**
I've begun scrutinizing individual member data against the Measure QM-CRC criteria. Specifically, I'm checking for continuous enrolment throughout the measurement year and confirming their age falls within the 46-75 range for 2026, rejecting those with multiple enrolment gaps.
**Processing Member Data**
I'm currently evaluating individual member eligibility for Measure QM-CRC. I've identified that while some members meet age criteria, their enrolment history or lack of recent screenings often disqualifies them. Several have been flagged for multiple enrolment gaps or screening dates outside the required 5-year window.
**Validating Specific Cases**
I'm now reviewing individual member data in detail. I've identified a mix of outcomes, with some members failing due to age limits or enrolment gaps, while others are compliant based on their screening dates and continuous enrolment status, such as members 71093, 71095, 71096, 71097, and 71098.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
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},
{
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{
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},
{
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
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],
"got": [
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],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.5 · OpenAI10.6s · 1,122 out | 11.2s · 1,099 out | 12.3s · 1,224 out
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
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},
{
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{
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{
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],
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],
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},
{
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],
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"ok": true,
"present": true
},
{
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"ok": true,
"present": true
},
{
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"want": [
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],
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"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
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"71093",
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],
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],
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],
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"71081",
"71082",
"71084",
"71088",
"71090",
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"71100"
]
}
Grader detail
json{
"fields": [
{
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"want": 11,
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},
{
"field": "numerator",
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{
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{
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],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
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"71088",
"71090",
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"71100"
],
"got": [
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"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
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"71085",
"71086",
"71087",
"71089"
],
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],
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"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
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},
{
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},
{
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},
{
"field": "compliant_members",
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"71083",
"71093",
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"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Sol · OpenAI6.3s · 511 out | 6.2s · 520 out | 7.1s · 508 out
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
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},
{
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},
{
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},
{
"field": "compliant_members",
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"71093",
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"71096",
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"71098",
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],
"got": [
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"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
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"71082",
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"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
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"present": true
},
{
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},
{
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},
{
"field": "rate",
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"present": true
},
{
"field": "compliant_members",
"want": [
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"71098",
"71099"
],
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"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.6 · xAI29.6s · 2,419 out | 37.6s · 2,756 out | 48.2s · 3,458 out
Reasoning · 2,262 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{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,599 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{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,301 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.
{
"71081": "not_eligible",
"71082": "not_eligible",
"71083": "eligible",
"71084": "not_eligible",
"71085": "eligible",
"71086": "eligible",
"71087": " eligible",
"71088": "eligible",
"71089": "eligible",
"71090": "eligible",
"71091": "eligible",
"71092": "eligible",
"71093": "eligible",
"71094": "eligible ",
"71095": "eligible",
"71096": "eligible",
"71097": "eligible",
"71098": "eligible",
"71099": "eligible",
"71100": "eligible"
} wait, I think I messed up the labels. Let me correct based on my earlier analysis.
Actually, looking back, the compliant are 71083,71093,71095,71096,71097,71098,71099 =7
non_compliant: 71085,71086,710 87,71089 =4
excluded:71092 =1
not_eligible:71081,71082,71084,71088,71090,71091,71094,71100 =8
So the JSON should have:
"71083": "compliant",
"71085": "non compliant",
"71086": "non_compliant",
"71087": "non_compliant",
"71089": "non_compliant",
"71092": "excluded",
"71093": "compliant",
"71095": "compliant",
"71096": "compliant",
" 71097": "compliant",
"71098": "compliant",
"71099": "compliant",
and the rest "not_eligible".
Let me fix that.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Grok 4.5 · xAI30.0s · 2,176 out | 44.0s · 3,067 out | 32.4s · 2,508 out
Reasoning · 2,019 tokens
The task requires me to analyze each member against the QM-CRC measure specification and categorize them.
{
"denominator": 19,
"numerator": 3,
"excluded": 0,
"not_eligible": 4,
"rate": 0.158,
"compliant_members": ["71083", "71086", "71096"],
"non_com compliant_members": ["71085", "71087", "71089"],
"excluded_members": [],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091"]
} Wait, I see I miscounted the not_eligible. Let me correct that.
Actually, looking back, 71090 and 71091 are age >75, so they should be in not_eligible, but I had them listed separately. Let me fix the JSON properly.
Corrected JSON:
{
" "denominator": 19,
"numerator": 3,
"excluded": 0,
"not_eligible": 4,
"rate": 0.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,910 tokens
The task requires me to analyze the roster of 20 members against the QM-CRC measure specification and report the population in a specific JSON format.
{
"population": {
"total": 20,
"compliant": 3,
"non_compliant": 0,
"excluded": 0,
"not_eligible": 17,
"rate": 0.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,351 tokens
The task requires me to analyze 20 members against the QM-CRC measure specification and report the population in a specific JSON format.
{
"eligible_population": 19,
"numerator": 12,
"exclusions": 1,
"denominator": 18,
"measure": 66.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 3.1 Pro · Google46.1s · 5,621 out | 40.0s · 5,697 out | 46.5s · 6,230 out
Reasoning · 5,339 tokens
# **My Thought Process for QM-CRC Measure Evaluation**
Alright, the task at hand is to meticulously evaluate a population of 20 members against the QM-CRC measure specification for Measurement Year 2026 and then present the results in a structured JSON format, detailing population counts and member lists. This requires a careful, step-by-step application of the eligibility criteria, numerator requirements, and exclusion criteria.
First, I need to solidify my understanding of the measure itself. The Measurement Year (MY) is defined as January 1, 2026, through December 31, 2026.
The **Eligible Population** has two key components:
1. **Age:** The member must be between 46 and 75 years old, inclusive, as of December 31, 2026.
2. **Continuous Enrollment:** They need to have been continuously enrolled for the entire MY (2026), with the allowance of no more than one gap in coverage, and that gap cannot exceed 45 days.
Then, I need to consider the **Numerator** requirements, which represent the different ways a member can demonstrate compliance with colorectal cancer screening:
* **N1:** A Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT) performed at any point during 2026.
* **N2:** A Stool DNA test performed during 2026, or within the two calendar years prior (2024 or 2025).
* **N3:** A Flexible Sigmoidoscopy performed during 2026, or within the four calendar years prior (2022, 2023, 2024, or 2025).
* **N4:** A CT Colonography performed during 2026, or within the four calendar years prior (2022, 2023, 2024, or 2025).
* **N5:** A Colonoscopy performed during 2026, or within the nine calendar years prior (2017 through 2025).
Crucially, before I can assess the numerator, I must evaluate the **Exclusions**. These are applied *only* if a member is deemed part of the eligible population.
* **E1:** The member has a diagnosis of colorectal cancer on or before December 31, 2026.
* **E2:** The member has undergone a total colectomy on or before December 31, 2026.
* **E3:** The member is on hospice during the Measurement Year.
* **E4:** The member is aged 66 or older as of December 31, 2026, *and* both frailty and advanced illness are documented during the Measurement Year.
Now, the actual evaluation process for each of the 20 members begins, treating each one as a distinct case.
* **MEMBER 71081:** Age is 75, so that's within the eligible range. However, looking at their enrollment, they have two gaps: one of 23 days and another of 29 days. The rule is *no more than one gap* up to 45 days. Since they have two gaps, they are **not_eligible**.
* **MEMBER 71082:** Their birthdate is September 15, 1981. As of December 31, 2026, they will be 45 years old (45 years and just over 3 months). The age criteria require 46 to 75. Therefore, this member is **not_eligible** due to age.
* **MEMBER 71083:** This member is 55 years old, which is within the eligible age range. Their enrollment is continuous, meeting that criterion. I've checked for exclusions, and none apply. For the numerator, I see they had a CT colonography on August 2, 2026 (satisfying N4), and a FIT on September 2, 2026 (satisfying N1). With eligible criteria met and numerator requirements fulfilled, this member is **compliant**.
* **MEMBER 71084:** This member is 59 years old, so age is fine. However, their enrollment history shows they weren't enrolled until April 15, 2026. This means there's a gap from January 1, 2026, to April 14, 2026 – a total of 104 days. This significantly exceeds the allowed 45-day gap. Thus, they are **not_eligible**.
* **MEMBER 71085:** This member is 67 years old, and their enrollment is continuous. No exclusions apply. However, when I review their claims data, there are no qualifying numerator services (FOBT/FIT, Stool DNA, Sigmoidoscopy, CT Colonography, or Colonoscopy) within the specified timeframes. Therefore, despite being eligible, they are **non_compliant**.
* **MEMBER 71086:** This member is 75 years old and has continuous enrollment. No exclusions are present. For the numerator, I see a CT colonography dated August 11, 2020. The look-back period for CT colonography (N4) is four years prior to the MY, meaning 2022 through 2026. Since 2020 falls outside this window, this service doesn't count. Without any other qualifying services, they are **non_compliant**.
* **MEMBER 71087:** This member is 59 years old. They have one enrollment gap of 32 days, which is within the acceptable limits, making them eligible. While they have documentation for frailty and advanced illness, their age (59) is below the threshold of 66 required for exclusion E4. For the numerator, I found a CT colonography on April 28, 2021. Similar to the previous case, the N4 look-back window is 2022-2026. Thus, the 2021 service is too early. Without a qualifying service, they are **non_compliant**.
* **MEMBER 71088:** This member is 50 years old. Their enrollment has two gaps: one of 17 days and another of 14 days. As the rule allows for *no more than one gap*, this member is **not_eligible**.
* **MEMBER 71089:** This member is 59 years old with continuous enrollment. No exclusions apply. However, I found no numerator services within the required timeframes. This makes them **non_compliant**.
* **MEMBER 71090:** This member's birthdate indicates they will be 76 years old as of December 31, 2026. This falls outside the eligible age range of 46-75. Therefore, they are **not_eligible**.
* **MEMBER 71091:** Similar to member 71090, this member will be 76 years old as of December 31, 2026. They are also **not_eligible** due to age.
* **MEMBER 71092:** This member is 55 years old with continuous enrollment, making them eligible. However, upon review of their medical history, I found a diagnosis of colorectal cancer (C18.7) on October 6, 2024. This meets exclusion criterion E1. Therefore, they are **excluded**.
* **MEMBER 71093:** This member is 50 years old and has continuous enrollment, meeting eligibility criteria. No exclusions apply. For the numerator, they had a FIT performed on July 2, 2026, which satisfies N1. This member is **compliant**.
* **MEMBER 71094:** This member's birthdate indicates they will be 45 years old as of December 31, 2026. They do not meet the minimum age requirement of 46. Thus, they are **not_eligible**.
* **MEMBER 71095:** This member is 47 years old with continuous enrollment, meeting eligibility. No exclusions apply. They had a FIT performed on May 26, 2026, fulfilling N1. This member is **compliant**.
* **MEMBER 71096:** This member is 59 years old with continuous enrollment. No exclusions are present. They had a colonoscopy on March 13, 2026, satisfying N5. This member is **compliant**.
* **MEMBER 71097:** This member is 75 years old. They have one enrollment gap of 21 days, which is within the allowed limit, making them eligible. No exclusions apply. For the numerator, a FIT was performed on October 11, 2026, satisfying N1. This member is **compliant**.
* **MEMBER 71098:** This member is 72 years old with continuous enrollment. No exclusions apply. They had a flexible sigmoidoscopy on April 14, 2023. The look-back period for N3 is 2022-2026, and 2023 falls within this range. This member is **compliant**.
* **MEMBER 71099:** This member is 47 years old. They have one enrollment gap of 39 days, which is permissible, making them eligible. No exclusions are found. For the numerator, a flexible sigmoidoscopy was performed on January 25, 2025. The N3 look-back period includes 2025. This member is **compliant**.
* **MEMBER 71100:** This member is 47 years old but was not enrolled until March 16, 2026. This creates an enrollment gap from January 1, 2026, to March 15, 2026, which is 74 days. This is more than the allowed 45-day gap. Therefore, they are **not_eligible**.
After this detailed evaluation, I can now consolidate the results.
**Summary of Member Status:**
* **Compliant:** 71083, 71093, 71095, 71096, 71097, 71098, 71099 (7 members)
* **Non-compliant:** 71085, 71086, 71087, 71089 (4 members)
* **Excluded:** 71092 (1 member)
* **Not Eligible:** 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 (8 members)
Let's double-check the counts: 7 (compliant) + 4 (non-compliant) + 1 (excluded) + 8 (not eligible) = 20 members. The total aligns.
The **denominator** for the measure rate consists of members who are either compliant or non-compliant, meaning they met the initial eligibility criteria but did not meet the numerator. So, the denominator is 7 (compliant) + 4 (non-compliant) = 11 members.
The **numerator** is the count of compliant members, which is 7.
The **excluded** count is 1.
The **not_eligible** count is 8.
The **rate** is calculated as (Numerator / Denominator) * 100.
Rate = (7 / 11) * 100 = 0.636363...
Rounding to one decimal place as is standard practice, the rate is 63.6%.
Finally, I will structure this information into the requested JSON format:
```json
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
```
This output precisely reflects my detailed analysis and application of all specified criteria for each member.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,415 tokens
**Analysis of QM-CRC Measure Specification Compliance for 20 Members**
My objective was to meticulously evaluate 20 members against the QM-CRC measure specification for the Measurement Year spanning January 1, 2026, through December 31, 2026. This involved a detailed breakdown of eligibility criteria, numerator requirements, and exclusion conditions.
First, I established the **Eligible Population (Denominator)**. This required members to be between 46 and 75 years old as of December 31, 2026, meaning their date of birth must fall between January 1, 1951, and December 31, 1980. Additionally, they needed to have continuous enrollment for the entire measurement year, with a strict allowance of no more than one gap in enrollment, and that gap could not exceed 45 days.
Then, I defined the **Numerator** conditions, which indicate a member's compliance with screening protocols. A member is compliant if they meet any of these criteria:
* **N1:** Completed a Fecal Occult Blood Test (FOBT) or Fecal Immunochemical Test (FIT) during 2026.
* **N2:** Underwent a Stool DNA test anytime from 2024 through 2026.
* **N3:** Had a Flexible Sigmoidoscopy during 2026 or within the four preceding years (2022-2026).
* **N4:** Received a CT Colonography during 2026 or within the four preceding years (2022-2026).
* **N5:** Had a Colonoscopy during 2026 or within the nine preceding years (2017-2026).
Crucially, I also identified the **Exclusions**. Members who met the eligible population criteria could still be excluded if:
* **E1:** Diagnosed with colorectal cancer on or before December 31, 2026.
* **E2:** Underwent a total colectomy on or before December 31, 2026.
* **E3:** Received hospice care at any point during the measurement year (2026).
* **E4:** Were aged 66 or older as of December 31, 2026, *and* had documentation of both frailty and advanced illness during 2026.
With these parameters firmly in place, I proceeded to evaluate each of the 20 members individually.
For **MEMBER 71081**, despite being 75 years old (within the eligible age range), their enrollment history showed two gaps (23 and 29 days). This violated the "no more than one gap" rule, rendering them `not_eligible`.
**MEMBER 71082** was 45 years old, making them ineligible as the minimum age is 46. Thus, `not_eligible`.
**MEMBER 71083**, aged 55, had continuous enrollment and met multiple numerator criteria: a CT colonography in 2026 (N4) and a FIT in 2026 (N1). They were `compliant`.
**MEMBER 71084** was 59 years old but was not enrolled from January 1 to April 14, 2026. This 104-day gap exceeded the permissible 45-day limit, classifying them as `not_eligible`.
**MEMBER 71085**, aged 67, was eligible and continuously enrolled but had no recorded screening tests within the measurement period. They were therefore `non_compliant`.
**MEMBER 71086**, aged 75, was eligible and continuously enrolled. However, their CT colonography was performed in 2020, which fell outside the allowed look-back window of 2022-2026 for N4. This resulted in a `non_compliant` status.
**MEMBER 71087**, age 59, had one enrollment gap of 32 days, which was acceptable. While they had documentation of frailty and advanced illness, their age (59) did not meet the E4 exclusion criteria (age 66 or older). However, their CT colonography in 2021 was outside the N4 window (2022-2026), making them `non_compliant`.
**MEMBER 71088**, age 50, had two enrollment gaps (17 and 14 days), failing the "no more than one gap" rule, thus `not_eligible`.
**MEMBER 71089**, age 59, was eligible and continuously enrolled but had no documented screening, resulting in a `non_compliant` status.
**MEMBER 71090** and **MEMBER 71091** were both 76 years old, exceeding the maximum age limit of 75, so they were `not_eligible`.
**MEMBER 71092**, age 55, was eligible and continuously enrolled. However, they had a diagnosis of C18.7 (Malignant neoplasm of sigmoid colon) in 2024, triggering the E1 exclusion for colorectal cancer. Consequently, they were `excluded`.
**MEMBER 71093**, age 50, was eligible, continuously enrolled, and had a FIT in 2026 (N1), making them `compliant`.
**MEMBER 71094** was 45 years old, below the minimum age of 46, and therefore `not_eligible`.
**MEMBER 71095**, age 47, was eligible, continuously enrolled, and had a FIT in 2026 (N1), qualifying them as `compliant`.
**MEMBER 71096**, age 59, was eligible, continuously enrolled, and had a colonoscopy in 2026 (N5), leading to a `compliant` status.
**MEMBER 71097**, age 75, had a single enrollment gap of 21 days, which was acceptable. They also had a FIT in 2026 (N1), making them `compliant`.
**MEMBER 71098**, age 72, was eligible and continuously enrolled. Their flexible sigmoidoscopy in 2023 fell within the N3 look-back window (2022-2026), resulting in a `compliant` status.
**MEMBER 71099**, age 47, had an enrollment gap of 39 days, which was acceptable. Their flexible sigmoidoscopy in 2025 was within the N3 look-back window (2022-2026), making them `compliant`.
Finally, **MEMBER 71100**, age 47, had an enrollment gap from January 1 to March 15, 2026, totaling 74 days, which exceeded the 45-day limit. They were therefore `not_eligible`.
In summary, out of the 20 members evaluated:
* **7 members** were found to be `compliant`.
* **4 members** were `non_compliant`.
* **1 member** was `excluded`.
* **8 members** were `not_eligible`.
The total number of members in the denominator (eligible and not excluded) was 11. The numerator (compliant members) was 7. Therefore, the calculated rate for this cohort is **63.6%** (7 compliant members out of 11 eligible members).
The identified members are categorized as follows:
* **Compliant Members:** ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
* **Non-Compliant Members:** ["71085", "71086", "71087", "71089"]
* **Excluded Members:** ["71092"]
* **Not Eligible Members:** ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
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Grader detail
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}Reasoning · 5,948 tokens
**QM-CRC Measure Evaluation - 2026**
Here's my thought process in evaluating the 20 members against the QM-CRC measure specification for the 2026 measurement year. My goal is to determine each member's compliance status – compliant, non_compliant, excluded, or not_eligible – and ultimately calculate the overall measure rate.
First, I've familiarized myself with the core criteria for eligibility and the numerator definitions. The measurement year is clearly defined as January 1, 2026, through December 31, 2026. For eligibility, members must be between 46 and 75 years old as of December 31, 2026, and have continuous enrollment throughout the year, with no more than one gap of up to 45 days.
The numerator comprises several screening methods within specific look-back periods from December 31, 2026:
* **N1 (FOBT or FIT):** Must occur during 2026.
* **N2 (Stool DNA test):** Valid from 2024 through 2026.
* **N3 (Flexible sigmoidoscopy):** Valid from 2022 through 2026.
* **N4 (CT colonography):** Valid from 2022 through 2026.
* **N5 (Colonoscopy):** Valid from 2017 through 2026.
I've also noted the exclusion criteria:
* **E1 (Colorectal cancer):** Diagnosed any time on or before December 31, 2026.
* **E2 (Total colectomy):** Performed any time on or before December 31, 2026.
* **E3 (Hospice):** Enrolled anytime during 2026.
* **E4 (Age 66+ with frailty/advanced illness):** Must be 66 or older by December 31, 2026, *and* have documentation of both frailty and advanced illness during 2026.
Now, I'll walk through my evaluation of each member, systematically applying these rules.
**MEMBER 71081:**
* Age: 75 as of Dec 31, 2026. This meets the age criteria.
* Enrolment: I see two distinct gaps: March 22 to April 13 (23 days) and July 24 to August 21 (29 days). The specification allows for *no more than one* gap. Since this member has two gaps, they are **not eligible**.
* Status: `not_eligible`.
**MEMBER 71082:**
* Age: 45 as of Dec 31, 2026. This falls outside the 46-75 age range.
* Status: `not_eligible`.
**MEMBER 71083:**
* Age: 55 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None identified.
* Screening: Performed a CT colonography on August 2, 2026 (N4, within window) and a FIT on September 2, 2026 (N1, within window). This member meets numerator criteria.
* Status: `compliant`.
**MEMBER 71084:**
* Age: 59 as of Dec 31, 2026. Eligible age.
* Enrolment: Enrolled only from April 15, 2026, onwards. This creates a gap from January 1 to April 14, which is 104 days. This gap exceeds the 45-day limit.
* Status: `not_eligible`.
**MEMBER 71085:**
* Age: 67 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: No exclusions apply.
* Screening: No screening listed within the eligible period. Therefore, this member does not meet the numerator criteria.
* Status: `non_compliant`.
**MEMBER 71086:**
* Age: 75 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: No exclusions apply.
* Screening: A CT colonography was performed in 2020. The look-back window for CT colonography (N4) is the current year (2026) or the four years prior (2022-2026). 2020 falls outside this 5-year window.
* Status: `non_compliant`.
**MEMBER 71087:**
* Age: 59 as of Dec 31, 2026. Eligible age.
* Enrolment: One gap from April 21 to May 22, totaling 32 days. This is within the acceptable limits. Eligible enrolment.
* Exclusions: Member is 59, so exclusion E4 (age 66+) does not apply, even with frailty/advanced illness documentation noted. No other exclusions apply.
* Screening: A CT colonography was performed in April 2021. The window for N4 is 2022-2026. 2021 is outside this window.
* Status: `non_compliant`.
**MEMBER 71088:**
* Age: 50 as of Dec 31, 2026. Eligible age.
* Enrolment: Two gaps identified: 17 days and 14 days. As with Member 71081, having more than one gap makes them ineligible.
* Status: `not_eligible`.
**MEMBER 71089:**
* Age: 59 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None apply.
* Screening: No screening listed within the eligible period.
* Status: `non_compliant`.
**MEMBER 71090:**
* Age: 76 as of Dec 31, 2026. This exceeds the maximum age of 75.
* Status: `not_eligible`.
**MEMBER 71091:**
* Age: 76 as of Dec 31, 2026. Exceeds the maximum age of 75.
* Status: `not_eligible`.
**MEMBER 71092:**
* Age: 55 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: A diagnosis of Colorectal cancer (C18.7) was recorded prior to December 31, 2026. This meets exclusion E1.
* Status: `excluded`.
**MEMBER 71093:**
* Age: 50 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a FIT on July 2, 2026 (N1, within window).
* Status: `compliant`.
**MEMBER 71094:**
* Age: 45 as of Dec 31, 2026. Falls outside the 46-75 age range.
* Status: `not_eligible`.
**MEMBER 71095:**
* Age: 47 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a FIT on May 26, 2026 (N1, within window).
* Status: `compliant`.
**MEMBER 71096:**
* Age: 59 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a Colonoscopy on March 13, 2026 (N5, within window).
* Status: `compliant`.
**MEMBER 71097:**
* Age: 75 as of Dec 31, 2026. Eligible age.
* Enrolment: One gap from April 25 to May 15, totaling 21 days. Within acceptable limits. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a FIT on October 11, 2026 (N1, within window).
* Status: `compliant`.
**MEMBER 71098:**
* Age: 72 as of Dec 31, 2026. Eligible age.
* Enrolment: Continuous. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a Flexible sigmoidoscopy on April 14, 2023. The window for N3 is 2022-2026. 2023 is within this window.
* Status: `compliant`.
**MEMBER 71099:**
* Age: 47 as of Dec 31, 2026. Eligible age.
* Enrolment: One gap from June 16 to July 24, totaling 39 days. Within acceptable limits. Eligible enrolment.
* Exclusions: None apply.
* Screening: Performed a Flexible sigmoidoscopy on January 25, 2025. The window for N3 is 2022-2026. 2025 is within this window.
* Status: `compliant`.
**MEMBER 71100:**
* Age: 47 as of Dec 31, 2026. Eligible age.
* Enrolment: Enrolled from March 16, 2026, onwards. The gap from January 1 to March 15 is 74 days (Jan 31 + Feb 28 + Mar 15). This gap exceeds the 45-day limit.
* Status: `not_eligible`.
**Final Tally and Rate Calculation:**
Based on this comprehensive review, I've categorized the members as follows:
* **Compliant Members (Numerator):** 7 members
* 71083, 71093, 71095, 71096, 71097, 71098, 71099
* **Non-compliant Members:** 4 members
* 71085, 71086, 71087, 71089
* **Excluded Members:** 1 member
* 71092
* **Not Eligible Members:** 8 members
* 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100
The **denominator** includes all members who are either compliant or non-compliant, as they were eligible but did not meet the numerator criteria. This totals 7 (compliant) + 4 (non-compliant) = 11 members.
The **numerator** is the count of compliant members, which is 7.
The **overall measure rate** is calculated as: (Numerator / Denominator) * 100
Rate = (7 / 11) * 100 = 63.636...%, which rounds to **63.6%**.
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Grader detail
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Reasoning · 787 tokens
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}Reasoning · 776 tokens
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}100Gemini 3 Flash · Google75.4s · 12,493 out | 59.0s · 11,627 out | 23.0s · 3,647 out
Reasoning · 12,211 tokens
**My Thought Process for Assessing Colorectal Cancer Screening Compliance**
I've just completed a detailed review of a cohort of members to determine their colorectal cancer (CRC) screening compliance for the measurement year 2026. My process involved meticulously applying a set of criteria to each individual, focusing on eligibility, continuous enrollment, and the performance of a qualifying screening test within the defined timeframes.
First and foremost, I established the foundational parameters for the measurement year: January 1, 2026, to December 31, 2026. For eligibility, members needed to be between 46 and 75 years old as of December 31, 2026. Crucially, they also had to maintain continuous enrollment throughout the entire measurement year, with a strict allowance for no more than *one* gap in coverage, and that gap could not exceed 45 days.
Following these broad eligibility requirements, I then considered the specific screening tests that would satisfy the numerator (N1-N5) and the potential exclusions (E1-E4) that would render a member non-compliant or excluded from the denominator. The screening windows were as follows:
* **N1 (FIT/FOBT):** Must have occurred *during* 2026.
* **N2 (Stool DNA):** Within a three-year window (2024-2026).
* **N3 (Flexible Sigmoidoscopy) & N4 (CT Colonography):** Within a five-year window (2022-2026).
* **N5 (Colonoscopy):** Within a ten-year window (2017-2026).
The exclusions were:
* **E1:** A diagnosis of colorectal cancer (codes C18-C21) at any point on or before December 31, 2026.
* **E2:** A history of total colectomy at any point on or before December 31, 2026.
* **E3:** Receipt of hospice care at any time during the measurement year (2026).
* **E4:** Being aged 66 or older *and* having both frailty and advanced illness documented during the measurement year (2026).
With these criteria in mind, I proceeded to evaluate each member, making specific decisions and noting my reasoning:
* **MEMBER 71081:** Initially considered eligible by age (75), but their enrollment history revealed *two* gaps (23 days and 29 days). Since the rule permits "no more than one gap of up to 45 days," this member was definitively marked as `not_eligible` due to the enrollment violation.
* **MEMBER 71082:** Although their enrollment was continuous, their age of 45 at year-end fell outside the required 46-75 age range. Therefore, they were also `not_eligible`.
* **MEMBER 71083:** This member met all age and enrollment criteria. They had two qualifying screenings: a CT colonography in August 2026 (within the N4 five-year window) and a FIT in September 2026 (within the N1 one-year window). This secured their `compliant` status.
* **MEMBER 71084:** This individual was 59 years old, but their enrollment began on April 15, 2026, meaning they were not continuously enrolled for the full measurement year. This made them `not_eligible`.
* **MEMBER 71085:** Eligible by age and enrollment. They had no qualifying screening performed during 2026. While they were 67 (meeting the age criteria for E4), they did not have documentation for both frailty *and* advanced illness. Consequently, they were not excluded but fell into the `non_compliant` category.
* **MEMBER 71086:** This 75-year-old member had continuous enrollment and no exclusions. However, their only recorded screening was a CT colonography in August 2020. This falls outside the 5-year window for N4 (2022-2026), making them `non_compliant`.
* **MEMBER 71087:** This 59-year-old had a single gap of 32 days, which is within the acceptable limits for enrollment. While they had frailty and advanced illness documented, their age (59) did not meet the 66+ requirement for exclusion E4. Their CT colonography from April 2021 was outside the 5-year window (2022-2026). Thus, they were `non_compliant`.
* **MEMBER 71088:** Similar to member 71081, this individual had two enrollment gaps (17 and 14 days), disqualifying them from eligibility and marking them as `not_eligible`.
* **MEMBER 71089:** Eligible by age and enrollment, this member had no qualifying screening performed and no exclusions. They were categorized as `non_compliant`.
* **MEMBER 71090 & 71091:** Both members were 76 years old as of December 31, 2026, exceeding the maximum age of 75 for eligibility. They were therefore `not_eligible`.
* **MEMBER 71092:** This member, aged 55 with continuous enrollment, had a significant exclusion: a diagnosis of colorectal cancer (C18.7) in October 2024, falling under E1. This resulted in their `excluded` status.
* **MEMBER 71093:** Eligible by age and enrollment, this member had a FIT screening in July 2026, meeting the N1 criteria. This made them `compliant`.
* **MEMBER 71094:** Aged 45 at year-end, they fell below the minimum age of 46 and were consequently `not_eligible`. (As a side note, their enrollment also had a 51-day gap, exceeding the 45-day limit, which would have also disqualified them.)
* **MEMBER 71095:** This 47-year-old had continuous enrollment and no exclusions. Their FIT screening in May 2026 satisfied the N1 requirement, resulting in `compliant` status.
* **MEMBER 71096:** Eligible by age and enrollment, they had a colonoscopy in March 2026, which fell within the N5 ten-year window. This confirmed their `compliant` status.
* **MEMBER 71097:** Aged 75 with a single 21-day enrollment gap (within limits), this member had a FIT screening in October 2026, satisfying the N1 criteria. They were `compliant`.
* **MEMBER 71098:** This 72-year-old with continuous enrollment had a flexible sigmoidoscopy in April 2023. This falls within the N3 five-year window (2022-2026), making them `compliant`.
* **MEMBER 71099:** Eligible by age (47) and enrollment (one 39-day gap), they had a flexible sigmoidoscopy in January 2025. This falls within the N3 five-year window (2022-2026), resulting in `compliant` status.
* **MEMBER 71100:** This member was 47 years old but did not have continuous enrollment, starting coverage in March 2026. This made them `not_eligible`.
**Final Tally and Rate Calculation:**
After this thorough review, I compiled the results:
* **Compliant:** 7 members (71083, 71093, 71095, 71096, 71097, 71098, 71099)
* **Non-compliant:** 4 members (71085, 71086, 71087, 71089)
* **Excluded:** 1 member (71092)
* **Not Eligible:** 8 members (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100)
The denominator for the CRC screening rate is the sum of compliant and non-compliant members, which is 7 + 4 = 11.
The numerator is the number of compliant members, which is 7.
Therefore, the calculated CRC screening rate for this cohort is (7 / 11) * 100, which rounds to **63.6%**.
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Grader detail
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}Reasoning · 11,345 tokens
### My Thought Process for Evaluating Colorectal Cancer Screening Compliance
As I approached this task, my primary objective was to meticulously evaluate each member against the criteria for the QM-CRC Colorectal Cancer Screening measure for the 2026 measurement year. I broke down the process into several key stages: understanding the measure's definition, identifying the eligible population (denominator), determining who met the numerator criteria, and then applying the exclusion rules.
First, I familiarized myself with the core components of the measure. The **measurement year** is clearly defined as January 1, 2026, to December 31, 2026. The **eligible population (denominator)** is defined by two main criteria:
1. **Age:** Members must be between 46 and 75 years old, inclusive, as of December 31, 2026. This translates to a Date of Birth (DOB) between January 1, 1951, and December 31, 1980.
2. **Enrolment:** They must have been continuously enrolled for the entire measurement year, with a concession for a maximum of one gap of no more than 45 days.
The **numerator** is met if a member has undergone any of the following screenings within specified timeframes:
* **N1:** FIT or FOBT in 2026.
* **N2:** Stool DNA test between 2024 and 2026.
* **N3:** Flexible sigmoidoscopy between 2022 and 2026.
* **N4:** CT colonography between 2022 and 2026.
* **N5:** Colonoscopy between 2017 and 2026.
Next, I considered the **exclusions (E1-E4)** that would render a member ineligible, even if they otherwise met the denominator and numerator criteria. These are:
* **E1:** Diagnosed with colorectal cancer (ICD codes C18-C21) on or before December 31, 2026.
* **E2:** Underwent a total colectomy on or before December 31, 2026.
* **E3:** Was in hospice care during 2026.
* **E4:** Was aged 66 or older on December 31, 2026, AND had documentation of both frailty and advanced illness during 2026.
With these rules in hand, I systematically reviewed each member:
* **MEMBER 71081:** Initially, their age (75) was within the eligible range. However, I noted their enrolment history showed *two* distinct gaps (23 days and 29 days). The measure specifically states "no more than one gap." Therefore, despite the gaps being individually less than 45 days, the presence of two gaps disqualified them. **Status: Not Eligible.**
* **MEMBER 71082:** Their age (45) fell outside the required 46-75 range. **Status: Not Eligible.**
* **MEMBER 71083:** This member met all the criteria. They were 55 (eligible age), continuously enrolled, and had a CT colonography in 2026, which falls within the N4 window (2022-2026). **Status: Compliant.**
* **MEMBER 71084:** Although 59 (eligible age), their enrolment began on April 15, 2026. This created a gap from January 1 to April 14, which is 104 days. This significantly exceeds the maximum allowed gap of 45 days. **Status: Not Eligible.**
* **MEMBER 71085:** This member was 67 (eligible age) and continuously enrolled. They had no exclusions. However, they did not undergo any screening within the required windows. **Status: Non-compliant.**
* **MEMBER 71086:** Aged 75 (eligible) and continuously enrolled. They had a CT colonography in 2020. Critically, the N4 window for CT colonography is 2022–2026. Since their screening was outside this window, they did not meet the numerator. **Status: Non-compliant.**
* **MEMBER 71087:** Aged 59 (eligible) and had one enrolment gap of 32 days, which is permissible. They were not excluded by E4 as they were under 66. However, their CT colonography was in 2021, which falls outside the N4 window (2022–2026). **Status: Non-compliant.**
* **MEMBER 71088:** This member had *two* enrolment gaps (17 days and 14 days). Similar to member 71081, having more than one gap violates the continuous enrolment requirement. **Status: Not Eligible.**
* **MEMBER 71089:** Aged 59 (eligible) and continuously enrolled with no exclusions. They did not have any qualifying screening. **Status: Non-compliant.**
* **MEMBER 71090 & 71091:** Both were 76 years old, exceeding the maximum eligible age of 75. **Status: Not Eligible.**
* **MEMBER 71092:** This member was 55 (eligible age) and continuously enrolled. However, they were diagnosed with colorectal cancer (C18.7) in 2024. This meets exclusion E1, rendering them not compliant. **Status: Excluded.**
* **MEMBER 71093:** Aged 55 (eligible), continuously enrolled, and had a FIT test in 2026 (N1 window). **Status: Compliant.**
* **MEMBER 71094:** Their age (45) was below the minimum of 46. **Status: Not Eligible.** (Interestingly, their enrolment gap was also 51 days, which would have made them ineligible regardless of age).
* **MEMBER 71095:** Aged 47 (eligible), continuously enrolled, and had a FIT test in 2026 (N1 window). **Status: Compliant.**
* **MEMBER 71096:** Aged 59 (eligible), continuously enrolled, and had a Colonoscopy in 2026 (N5 window: 2017–2026). **Status: Compliant.**
* **MEMBER 71097:** Aged 75 (eligible) with one enrolment gap of 21 days (permissible). They had a FIT test in 2026 (N1 window). **Status: Compliant.**
* **MEMBER 71098:** Aged 72 (eligible), continuously enrolled, and had a Flexible sigmoidoscopy in 2023 (N3 window: 2022–2026). **Status: Compliant.**
* **MEMBER 71099:** Aged 47 (eligible) with one enrolment gap of 39 days (permissible). They had a Flexible sigmoidoscopy in 2025 (N3 window: 2022–2026). **Status: Compliant.**
* **MEMBER 71100:** Aged 47 (eligible), but their enrolment started on March 16, creating a gap of 74 days, exceeding the 45-day limit. **Status: Not Eligible.**
After categorizing each member, I tallied the results:
* **Compliant Members (Numerator):** 7 (71083, 71093, 71095, 71096, 71097, 71098, 71099)
* **Non-compliant Members:** 4 (71085, 71086, 71087, 71089)
* **Excluded Members:** 1 (71092)
* **Not Eligible Members:** 8 (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100)
The **denominator** consists of members who are eligible but not excluded. This is the sum of compliant and non-compliant members: 7 + 4 = 11.
The **rate** is calculated as (Numerator / Denominator) * 100.
So, (7 / 11) * 100 = 63.6363...%, which rounds to **63.6%**.
Throughout this process, I performed self-checks to ensure I hadn't overlooked any details, particularly regarding the specific date ranges for screenings and the nuances of the enrolment and age criteria. The distinction between "Not Eligible" (failing initial criteria like age or enrolment) and "Excluded" (meeting initial criteria but having a disqualifying condition) was crucial. My final review confirmed that all members were correctly categorized and the rate calculation was accurate.
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Grader detail
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}Reasoning · 3,365 tokens
**My Thought Process for QM-CRC Measure Analysis**
Alright, let's break down this Colorectal Cancer Screening (QM-CRC) measure for the 2026 measurement year. My objective is to meticulously determine eligibility and compliance for each individual on the roster.
First, I need to establish the core parameters for eligibility. The **measurement year** is straightforward: January 1, 2026, to December 31, 2026.
The **denominator criteria**, defining who is even *eligible* to be counted, require the patient to be between **46 and 75 years old** as of December 31, 2026. Crucially, they also need to have been **continuously enrolled for all of 2026, with no more than *one* gap of up to 45 days**. This "one gap" rule is a key point I'll be watching closely.
Now, for the **numerator criteria**, which define who is considered *compliant*. A patient meets compliance if they have had *any one* of the following screenings within specific timeframes:
* **N1:** A FIT/FOBT in 2026.
* **N2:** A Stool DNA test in 2024, 2025, or 2026 (a 3-year window).
* **N3:** A Flexible sigmoidoscopy in 2022, 2023, 2024, 2025, or 2026 (a 5-year window).
* **N4:** A CT colonography in 2022, 2023, 2024, 2025, or 2026 (also a 5-year window).
* **N5:** A Colonoscopy in 2017 through 2026 (a broad 10-year window).
Then, I need to account for **exclusions**. These members are removed from the denominator entirely, regardless of screening status.
* **E1:** Diagnosed with colorectal cancer (codes C18-C21) at any point on or before December 31, 2026.
* **E2:** Undergone a total colectomy at any point on or before December 31, 2026.
* **E3:** Received hospice care during 2026.
* **E4:** This is a specific exclusion for older patients: they must be **66 years or older** as of December 31, 2026, *and* have documented **frailty and advanced illness** in 2026. This is a compound condition.
With these rules in place, I start processing the individual members, applying each criterion systematically.
For instance, I see a member whose age is 75. They are within the eligible age range. However, their enrollment history shows *two* gaps, one for 23 days and another for 29 days. The rule clearly states "no more than *one* gap." Therefore, this member is **Not Eligible**.
Another case: age 45. This immediately flags them as **Not Eligible** because the minimum age is 46.
Then there's a 55-year-old. They are eligible by age. Their enrollment is continuous, so that's fine. I check exclusions – none apply. Now, for compliance: they had a CT colonography on August 2, 2026. The window for N4 (CT colonography) is 2022-2026. August 2026 falls squarely within that window. So, this member is **Compliant**.
I encounter a 59-year-old whose enrollment started on April 15, 2026. Their enrollment gap from January 1 to April 14, 2026, is 104 days. This is a single gap, but it's far longer than the allowed 45 days. Therefore, **Not Eligible**.
A 67-year-old, continuously enrolled. No exclusions apply (specifically checking E4 – they don't have frailty/advanced illness documented). However, a review of their screening shows *no* recorded screening for 2026 or within any of the applicable windows. This member is **Non-Compliant**.
For a 75-year-old, continuously enrolled and no exclusions. Their CT colonography was done on August 11, 2020. The N4 window for CT colonography is 2022-2026. 2020 is outside this 5-year window. Thus, they are **Non-Compliant**.
Another 59-year-old. They have one gap of 32 days, which is acceptable. I check exclusions: they have documented frailty and advanced illness. However, E4 *requires* the patient to be 66 or older. Since this member is only 59, E4 does not apply. They are not excluded. For compliance, they had a CT colonography in April 2021. The N4 window is 2022-2026. 2021 is outside this window, so they are **Non-Compliant**.
A 50-year-old has two gaps in enrollment: 17 days and then 14 days. The rule is "no more than *one* gap." This member is **Not Eligible**.
A 59-year-old, continuously enrolled, no exclusions. No screening recorded. **Non-Compliant**.
A 76-year-old. This is immediately **Not Eligible** as the maximum age is 75. The same applies to another 76-year-old.
A 55-year-old, continuously enrolled. I check exclusions and find they were diagnosed with colorectal cancer (C18.7) in October 2024. This triggers E1. This member is **Excluded**.
A 50-year-old, continuously enrolled, no exclusions. They had a FIT test in July 2026. This meets N1 (FIT/FOBT in 2026). This member is **Compliant**.
A 45-year-old is **Not Eligible** due to age. This is followed by another 45-year-old who is also **Not Eligible**.
A 47-year-old, continuously enrolled, no exclusions. They had a FIT test in May 2026, meeting N1. **Compliant**.
A 59-year-old, continuously enrolled, no exclusions. They had a Colonoscopy in March 2026. The N5 window is 2017-2026. This meets N5. **Compliant**.
A 75-year-old, continuously enrolled with one 21-day gap, no exclusions. They had a FIT test in October 2026, meeting N1. **Compliant**.
A 72-year-old, continuously enrolled, no exclusions. They had a Flexible sigmoidoscopy in April 2023. The N3 window is 2022-2026. This meets N3. **Compliant**.
A 47-year-old, continuously enrolled with one 39-day gap, no exclusions. They had a Flexible sigmoidoscopy in January 2025. The N3 window is 2022-2026. This meets N3. **Compliant**.
Finally, a 47-year-old whose enrollment started March 16, 2026. The gap from January 1 to March 15, 2026, is 74 days. This single gap exceeds the 45-day limit. Therefore, **Not Eligible**.
After processing all individuals, I can categorize them. I found:
* **Not Eligible:** 8 members (due to age, enrollment gaps exceeding the limit, or multiple enrollment gaps).
* **Excluded:** 1 member (due to a colorectal cancer diagnosis).
* **Compliant (Numerator):** 7 members (met all eligibility criteria and had a qualifying screening).
* **Non-Compliant:** 4 members (met eligibility criteria but did not have a qualifying screening within the defined windows).
The **Denominator** is the sum of Compliant and Non-Compliant members: 7 + 4 = 11.
The **Numerator** is the count of Compliant members: 7.
The **Rate** is calculated as (Numerator / Denominator) * 100. So, (7 / 11) * 100 = 63.6363...%, which I'll round to **63.6%**.
I then compile the lists of member IDs for each category to ensure accuracy and cross-reference my work. The total roster count is 20, which matches my individual counts (8 + 1 + 7 + 4 = 20). My detailed analysis confirms the final rate.
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"numerator": 7,
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Grader detail
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"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K3 · Moonshot63.3s · 2,877 out | 33.4s · 1,628 out | 107.9s · 3,031 out
Reasoning · 2,708 tokens
Let me work through each member against the QM-CRC specification.
Measure QM-CRC:
- Measurement year: 2026-01-01 through 2026-12-31.
- 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:
- N1: FOBT or FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (2024-01-01 through 2026-12-31).
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022-01-01 through 2026-12-31).
- N4: CT colonography during 2026 or four years prior (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 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.
Now each member:
MEMBER 71081. DOB 1951-10-15, age 75 on 2026-12-31. Age eligible (46-75).
Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Two gaps: 03-21 to 04-14 gap, and 07-23 to 08-22 gap. The record says gaps of 23 and 29 days. Two gaps — fails continuous enrolment (no more than one gap). So not_eligible.
Wait — "no more than one gap of up to 45 days". Two gaps means fails. not_eligible.
Even though FIT 2025-10-03 — that's not during 2026 anyway (N1 requires during 2026). But enrolment fails first. not_eligible.
MEMBER 71082. DOB 1981-09-15, age 45 on 2026-12-31. Age must be 46-75. 45 < 46. not_eligible.
MEMBER 71083. Age 55. Enrolled continuous full year. Eligible.
Screening: 2026-08-02 CT colonography (N4, during 2026) — meets numerator. Also FIT 2026-09-02 (N1). No exclusions. compliant.
MEMBER 71084. DOB 1967-02-19, age 59. Enrolment: 2026-04-15 onward only. Not enrolled 2026-01-01 to 2026-04-14 — that's not a "gap" per se but missing coverage of the full measurement year. Continuous enrolment requires full measurement year with no more than one gap up to 45 days. Not enrolled from Jan 1 to Apr 14 = 103 days missing at start. That's more than 45 days. Fails enrolment. not_eligible.
Actually, is a period before first enrolment a "gap"? Typically in HEDIS, continuous enrollment allows one gap of up to 45 days. Here the member wasn't enrolled Jan 1–Apr 14, which is 103 days, exceeding 45. So fails regardless of interpretation. not_eligible.
MEMBER 71085. DOB 1959-01-11, age 67. Enrolled continuous, no gaps. Eligible.
No screening. No frailty/advanced illness documented ("no frailty or advanced illness documented"). No exclusions. non_compliant.
MEMBER 71086. DOB 1951-02-07, age 75. Enrolled continuous. Eligible.
Screening: 2020-08-11 CT colonography. N4 window: 2026 or four years prior = 2022-01-01 through 2026-12-31. 2020-08-11 is outside. Not numerator.
Exclusions: none documented (no frailty/AI). Age 75 ≥ 66, but E4 requires both frailty and advanced illness; neither documented. So non_compliant.
MEMBER 71087. DOB 1967-06-23, age 59. Enrolment: one gap of 32 days (04-20 to 05-23). One gap ≤ 45. Eligible.
Screening: 2021-04-28 CT colonography. N4 window 2022-01-01 onward — 2021-04-28 outside. Not numerator.
Other: frailty 2026-05-25, advanced illness 2026-06-21, both during measurement year. But E4 requires age 66+. Member is 59. So E4 doesn't apply. non_compliant.
MEMBER 71088. DOB 1976-06-16, age 50. Enrolment: three segments, gaps of 17 and 14 days — two gaps. Fails continuous enrolment (more than one gap). not_eligible.
Screening: 2021-07-01 flex sig — outside five-year window anyway (2022-01-01 onward). But enrolment fails first. not_eligible.
MEMBER 71089. DOB 1967-11-24, age 59. Continuous, no gaps. Eligible. No screening. No exclusions. non_compliant.
MEMBER 71090. DOB 1950-05-28, age 76 on 2026-12-31. Age must be 46-75. 76 > 75. not_eligible.
MEMBER 71091. DOB 1950-07-12, age 76 on 2026-12-31. Over 75. not_eligible.
MEMBER 71092. DOB 1971-06-21, age 55. Continuous. Eligible.
Exclusion E1: C18.7 diagnosed 2024-10-06, colorectal cancer any time on or before 2026-12-31. Excluded. (Even though stool DNA 2023-02-25 within three-year window — exclusion wins.)
MEMBER 71093. DOB 1976-11-04, age 50. Continuous. Eligible. FIT 2026-07-02 (N1). No exclusions. compliant.
MEMBER 71094. DOB 1981-12-09, age 45 on 2026-12-31. Under 46. not_eligible.
MEMBER 71095. DOB 1979-11-11, age 47. Continuous. Eligible. FIT 2026-05-26 (N1). compliant.
MEMBER 71096. DOB 1967-03-27, age 59. Continuous. Eligible. Colonoscopy 2026-03-13 (N5). compliant.
MEMBER 71097. DOB 1951-08-03, age 75. Enrolment: one gap of 21 days (04-24 to 05-16). Eligible.
Screening: FIT 2026-10-11 (N1). No exclusions. compliant.
MEMBER 71098. DOB 1954-09-24, age 72. Continuous. Eligible.
Screening: 2023-04-14 flex sig. N3 window: 2022-01-01 through 2026-12-31. 2023-04-14 within. Numerator met. No frailty/AI documented. compliant.
MEMBER 71099. DOB 1979-09-26, age 47. Enrolment: one gap 39 days (06-15 to 07-25). Eligible.
Screening: 2025-01-25 flex sig. N3 window 2022-01-01 onward — within. compliant.
MEMBER 71100. DOB 1979-01-17, age 47. Enrolment: 2026-03-16 onward; not enrolled before. Missing 2026-01-01 to 2026-03-15 = 74 days > 45. Fails enrolment. not_eligible.
(Screening CT colonography 2020-11-17 outside window anyway. Advanced illness 2026-01-23 during MY but age 47 < 66 so E4 irrelevant, but not eligible anyway.)
Now tally:
Denominator (eligible, not excluded): compliant + non_compliant.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7 members.
Non_compliant: 71085, 71086, 71087, 71089 = 4 members.
Excluded: 71092 = 1 member.
Not eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 = 8 members.
Total: 7+4+1+8 = 20. ✓
Denominator = 7 + 4 = 11.
Numerator = 7.
Rate = 7/11 × 100 = 63.6363... → 63.6 (rounded half up to one decimal).
Let me double-check some edge cases.
71081: gaps of 23 and 29 days — two gaps. "no more than one gap of up to 45 days". Two gaps → fails. not_eligible. Correct.
71088: two gaps (17 and 14 days). Fails. not_eligible.
71084: enrolled only from 2026-04-15. Missing Jan 1–Apr 14 = 103 days. Even if treated as a gap, exceeds 45 days. Fails. not_eligible.
71100: missing Jan 1–Mar 15 = 74 days. Fails. not_eligible.
71090: age 76 — over the 75 cap. not_eligible. Note FIT 2026-06-02 during MY, but age fails.
71091: age 76. not_eligible.
71082: age 45. Under 46. not_eligible. Note frailty + advanced illness documented but age 45 — E4 needs 66+ anyway; not eligible by age.
71094: age 45. not_eligible.
71086: CT colonography 2020-08-11. Five-year window: 2026 and four years prior → 2022-01-01 to 2026-12-31. 2020 is six years prior. Outside. non_compliant. Age 75 — within 46-75. Yes.
71087: CT colonography 2021-04-28 — outside 2022-01-01 window. Frailty + AI but age 59, E4 needs 66+. non_compliant.
71092: excluded via E1 (C18.7, sigmoid colon — C18 codes are colorectal cancer, C18-C21). Excluded.
71098: flex sig 2023-04-14, within 2022-01-01–2026-12-31. compliant.
71099: flex sig 2025-01-25, within window. compliant.
71097: FIT 2026-10-11 during 2026. compliant. One gap 21 days OK.
71083: CT colonography 2026-08-02 during 2026 → N4. compliant.
71093: FIT 2026-07-02. compliant.
71095: FIT 2026-05-26. compliant.
71096: colonoscopy 2026-03-13. compliant.
Non-compliant list: 71085, 71086, 71087, 71089.
Rate: 7/11 = 0.636363... × 100 = 63.6363... → 63.6.
Denominator = 11, numerator = 7, excluded = 1, not_eligible = 8.
Output JSON.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,195 tokens
:Let me work through each member.
**Measure spec recap:**
- Age: 46–75 as of 2026-12-31.
- Continuous enrolment: full measurement year (2026-01-01 to 2026-12-31), no more than one gap of up to 45 days.
- Numerator: N1 FOBT/FIT during 2026; N2 stool DNA 2026 or 2 prior years (2024-01-01 onwards); N3 flex sig 2026 or 4 prior years (2022-01-01 onwards); N4 CT colonography 2026 or 4 prior (2022-01-01 onwards); N5 colonoscopy 2026 or 9 prior (2017-01-01 onwards).
- Exclusions: E1 CRC (C18-C21) any time on/before 2026-12-31; E2 total colectomy; E3 hospice during MY; E4 age ≥66 AND both frailty and advanced illness documented during MY.
**MEMBER 71081** — 75 yo. Enrolment: three segments with gaps of 23 and 29 days → two gaps. Spec: "no more than one gap of up to 45 days." Two gaps → fails continuous enrolment → not_eligible.
Wait, let me verify gaps: Segment 1 ends 2026-03-21, segment 2 starts 2026-04-14. Days between: 2026-03-22 to 2026-04-13 = 23 days. Yes. Segment 2 ends 2026-07-23, segment 3 starts 2026-08-22: gap 2026-07-24 to 2026-08-21 = 29 days. Two gaps → not eligible (more than one gap). not_eligible.
**MEMBER 71082** — 45 yo → not_eligible (age).
**MEMBER 71083** — 55 yo, continuous. CT colonography 2026-08-02 (N4), FIT 2026-09-02 (N1). Compliant.
**MEMBER 71084** — 59 yo, enrolled from 2026-04-15 only → fails continuous enrolment → not_eligible. (Flex sig 2021 would be within 5-year window but enrolment fails.)
**MEMBER 71085** — 67 yo, continuous. No screening. No frailty/advanced illness → not excluded. Non_compliant.
**MEMBER 71086** — 75 yo, continuous. CT colonography 2020-08-11. N4 window: 2026 or four years prior = 2022-01-01 through 2026-12-31. 2020 is outside → not numerator. Non_compliant.
**MEMBER 71087** — 59 yo, one gap of 32 days → eligible (one gap ≤45). CT colonography 2021-04-28 → N4 window is 2022-2026 → outside. Frailty + advanced illness documented during MY, but age 59 < 66 → E4 doesn't apply. Non_compliant.
**MEMBER 71088** — 50 yo. Gaps of 17 and 14 → two gaps → not_eligible.
**MEMBER 71089** — 59 yo, continuous, no screening → non_compliant.
**MEMBER 71090** — 76 yo → not_eligible (age).
**MEMBER 71091** — 76 yo → not_eligible.
**MEMBER 71092** — 55 yo, continuous. Stool DNA 2023-02-25 → N2 window: 2026 or two years prior = 2024-01-01 onwards. 2023 outside → not numerator. But E1: C18.7 colorectal cancer 2024-10-06 → excluded. Excluded.
**MEMBER 71093** — 50 yo, continuous. FIT 2026-07-02 → compliant.
**MEMBER 71094** — 45 yo → not_eligible (age). Also one gap 51 days > 45 would fail anyway.
**MEMBER 71095** — 47 yo, continuous, FIT 2026-05-26 → compliant.
**MEMBER 71096** — 59 yo, continuous, colonoscopy 2026-03-13 → compliant.
**MEMBER 71097** — 75 yo, one gap 21 days → eligible. FIT 2026-10-11 → compliant.
**MEMBER 71098** — 72 yo, continuous. Flex sig 2023-04-14 → N3 window: 2026 or four years prior = 2022-01-01 onwards. 2023 within → compliant.
**MEMBER 71099** — 47 yo. One gap 39 days → eligible. Flex sig 2025-01-25 → within 5-year window → compliant.
**MEMBER 71100** — 47 yo. Enrolled from 2026-03-16 → fails continuous enrolment → not_eligible. (Advanced illness alone wouldn't exclude anyway; age < 66.)
Counts:
- Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 → 7
- Non_compliant: 71085, 71086, 71087, 71089 → 4
- Excluded: 71092 → 1
- Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 → 8
Total: 7+4+1+8 = 20 ✓
Denominator = compliant + non_compliant = 11. Numerator = 7. Rate = 7/11 × 100 = 63.636... → 63.6 (round half up to one decimal).
Double-check 71081: gaps of 23 and 29 — two gaps, rule allows at most one gap → not_eligible. Correct.
Double-check 71086 CT colonography 2020-08-11: "during 2026 or the four years prior" → four years prior to 2026 = 2022, 2023, 2024, 2025 plus 2026. 2020 not included. Non_compliant. Correct.
Double-check 71087: CT colonography 2021-04-28 → outside 2022–2026 window. Frailty + advanced illness during MY but age 59 → no exclusion. Non_compliant.
Rate: 7/11 = 0.636363... ×100 = 63.6363 → 63.6.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,866 tokens
Let me work through each member against the QM-CRC specification.
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:
- N1: FOBT or FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (2024-01-01 through 2026-12-31).
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022-01-01 through 2026-12-31 — 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).
- 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 as of 2026-12-31 AND both frailty and advanced illness during measurement year.
Now each member:
MEMBER 71081: DOB 1951-10-15, age 75 on 2026-12-31. Age OK (46–75).
Enrolment: segments 2026-01-01→2026-03-21; 2026-04-14→2026-07-23; 2026-08-22→2026-12-31. Gaps of 23 and 29 days. That's TWO gaps. The rule: "no more than one gap of up to 45 days." Two gaps → fails continuous enrolment. So not_eligible.
Wait, let me check gap calculation: gap from 2026-03-21 to 2026-04-14: days not enrolled: 03-22 through 04-13 = March 22–31 (10 days) + April 1–13 (13 days) = 23 days. Matches. Gap 2: 07-24 to 08-21: July 24–31 (8 days) + Aug 1–21 (21 days) = 29 days. Matches. Two gaps → fails enrolment → not_eligible.
Even though FIT 2025-10-03 would not count anyway (N1 needs 2026). Not eligible due to enrolment. → not_eligible.
MEMBER 71082: DOB 1981-09-15, age 45 on 2026-12-31. Age 45 < 46 → not_eligible (age). Even though frailty + advanced illness, exclusion E4 requires age ≥66, and also exclusions only apply if in eligible population. → not_eligible.
MEMBER 71083: DOB 1971-06-11, age 55. Eligible (age OK, continuous enrolment).
Screening: CT colonography 2026-08-02 (N4, within window) → numerator met. Also FIT 2026-09-02 (N1). Compliant.
MEMBER 71084: DOB 1967-02-19, age 59. Enrolment starts 2026-04-15 — not enrolled full year → fails continuous enrolment → not_eligible.
MEMBER 71085: DOB 1959-01-11, age 67. Eligible age; continuous. No screening → in denominator, non_compliant. No frailty/AI → no exclusion. Non-compliant.
MEMBER 71086: DOB 1951-02-07, age 75. Eligible. CT colonography 2020-08-11. N4 window: 2026 or four years prior → 2022-01-01 through 2026-12-31. 2020-08-11 is outside (6 years prior). So not numerator. → non_compliant.
MEMBER 71087: DOB 1967-06-23, age 59. Enrolment: one gap of 32 days → OK (one gap ≤45 days). Age: 59 — E4 requires age ≥66; 59 < 66, so E4 doesn't apply. In denominator.
Screening: CT colonography 2021-04-28. Window N4: 2022-01-01 onward. 2021 is 5 years prior — outside five-year window. → non_compliant.
MEMBER 71088: DOB 1976-06-16, age 50. Enrolment: gaps of 17 and 14 days — TWO gaps → fails enrolment → not_eligible.
MEMBER 71089: DOB 1967-11-24, age 59. Eligible, continuous. No screening → non_compliant.
MEMBER 71090: DOB 1950-05-28, age 76 on 2026-12-31. Age 76 > 75 → not_eligible (age). Despite FIT 2026-06-02. → not_eligible.
MEMBER 71091: DOB 1950-07-12, age 76 on 2026-12-31. → not_eligible (age).
MEMBER 71092: DOB 1971-06-21, age 55. Eligible, continuous. Exclusion E1: colorectal cancer C18.7 diagnosed 2024-10-06 (on or before 2026-12-31) → excluded. Even though stool DNA 2023-02-25 — N2 window is 2026 or two years prior = 2024-01-01 through 2026-12-31; 2023 is outside. But exclusion applies anyway → excluded.
MEMBER 71093: DOB 1976-11-04, age 50. Eligible, continuous. FIT 2026-07-02 (N1) → compliant.
MEMBER 71094: DOB 1981-12-09, age 45 → not_eligible (age).
MEMBER 71095: DOB 1979-11-11, age 47. Eligible, continuous. FIT 2026-05-26 → compliant.
MEMBER 71096: DOB 1967-03-27, age 59. Eligible, continuous. Colonoscopy 2026-03-13 (N5) → compliant.
MEMBER 71097: DOB 1951-08-03, age 75. Eligible age. Enrolment: one gap of 21 days → OK. FIT 2026-10-11 → compliant.
MEMBER 71098: DOB 1954-09-24, age 72. Eligible, continuous. Flexible sigmoidoscopy 2023-04-14. N3 window: 2026 or four years prior = 2022-01-01 through 2026-12-31. 2023-04-14 is within → compliant.
MEMBER 71099: DOB 1979-09-26, age 47. Enrolment: one gap of 39 days → OK. Sigmoidoscopy 2025-01-25 → within N3 window (2022–2026) → compliant.
MEMBER 71100: DOB 1979-01-17, age 47. Enrolment starts 2026-03-16 — not full year → not_eligible.
Now let me double check exclusion evaluation ordering: Exclusions are evaluated before numerator only for members in eligible population. Members failing age/enrolment are not_eligible regardless.
Check for possible E4 cases: Members aged ≥66: 71081 (75, but not eligible due to enrolment; no frailty/AI anyway), 71085 (67, no frailty/AI — non_compliant), 71086 (75, no frailty/AI), 71090 (76, not eligible age), 71091 (76, not eligible), 71097 (75, no frailty/AI), 71098 (72, no frailty/AI). Member 71082 has frailty + AI but age 45 → E4 not applicable, and age fails anyway → not_eligible.
Hospice: none documented. Colectomy: none.
Now compile:
Eligible population (before exclusions): members passing age + enrolment:
- 71083 (55, continuous) ✓
- 71085 (67, continuous) ✓
- 71086 (75, continuous) ✓
- 71087 (59, one gap 32d) ✓
- 71089 (59, continuous) ✓
- 71092 (55, continuous) ✓
- 71093 (50, continuous) ✓
- 71095 (47, continuous) ✓
- 71096 (59, continuous) ✓
- 71097 (75, one gap 21d) ✓
- 71098 (72, continuous) ✓
- 71099 (47, one gap 39d) ✓
That's 12 members.
Exclusions: 71092 (E1 colorectal cancer) → excluded. Others: none.
Denominator = 12 − 1 = 11.
Numerator (compliant):
- 71083: CT colonography 2026 ✓
- 71093: FIT 2026 ✓
- 71095: FIT 2026 ✓
- 71096: colonoscopy 2026 ✓
- 71097: FIT 2026 ✓
- 71098: sigmoidoscopy 2023 ✓
- 71099: sigmoidoscopy 2025 ✓
Compliant = 7.
Non-compliant:
- 71085 (no screening)
- 71086 (CT colonography 2020, outside 5-yr window)
- 71087 (CT colonography 2021, outside 5-yr window)
- 71089 (no screening)
Non-compliant = 4.
Denominator 7 + 4 = 11 ✓.
Excluded = 1 (71092).
Not_eligible: 71081 (two gaps), 71082 (age 45), 71084 (enrolment partial), 71088 (two gaps), 71090 (age 76), 71091 (age 76), 71094 (age 45), 71100 (enrolment partial). That's 8.
Total: 11 + 1 + 8 = 20 ✓.
Rate = 7/11 × 100 = 63.636... → rounded half up to one decimal = 63.6.
Let me double check 71087's window: N4 CT colonography during 2026 or the four years prior. Four years prior to 2026: 2022, 2023, 2024, 2025. So window 2022-01-01 to 2026-12-31. 2021-04-28 is outside. Yes, non_compliant.
71086: CT colonography 2020-08-11 — outside. Non-compliant.
71098: sigmoidoscopy 2023-04-14. N3 window: 2026 or four years prior → 2022–2026. 2023 within. Compliant.
71099: sigmoidoscopy 2025-01-25 → within. But wait, enrolment: gap 2026-06-15 to 2026-07-25 = 39 days, one gap → eligible. Compliant.
71097: age 75 OK, one gap 21 days OK, FIT 2026-10-11 → compliant.
71081: two gaps (23 + 29). Hmm — could reinterpretation be "no more than one gap of up to 45 days" meaning each gap must be ≤45 and at most one gap allowed? Yes, standard interpretation: at most one gap, and that gap ≤45 days. Two gaps → fails. Also note total gap days interpretation might differ, but the spec fields describe "One gap of 21 days" vs "Gaps of 23 and 29 days" — the roster authors clearly intend two gaps to fail. not_eligible.
71088: two gaps → not_eligible.
71084 and 71100: not enrolled full year → not_eligible.
Rate: 7/11 = 0.636363... × 100 = 63.6363 → 63.6.
Final JSON:
denominator: 11
numerator: 7
excluded: 1
not_eligible: 8
rate: 63.6
compliant_members: ["71083","71093","71095","71096","71097","71098","71099"]
non_compliant_members: ["71085","71086","71087","71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Gemini 2.5 Pro · Google35.2s · 4,344 out | 51.3s · 6,212 out | 32.8s · 3,500 out
Reasoning · 4,062 tokens
Okay, I've gone through the process of evaluating this roster of 20 members against the QM-CRC colorectal cancer screening measure for the 2026 measurement year. My thought process involved carefully dissecting the measure specifications and then systematically applying them to each individual member.
Here’s how I approached it:
**1. Deconstructing the Measure Specifications:**
My first step was to internalize the core requirements. This meant breaking down the eligible population (denominator), the numerator criteria (different screening types and their look-back periods), and the exclusion criteria. I noted the specific date ranges for the measurement year (2026-01-01 to 2026-12-31) and the look-back periods for each screening modality.
* **Eligible Population:** I focused on age (46-75 as of 2026-12-31) and continuous enrollment (full year with at most one gap of up to 45 days). These were the primary gates for even considering a member for compliance.
* **Numerator Criteria:** I mentally listed out the different screening tests (FOBT/FIT, Stool DNA, Flex Sig, CT Colonography, Colonoscopy) and their associated look-back windows. The key here was ensuring the test date fell within the *specified look-back period* relative to the measurement year.
* **Exclusions:** I made a mental checklist of the exclusion conditions: colorectal cancer diagnosis (C18-C21), total colectomy, hospice care, and specific age/frailty/advanced illness documentation. I understood that if any exclusion applied, the member was immediately removed from potential compliance, regardless of their screening status.
**2. Iterative Member Evaluation:**
With the rules clearly defined, I began processing each member individually. For each member, I followed a consistent, layered approach:
* **Age Check:** First, I checked if their age as of 2026-12-31 placed them within the 46-75 range. If not, they were immediately marked as "Not Eligible."
* **Enrollment Check:** If their age was acceptable, I then examined their enrollment history. I paid close attention to the number and duration of any gaps. If there were more than one gap, or a gap exceeding 45 days, they were "Not Eligible."
* **Exclusion Check:** If they passed the age and enrollment criteria, I moved on to the exclusions. I scoured their record for any condition that would disqualify them. If an exclusion was met, they were marked as "Excluded."
* **Numerator Check:** Only after a member was confirmed as part of the eligible population *and* had no applicable exclusions did I assess their screening status. I looked for any screening test that met *any* of the numerator criteria, paying close attention to the test date and the corresponding look-back period. If a qualifying test was found, they were "Compliant."
* **Non-Compliant Status:** If a member was eligible for the denominator but did not have a qualifying screening test within the specified look-back periods, they were marked as "Non-Compliant."
**3. Applying the Logic to Specific Members (Examples):**
* **Member 71081:** Their age was fine (75), but they had *two* enrollment gaps (23 and 29 days). The specification clearly states "no more than one gap." This immediately disqualified them as "Not Eligible."
* **Member 71083:** Age 55 and continuous enrollment made them eligible. No exclusions applied. Crucially, they had a CT colonography on 2026-08-02. This falls within the N4 criteria (CT colonography during 2026 with a 5-year look-back). Thus, they are "Compliant."
* **Member 71086:** Age 75 and continuous enrollment put them in the eligible pool. No exclusions. However, their CT colonography was in 2020. The look-back for CT colonography is 5 years, meaning it should be from 2022-01-01 to 2026-12-31. The 2020 date is outside this window, making them "Non-Compliant."
* **Member 71092:** Age 55 and continuous enrollment made them eligible. However, they had a diagnosis of C18.7 (colorectal cancer) in 2024. Since this occurred before 2026-12-31, exclusion E1 applied. They are "Excluded," even though they might have had a qualifying screening test.
* **Member 71098:** Age 72 and continuous enrollment qualified them. No exclusions. They had a flexible sigmoidoscopy on 2023-04-14. The look-back for flexible sigmoidoscopy (N3) is 5 years, covering 2022-01-01 to 2026-12-31. Their 2023 date falls within this window, so they are "Compliant."
**4. Tallying and Calculating the Rate:**
After processing all 20 members, I consolidated their statuses. I created distinct lists for "Compliant," "Non-Compliant," "Excluded," and "Not Eligible" members. I then performed a quick sanity check to ensure the sum of members in each category equaled the total roster size (20).
Finally, I calculated the performance rate:
* **Denominator:** This is the sum of "Compliant" and "Non-Compliant" members. In this case, 7 (Compliant) + 4 (Non-Compliant) = 11.
* **Numerator:** This is simply the count of "Compliant" members, which is 7.
* **Rate Calculation:** (Numerator / Denominator) * 100. So, (7 / 11) * 100 = 63.6363...%
* **Rounding:** As per standard practice, I rounded the rate to one decimal place, resulting in 63.6%.
**5. Structuring the Output:**
My final step was to organize these findings into the requested JSON format, ensuring all the calculated figures and lists of member IDs were accurately represented.
This structured, step-by-step approach, focusing first on eligibility, then exclusions, and finally numerator criteria, allowed me to systematically and accurately assess each member against the complex requirements of the QM-CRC measure.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,930 tokens
Here's a summary of my thought process as I evaluated the roster of 20 members against the QM-CRC measure specification for 2026. My primary goal was to meticulously apply the criteria for eligibility, exclusions, and numerator compliance for each individual.
I began by thoroughly reviewing the QM-CRC measure specification itself. This involved understanding the precise age range (46-75 on 2026-12-31), the continuous enrollment requirement (full year with no more than one gap of up to 45 days), and the various screening tests that qualify for the numerator (FIT/FOBT, Stool DNA, Flex sig, CT colonography, Colonoscopy) along with their specific lookback periods. Crucially, I also absorbed the exclusion criteria: colorectal cancer diagnosis, total colectomy, hospice, and the specific combination of advanced age (>=66), frailty, and advanced illness.
With the specification firmly in mind, I decided to approach the evaluation member by member, processing each one systematically to avoid errors. This iterative process allowed me to build a clear picture of each individual's status.
For **Member 71081**, my initial check was age, which was 75 on 2026-12-31, falling within the eligible range. However, when I examined the enrollment dates, I found two gaps: one for 23 days and another for 29 days. Since the specification clearly states "no more than one gap," this member was immediately classified as `not_eligible`.
Next, **Member 71082** presented a clear age-based ineligibility. Their date of birth placed them at 45 years old on 2026-12-31, outside the 46-75 range, leading to a `not_eligible` status.
**Member 71083** passed the age and continuous enrollment checks. The critical step was checking the numerator. I found two qualifying events: a CT colonography in August 2026 and a FIT test in September 2026. Either of these would suffice, so I confidently classified this member as `compliant`.
For **Member 71084**, the issue was enrollment. They were only enrolled from April 2026 onwards, meaning they did not meet the "full measurement year" requirement, thus designating them as `not_eligible`.
In **Member 71085**'s case, age and enrollment were satisfactory. However, upon reviewing their record for numerator actions, I found no evidence of any qualifying screening test. This led me to categorize them as `non_compliant`.
**Member 71086** also met age and enrollment criteria. The concern here was the screening test. They had a CT colonography in August 2020. I immediately recalled the lookback window for CT colonography is five years (2022-2026). Since 2020 falls outside this window, they were classified as `non_compliant`.
For **Member 71087**, age and enrollment (one gap of 32 days, within the limit) were acceptable. The screening test was a CT colonography in April 2021. Again, referencing the five-year lookback (2022-2026), this date was too early, resulting in a `non_compliant` status.
**Member 71088** was flagged due to enrollment. Similar to Member 71081, they had two enrollment gaps (17 days and 14 days). This violated the "no more than one gap" rule, making them `not_eligible`.
**Member 71089**, like Member 71085, met the age and enrollment requirements but lacked any record of a qualifying screening test, leading to a `non_compliant` classification.
**Member 71090** and **Member 71091** were straightforward rejections based on age, both being 76 on 2026-12-31, exceeding the maximum age limit. They were marked `not_eligible`.
My evaluation of **Member 71092** involved a careful consideration of exclusions. While their age and enrollment were fine, I discovered a diagnosis of colorectal cancer (C18.7) in October 2024. This falls squarely under exclusion E1 ("Colorectal cancer (C18-C21) anytime on or before 2026-12-31"). Therefore, even if they had met a numerator criterion (which, upon closer inspection, a 2023 Stool DNA test did not, as the lookback is 2024-2026), the exclusion would still apply. This member was correctly classified as `excluded`.
**Member 71093** was found to be `compliant`. They met age and enrollment requirements, and had a qualifying FIT test in July 2026, which is within the one-year measurement window.
**Member 71094** was another clear age-based `not_eligible` case, being 45 on 2026-12-31.
**Member 71095** met all criteria: age, continuous enrollment, and a FIT test in May 2026, earning them a `compliant` status.
**Member 71096** was also `compliant`. They were within the age range, continuously enrolled, and had a colonoscopy in March 2026, well within the ten-year lookback window.
**Member 71097** passed age and enrollment checks (one gap of 21 days, within the limit). They had a FIT test in October 2026, making them `compliant`.
**Member 71098** was `compliant`. Their age and enrollment were fine, and they had a flexible sigmoidoscopy in April 2023. I confirmed this fell within the five-year lookback period (2022-2026).
Similarly, **Member 71099** was `compliant`. They met age and enrollment criteria (one gap of 39 days, within the limit) and had a flexible sigmoidoscopy in January 2025, which is also within the 2022-2026 lookback.
Finally, **Member 71100** was flagged for enrollment. They were not enrolled for the full measurement year, marking them as `not_eligible`.
Throughout this process, I made it a point to double-check the lookback windows for each screening test type against the specific dates recorded for each member. This rigorous re-verification of the lookback periods (N1: 1 year, N2: 3 years, N3/N4: 5 years, N5: 10 years) was crucial for ensuring accuracy, especially for members who had screening tests outside the current measurement year.
After classifying all 20 members, I compiled the results:
* **Compliant:** 7 members
* **Non-compliant:** 4 members
* **Excluded:** 1 member
* **Not Eligible:** 8 members
This summation allowed me to calculate the denominator (compliant + non-compliant = 11) and the numerator (compliant = 7). From these figures, I derived the rate of 63.6% (7/11 * 100, rounded to one decimal place). I then organized the individual member IDs into their respective categories, ensuring numerical ordering for clarity in the final JSON output. My confidence in these classifications is high, stemming from the systematic, step-by-step application of each criterion in the QM-CRC specification.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,218 tokens
Alright, I'm tackling the QM-CRC colorectal cancer screening measure for the 2026 measurement year. My task is to evaluate a roster of 20 members against these specifications, and I'm going to walk through my thought process for each one.
First, I'm laser-focused on the **eligible population**. For this measure, that means members who are between 46 and 75 years old as of December 31, 2026, and who have been continuously enrolled for the entire measurement year, with at most a single gap of up to 45 days.
Then, to be considered **compliant** (the numerator), a member needs to have had one of several specific screenings: a FIT or FOBT within 2026; a Stool DNA test within 2024-2026; a flexible sigmoidoscopy or CT colonography within 2022-2026; or a colonoscopy within 2017-2026.
And, critically, I need to watch out for **exclusions**. These include a colorectal cancer diagnosis (ICD-10 codes C18-C21) at any point up to the end of 2026, a total colectomy before the end of 2026, hospice care during 2026, or for members aged 66 and older, documented frailty and advanced illness in 2026.
Now, let's dive into the individual members.
**MEMBER 71081:** Age 75, so that's within the 46-75 range. Good. But, upon checking enrollment, I see two gaps: one of 23 days and another of 29 days. The rule states "no more than one gap," so this member unfortunately falls outside the eligible population due to their enrollment history.
**MEMBER 71082:** This member is only 45. The eligible age range starts at 46. So, too young. Not eligible.
**MEMBER 71083:** Age 55, which is perfect. Enrollment is continuous, no gaps. No exclusions are present. Now, for the numerator: I see a CT colonography performed on August 2, 2026. That falls under the N4 criteria (CT colonography within 2022-2026) and it also has a FIT in 2026, meeting N1. Either one makes this member compliant. So, **compliant**.
**MEMBER 71084:** Age 59, okay. But their enrollment starts on April 15, 2026. They weren't enrolled for the full measurement year. Not eligible.
**MEMBER 71085:** Age 67, enrollment is continuous, and there are no exclusions. However, looking at their screening history, I don't see any of the qualifying procedures within the specified lookback periods. Therefore, this member is **non-compliant**.
**MEMBER 71086:** Age 75, continuous enrollment, no exclusions. They had a CT colonography on August 11, 2020. The lookback for CT colonography (N4) is from 2022-01-01 to 2026-12-31. Their 2020 screening is too old. No other screenings are listed. So, **non-compliant**.
**MEMBER 71087:** Age 59, okay. Their enrollment has one gap of 32 days, which is within the "no more than one gap of up to 45 days" rule, so that's fine. They are not age 66+, so exclusion E4 doesn't apply. No other exclusions. However, their CT colonography was on April 28, 2021. Again, the N4 lookback starts in 2022. This screening is too old. No other qualifying screenings. This member is **non-compliant**.
**MEMBER 71088:** Age 50, within range. But their enrollment has two gaps: one of 17 days and another of 14 days. This violates the "no more than one gap" rule. Not eligible.
**MEMBER 71089:** Age 59, continuous enrollment, no exclusions. Similar to member 71085, I'm not finding any qualifying screenings within the specified timeframes. This member is **non-compliant**.
**MEMBER 71090:** Age 76. This is outside the 46-75 age range. Not eligible.
**MEMBER 71091:** Age 76. Also outside the eligible age range. Not eligible.
**MEMBER 71092:** Age 55, enrollment is continuous, no issues there. However, I see a diagnosis of C18.7 in 2024. C18 codes are for malignant neoplasms of the colon, and this falls under exclusion E1. This member is **excluded**.
**MEMBER 71093:** Age 50, continuous enrollment, no exclusions. They had a FIT on July 2, 2026, which clearly meets the N1 criterion. This member is **compliant**.
**MEMBER 71094:** Age 45. Too young, as the eligible range starts at 46. Not eligible.
**MEMBER 71095:** Age 47, continuous enrollment, no exclusions. They had a FIT on May 26, 2026, meeting N1. This member is **compliant**.
**MEMBER 71096:** Age 59, continuous enrollment, no exclusions. They had a colonoscopy on March 13, 2026. This meets the N5 criterion (colonoscopy within 2017-2026). This member is **compliant**.
**MEMBER 71097:** Age 75, continuous enrollment, no exclusions. They had a FIT on October 11, 2026, meeting N1. This member is **compliant**.
**MEMBER 71098:** Age 72, continuous enrollment, no exclusions. They had a flexible sigmoidoscopy on April 14, 2023. The N3 lookback for flexible sigmoidoscopy is from 2022-01-01 to 2026-12-31. This screening falls within that window. This member is **compliant**.
**MEMBER 71099:** Age 47, enrollment has one gap of 39 days, which is allowed. No exclusions. They had a flexible sigmoidoscopy on January 25, 2025. Again, the N3 lookback covers this period. This member is **compliant**.
**MEMBER 71100:** Age 47, okay. But their enrollment starts on March 16, 2026. They weren't enrolled for the full measurement year. Not eligible.
So, to summarize my findings:
* **Compliant members:** 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members.
* **Non-compliant members:** 71085, 71086, 71087, 71089. That's 4 members.
* **Excluded members:** 71092. That's 1 member.
* **Not-eligible members:** 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8 members.
Checking my counts: 7 + 4 + 1 + 8 equals 20. Perfect.
Now, for the calculation:
The denominator is the sum of compliant and non-compliant members: 7 + 4 = 11.
The numerator is the number of compliant members: 7.
The rate is (7 / 11) * 100, which comes out to approximately 63.6%.
I've also compiled the final lists of members by their status, which I'll now use to assemble the output in the required JSON format. Everything looks good and double-checked.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.2 · Z.ai106.7s · 6,420 out | 237.5s · 8,196 out | 32.9s · 2,507 out
Reasoning · 6,111 tokens
Let me go through each member systematically 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: 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 two years prior (2024-2026, three-year window)
- N3. Flexible sigmoidoscopy during 2026 or four years prior (2022-2026, five-year window)
- N4. CT colonography during 2026 or four years prior (2022-2026, five-year window)
- N5. Colonoscopy during 2026 or nine years prior (2017-2026, 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 71081**
- DOB: 1951-10-15, age 75 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days.
- First gap: 2026-03-22 to 2026-04-13 = 23 days (actually let me count: March 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 = 10 days in March; April 1-13 = 13 days; total = 22 days? Let me think more carefully. Gap between end of first enrollment (2026-03-21) and start of second (2026-04-14). Days not enrolled: 2026-03-22 through 2026-04-13. That's 10 days in March (22-31) + 13 days in April (1-13) = 23 days. Yes, 23 days.
- Second gap: 2026-07-24 through 2026-08-21. July 24-31 = 8 days, August 1-21 = 21 days. Total = 29 days.
- Two gaps. The rule says "no more than one gap of up to 45 days." This member has TWO gaps. So they don't meet continuous enrolment.
- Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means at most one gap, and that gap must be ≤45 days. Two gaps means not continuously enrolled.
- Not eligible (enrolment) → **not_eligible**
**MEMBER 71082**
- DOB: 1981-09-15, age 45 on 2026-12-31 → age 45, not 46-75 → **not_eligible** (age)
**MEMBER 71083**
- DOB: 1971-06-11, age 55 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2026-08-02 CT colonography (N4, during 2026 ✓), 2026-09-02 FIT (N1, during 2026 ✓)
- No exclusions
- → **compliant**
**MEMBER 71084**
- DOB: 1967-02-19, age 59 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-04-15 through 2026-12-31, not enrolled before. Not the full measurement year (missing Jan 1 - Apr 14). This is not continuous enrolment for the full year.
- The gap from Jan 1 to Apr 14 is a large gap (over 100 days). The rule says "the full measurement year with no more than one gap of up to 45 days."
- Wait, but if they weren't enrolled before 2026-04-15, is that considered a gap? The member doesn't have the full measurement year of enrolment. Let me re-read: "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) with at most one gap of up to 45 days. Being enrolled only from 2026-04-15 means they're missing more than 45 days from the start. This is not continuous enrolment.
- Actually, wait. Let me think about this differently. In HEDIS-like measures, continuous enrollment typically means enrolled throughout the measurement period, allowing small gaps. If someone first enrolls on 2026-04-15, they weren't enrolled from Jan 1 to Apr 14 — that's a gap of ~103 days, which exceeds 45 days.
- → **not_eligible** (enrolment)
**MEMBER 71085**
- DOB: 1959-01-11, age 67 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: No colorectal screening on record → does not meet numerator
- Exclusions: No CRC, no colectomy, no hospice. Age 67 ≥ 66, but no frailty or advanced illness documented → E4 does not apply (needs both frailty AND advanced illness)
- → **non_compliant**
**MEMBER 71086**
- DOB: 1951-02-07, age 75 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2020-08-11 CT colonography. N4 is CT colonography during 2026 or four years prior (2022-2026). 2020 is outside this window (before 2022). Does this meet any numerator?
- N1: FIT/FOBT during 2026 — no
- N2: Stool DNA during 2024-2026 — no
- N3: Flexible sigmoidoscopy during 2022-2026 — no
- N4: CT colonography during 2022-2026 — 2020 is before 2022, so no
- N5: Colonoscopy during 2017-2026 — no, this was CT colonography not colonoscopy
- Does not meet numerator
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. Age 75 ≥ 66, but no frailty or advanced illness → E4 doesn't apply.
- → **non_compliant**
**MEMBER 71087**
- DOB: 1967-06-23, age 59 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days.
- Gap: 2026-04-21 through 2026-05-22. April 21-30 = 10 days, May 1-22 = 22 days. Total = 32 days. ✓ (one gap, ≤45 days)
- Continuous enrolment ✓
- Screening: 2021-04-28 CT colonography. N4 is CT colonography during 2022-2026. 2021 is before 2022, so no. Does not meet any numerator.
- N1: no FIT/FOBT in 2026
- N2: no stool DNA in 2024-2026
- N3: no flex sig in 2022-2026
- N4: CT colonography in 2021, outside 2022-2026 window — no
- N5: no colonoscopy in 2017-2026
- Does not meet numerator
- Exclusions: Age 59, not ≥ 66, so E4 doesn't apply. No CRC, no colectomy, no hospice.
- Wait, the member has frailty (2026-05-25) and advanced illness (2026-06-21), both during the measurement year. But E4 requires age 66+. Age is 59, so E4 doesn't apply.
- No other exclusions apply.
- → **non_compliant**
**MEMBER 71088**
- DOB: 1976-06-16, age 50 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days.
- Two gaps → not continuous enrolment (no more than one gap allowed)
- Wait, let me check: "no more than one gap of up to 45 days" — this means at most one gap. Two gaps means not eligible.
- → **not_eligible** (enrolment — two gaps)
**MEMBER 71089**
- DOB: 1967-11-24, age 59 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: No colorectal screening → does not meet numerator
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. Age 59, not ≥ 66.
- → **non_compliant**
**MEMBER 71090**
- DOB: 1950-05-28, age 76 on 2026-12-31 → age 76, not 46-75 → **not_eligible** (age)
**MEMBER 71091**
- DOB: 1950-07-12, age 76 on 2026-12-31 → age 76, not 46-75 → **not_eligible** (age)
**MEMBER 71092**
- DOB: 1971-06-21, age 55 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2023-02-25 Stool DNA test. N2 is stool DNA during 2024-2026 (three-year window from 2026-12-31). 2023 is before 2024, so this doesn't meet N2.
- Wait, let me recalculate. "Stool DNA test during 2026 or the two years prior (three-year window)." So the window is 2024, 2025, 2026. 2023 is outside this window.
- Does not meet numerator.
- Exclusions: E1 — Colorectal cancer (C18-C21). The member has "2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon." C18.7 is in the range C18-C21. This is a required exclusion.
- → **excluded** (E1: colorectal cancer)
**MEMBER 71093**
- DOB: 1976-11-04, age 50 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2026-07-02 FIT → N1 met (FIT during 2026) ✓
- No exclusions
- → **compliant**
**MEMBER 71094**
- DOB: 1981-12-09, age 45 on 2026-12-31 → age 45, not 46-75 → **not_eligible** (age)
Wait, let me double-check. Age 45 on 2026-12-31. The eligible population is 46 through 75. So age 45 is not eligible.
**MEMBER 71095**
- DOB: 1979-11-11, age 47 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2026-05-26 FIT → N1 met ✓
- No exclusions
- → **compliant**
**MEMBER 71096**
- DOB: 1967-03-27, age 59 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2026-03-13 Colonoscopy → N5 met (colonoscopy during 2026) ✓
- No exclusions
- → **compliant**
**MEMBER 71097**
- DOB: 1951-08-03, age 75 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days.
- Gap: 2026-04-25 through 2026-05-15. April 25-30 = 6 days, May 1-15 = 15 days. Total = 21 days. ✓ (one gap, ≤45 days)
- Continuous enrolment ✓
- Screening: 2026-10-11 FIT → N1 met (FIT during 2026) ✓
- No exclusions (age 75, but no frailty/advanced illness, so E4 doesn't apply)
- → **compliant**
**MEMBER 71098**
- DOB: 1954-09-24, age 72 on 2026-12-31 → age 46-75 ✓
- Enrolment: continuous full year ✓
- Screening: 2023-04-14 Flexible sigmoidoscopy. N3 is flex sig during 2022-2026 (five-year window). 2023 is within 2022-2026 ✓
- No exclusions (age 72, but no frailty/advanced illness, so E4 doesn't apply)
- → **compliant**
**MEMBER 71099**
- DOB: 1979-09-26, age 47 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days.
- Gap: 2026-06-16 through 2026-07-24. June 16-30 = 15 days, July 1-24 = 24 days. Total = 39 days. ✓ (one gap, ≤45 days)
- Continuous enrolment ✓
- Screening: 2025-01-25 Flexible sigmoidoscopy. N3 is flex sig during 2022-2026 (five-year window). 2025 is within this window ✓
- No exclusions
- → **compliant**
**MEMBER 71100**
- DOB: 1979-01-17, age 47 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-03-16 through 2026-12-31, not enrolled before 2026-03-16. This means they're missing Jan 1 - Mar 15, which is more than 45 days (73 days). Not continuous enrolment for the full year.
- → **not_eligible** (enrolment)
- Wait, let me reconsider. The gap from Jan 1 to Mar 15 is 74 days (Jan 1-31 = 31 days, Feb 1-28 = 28 days, Mar 1-15 = 15 days, total = 31+28+15 = 74 days). That's way more than 45 days.
- Actually, I need to think about this more carefully. If they weren't enrolled at all before 2026-03-16, is that considered a "gap" in enrollment? In HEDIS terms, continuous enrollment means being enrolled for the entire period. If they first enrolled on March 16, they weren't enrolled for Jan 1 - Mar 15, which is a gap of more than 45 days. So they don't meet continuous enrollment.
- → **not_eligible** (enrolment)
Now let me also reconsider some members.
Let me reconsider MEMBER 71082:
- DOB: 1981-09-15, age 45 on 2026-12-31. The eligible age is 46-75. Age 45 is not in range. → not_eligible (age)
- Even though the member has frailty and advanced illness, these are exclusion criteria evaluated only for those in the eligible population. Since the member is not_eligible due to age, that takes precedence.
Let me reconsider MEMBER 71084:
- DOB: 1967-02-19, age 59 on 2026-12-31 → age 46-75 ✓
- Enrolment: 2026-04-15 through 2026-12-31, not enrolled before. Missing 2026-01-01 through 2026-04-14 (104 days). This is more than 45 days. → not_eligible (enrolment)
Let me reconsider MEMBER 71094:
- DOB: 1981-12-09, age 45 on 2026-12-31. Age 45 is not in 46-75 range. → not_eligible (age)
Let me reconsider MEMBER 71081:
- DOB: 1951-10-15, age 75 on 2026-12-31 → age 46-75 ✓
- Enrolment: three segments with two gaps (23 and 29 days). "No more than one gap" — two gaps means not eligible. → not_eligible (enrolment)
Let me reconsider MEMBER 71088:
- DOB: 1976-06-16, age 50 on 2026-12-31 → age 46-75 ✓
- Enrolment: three segments with two gaps (17 and 14 days). Two gaps, so not eligible. → not_eligible (enrolment)
Now let me also double-check MEMBER 71090 and 71091:
- 71090: DOB 1950-05-28, age 76 on 2026-12-31 → not_eligible (age > 75)
- 71091: DOB 1950-07-12, age 76 on 2026-12-31 → not_eligible (age > 75)
Let me also double-check the ages for 71094 and 71082:
- 71082: DOB 1981-09-15 → on 2026-12-31, age = 2026 - 1981 = 45 (birthday already passed on Sep 15). Age 45. Not in 46-75. → not_eligible
- 71094: DOB 1981-12-09 → on 2026-12-31, age = 2026 - 1981 = 45 (birthday Dec 9 has passed). Age 45. Not in 46-75. → not_eligible
Wait, let me recalculate. DOB 1981-12-09. On 2026-12-31:
- 2026 - 1981 = 45. Birthday Dec 9 has already occurred (Dec 9 < Dec 31), so age is 45. Not in 46-75. → not_eligible. ✓
Now let me compile the results:
**Compliant members:**
- 71083 (CT colonography 2026, FIT 2026)
- 71093 (FIT 2026)
- 71095 (FIT 2026)
- 71096 (Colonoscopy 2026)
- 71097 (FIT 2026)
- 71098 (Flex sig 2023, within 5-year window)
- 71099 (Flex sig 2025, within 5-year window)
**Non-compliant members:**
- 71085 (no screening, age 67, no exclusions)
- 71086 (CT colonography 2020, outside 5-year window; age 75, no frailty/advanced illness)
- 71087 (CT colonography 2021, outside 5-year window; age 59, has frailty+advanced illness but age < 66)
- 71089 (no screening)
**Excluded members:**
- 71092 (colorectal cancer C18.7)
**Not eligible members:**
- 71081 (age 75 OK, but two gaps in enrolment)
- 71082 (age 45, not 46-75)
- 71084 (age 59 OK, but enrolment only from 2026-04-15, gap > 45 days)
- 71088 (age 50 OK, but two gaps in enrolment)
- 71090 (age 76, not 46-75)
- 71091 (age 76, not 46-75)
- 71094 (age 45, not 46-75)
- 71100 (age 47 OK, but enrolment only from 2026-03-16, gap > 45 days)
Let me count:
- Compliant: 7 members (71083, 71093, 71095, 71096, 71097, 71098, 71099)
- Non-compliant: 4 members (71085, 71086, 71087, 71089)
- Excluded: 1 member (71092)
- Not eligible: 8 members (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100)
Total: 7 + 4 + 1 + 8 = 20 ✓
Denominator = compliant + non_compliant = 7 + 4 = 11
Numerator = 7
Excluded = 1
Not eligible = 8
Rate = 7/11 × 100 = 63.636... → 63.64 (rounded half up to one decimal place)
Wait, the spec says "rounded half up to one decimal place." So 63.636... → 63.6.
Let me recalculate: 7/11 = 0.63636... × 100 = 63.6363... → rounded to one decimal place = 63.6.
Actually, 63.6363... rounds to 63.6 at one decimal place (since the second decimal is 3, which is < 5, so we round down). Wait, one decimal place means we look at the second decimal digit. 63.63... → the first decimal is 6, the second is 3. Since the second is 3 < 5, we keep the first as 6. So 63.6.
Hmm wait, let me recalculate more carefully. 7/11 = 0.6363636363... × 100 = 63.6363636...%. Rounded to one decimal place: look at the second decimal digit (3), which is < 5, so round down. → 63.6.
Let me verify the members once more:
71081: Age 75 ✓. Enrolment has two gaps (23 and 29 days). Rule allows at most one gap. → not_eligible
71082: Age 45. Not in 46-75. → not_eligible
71083: Age 55 ✓. Continuous enrolment ✓. FIT in 2026 ✓. → compliant
71084: Age 59 ✓. Enrolment from 2026-04-15, gap of ~103 days from Jan 1. → not_eligible
71085: Age 67 ✓. Continuous enrolment ✓. No screening. Age ≥66 but no frailty or advanced illness → E4 doesn't apply. → non_compliant
71086: Age 75 ✓. Continuous enrolment ✓. CT colonography 2020, outside N4 window (2022-2026). No other screening. No exclusions (age 75 ≥66 but no frailty/advanced illness). → non_compliant
71087: Age 59 ✓. Enrolment: one gap of 32 days ✓. CT colonography 2021, outside N4 window (2022-2026). Has frailty and advanced illness but age 59 < 66 → E4 doesn't apply. → non_compliant
71088: Age 50 ✓. Enrolment: two gaps (17 and 14 days). → not_eligible
71089: Age 59 ✓. Continuous enrolment ✓. No screening. → non_compliant
71090: Age 76. Not in 46-75. → not_eligible
71091: Age 76. Not in 46-75. → not_eligible
71092: Age 55 ✓. Continuous enrolment ✓. Stool DNA 2023, outside N2 window (2024-2026). Has C18.7 (colorectal cancer) → E1 exclusion. → excluded
71093: Age 50 ✓. Continuous enrolment ✓. FIT 2026 ✓. → compliant
71094: Age 45. Not in 46-75. → not_eligible
71095: Age 47 ✓. Continuous enrolment ✓. FIT 2026 ✓. → compliant
71096: Age 59 ✓. Continuous enrolment ✓. Colonoscopy 2026 ✓. → compliant
71097: Age 75 ✓. Enrolment: one gap of 21 days ✓. FIT 2026 ✓. → compliant
71098: Age 72 ✓. Continuous enrolment ✓. Flex sig 2023, within N3 window (2022-2026) ✓. → compliant
71099: Age 47 ✓. Enrolment: one gap of 39 days ✓. Flex sig 2025, within N3 window (2022-2026) ✓. → compliant
71100: Age 47 ✓. Enrolment from 2026-03-16, gap of ~74 days from Jan 1. → not_eligible
All checks out. Let me finalize:
denominator = 11
numerator = 7
excluded = 1
not_eligible = 8
rate = 63.6
compliant_members = ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
non_compliant_members = ["71085", "71086", "71087", "71089"]
excluded_members = ["71092"]
not_eligible_members = ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 7,859 tokens
Let me go through each member systematically.
**MEMBER 71081**
- DOB: 1951-10-15, age 75 on 2026-12-31. Age 46-75? Yes, 75 is included.
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days.
- The rule says "no more than one gap of up to 45 days." This member has TWO gaps (23 and 29 days). The rule says "no more than one gap." So this member fails continuous enrolment.
- Status: not_eligible (fails continuous enrolment)
**MEMBER 71082**
- DOB: 1981-09-15, age 45 on 2026-12-31. Age 46-75? No, 45 is below 46.
- Status: not_eligible (age)
**MEMBER 71083**
- DOB: 1971-06-11, age 55 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2026-08-02 CT colonography (N4, five-year window: 2026 or four years prior, so 2022-2026). Yes, in 2026.
- Also 2026-09-02 FIT (N1, during 2026). Yes.
- No exclusions.
- Status: compliant
**MEMBER 71084**
- DOB: 1967-02-19, age 59 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-04-15 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-15.
- The rule says "the full measurement year." This member was not enrolled for the full year.
- Wait, "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Does this mean they must be enrolled the entire year? Or does it mean the gaps in their enrolment must be no more than one gap of up to 45 days?
- Looking at this more carefully: "the full measurement year" — this means they need to be enrolled from 2026-01-01 through 2026-12-31, with no more than one gap of up to 45 days. If someone starts enrolment on 2026-04-15, they weren't enrolled at the beginning of the year, so they don't meet continuous enrolment for the full measurement year.
- Actually, let me reconsider. In HEDIS-like measures, "continuous enrollment" typically means enrolled for the entire measurement period. The "gap" allowance is for brief lapses within that period. If someone wasn't enrolled at all during part of the year (like the first 3.5 months), they don't meet continuous enrollment.
- Hmm, but the way it's phrased: "the full measurement year with no more than one gap of up to 45 days." This could mean: enrolled for the full year, and any gaps in that enrolment are no more than one gap of up to 45 days. So if you're enrolled 2026-04-15 through 2026-12-31, you're missing Jan 1 - Apr 14, which is more than 45 days. So you fail.
- Actually, I think the standard HEDIS interpretation is that the member must be enrolled continuously from January 1 through December 31, with the allowance for one gap of up to 45 days. A gap at the beginning or end doesn't count as a "gap" — it means the member simply wasn't enrolled. So members who start mid-year don't meet continuous enrollment for the full measurement year.
- Wait, but some measures allow enrollment to start at a certain point. 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. The only exception is one gap of up to 45 days. If the member wasn't enrolled from Jan 1 to Apr 14, that's not a "gap" — that's just not being enrolled for the full year.
- Hmm, but actually, I think in practice, a gap at the beginning would be treated as not meeting the continuous enrollment requirement. The "one gap of up to 45 days" is typically interpreted as: the member was enrolled for the full year, except for one brief lapse of no more than 45 days.
- So if the member is enrolled from 2026-04-15 through 2026-12-31, that's missing the first ~3.5 months, which is more than 45 days. So they fail continuous enrollment.
- Status: not_eligible (fails continuous enrolment)
Actually wait, let me reconsider. I need to think about this more carefully. The member enrolled on 2026-04-15. The gap from Jan 1 to Apr 14 is 104 days. That's way more than 45 days. But is that even a "gap"? A gap implies there was enrollment, then a break, then enrollment again. If the member was never enrolled before Apr 15, there's no gap — just a late start.
The specification says "the full measurement year with no more than one gap of up to 45 days." I think "the full measurement year" means the member must be enrolled for the full year (Jan 1 - Dec 31), and the only allowable deviation is one gap of up to 45 days. If the member wasn't enrolled for part of the year (and it's more than 45 days), they don't meet the requirement.
But another interpretation: the member has gaps in their enrollment. The gap from Jan 1 to Apr 14 is 104 days. If we count that as a gap, it exceeds 45 days. So the member fails.
Either way, member 71084 fails continuous enrollment.
Actually, I want to be more precise. Let me reconsider the exact wording: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
I think this means:
- The member must be enrolled for the full measurement year (Jan 1 - Dec 31)
- They are allowed no more than one gap
- That gap can be up to 45 days
So if a member is enrolled from Apr 15 to Dec 31, they're missing Jan 1 to Apr 14 (104 days). That's more than 45 days, so they fail. But also, there's no enrollment gap per se — they just weren't enrolled at all during that time. The standard interpretation would be that the member doesn't meet continuous enrollment because they weren't enrolled for the full year.
Hmm, but actually, I think the standard HEDIS interpretation is that a gap at the beginning or end is NOT considered a gap. The member must simply be enrolled from Jan 1 to Dec 31, with the allowance for one gap of up to 45 days during that period. If the member starts on Apr 15, they're not enrolled from Jan 1, so they fail the "full measurement year" requirement.
Let me look at the members who have gaps and see if the test is designed to distinguish:
- 71081: Two gaps of 23 and 29 days → fails (more than one gap)
- 71087: One gap of 32 days → passes (one gap, up to 45 days)
- 71088: Two gaps of 17 and 14 days → fails (more than one gap)
- 71090: One gap of 28 days → passes
- 71091: One gap of 39 days → passes
- 71094: One gap of 51 days → fails (gap exceeds 45 days)
- 71097: One gap of 21 days → passes
- 71099: One gap of 39 days → passes
- 71084: Not enrolled before Apr 15 → fails (not full year)
- 71100: Not enrolled before Mar 16 → fails (not full year)
OK, so for members 71084 and 71100, they start mid-year. I'll treat them as not_eligible because they don't have enrollment for the full measurement year. The gap from Jan 1 to their start date is more than 45 days.
Actually, wait. Let me reconsider. In some HEDIS measures, the continuous enrollment requirement allows the member to be enrolled from a certain date, not necessarily Jan 1. But the specification here says "the full measurement year," which strongly implies Jan 1 through Dec 31.
But actually, I realize I need to think about this differently. If a member is enrolled from Apr 15 through Dec 31, the period from Jan 1 to Apr 14 could be considered a gap. That gap is 104 days, which exceeds 45 days. So the member fails.
If a member is enrolled from Jan 1 to Dec 31 with one gap of 30 days in the middle, that's one gap of 30 days, which is ≤ 45 days. So they pass.
If a member is enrolled from Jan 1 to Dec 31 with two gaps of 20 days each, that's two gaps, which is more than one. So they fail.
I think the cleanest interpretation is: the member must have enrollment covering Jan 1 through Dec 31, with at most one interruption of ≤ 45 days. Any period where the member is not enrolled counts as a gap. If there are 0 gaps, that's fine. If there's 1 gap ≤ 45 days, that's fine. Otherwise, fail.
Under this interpretation:
- 71084: gap from Jan 1 to Apr 14 = 104 days → more than 45 days → fail
- 71100: gap from Jan 1 to Mar 15 = 73 days → more than 45 days → fail
Both fail. So both are not_eligible.
Let me continue with the remaining members.
**MEMBER 71085**
- DOB: 1959-01-11, age 67 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: No colorectal screening on record. So doesn't meet numerator.
- Exclusions: No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness. Age 66+ but no frailty/advanced illness. Not excluded.
- Status: non_compliant
**MEMBER 71086**
- DOB: 1951-02-07, age 75 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2020-08-11 CT colonography.
- N4: CT colonography during 2026 or the four years prior (five-year window). The five-year window from 2026-12-31 would be 2022-2026. 2020 is outside this window. So this doesn't meet the numerator.
- Exclusions: No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness. Age 66+ but no frailty/advanced illness. Not excluded.
- Status: non_compliant
Wait, let me recalculate the N4 window. "CT colonography during 2026 or the four years prior (five-year window)." Measured back from 2026-12-31:
- 2026, 2025, 2024, 2023, 2022. So the window is 2022-01-01 through 2026-12-31.
- 2020-08-11 is before 2022. So it doesn't count.
Actually, wait. Let me reconsider. "During 2026 or the four years prior" — does this mean calendar years 2022, 2023, 2024, 2025, 2026? Or does it mean 4 years back from the date 2026-12-31, which would be 2022-12-31?
I think in HEDIS, these look-back windows are typically based on calendar years. "During 2026 or the four years prior" means during calendar years 2022, 2023, 2024, 2025, or 2026. So the window is 2022-01-01 through 2026-12-31.
2020-08-11 is before 2022-01-01, so it doesn't count.
Status: non_compliant
**MEMBER 71087**
- DOB: 1967-06-23, age 59 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days.
- One gap, 32 days ≤ 45 days. Passes continuous enrolment.
- Screening: 2021-04-28 CT colonography.
- N4: CT colonography during 2026 or four years prior (2022-2026). 2021 is before 2022. Doesn't count.
- No other screening. Doesn't meet numerator.
- Exclusions: Frailty documented 2026-05-25, advanced illness documented 2026-06-21. Age 59, so not 66+. E4 requires age 66+ AND frailty AND advanced illness. Member is 59, so E4 doesn't apply. No other exclusions.
- Status: non_compliant
**MEMBER 71088**
- DOB: 1976-06-16, age 50 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days.
- Two gaps. "No more than one gap" — this has two. Fails continuous enrolment.
- Status: not_eligible (fails continuous enrolment — two gaps)
**MEMBER 71089**
- DOB: 1967-11-24, age 59 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: No colorectal screening on record. Doesn't meet numerator.
- Exclusions: None.
- Status: non_compliant
**MEMBER 71090**
- DOB: 1950-05-28, age 76 on 2026-12-31. Age 46-75? No, 76 exceeds 75.
- Status: not_eligible (age)
Wait, the age range is 46 through 75. 76 is outside the range. So 71090 is not_eligible.
**MEMBER 71091**
- DOB: 1950-07-12, age 76 on 2026-12-31. Age 46-75? No, 76 exceeds 75.
- Status: not_eligible (age)
Wait, but let me double-check. DOB 1950-07-12. On 2026-12-31, age = 2026 - 1950 = 76 (since July 12 has passed, they've had their birthday). So yes, 76 years old. Not eligible.
Hmm wait, the prompt says "so 76 years old on 2026-12-31" for 71091. So the prompt confirms. Not eligible.
**MEMBER 71092**
- DOB: 1971-06-21, age 55 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2023-02-25 Stool DNA test.
- N2: Stool DNA test during 2026 or two years prior (three-year window). Window: 2024-2026. 2023 is before 2024. Doesn't count.
- Other history: 2024-10-06 Diagnosis C18.7 (malignant neoplasm of sigmoid colon).
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. C18.7 falls in C18-C21. This is an exclusion.
- Status: excluded (E1 — colorectal cancer)
**MEMBER 71093**
- DOB: 1976-11-04, age 50 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2026-07-02 Faecal immunochemical test.
- N1: FIT during 2026. Yes, meets numerator.
- No exclusions.
- Status: compliant
**MEMBER 71094**
- DOB: 1981-12-09, age 45 on 2026-12-31. Age 46-75? No, 45 is below 46.
- Status: not_eligible (age)
Wait, the prompt says "so 45 years old on 2026-12-31." The eligible age is 46-75. 45 is below 46. Not eligible.
But wait, let me check the gap too:
- Enrolment: 2026-01-01 through 2026-04-24; 2026-06-15 through 2026-12-31. One gap of 51 days.
- 51 > 45, so even if age were OK, the gap exceeds 45 days. But age already disqualifies.
- Status: not_eligible (age)
Actually, the instructions say "A member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So age is the determining factor. not_eligible.
**MEMBER 71095**
- DOB: 1979-11-11, age 47 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2026-05-26 Faecal immunochemical test.
- N1: FIT during 2026. Yes.
- No exclusions.
- Status: compliant
**MEMBER 71096**
- DOB: 1967-03-27, age 59 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2026-03-13 Colonoscopy.
- N5: Colonoscopy during 2026 or nine years prior (ten-year window). Window: 2017-2026. 2026 is in the window. Yes.
- No exclusions.
- Status: compliant
**MEMBER 71097**
- DOB: 1951-08-03, age 75 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days.
- One gap, 21 ≤ 45. Passes.
- Screening: 2026-10-11 Faecal immunochemical test.
- N1: FIT during 2026. Yes.
- No exclusions.
- Status: compliant
**MEMBER 71098**
- DOB: 1954-09-24, age 72 on 2026-12-31. Age 46-75? Yes.
- Enrolment: continuous all year. Yes.
- Screening: 2023-04-14 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window). Window: 2022-2026. 2023 is in the window. Yes.
- No exclusions.
- Status: compliant
**MEMBER 71099**
- DOB: 1979-09-26, age 47 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days.
- One gap, 39 ≤ 45. Passes.
- Screening: 2025-01-25 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window). Window: 2022-2026. 2025 is in the window. Yes.
- No exclusions.
- Status: compliant
**MEMBER 71100**
- DOB: 1979-01-17, age 47 on 2026-12-31. Age 46-75? Yes.
- Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16.
- The gap from Jan 1 to Mar 15 is about 73 days. More than 45 days. Fails continuous enrolment.
- Status: not_eligible (fails continuous enrolment)
Now let me also reconsider member 71084:
- Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15.
- Gap from Jan 1 to Apr 14 = 104 days. More than 45 days. Fails.
- Status: not_eligible (fails continuous enrolment)
Let me now reconsider whether the "not enrolled before" periods count as gaps. The specification says "the full measurement year with no more than one gap of up to 45 days." If the member is not enrolled at all during the first part of the year, is that a "gap"?
I think the intent is that the member must be enrolled for the full year, with at most one brief interruption. If the member isn't enrolled at the beginning of the year, they don't meet "the full measurement year" requirement. The "gap" provision is for brief lapses in coverage, not for being unenrolled at the start or end.
In HEDIS, the standard approach is:
- The member must be enrolled from Jan 1 through Dec 31
- One gap of up to 45 days is allowed
- The gap must be within the measurement period (i.e., the member was enrolled before and after the gap)
If the member starts on Apr 15, there's no enrollment before that, so it's not a "gap" — it's just not being enrolled. The member fails the continuous enrollment requirement.
So my assessment stands: 71084 and 71100 are not_eligible due to failing continuous enrolment.
But wait, I need to reconsider. Could it be that the gap from Jan 1 to Apr 14 is considered a "gap" in enrollment? If the member should have been enrolled but wasn't, that's a gap. The measure says "no more than one gap of up to 45 days." If this gap is 104 days, it exceeds 45 days, so the member fails.
Either way, the result is the same: not_eligible.
Let me now also double-check the age calculations for the borderline cases:
- 71081: DOB 1951-10-15. On 2026-12-31, age = 75 (turned 75 on Oct 15, 2026). Age 75 is within 46-75. ✓
- 71082: DOB 1981-09-15. On 2026-12-31, age = 45 (turned 45 on Sep 15, 2026). Age 45 is below 46. Not eligible. ✓
- 71090: DOB 1950-05-28. On 2026-12-31, age = 76 (turned 76 on May 28, 2026). Age 76 exceeds 75. Not eligible. ✓
- 71091: DOB 1950-07-12. On 2026-12-31, age = 76. Not eligible. ✓
- 71094: DOB 1981-12-09. On 2026-12-31, age = 45 (hasn't turned 46 yet — birthday is Dec 9, which has passed... wait, Dec 9 is before Dec 31, so they've had their birthday). 2026 - 1981 = 45. So they're 45. Not eligible. ✓
Wait, 1981-12-09. On 2026-12-31: 2026 - 1981 = 45. Since Dec 9 has passed (Dec 9 < Dec 31), they've already turned 45. So age 45. Below 46. Not eligible.
Hmm, actually the prompt says "so 45 years old on 2026-12-31" which confirms.
Now let me also reconsider the exclusions more carefully:
**E4**: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Which members are 66+?
- 71081: 75, but not_eligible (two gaps)
- 71085: 67, no frailty/advanced illness → not excluded
- 71086: 75, no frailty/advanced illness → not excluded
- 71090: 76, not_eligible (age)
- 71091: 76, not_eligible (age)
- 71097: 75, no frailty/advanced illness → not excluded
- 71098: 72, no frailty/advanced illness → not excluded
None of the eligible members who are 66+ have both frailty and advanced illness, so no E4 exclusions among eligible members.
Wait, let me check 71087: age 59, frailty + advanced illness. But age is 59, not 66+. E4 doesn't apply. And they're in the eligible population (age 59, one gap of 32 days). So they're non_compliant (no qualifying screening).
Let me also check 71084: age 59, frailty only. But they're not_eligible due to enrolment. So E4 doesn't matter.
Now let me also reconsider 71092 more carefully:
- Screening: 2023-02-25 Stool DNA test.
- N2 window: 3-year window from 2026-12-31 = 2024-2026. 2023 is outside.
- But also check other numerator criteria. No other screening listed. So doesn't meet numerator.
- Exclusion: C18.7 diagnosis on 2024-10-06. This is colorectal cancer (C18-C21). E1 applies.
- Since the member meets an exclusion, they are excluded (not non_compliant).
But wait, I need to check if 71092 meets the eligible population first:
- Age: 55 on 2026-12-31. Yes (46-75).
- Enrolment: continuous all year. Yes.
- So 71092 is in the eligible population and meets exclusion E1. Status: excluded.
Now let me compile the final results:
**Compliant members:**
- 71083: CT colonography 2026 + FIT 2026 → meets numerator
- 71093: FIT 2026 → meets numerator
- 71095: FIT 2026 → meets numerator
- 71096: Colonoscopy 2026 → meets numerator
- 71097: FIT 2026 → meets numerator
- 71098: Flexible sigmoidoscopy 2023 (within 5-year window) → meets numerator
- 71099: Flexible sigmoidoscopy 2025 (within 5-year window) → meets numerator
**Non-compliant members:**
- 71085: No screening, age 67, no exclusions
- 71086: CT colonography 2020 (outside 5-year window), age 75, no exclusions
- 71087: CT colonography 2021 (outside 5-year window), age 59 (E4 doesn't apply), no other exclusions
- 71089: No screening, age 59, no exclusions
**Excluded memjson{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
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"ok": true,
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},
{
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"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"71093",
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"got": [
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"71093",
"71095",
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],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
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],
"got": [
"71085",
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],
"ok": true,
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},
{
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"want": [
"71092"
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"got": [
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"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,329 tokens
Let me go through each member systematically.
**MEMBER 71081.** DOB 1951-10-15, age 75 on 2026-12-31. Age eligible (46-75).
Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps of 23 and 29 days. That's two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means not continuously enrolled. **Not eligible** (enrolment).
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.
Screening: 2025-10-03 FIT. But not eligible due to enrolment.
**MEMBER 71082.** DOB 1981-09-15, age 45 on 2026-12-31. Age 45, not in 46-75. **Not eligible** (age).
**MEMBER 71083.** DOB 1971-06-11, age 55. Age eligible. Continuous enrolment.
Screening: 2026-08-02 CT colonography (N4, during 2026, five-year window) and 2026-09-02 FIT (N1, during 2026). No exclusions. **Compliant**.
**MEMBER 71084.** DOB 1967-02-19, age 59. Age eligible. Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before. Not continuous for full measurement year (only enrolled from April 15). Does "the full measurement year" require enrollment from 2026-01-01? It says "the full measurement year with no more than one gap of up to 45 days." Not enrolled for the full year → **Not eligible** (enrolment).
Screening: 2021-05-09 flexible sigmoidoscopy. N3: during 2026 or four years prior (five-year window: 2022-2026). 2021 is outside the window. But not eligible anyway.
Frailty only, no advanced illness, so no E4 exclusion regardless.
**MEMBER 71085.** DOB 1959-01-11, age 67. Age eligible. Continuous enrolment. No screening. No exclusions. **Non-compliant**.
**MEMBER 71086.** DOB 1951-02-07, age 75. Age eligible. Continuous enrolment.
Screening: 2020-08-11 CT colonography. N4: during 2026 or four years prior (2022-2026). 2020 is outside. N5 colonoscopy? No. No other screening. **Non-compliant**.
**MEMBER 71087.** DOB 1967-06-23, age 59. Age eligible. Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days. One gap ≤45 days → continuous enrolment OK.
Screening: 2021-04-28 CT colonography. N4: 2022-2026 window. 2021 is outside. No other screening.
Exclusions: Frailty 2026-05-25, advanced illness 2026-06-21. Age 59, not 66+. E4 requires age 66+. So no E4 exclusion. **Non-compliant**.
**MEMBER 71088.** DOB 1976-06-16, age 50. Age eligible. Enrolment: three segments with gaps of 17 and 14 days. Two gaps → fails continuous enrolment. **Not eligible** (enrolment).
Screening: 2021-07-01 flexible sigmoidoscopy. N3: 2022-2026. Outside window. But not eligible anyway.
**MEMBER 71089.** DOB 1967-11-24, age 59. Age eligible. Continuous enrolment. No screening. No exclusions. **Non-compliant**.
**MEMBER 71090.** DOB 1950-05-28, age 76 on 2026-12-31. Age 76, outside 46-75. **Not eligible** (age).
Screening: 2026-06-02 FIT. But age not eligible.
**MEMBER 71091.** DOB 1950-07-12, age 76. **Not eligible** (age).
**MEMBER 71092.** DOB 1971-06-21, age 55. Age eligible. Continuous enrolment.
Screening: 2023-02-25 stool DNA test. N2: during 2026 or two years prior (2024-2026). 2023 is outside the three-year window.
Exclusion: C18.7 diagnosis on 2024-10-06. E1: colorectal cancer C18-C21 any time on or before 2026-12-31. C18.7 is in C18-C21. **Excluded**.
**MEMBER 71093.** DOB 1976-11-04, age 50. Age eligible. Continuous enrolment.
Screening: 2026-07-02 FIT. N1: during 2026. **Compliant**.
**MEMBER 71094.** DOB 1981-12-09, age 45 on 2026-12-31. Age 45, not in 46-75. **Not eligible** (age).
**MEMBER 71095.** DOB 1979-11-11, age 47. Age eligible. Continuous enrolment.
Screening: 2026-05-26 FIT. N1. **Compliant**.
**MEMBER 71096.** DOB 1967-03-27, age 59. Age eligible. Continuous enrolment.
Screening: 2026-03-13 colonoscopy. N5: during 2026 or nine years prior (2017-2026). **Compliant**.
**MEMBER 71097.** DOB 1951-08-03, age 75. Age eligible. Enrolment: one gap of 21 days. Continuous enrolment OK.
Screening: 2026-10-11 FIT. N1. **Compliant**.
**MEMBER 71098.** DOB 1954-09-24, age 72. Age eligible. Continuous enrolment.
Screening: 2023-04-14 flexible sigmoidoscopy. N3: during 2026 or four years prior (2022-2026). 2023 is within 2022-2026. **Compliant**.
**MEMBER 71099.** DOB 1979-09-26, age 47. Age eligible. Enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap of 39 days. OK.
Screening: 2025-01-25 flexible sigmoidoscopy. N3: 2022-2026. 2025 is within. **Compliant**.
**MEMBER 71100.** DOB 1979-01-17, age 47. Age eligible. Enrolment: 2026-03-16 through 2026-12-31, not enrolled before. Not full year. **Not eligible** (enrolment).
Screening: 2020-11-17 CT colonography. N4: 2022-2026. Outside. Advanced illness only, no frailty. But not eligible anyway.
Let me compile:
**Compliant:** 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7
**Non-compliant:** 71085, 71086, 71087, 71089 = 4
**Excluded:** 71092 = 1
**Not eligible:** 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 = 8
Total: 7 + 4 + 1 + 8 = 20 ✓
Denominator = compliant + non-compliant = 7 + 4 = 11
Numerator = 7
Excluded = 1
Not eligible = 8
Rate = 7/11 × 100 = 63.636... → 63.6
Let me double-check 71081. Three enrollment segments. The spec says "no more than one gap of up to 45 days." Two gaps (23 and 29 days). Two gaps exceeds "no more than one gap." Not eligible. Correct.
Let me double-check 71088. Three segments, two gaps (17 and 14 days). Two gaps. Not eligible. Correct.
Let me re-check 71087. Two segments, one gap of 32 days. One gap ≤45 days. Eligible. Screening 2021-04-28 CT colonography. N4 window: 2022-2026. 2021 outside. No other screening. Frailty + advanced illness but age 59, E4 requires 66+. Non-compliant. Correct.
Let me re-check 71098. Flexible sigmoidoscopy 2023-04-14. N3: "during 2026 or the four years prior (five-year window)." So 2022, 2023, 2024, 2025, 2026. 2023 is in. Compliant. Correct.
71099: Flexible sigmoidoscopy 2025-01-25. 2025 in 2022-2026. Compliant. Correct.
71086: CT colonography 2020-08-11. N4 window 2022-2026. 2020 outside. Non-compliant. Correct.
71084: Not enrolled full year. Not eligible. Correct.
71100: Not enrolled full year. Not eligible. Correct.
Rate = 7/11 = 0.636363... × 100 = 63.6363... → 63.6.json{
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"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
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}
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"fabricated": false,
"abstained": false
}100Claude Opus 4.8 · Anthropic21.3s · 1,637 out | 18.7s · 1,561 out | 19.0s · 1,457 out
Reasoning · 1,446 tokens
[omitted]json{
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Grader detail
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}Reasoning · 1,370 tokens
[omitted]json{
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Grader detail
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}Reasoning · 1,266 tokens
[omitted]json{
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Grader detail
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}100Claude Sonnet 5 · Anthropic26.9s · 3,140 out | 25.5s · 2,934 out | 35.6s · 3,622 out
Reasoning · 2,949 tokens
[omitted]json{
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"excluded": 1,
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}
Grader detail
json{
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}Reasoning · 2,743 tokens
[omitted]json{
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"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
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Grader detail
json{
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"fabricated": false,
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}Reasoning · 3,431 tokens
[omitted]json{
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"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
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}
Grader detail
json{
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},
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],
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"present": true
},
{
"field": "not_eligible_members",
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}100Claude Sonnet 4.6 · Anthropic57.4s · 4,076 out | 58.3s · 3,954 out | 48.3s · 4,194 out
Reasoning · 3,902 tokens
Let me analyze each member against the measure specification.
**ELIGIBLE POPULATION:**
- Age: 46-75 as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**NUMERATOR criteria:**
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or 2024-2025 (3-year window back from 2026-12-31)
- N3: Flexible sigmoidoscopy during 2026 or 2022-2025 (5-year window back from 2026-12-31, so on or after 2022-01-01)
- N4: CT colonography, same 5-year window as N3, on or after 2022-01-01
- N5: Colonoscopy during 2026 or the nine years prior, a 10-year window on or after 2017-01-01
I'm double-checking each window's exact start date by counting years back from 2026-12-31 to make sure I'm applying the cutoffs correctly.
Now I'm listing exclusions: colorectal cancer diagnosis, total colectomy, hospice at any point during the measurement year, and the age 66+ frailty/advanced illness combination as of 2026-12-31. With all the criteria settled, I'm ready to start evaluating members one by one, beginning with member 71081.
For this member, born 1951-10-15, they'd turn 75 by end of 2026, which fits the 46-75 age requirement. Checking their enrollment periods, I see coverage from January through late March, then mid-April through late July with a 29-day gap, then late August through year-end, so I need to verify these gaps meet the continuous enrollment allowance.
With two gaps of 23 and 29 days, this exceeds the "no more than one gap" rule, so I'm marking this member as not_eligible on enrollment grounds.
Moving to the next member: DOB 1981-09-15 makes them 45 in 2026, falling outside the 46-75 age range, so they're not_eligible based on age alone.
Next member: DOB 1971-06-11 puts them at 55, satisfying the age criterion, with continuous enrollment and no documented exclusions so far.
Checking their screening records — CT colonography and FIT both meet the required codes, so this member is compliant.
Then for the member born 1967-02-19 (age 59), enrollment doesn't start until 2026-04-15, meaning they weren't covered from the start of the measurement year — this fails the continuous enrollment requirement, making them not_eligible.
Now looking at DOB 1959-01-11, age 67 fits within range, so I'm checking their enrollment status next.
Continuous enrollment confirmed, no exclusions apply, and no colorectal screening exists on record — non_compliant.
For the age-75 member, enrollment and exclusions are clear, but their only screening (CT colonography from 2020) falls before the required 2022-01-01 window, so it doesn't count — non_compliant. Moving on to the next member's DOB.
Age 50 checks out for member 71088, but enrollment has two gaps (17 days, 14 days), so this member is not_eligible.
Member 71089: age 59, continuous enrollment, no exclusions, but no colorectal screening on record — non_compliant.
Member 71090: age 76 falls outside the 46-75 range, so not_eligible.
Member 71091: same issue, age 76, not_eligible.
Member 71092: age 55, continuous enrollment, but has a C18.7 colorectal cancer diagnosis triggering exclusion E1 — excluded.
Member 71093: age 50, checking enrollment continuity now.
Member 71093 completes: no exclusions, FIT screening on 2026-07-02 satisfies N1 — compliant.
Member 71094: age 45 falls below the 46-75 range — not_eligible.
Member 71095: age 47, continuous enrollment, no exclusions, FIT screening 2026-05-26 satisfies N1 — compliant.
Member 71096: age 59 qualifies, now checking enrollment continuity.
Member 71096 completes: continuous enrollment, no exclusions, colonoscopy 2026-03-13 satisfies N5 — compliant.
Member 71097: age 75 qualifies with a single 21-day enrollment gap that's acceptable, no exclusions, FIT screening 2026-10-11 satisfies N1 — compliant.
Member 71098: age 72 qualifies, now moving into the enrollment check.
That confirms member 71099 as compliant. Member 71100 has enrollment starting only 2026-03-16, so they don't meet the full measurement year requirement and are not_eligible.
Now I'm compiling the final lists: not_eligible includes 71081, 71082, 71084, 71088, 71090, 71091, 71094, and 71100; excluded includes 71092 for colorectal cancer history; compliant includes 71083, 71093, 71095, 71096, 71097, and others I've verified.
Counting up: 8 not_eligible, 1 excluded, 7 compliant, 4 non_compliant, totaling 20 members. This gives a denominator of 11 (compliant + non_compliant), a numerator of 7, and a rate of 7/11 = 63.6%.
Spot-checking a few cases: 71081 has two gaps in enrollment, which violates the "no more than one gap of up to 45 days" rule, so it's not_eligible. For 71087 and 71086, their CT colonography dates fall before the 2022-01-01 start of the 5-year N4 window, so those screenings don't qualify, making both non_compliant. Now I'm checking 71098's flexible sigmoidoscopy date against the N3 window.
71099's screening also falls within its window, so it's compliant too. That puts the compliance rate at 7 out of 11, which is 63.6%. I'm also verifying ages for 71091 and 71090 — both born in 1950, so I need to confirm whether they've turned 76 by end of 2026, which would make them ineligible.
json{
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"numerator": 7,
"excluded": 1,
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"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
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"want": 1,
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"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
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"71088",
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"71094",
"71100"
],
"ok": true,
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}
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"fabricated": false,
"abstained": false
}Reasoning · 3,780 tokens
Let me analyze each member against the measure specification.
**MEASURE QM-CRC — COLORECTAL CANCER SCREENING**
- Measurement year: 2026-01-01 through 2026-12-31
- Age: 46-75 as of 2026-12-31
- Continuous enrollment: full measurement year with no more than one gap of up to 45 days
Let me go through each member:
---
**MEMBER 71081**
- DOB: 1951-10-15, age 75 on 2026-12-31 ✓ (46-75)
- Enrollment has two separate gaps (23 days and 29 days), which violates the "no more than one gap" rule even though each individual gap is under 45 days.
- **not_eligible** — fails continuous enrollment due to having two gaps rather than one.
Moving to member 71082: DOB 1981-09-15 makes them 45 at year-end, under the required 46-75 range, so **not_eligible**.
Member 71083: DOB 1971-06-11, age 55, enrollment continuous with no gaps, no exclusions, and a CT colonography on 2026-08-02 falls within the 5-year screening window — **compliant**.
Member 71084: DOB 1967-02-19, age 59 ✓, but enrollment only starts 2026-04-15 through year-end, so checking whether this meets the continuous enrollment requirement.
Since they weren't enrolled at all for the first ~104 days of the year, this isn't a mid-year gap but rather a missing start — they don't have a full measurement year, so this member is **not_eligible**.
Member 71085: DOB 1959-01-11, age 67 ✓, continuous enrollment, no exclusions, but no screening on record — **non_compliant**.
Now checking member 71086, DOB 1951-02-07, who turns 75 by year-end, right at the upper edge of the eligible age range.
I'm checking the screening date against the five-year lookback window (2022-2026) for the CT colonography requirement, and their 2020-08-11 screening falls outside that window.
So member 68729 becomes non_compliant with no valid screening on record.
Moving to member 71087: I confirm age eligibility (59 on 2026-12-31), verify enrollment with a single 32-day gap that stays within the 45-day allowance, and note documented frailty and advanced illness indicators. Since they're under 66, the E4 exclusion doesn't apply, and I don't see colorectal cancer, colectomy, or hospice history that would trigger other exclusions.
Then for the CT colonography screening from 2021-04-28, I check it against the four-year lookback window starting 2022-01-01, and since the screening predates that window, it doesn't count—making this member non_compliant too.
Next I check member 71088: age 50, but their enrollment history shows two separate gaps (17 and 14 days), which fails the enrollment continuity requirement regardless of gap length, so I mark them not_eligible.
Then I start member 71089, confirming age 59 and continuous enrollment.
With no gaps and no exclusions but no screening on record, member 71089 is non_compliant. Moving on, members 71090 and 71091 both fail the age requirement since they're 76 on the measurement date, exceeding the 46-75 range, so both are not_eligible. Then I begin evaluating member 71092, age 55 with continuous enrollment, but I notice a 2024 diagnosis of C18.7 (malignant neoplasm of sigmoid colon), which falls under the colorectal cancer exclusion codes C18-C21.
Since this diagnosis triggers exclusion E1, member 71092 is excluded. Member 71093, age 50 with continuous enrollment and no exclusions, has a valid FIT screening on 2026-07-02, so they're compliant. Member 71094 fails eligibility since they're only 45, and even though they also have a 51-day enrollment gap, the age failure takes precedence, so they're not_eligible. I'm now starting to review member 71095's records.
Member 71097's gap totals only 21 days, well within tolerance, and their FIT screening in October checks out fine—compliant.
Moving to member 71098, born 1954, continuously enrolled with no exclusions. Their flexible sigmoidoscopy from 2023 falls within the five-year lookback window (2022-2026), so this satisfies the requirement.
Next, member 71099, born 1979, with a 39-day enrollment gap that's still under the 45-day threshold. Their 2025 sigmoidoscopy also falls within the five-year window—compliant.
Now checking member 71100, born 1979, starting to verify their enrollment periods.
Member 71100 wasn't enrolled from the start of the year, so they're not eligible. Now I'm compiling the final results: not_eligible for members with excessive gaps, age issues, or late enrollment (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100); excluded for 71092 due to prior colorectal cancer; and compliant for 71083 and 71093.
Marking 71095-71099 as compliant, and 71085, 71086, 71087, 71089 as non-compliant. Double-checking 71087: age 59, so the age-66+ exclusion doesn't apply, and I'm working through the five-year screening window for CT colonography, which spans 2022-01-01 through 2026-12-31, checking whether their 2021-04-28 exam falls within that window — it appears to fall just outside it.
For 71086, the CT colonography date of 2020-08-11 also falls before the 2022-01-01 window start, so this is non_compliant as well. I'm confirming the "four years prior to 2026" language means 2022-2025 plus 2026 itself, giving the correct five-year window boundaries.
Applying this same window logic to N3 (flexible sigmoidoscopy, 2022-2026): 71098 and 71099 both fall within range and qualify, while 71088 and 71084 are already excluded as not_eligible regardless. For N5 (colonoscopy, ten-year window covering 2017-2026), 71096's date of 2026-03-13 qualifies. I'm now checking N2's stool DNA three-year window, which covers 2024-2026.
71092 falls within that window but gets excluded anyway due to the E1 criterion. Checking 71100 and 71084 further, both fail continuous enrollment requirements since they weren't enrolled from the start of the measurement year, landing them in not_eligible.
I'm now finalizing the classification: eight members are not_eligible (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100), one is excluded (71092), seven are compliant (71083, 71093, 71095, 71096, 71097, 71098, 71099), and four are non_compliant (71085, 71086, 71087, 71089).
The total checks out at 20 members. With a denominator of 11 (compliant plus non_compliant) and a numerator of 7, the compliance rate comes to 7/11 × 100 = 63.6%.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
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"fabricated": false,
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}Reasoning · 4,021 tokens
Let me evaluate each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION:**
- 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:**
- N1: FOBT or FIT during 2026
- N2: Stool DNA during 2026 or 2024-2025 (3-year window back from 2026-12-31 = 2024-01-01 through 2026-12-31)
- N3: Flexible sigmoidoscopy within a 5-year window (2022-2026)
- N4: CT colonography within a 5-year window (2022-2026)
- N5: Colonoscopy within a 10-year window (2017-2026)
**EXCLUSIONS:**
- E1: Colorectal cancer diagnosis (C18-C21)
I'm now checking exclusions for colectomy, hospice enrollment, and advanced illness/frailty for members 66+, then moving into member-by-member evaluation. For member 71081, I'm verifying age eligibility (75, within 46-75 range) and mapping out their enrollment periods and gaps across 2026 to determine continuous enrollment status.
Calculating the gap durations for 71081: two separate gaps of 23 and 29 days. Since the rule allows only one gap of up to 45 days, having two gaps disqualifies this member from continuous enrollment, so they're not_eligible.
Moving to member 71082, whose age of 45 falls below the required 46-75 range, making them not_eligible on age grounds alone.
For member 71083, everything checks out: age 55, continuous enrollment, all exclusions clear, and a CT colonography from 2026-08-02 satisfies the numerator, so this member is compliant.
Now looking at member 71084, age 59 qualifies, but enrollment only starts 2026-04-15 rather than covering the full measurement year, so I need to check whether this gap from the start of the year falls within the allowed continuous enrollment threshold.
That gap of 104 days from January 1st to April 14th exceeds the 45-day allowance for continuous enrollment, so this member is not eligible for the measure.
Moving to member 71085, age 67 checks out and enrollment is continuous with no gaps, and I'm now verifying each of the exclusion criteria one by one.
Confirming that window as 2022-01-01 through 2026-12-31, so 71086 is non_compliant.
Moving to member 71087: age 59, enrollment gap of 32 days is within tolerance, and none of the exclusions apply since they're under 66. Now checking the CT colonography from 2021-04-28 against the five-year window.
This falls outside the required window, marking 71087 as non_compliant.
For member 71088, age 50 checks out, but the enrollment has two gaps (17 days and 14 days), which fails the requirement since only one gap is allowed. This makes 71088 not_eligible.
Now moving to member 71089, age 59 with continuous enrollment and no gaps.
I'm checking exclusions for 71089, finding none, but the numerator shows no screening was done, so this member is non_compliant.
Members 71090 and 71091 both turn 76 during 2026, putting them outside the 46-75 age range, so both are not_eligible.
For member 71092, age 55 checks out with continuous enrollment, and now I'm reviewing an exclusion for a malignancy diagnosis coded C18.7 from October 2024.
That C18.7 code is malignant neoplasm of the sigmoid colon, which counts as colorectal cancer, so this exclusion applies and 71092 is excluded.
Member 71093 at age 50 with continuous enrollment and no exclusions has a valid FIT test from July 2026, making them compliant.
For member 71094, I'm calculating their age as of the end of 2026 - born December 1981, they'd only be 45 since their birthday hasn't occurred yet, so they fall below the 46-75 requirement and are not_eligible.
There's also a 51-day enrollment gap for this member, but the age failure already determines the outcome first.
Moving to 71095, age 47 with continuous enrollment and no exclusions, they have a FIT test from May 2026, making them compliant. Member 71096 at age 59 similarly qualifies through a colonoscopy from March 2026, marking them compliant as well. Now checking 71097 at age 75 with enrollment starting January 2026.
For 71097, I'm noting a 21-day enrollment gap that's acceptable, and their FIT test from October 2026 makes them compliant. Member 71098 at 72 qualifies through a flexible sigmoidoscopy from 2023 that falls within the five-year lookback window, making them compliant too. Now reviewing 71099 at age 47 with a 39-day enrollment gap that's within limits, checking their flexible sigmoidoscopy from January 2025 against the five-year window requirement.
Moving to member 71100 at 47, but their enrollment starts too late in March 2026, creating a 74-day gap before that which exceeds the 45-day threshold, so they're not eligible. I'm now starting to compile the final summary, listing out members who fail eligibility due to enrollment gaps or age issues, beginning with 71081 through 71090 and continuing.
I'm double-checking the ages for 71090 and 71091, confirming both turn 76 by end of 2026, putting them over the 75-year limit. I'm categorizing 71092 as excluded due to colorectal cancer, then listing the compliant members (71083, 71093, and several others) and identifying 71085 through 71089 as needing further review for non-compliance, starting my verification with 71085.
Working through each member's screening details: 71085 has no screening on record so it's non-compliant, 71086's CT colonography falls outside the required 5-year window, 71087 has the same window issue despite a valid enrollment gap, and 71089 simply has no screening at all. Then I move into confirming the compliant cases, checking that 71083, 71093, and 71095 each have valid screenings (CT colonography or FIT) within the required timeframe, and I'm starting to verify 71096's age next.
With excluded=1 and not_eligible=8, the total comes to 20, matching my count. The rate calculates to 7/11 × 100 = 63.6%. I'm double-checking the not_eligible members and confirming edge cases like 71081's two gaps disqualifying it, and 71084's large enrollment gap at the start of the year exceeding the allowed threshold.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
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},
{
"field": "not_eligible_members",
"want": [
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"fabricated": false,
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}100Qwen3.7 Max · Alibaba90.6s · 6,618 out | 89.9s · 6,361 out | 63.5s · 4,799 out
Reasoning · 6,386 tokens
Let me evaluate each member against the QM-CRC measure specification.
**ELIGIBLE POPULATION:**
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: full measurement year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
**NUMERATOR (any one):**
- N1: FIT/FOBT 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 measurement year (2026)
- E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year (2026)
Let me go through each member:
---
**MEMBER 71081**
- DOB: 1951-10-15, Age on 2026-12-31: 75. Age eligible (46-75).
- Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31.
- Gap 1: 2026-03-22 to 2026-04-13 = 23 days
- Gap 2: 2026-07-24 to 2026-08-21 = 29 days
- Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means they fail continuous enrolment.
- Wait, let me re-read: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
- Two gaps means NOT eligible. So not_eligible.
**MEMBER 71082**
- DOB: 1981-09-15, Age on 2026-12-31: 45. Age NOT eligible (needs 46-75).
- Not eligible.
**MEMBER 71083**
- DOB: 1971-06-11, Age on 2026-12-31: 55. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2026-08-02 CT colonography (N4 - during 2026), 2026-09-02 FIT (N1 - during 2026).
- No exclusions.
- Compliant (numerator met).
**MEMBER 71084**
- DOB: 1967-02-19, Age on 2026-12-31: 59. Age eligible.
- Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15.
- This is a gap from 2026-01-01 to 2026-04-14. That's about 104 days. More than 45 days.
- Not eligible.
**MEMBER 71085**
- DOB: 1959-01-11, Age on 2026-12-31: 67. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: None on record.
- No exclusions (no frailty, no advanced illness, no CRC, no colectomy, no hospice).
- Non-compliant (no numerator).
**MEMBER 71086**
- DOB: 1951-02-07, Age on 2026-12-31: 75. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2020-08-11 CT colonography.
- N4: CT colonography during 2026 or four years prior. Four years prior means 2022-2026. 2020 is outside this window.
- Does not meet numerator.
- No exclusions.
- Non-compliant.
**MEMBER 71087**
- DOB: 1967-06-23, Age on 2026-12-31: 59. Age eligible.
- Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days.
- One gap, 32 days ≤ 45 days. Eligible.
- Screening: 2021-04-28 CT colonography.
- N4: CT colonography during 2026 or four years prior (2022-2026). 2021 is outside.
- Does not meet numerator.
- Exclusions: Age 59, so E4 doesn't apply (needs 66+). Frailty and advanced illness documented, but age is 59, not 66+.
- Non-compliant.
**MEMBER 71088**
- DOB: 1976-06-16, Age on 2026-12-31: 50. Age eligible.
- Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31.
- Gap 1: 2026-02-17 to 2026-03-05 = 17 days
- Gap 2: 2026-05-14 to 2026-05-27 = 14 days
- Two gaps. "No more than one gap of up to 45 days." Two gaps = not eligible.
- Not eligible.
**MEMBER 71089**
- DOB: 1967-11-24, Age on 2026-12-31: 59. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: None on record.
- No exclusions.
- Non-compliant.
**MEMBER 71090**
- DOB: 1950-05-28, Age on 2026-12-31: 76. Age NOT eligible (needs 46-75).
- Not eligible.
**MEMBER 71091**
- DOB: 1950-07-12, Age on 2026-12-31: 76. Age NOT eligible (needs 46-75).
- Not eligible.
**MEMBER 71092**
- DOB: 1971-06-21, Age on 2026-12-31: 55. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2023-02-25 Stool DNA test.
- N2: Stool DNA test during 2026 or two years prior (2024, 2025, 2026). 2023 is outside.
- Does not meet numerator via N2.
- Exclusions: 2024-10-06 Diagnosis C18.7 (colorectal cancer). E1 applies.
- Excluded.
**MEMBER 71093**
- DOB: 1976-11-04, Age on 2026-12-31: 50. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2026-07-02 FIT.
- N1: FIT during 2026. Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71094**
- DOB: 1981-12-09, Age on 2026-12-31: 45. Age NOT eligible (needs 46-75).
- Not eligible.
**MEMBER 71095**
- DOB: 1979-11-11, Age on 2026-12-31: 47. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2026-05-26 FIT.
- N1: FIT during 2026. Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71096**
- DOB: 1967-03-27, Age on 2026-12-31: 59. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2026-03-13 Colonoscopy.
- N5: Colonoscopy during 2026 or nine years prior. Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71097**
- DOB: 1951-08-03, Age on 2026-12-31: 75. Age eligible.
- Enrolment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. One gap of 21 days.
- One gap, 21 days ≤ 45 days. Eligible.
- Screening: 2026-10-11 FIT.
- N1: FIT during 2026. Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71098**
- DOB: 1954-09-24, Age on 2026-12-31: 72. Age eligible.
- Enrolment: continuous, no gaps. Eligible.
- Screening: 2023-04-14 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022, 2023, 2024, 2025, 2026). 2023 is within the window.
- Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71099**
- DOB: 1979-09-26, Age on 2026-12-31: 47. Age eligible.
- Enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap of 39 days.
- One gap, 39 days ≤ 45 days. Eligible.
- Screening: 2025-01-25 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or four years prior (2022-2026). 2025 is within.
- Meets numerator.
- No exclusions.
- Compliant.
**MEMBER 71100**
- DOB: 1979-01-17, Age on 2026-12-31: 47. Age eligible.
- Enrolment: 2026-03-16 through 2026-12-31. Not enrolled before 2026-03-16.
- Gap from 2026-01-01 to 2026-03-15. That's about 74 days. More than 45 days.
- Not eligible.
Let me recheck the gap calculations:
**MEMBER 71081:**
- Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31.
- Gap 1: 2026-03-22 to 2026-04-13. March has 31 days. From 3/22 to 3/31 = 10 days. From 4/1 to 4/13 = 13 days. Total = 23 days.
- Gap 2: 2026-07-24 to 2026-08-21. July has 31 days. From 7/24 to 7/31 = 8 days. From 8/1 to 8/21 = 21 days. Total = 29 days.
- Two gaps. Not eligible.
**MEMBER 71088:**
- Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31.
- Gap 1: 2026-02-17 to 2026-03-05. Feb has 28 days in 2026. From 2/17 to 2/28 = 12 days. From 3/1 to 3/5 = 5 days. Total = 17 days.
- Gap 2: 2026-05-14 to 2026-05-27. From 5/14 to 5/27 = 14 days.
- Two gaps. Not eligible.
Let me recheck 71084:
- Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before.
- Gap: 2026-01-01 to 2026-04-14. Jan: 31 days, Feb: 28 days, Mar: 31 days, Apr 1-14: 14 days. Total = 104 days.
- More than one gap? It's one gap but > 45 days. Not eligible.
Let me recheck 71100:
- Enrolment: 2026-03-16 through 2026-12-31. Not enrolled before.
- Gap: 2026-01-01 to 2026-03-15. Jan: 31 days, Feb: 28 days, Mar 1-15: 15 days. Total = 74 days.
- One gap but > 45 days. Not eligible.
Now let me recheck 71090 and 71091:
- 71090: DOB 1950-05-28, age on 2026-12-31: 2026 - 1950 = 76. Not eligible (over 75).
- 71091: DOB 1950-07-12, age on 2026-12-31: 2026 - 1950 = 76. Not eligible.
Let me recheck 71094:
- DOB 1981-12-09, age on 2026-12-31: 2026 - 1981 = 45. Birthday is 12/09, so on 12/31 they are 45. Not eligible (needs 46+).
Let me recheck 71082:
- DOB 1981-09-15, age on 2026-12-31: 2026 - 1981 = 45. Birthday is 9/15, so on 12/31 they are 45. Not eligible.
Now let me recheck 71086:
- DOB 1951-02-07, age on 2026-12-31: 75. Age eligible.
- Screening: 2020-08-11 CT colonography.
- N4 window: 2026 or four years prior. "Four years prior" from 2026-12-31 means 2022-01-01 to 2026-12-31.
- 2020-08-11 is outside the window.
- Non-compliant.
Let me recheck 71087:
- DOB 1967-06-23, age on 2026-12-31: 59. Age eligible.
- Enrolment: one gap of 32 days. Eligible.
- Screening: 2021-04-28 CT colonography.
- N4 window: 2022-2026. 2021 is outside.
- Non-compliant.
Now let me recheck 71092:
- DOB 1971-06-21, age on 2026-12-31: 55. Age eligible.
- Enrolment: continuous. Eligible.
- Screening: 2023-02-25 Stool DNA test.
- N2 window: 2024, 2025, 2026. 2023 is outside.
- Exclusion: E1 - CRC diagnosis C18.7 on 2024-10-06. Excluded.
- Note: Even though they don't meet numerator, exclusion is evaluated before numerator. So they are excluded.
Wait, let me re-read: "Exclusions are evaluated before the numerator, and only for members who are in the eligible population: a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented. A member who meets both an exclusion and the numerator is excluded, not compliant."
So for 71092: eligible population (age and enrolment OK), then check exclusions: E1 applies (CRC). So excluded.
Let me compile the results:
**Not eligible:**
- 71081 (two gaps in enrolment)
- 71082 (age 45)
- 71084 (gap > 45 days)
- 71088 (two gaps in enrolment)
- 71090 (age 76)
- 71091 (age 76)
- 71094 (age 45)
- 71100 (gap > 45 days)
Count: 8
**Excluded:**
- 71092 (E1 - CRC)
Count: 1
**Compliant (numerator):**
- 71083 (CT colonography 2026, FIT 2026)
- 71093 (FIT 2026)
- 71095 (FIT 2026)
- 71096 (Colonoscopy 2026)
- 71097 (FIT 2026)
- 71098 (Flex sig 2023)
- 71099 (Flex sig 2025)
Count: 7
**Non-compliant:**
- 71085 (no screening)
- 71086 (CT colonography 2020 - outside window)
- 71087 (CT colonography 2021 - outside window)
- 71089 (no screening)
Count: 4
Let me verify total: 8 + 1 + 7 + 4 = 20. Correct.
Denominator = compliant + non_compliant = 7 + 4 = 11.
Rate = 7 / 11 × 100 = 63.636... = 63.6 (rounded half up to one decimal).
Let me double-check 7/11:
7 ÷ 11 = 0.636363...
× 100 = 63.6363...
Rounded to one decimal: 63.6.
Let me double-check all members once more:
**71081**: Age 75 ✓. Enrolment: 2 gaps (23 and 29 days). Two gaps → not eligible. ✓
**71082**: Age 45. Not eligible. ✓
**71083**: Age 55 ✓. Continuous ✓. CT colonography 2026-08-02 ✓ (N4). Compliant. ✓
**71084**: Age 59 ✓. Enrolment from 2026-04-15. Gap from 1/1 to 4/14 = 104 days > 45. Not eligible. ✓
**71085**: Age 67 ✓. Continuous ✓. No screening. Non-compliant. ✓
**71086**: Age 75 ✓. Continuous ✓. CT colonography 2020-08-11. N4 window is 2022-2026. Outside. Non-compliant. ✓
**71087**: Age 59 ✓. One gap 32 days ✓. CT colonography 2021-04-28. N4 window 2022-2026. Outside. Non-compliant. ✓
**71088**: Age 50 ✓. Two gaps (17 and 14 days). Two gaps → not eligible. ✓
**71089**: Age 59 ✓. Continuous ✓. No screening. Non-compliant. ✓
**71090**: Age 76. Not eligible. ✓
**71091**: Age 76. Not eligible. ✓
**71092**: Age 55 ✓. Continuous ✓. CRC C18.7 on 2024-10-06. E1 exclusion. Excluded. ✓
**71093**: Age 50 ✓. Continuous ✓. FIT 2026-07-02. N1 ✓. Compliant. ✓
**71094**: Age 45. Not eligible. ✓
**71095**: Age 47 ✓. Continuous ✓. FIT 2026-05-26. N1 ✓. Compliant. ✓
**71096**: Age 59 ✓. Continuous ✓. Colonoscopy 2026-03-13. N5 ✓. Compliant. ✓
**71097**: Age 75 ✓. One gap 21 days ✓. FIT 2026-10-11. N1 ✓. Compliant. ✓
**71098**: Age 72 ✓. Continuous ✓. Flex sig 2023-04-14. N3 window 2022-2026. 2023 is in. Compliant. ✓
**71099**: Age 47 ✓. One gap 39 days ✓. Flex sig 2025-01-25. N3 window 2022-2026. 2025 is in. Compliant. ✓
**71100**: Age 47 ✓. Enrolment from 2026-03-16. Gap from 1/1 to 3/15 = 74 days > 45. Not eligible. ✓
All looks correct.
Summary:
- denominator: 11
- numerator: 7
- excluded: 1
- not_eligible: 8
- rate: 63.6
- compliant_members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
- non_compliant_members: ["71085", "71086", "71087", "71089"]
- excluded_members: ["71092"]
- not_eligible_members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
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"ok": true,
"present": true
},
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"want": [
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"got": [
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"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
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"got": [
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"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 6,129 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 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, 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 (2017-2026).
**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 evaluate each member:
**MEMBER 71081**
- DOB: 1951-10-15, age 75 on 2026-12-31. Age eligible (46-75).
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days.
- Two gaps: 23 days and 29 days. The rule says "no more than one gap of up to 45 days." Two gaps means they fail the continuous enrolment requirement.
- Wait, let me re-read: "no more than one gap of up to 45 days." So if there are two gaps, even if both are ≤45 days, the member fails enrolment.
- NOT ELIGIBLE.
**MEMBER 71082**
- DOB: 1981-09-15, age 45 on 2026-12-31. Age NOT eligible (needs 46-75).
- NOT ELIGIBLE.
**MEMBER 71083**
- DOB: 1971-06-11, age 55 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2026-08-02 CT colonography (N4 - within 5 years), 2026-09-02 FIT (N1 - during 2026).
- No exclusions.
- COMPLIANT (numerator met).
**MEMBER 71084**
- DOB: 1967-02-19, age 59 on 2026-12-31. Age eligible.
- Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15.
- This means there's a gap from 2026-01-01 to 2026-04-14. That's about 104 days. This is more than one gap of up to 45 days. Actually, the member is not enrolled from the start of the year. The gap from Jan 1 to Apr 14 is 104 days (or we could say the member wasn't enrolled at all for that period). This fails continuous enrolment.
- NOT ELIGIBLE.
**MEMBER 71085**
- DOB: 1959-01-11, age 67 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: No colorectal screening on record.
- No exclusions (no frailty, no advanced illness).
- NON-COMPLIANT.
**MEMBER 71086**
- DOB: 1951-02-07, age 75 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2020-08-11 CT colonography.
- N4: CT colonography during 2026 or the four years prior (2022-2026). 2020-08-11 is outside the 5-year window.
- No other screening.
- No exclusions.
- NON-COMPLIANT.
**MEMBER 71087**
- DOB: 1967-06-23, age 59 on 2026-12-31. Age eligible.
- Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days.
- One gap of 32 days ≤ 45 days. Enrolment eligible.
- Screening: 2021-04-28 CT colonography.
- N4: CT colonography during 2026 or the four years prior (2022-2026). 2021-04-28 is outside the 5-year window (needs to be on or after 2022-01-01).
- Wait, let me recalculate. "2026 or the four years prior" means 2022, 2023, 2024, 2025, 2026. So the window is 2022-01-01 through 2026-12-31.
- 2021-04-28 is before 2022-01-01, so outside the window.
- No other screening.
- Exclusions: Age 59, not 66+. E4 doesn't apply.
- NON-COMPLIANT.
**MEMBER 71088**
- DOB: 1976-06-16, age 50 on 2026-12-31. Age eligible.
- Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days.
- Two gaps. "No more than one gap of up to 45 days." Two gaps fails enrolment.
- NOT ELIGIBLE.
**MEMBER 71089**
- DOB: 1967-11-24, age 59 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: No colorectal screening on record.
- No exclusions.
- NON-COMPLIANT.
**MEMBER 71090**
- DOB: 1950-05-28, age 76 on 2026-12-31. Age NOT eligible (needs 46-75, 76 is outside).
- NOT ELIGIBLE.
**MEMBER 71091**
- DOB: 1950-07-12, age 76 on 2026-12-31. Age NOT eligible (76 > 75).
- NOT ELIGIBLE.
**MEMBER 71092**
- DOB: 1971-06-21, age 55 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2023-02-25 Stool DNA test.
- N2: Stool DNA test during 2026 or the two years prior (2024, 2025, 2026). 2023-02-25 is outside the 3-year window (needs to be on or after 2024-01-01).
- Wait, "during 2026 or the two years prior" - that's 2024, 2025, 2026. So window is 2024-01-01 through 2026-12-31.
- 2023-02-25 is before 2024-01-01, so outside the window.
- Exclusions: 2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon.
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. C18.7 is in C18 range.
- EXCLUDED.
**MEMBER 71093**
- DOB: 1976-11-04, age 50 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2026-07-02 FIT.
- N1: FIT during 2026. Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71094**
- DOB: 1981-12-09, age 45 on 2026-12-31. Age NOT eligible (needs 46+).
- NOT ELIGIBLE.
**MEMBER 71095**
- DOB: 1979-11-11, age 47 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2026-05-26 FIT.
- N1: FIT during 2026. Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71096**
- DOB: 1967-03-27, age 59 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2026-03-13 Colonoscopy.
- N5: Colonoscopy during 2026 or the nine years prior (2017-2026). Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71097**
- DOB: 1951-08-03, age 75 on 2026-12-31. Age eligible.
- Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days.
- One gap of 21 days ≤ 45 days. Enrolment eligible.
- Screening: 2026-10-11 FIT.
- N1: FIT during 2026. Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71098**
- DOB: 1954-09-24, age 72 on 2026-12-31. Age eligible.
- Enrolment: continuous, no gaps. Enrolment eligible.
- Screening: 2023-04-14 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (2022-2026). 2023-04-14 is within the window. Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71099**
- DOB: 1979-09-26, age 47 on 2026-12-31. Age eligible.
- Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days.
- One gap of 39 days ≤ 45 days. Enrolment eligible.
- Screening: 2025-01-25 Flexible sigmoidoscopy.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (2022-2026). 2025-01-25 is within the window. Yes.
- No exclusions.
- COMPLIANT.
**MEMBER 71100**
- DOB: 1979-01-17, age 47 on 2026-12-31. Age eligible.
- Enrolment: 2026-03-16 through 2026-12-31. Not enrolled before 2026-03-16.
- Gap from 2026-01-01 to 2026-03-15 is about 74 days. This is more than 45 days. Fails continuous enrolment.
- NOT ELIGIBLE.
Let me recount:
NOT ELIGIBLE:
- 71081 (two gaps)
- 71082 (age 45)
- 71084 (not enrolled from start, gap > 45 days)
- 71088 (two gaps)
- 71090 (age 76)
- 71091 (age 76)
- 71094 (age 45)
- 71100 (not enrolled from start, gap > 45 days)
That's 8 not eligible.
EXCLUDED:
- 71092 (colorectal cancer C18.7)
That's 1 excluded.
COMPLIANT:
- 71083 (CT colonography 2026, FIT 2026)
- 71093 (FIT 2026)
- 71095 (FIT 2026)
- 71096 (Colonoscopy 2026)
- 71097 (FIT 2026)
- 71098 (Flex sig 2023)
- 71099 (Flex sig 2025)
That's 7 compliant.
NON-COMPLIANT:
- 71085 (no screening)
- 71086 (CT colonography 2020, outside window)
- 71087 (CT colonography 2021, outside window)
- 71089 (no screening)
That's 4 non-compliant.
Total: 8 + 1 + 7 + 4 = 20. Correct.
Denominator = compliant + non-compliant = 7 + 4 = 11
Numerator = 7
Excluded = 1
Not eligible = 8
Rate = 7 / 11 × 100 = 63.636... → 63.6
Let me double-check each member:
**71081**: Age 75, eligible age. Enrolment gaps:
- 2026-03-21 to 2026-04-14: March has 31 days, so from March 22 to April 13 = 10 + 13 = 23 days gap.
- 2026-07-23 to 2026-08-22: July has 31 days, so from July 24 to Aug 21 = 8 + 21 = 29 days gap.
Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means not eligible. Correct.
**71082**: Age 45. Not eligible. Correct.
**71083**: Age 55, continuous enrolment. CT colonography 2026-08-02 (N4 met). FIT 2026-09-02 (N1 met). Compliant. Correct.
**71084**: Age 59. Enrolled 2026-04-15 through 2026-12-31. Not enrolled before. The gap from 2026-01-01 to 2026-04-14 is 104 days. This is one gap but > 45 days. Not eligible. Correct.
**71085**: Age 67, continuous enrolment. No screening. No exclusions. Non-compliant. Correct.
**71086**: Age 75, continuous enrolment. CT colonography 2020-08-11. N4 window is 2022-2026 (5 years: 2026 or 4 years prior). 2020 is outside. Non-compliant. Correct.
**71087**: Age 59. One gap of 32 days. Enrolment eligible. CT colonography 2021-04-28. N4 window is 2022-2026. 2021 is outside. Frailty documented but age 59, not 66+. E4 doesn't apply. Non-compliant. Correct.
**71088**: Age 50. Two gaps (17 and 14 days). Not eligible. Correct.
**71089**: Age 59, continuous enrolment. No screening. Non-compliant. Correct.
**71090**: Age 76. Not eligible. Correct.
**71091**: Age 76. Not eligible. Correct.
**71092**: Age 55, continuous enrolment. Stool DNA 2023-02-25. N2 window is 2024-2026. Outside. C18.7 diagnosis on 2024-10-06. E1 exclusion. Excluded. Correct.
**71093**: Age 50, continuous enrolment. FIT 2026-07-02. N1 met. Compliant. Correct.
**71094**: Age 45. Not eligible. Correct.
**71095**: Age 47, continuous enrolment. FIT 2026-05-26. N1 met. Compliant. Correct.
**71096**: Age 59, continuous enrolment. Colonoscopy 2026-03-13. N5 met. Compliant. Correct.
**71097**: Age 75. One gap of 21 days. Enrolment eligible. FIT 2026-10-11. N1 met. Compliant. Correct.
**71098**: Age 72, continuous enrolment. Flex sig 2023-04-14. N3 window is 2022-2026. 2023 is within. Compliant. Correct.
**71099**: Age 47. One gap of 39 days. Enrolment eligible. Flex sig 2025-01-25. N3 window is 2022-2026. 2025 is within. Compliant. Correct.
**71100**: Age 47. Enrolled 2026-03-16 through 2026-12-31. Gap from Jan 1 to Mar 15 = 31 + 28 + 15 = 74 days. One gap but > 45 days. Not eligible. Correct.
Wait, I should double-check the gap calculation for 71100. Not enrolled before 2026-03-16. The measurement year starts 2026-01-01. So the gap is from 2026-01-01 to 2026-03-15.
Jan: 31 days, Feb: 28 days, Mar 1-15: 15 days. Total = 31 + 28 + 15 = 74 days.
This is one gap but exceeds 45 days. Not eligible. Correct.
Let me also verify 71084. Not enrolled before 2026-04-15. Gap from 2026-01-01 to 2026-04-14.
Jan: 31, Feb: 28, Mar: 31, Apr 1-14: 14. Total = 31 + 28 + 31 + 14 = 104 days. One gap > 45 days. Not eligible. Correct.
Summary:
- Denominator: 11
- Numerator: 7
- Excluded: 1
- Not eligible: 8
- Rate: 7/11 × 100 = 63.636... → 63.6
Compliant members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
Non-compliant members: ["71085", "71086", "71087", "71089"]
Excluded members: ["71092"]
Not eligible members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Let me verify 71087 once more for exclusion E4:
- Age 59 on 2026-12-31. E4 requires age 66 or older. So E4 doesn't apply even though both frailty and advanced illness are documented. Correct, non-compliant.
And 71085:
- Age 67. No frailty, no advanced illness. E4 doesn't apply. Correct, non-compliant.
And 71086:
- Age 75. CT colonography 2020-08-11. Let me recheck the window.
- N4: "CT colonography during 2026 or the four years prior (five-year window)."
- 2026 or four years prior = 2026, 2025, 2024, 2023, 2022. So the window starts 2022-01-01.
- 2020-08-11 is before 2022-01-01. Outside window. Non-compliant. Correct.
And 71087:
- CT colonography 2021-04-28. Window starts 2022-01-01. Outside. Non-compliant. Correct.
Everything looks right. Let me also verify 71092's exclusion:
- C18.7 is malignant neoplasm of sigmoid colon. C18 is in the C18-C21 range. E1 applies. Excluded. Correct.
And let me verify 71092's numerator status just to be sure (though exclusion takes precedence):
- Stool DNA 2023-02-25. N2 window: "2026 or the two years prior (three-year window)" = 2026, 2025, 2024. Window starts 2024-01-01.
- 2023-02-25 is before 2024-01-01. Outside window.
- So even without exclusion, would be non-compliant. But exclusion applies, so excluded. Correct.
Final check on rate: 7/11 = 0.636363... × 100 = 63.6363... Rounded half up to one decimal = 63.6. Correct.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
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"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,567 tokens
Let me evaluate each member against the measure specification for QM-CRC (Colorectal Cancer Screening).
**ELIGIBLE POPULATION (denominator):**
- Age: 46 through 75 years as of 2026-12-31
- Continuous enrolment: the full measurement year (2026-01-01 through 2026-12-31) with no more than one gap of up to 45 days.
**NUMERATOR:**
- N1. FIT/FOBT 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 (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 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 71081:**
- Age: 75 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days.
- Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps means NOT eligible.
- 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 = not eligible.
- Status: **not_eligible** (fails continuous enrolment - two gaps)
---
**MEMBER 71082:**
- Age: 45 on 2026-12-31. Below 46. NOT in range.
- Status: **not_eligible** (fails age requirement)
---
**MEMBER 71083:**
- Age: 55 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. None apply.
- Numerator:
- 2026-08-02 CT colonography → N4 (2026 or 4 years prior = 2022-2026). YES.
- 2026-09-02 FIT → N1 (during 2026). YES.
- Status: **compliant**
---
**MEMBER 71084:**
- Age: 59 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15.
- This is not continuous enrolment for the full measurement year. The gap from 2026-01-01 to 2026-04-14 is 104 days. This is more than one gap or more than 45 days.
- Actually, there's no coverage from Jan 1 to Apr 14. That's a gap of about 104 days at the beginning. This fails continuous enrolment.
- Status: **not_eligible** (fails continuous enrolment)
---
**MEMBER 71085:**
- Age: 67 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. None apply.
- Numerator: No colorectal screening on record. Does NOT meet numerator.
- Status: **non_compliant**
---
**MEMBER 71086:**
- Age: 75 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: No CRC, no colectomy, no hospice, no frailty/advanced illness. None apply.
- Numerator:
- 2020-08-11 CT colonography → N4 requires 2026 or 4 years prior (2022-2026). 2020 is outside the window. NO.
- No other screening. Does NOT meet numerator.
- Status: **non_compliant**
---
**MEMBER 71087:**
- Age: 59 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days.
- One gap, ≤ 45 days. ✓
- Eligible population: YES
- Exclusions:
- E4: Age 66 or older? No, 59. E4 does not apply.
- No CRC, no colectomy, no hospice. None apply.
- Numerator:
- 2021-04-28 CT colonography → N4 requires 2022-2026. 2021 is outside. NO.
- No other screening. Does NOT meet numerator.
- Status: **non_compliant**
---
**MEMBER 71088:**
- Age: 50 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days.
- Two gaps. "No more than one gap of up to 45 days." Two gaps = NOT eligible.
- Status: **not_eligible** (fails continuous enrolment - two gaps)
---
**MEMBER 71089:**
- Age: 59 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator: No screening on record. Does NOT meet numerator.
- Status: **non_compliant**
---
**MEMBER 71090:**
- Age: 76 on 2026-12-31. Above 75. NOT in range.
- Status: **not_eligible** (fails age requirement)
---
**MEMBER 71091:**
- Age: 76 on 2026-12-31. Above 75. NOT in range.
- Status: **not_eligible** (fails age requirement)
---
**MEMBER 71092:**
- Age: 55 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions:
- E1: 2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon. This is colorectal cancer (C18). YES, excluded.
- Status: **excluded** (E1)
---
**MEMBER 71093:**
- Age: 50 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2026-07-02 FIT → N1 (during 2026). YES.
- Status: **compliant**
---
**MEMBER 71094:**
- Age: 45 on 2026-12-31. Below 46. NOT in range.
- Status: **not_eligible** (fails age requirement)
---
**MEMBER 71095:**
- Age: 47 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2026-05-26 FIT → N1 (during 2026). YES.
- Status: **compliant**
---
**MEMBER 71096:**
- Age: 59 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2026-03-13 Colonoscopy → N5 (2026 or 9 years prior = 2017-2026). YES.
- Status: **compliant**
---
**MEMBER 71097:**
- Age: 75 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days.
- One gap, ≤ 45 days. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2026-10-11 FIT → N1 (during 2026). YES.
- Status: **compliant**
---
**MEMBER 71098:**
- Age: 72 on 2026-12-31. In range (46-75). ✓
- Enrolment: continuous, no gaps. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2023-04-14 Flexible sigmoidoscopy → N3 (2026 or 4 years prior = 2022-2026). 2023 is within the window. YES.
- Status: **compliant**
---
**MEMBER 71099:**
- Age: 47 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days.
- One gap, ≤ 45 days. ✓
- Eligible population: YES
- Exclusions: None apply.
- Numerator:
- 2025-01-25 Flexible sigmoidoscopy → N3 (2026 or 4 years prior = 2022-2026). 2025 is within the window. YES.
- Status: **compliant**
---
**MEMBER 71100:**
- Age: 47 on 2026-12-31. In range (46-75). ✓
- Enrolment: 2026-03-16 through 2026-12-31. Not enrolled before 2026-03-16.
- Gap from 2026-01-01 to 2026-03-15 is about 74 days. This is more than 45 days.
- Actually, is this considered a gap? The member wasn't enrolled at the start of the year. The requirement is "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, that's a gap at the beginning of the year. 74 days > 45 days, so fails.
- Status: **not_eligible** (fails continuous enrolment)
---
Let me compile the results:
**Compliant (7):** 71083, 71093, 71095, 71096, 71097, 71098, 71099
**Non-compliant (4):** 71085, 71086, 71087, 71089
**Excluded (1):** 71092
**Not eligible (8):** 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100
Let me double-check the counts:
- Compliant: 7
- Non-compliant: 4
- Excluded: 1
- Not eligible: 8
- Total: 7 + 4 + 1 + 8 = 20 ✓
Denominator = compliant + non_compliant = 7 + 4 = 11
Numerator = compliant = 7
Rate = 7 / 11 × 100 = 63.636... → rounded half up to one decimal = 63.6
Let me re-verify each member carefully:
**71081:** Age 75 ✓. Enrolment gaps: 23 and 29 days. Two gaps → not_eligible. ✓
**71082:** Age 45 → not_eligible. ✓
**71083:** Age 55 ✓. Continuous ✓. CT colonography 2026-08-02 (N4: 2022-2026) ✓. FIT 2026-09-02 (N1) ✓. Compliant. ✓
**71084:** Age 59 ✓. Enrolment from 2026-04-15 only. Gap from Jan 1 to Apr 14 = 104 days. More than 45 days → not_eligible. ✓
**71085:** Age 67 ✓. Continuous ✓. No exclusions. No screening → non_compliant. ✓
**71086:** Age 75 ✓. Continuous ✓. No exclusions. CT colonography 2020-08-11 → N4 window is 2022-2026. 2020 is outside → non_compliant. ✓
**71087:** Age 59 ✓. One gap of 32 days ✓. No exclusions (age 59, not 66+). CT colonography 2021-04-28 → N4 window is 2022-2026. 2021 is outside → non_compliant. ✓
**71088:** Age 50 ✓. Two gaps (17 and 14 days) → not_eligible. ✓
**71089:** Age 59 ✓. Continuous ✓. No exclusions. No screening → non_compliant. ✓
**71090:** Age 76 → not_eligible. ✓
**71091:** Age 76 → not_eligible. ✓
**71092:** Age 55 ✓. Continuous ✓. C18.7 diagnosis → E1 exclusion → excluded. ✓
**71093:** Age 50 ✓. Continuous ✓. FIT 2026-07-02 (N1) ✓. Compliant. ✓
**71094:** Age 45 → not_eligible. ✓
**71095:** Age 47 ✓. Continuous ✓. FIT 2026-05-26 (N1) ✓. Compliant. ✓
**71096:** Age 59 ✓. Continuous ✓. Colonoscopy 2026-03-13 (N5: 2017-2026) ✓. Compliant. ✓
**71097:** Age 75 ✓. One gap of 21 days ✓. FIT 2026-10-11 (N1) ✓. Compliant. ✓
**71098:** Age 72 ✓. Continuous ✓. Flexible sigmoidoscopy 2023-04-14 (N3: 2022-2026) ✓. Compliant. ✓
**71099:** Age 47 ✓. One gap of 39 days ✓. Flexible sigmoidoscopy 2025-01-25 (N3: 2022-2026) ✓. Compliant. ✓
**71100:** Age 47 ✓. Enrolment from 2026-03-16 only. Gap from Jan 1 to Mar 15 = 74 days → not_eligible. ✓
All checks pass.
Summary:
- Denominator: 11
- Numerator: 7
- Excluded: 1
- Not eligible: 8
- Rate: 63.6
Compliant: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
Non-compliant: ["71085", "71086", "71087", "71089"]
Excluded: ["71092"]
Not eligible: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
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"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
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"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"71093",
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"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
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],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 · Z.ai37.7s · 4,787 out | 26.0s · 3,672 out | 27.5s · 5,387 out
Reasoning · 3,388 tokens
Let me work through each member against the specification.
Measure: colorectal cancer screening, MY 2026-01-01 through 2026-12-31.
Eligible population:
- Age 46 through 75 as of 2026-12-31.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
Numerator (look-back windows from 2026-12-31):
- N1: FOBT/FIT during 2026.
- N2: Stool DNA during 2026 or two years prior (three-year window: 2024-2026).
- 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: 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 MY.
Order: not_eligible check first (age, event, enrolment). Then exclusions for eligible members. Then numerator.
MEMBER 71081. DOB 1951-10-15, 75 years old on 2026-12-31. Age 75 — within 46-75. Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Two gaps: 2026-03-22 to 2026-04-13 (23 days), and 2026-07-24 to 2026-08-21 (29 days). Two gaps — "no more than one gap of up to 45 days" — two gaps exceeds the allowance. So not continuously enrolled → not_eligible. Note: the spec says continuous enrolment "the full measurement year with no more than one gap of up to 45 days." Two gaps violate. Also the member is 75, which is eligible age. But enrolment fails. not_eligible.
Wait — also need to consider: does "continuous enrolment" mean enrolled at start and end of year? 2026-01-01 start, 2026-12-31 end — yes, but two gaps. So not_eligible.
MEMBER 71082. DOB 1981-09-15, 45 years old on 2026-12-31. Age 45 — below 46 → not_eligible. (Even though frailty + advanced illness documented, age fails first.) not_eligible.
MEMBER 71083. DOB 1971-06-11, 55. Enrolled full year continuous. Age OK. Screening: 2026-08-02 CT colonography (N4, within 2026) and 2026-09-02 FIT (N1). No exclusions. → compliant.
MEMBER 71084. DOB 1967-02-19, 59. Enrolment: 2026-04-15 through 2026-12-31, continuous from that date, not enrolled before. Not enrolled the full measurement year — the continuous enrolment criterion says "the full measurement year with no more than one gap of up to 45 days." A member who enrolls from 2026-04-15 has a gap of more than 45 days at the start? Or is it "not enrolled the full year"?
Hmm. How to treat partial-year enrolment? The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If someone enrolls starting 2026-04-15, they're missing 2026-01-01 through 2026-04-14, which is a gap of 104 days (or is it not a "gap" because they were never enrolled?). In typical HEDIS, continuous enrollment means the measurement year plus allowing gaps. A member who enrolls mid-year doesn't meet continuous enrolment for the full year.
But wait — let's think about how this harness intends it. The phrase "the full measurement year" suggests enrollment must span the whole year. Member 71084: enrolled 2026-04-15 through 2026-12-31 — does not cover the full year. So not_eligible.
Member 71100: enrolled 2026-03-16 through 2026-12-31, not enrolled before — also not full year → not_eligible.
Hmm, but let me reconsider. The roster has members with one gap of up to 45 days (e.g., 71087: one gap of 32 days — that satisfies "no more than one gap of up to 45 days" and enrolled 2026-01-01 through 2026-12-31 with a gap in between). Members 71084 and 71100 don't start at 2026-01-01. Under "continuous enrolment: the full measurement year," starting mid-year means not enrolled for the full measurement year. So they'd be not_eligible.
Alternatively, one could interpret a late start as a "gap" — 2026-01-01 to 2026-04-14 for 71084 is 104 days, exceeding 45 days, so fails either way. For 71100: 2026-01-01 to 2026-03-15 is 74 days, exceeding 45 days, fails either way. So both interpretations give not_eligible.
MEMBER 71084 → not_eligible (enrolment). Also note: frailty documented 2026-03-11, but age 59, so E4 wouldn't apply anyway (needs 66+). And flex sig 2021-05-09 — outside five-year window (2022-2026) anyway. But enrolment fails.
MEMBER 71085. DOB 1959-01-11, 67 on 2026-12-31. Enrolled full year continuous. No screening. No frailty/advanced illness, no hospice, no CRC, no colectomy. Age 66+ but no frailty+advanced illness, so no E4. → non_compliant.
MEMBER 71086. DOB 1951-02-07, 75 on 2026-12-31. Age 75 — eligible (46 through 75, inclusive). Enrolled full year. Screening: 2020-08-11 CT colonography. N4 window: 2026 or four years prior = 2022-2026. 2020 is outside window. → non_compliant. No exclusions.
MEMBER 71087. DOB 1967-06-23, 59. Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days — allowed (no more than one gap up to 45 days). Enrolled full year with one gap ≤ 45 days → eligible. Screening: 2021-04-28 CT colonography — N4 window 2022-2026; 2021 outside. Not numerator. Exclusions: frailty documented 2026-05-25 and advanced illness 2026-06-21 — but E4 requires age 66+. Age 59 → E4 does not apply. So → non_compliant.
MEMBER 71088. DOB 1976-06-16, 50. Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31. Gaps of 17 and 14 days — two gaps. "No more than one gap" — two gaps fail → not_eligible. Screening: flex sig 2021-07-01 — outside window anyway. → not_eligible.
MEMBER 71089. DOB 1967-11-24, 59. Enrolled full year continuous. No screening. No exclusions. → non_compliant.
MEMBER 71090. DOB 1950-05-28, 76 on 2026-12-31. Age 76 — above 75 → not_eligible (age). Even though FIT in 2026 and enrolment has one gap of 28 days. Age fails → not_eligible.
MEMBER 71091. DOB 1950-07-12, 76 on 2026-12-31. Age 76 → not_eligible. (FIT 2026 twice, one gap 39 days — but age fails.) → not_eligible.
MEMBER 71092. DOB 1971-06-21, 55. Enrolled full year. Stool DNA 2023-02-25 — N2 window: 2026 or two years prior = 2024-2026. 2023 is outside the three-year window. Hmm, "two years prior" — years prior: 2024 and 2025, plus 2026 = three-year window. 2023 is three years prior, outside. So no numerator. But: diagnosis C18.7 on 2024-10-06 — E1 colorectal cancer any time on or before 2026-12-31. → excluded. Exclusions evaluated before numerator. So → excluded.
MEMBER 71093. DOB 1976-11-04, 50. Enrolled full year. FIT 2026-07-02 — N1. → compliant.
MEMBER 71094. DOB 1981-12-09, 45 on 2026-12-31. Age 45 → below 46 → not_eligible. (Also gap of 51 days would fail, and FIT 2026 would be numerator — but age fails.) → not_eligible.
MEMBER 71095. DOB 1979-11-11, 47. Enrolled full year. FIT 2026-05-26 — N1. → compliant.
MEMBER 71096. DOB 1967-03-27, 59. Enrolled full year. Colonoscopy 2026-03-13 — N5. → compliant.
MEMBER 71097. DOB 1951-08-03, 75 on 2026-12-31. Age 75 — eligible (inclusive). Enrolment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. One gap of 21 days — allowed. FIT 2026-10-11 — N1. → compliant.
MEMBER 71098. DOB 1954-09-24, 72 on 2026-12-31. Enrolled full year. Flex sig 2023-04-14 — N3 window: 2026 or four years prior = 2022-2026. 2023 within window. → compliant. No exclusions (age 72 but no frailty/advanced illness).
MEMBER 71099. DOB 1979-09-26, 47. Enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap of 39 days — allowed. Flex sig 2025-01-25 — N3 window 2022-2026. 2025 within. → compliant.
MEMBER 71100. DOB 1979-01-17, 47. Enrolment: 2026-03-16 through 2026-12-31, not enrolled before. Not the full measurement year → not_eligible. (Also advanced illness 2026-01-23 but no frailty, and age 47 anyway.) CT colonography 2020-11-17 outside window. → not_eligible.
Wait, let me double-check the enrolment interpretation for 71084 and 71100. The spec: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This is modelled on HEDIS CRC measure: "Continuous enrollment during the measurement year and the two years prior" — actually HEDIS CRC requires continuous enrollment from the measurement year's start... Let me not import HEDIS. The spec here: enrolment for the full measurement year, allowing no more than one gap of up to 45 days. A member enrolled 2026-03-16 to 2026-12-31 is not enrolled for the full measurement year — missing Jan 1 to Mar 15 (74 days). If we count that as a gap, it exceeds 45 days. Either way, fails. So not_eligible. Confident.
Let me double check the gap calculations to be safe:
71081: 2026-01-01 to 2026-03-21, then 2026-04-14. Gap from 2026-03-22 to 2026-04-13 = 23 days (stated). Then 2026-07-23 to 2026-08-22: gap 2026-07-24 to 2026-08-21 = 29 days (stated). Two gaps → fails. Also both ≤45 but two gaps > one. → not_eligible.
71087: gap stated 32 days, one gap → OK.
71088: gaps 17 and 14 — two gaps → fails.
71090: gap 28 days, one gap → OK enrolment-wise, but age 76 → not_eligible.
71091: gap 39 days, one → OK enrolment-wise, age 76 → not_eligible.
71094: gap 51 days — one gap but 51 > 45 → fails enrolment. Plus age 45 → fails age. Either way not_eligible.
71097: gap 21 days, one → OK.
71099: gap 39 days, one → OK.
71082: age 45 → not_eligible.
Now compile:
not_eligible: 71081 (two gaps), 71082 (age 45), 71084 (not full-year enrolment), 71088 (two gaps), 71090 (age 76), 71091 (age 76), 71094 (age 45; gap 51), 71100 (not full-year enrolment). That's 8 members.
excluded: 71092 (E1 CRC). Any others? Let me scan for hospice — none documented anywhere. Colectomy — none. CRC — only 71092. E4: age 66+ AND frailty AND advanced illness during MY.
Check each eligible member 66+:
- 71085: 67, no frailty/advanced illness → no.
- 71086: 75, none → no.
- 71097: 75, none → no.
- 71098: 72, none → no.
- 71081: 75, but not eligible.
- 71090, 71091: 76, not eligible.
So excluded = [71092] only. Excluded count 1.
denominator (eligible after exclusions removed) = compliant + non_compliant.
compliant: 71083 (CT colonography 2026 + FIT 2026), 71093 (FIT 2026), 71095 (FIT 2026), 71096 (colonoscopy 2026), 71097 (FIT 2026), 71098 (flex sig 2023 within 2022-2026), 71099 (flex sig 2025 within window). That's 7.
non_compliant: 71085 (no screening), 71086 (CT colonography 2020, outside 2022-2026 window), 71087 (CT colonography 2021, outside window; age 59 so E4 doesn't apply), 71089 (no screening). That's 4.
Total check: 8 not_eligible + 1 excluded + 7 compliant + 4 non_compliant = 20. ✓
denominator = 7 + 4 = 11. numerator = 7. rate = 7/11 × 100 = 63.6363...% → rounded half up to one decimal = 63.6.
Let me double-check 7/11 = 0.636363... ×100 = 63.6363... → 63.6.
Double-check numerator windows:
N3/N4: "during 2026 or the four years prior (five-year window)" — 2026, 2025, 2024, 2023, 2022. 71098 flex sig 2023-04-14 ✓. 71099 flex sig 2025-01-25 ✓. 71087 CT colonography 2021-04-28 ✗ (outside). 71088 flex sig 2021-07-01 ✗ (but not eligible anyway). 71084 flex sig 2021-05-09 ✗ (not eligible anyway). 71086 CT colonography 2020-08-11 ✗.
N2: "during 2026 or the two years prior (three-year window)" — 2026, 2025, 2024. 71092 stool DNA 2023-02-25 ✗. But 71092 is excluded anyway (E1 before numerator evaluation). Right — exclusions evaluated before numerator, so even if numerator met, excluded. Here numerator not met either, but excluded wins.
N5: colonoscopy 2026 or nine years prior — 2017-2026. 71096 colonoscopy 2026-03-13 ✓.
N1: FIT during 2026. 71081 FIT 2025-10-03 ✗ (2025, not 2026) — but not eligible anyway. 71083 FIT 2026-09-02 ✓. 71090 FIT 2026-06-02 ✓ but age 76 → not_eligible. 71091 FITs 2026 ✓ but age 76 → not_eligible. 71093 ✓. 71094 FIT 2026-06-06 but age 45 → not_eligible. 71095 ✓. 71097 ✓.
Age boundary check: "46 through 75 years as of 2026-12-31." 71081: 75 — OK. 71086: 75 — OK. 71097: 75 — OK. 71090: 76 — fail. 71091: 76 — fail. 71082: 45 — fail. 71094: 45 — fail.
71081: age OK but two gaps → not_eligible.
E4 check for 71082: age 45, frailty + advanced illness — fails age, so not_eligible. Correct per the rule ordering: "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented."
71100: advanced illness documented 2026-01-23 — but not enrolled at that time (enrolled from 2026-03-16). E4 requires age 66+ AND both frailty and advanced illness. Age 47 → E4 doesn't apply. Not eligible anyway due to enrolment.
Everything checks out.
Final answer:
denominator: 11
numerator: 7
excluded: 1
not_eligible: 8
rate: 63.6
compliant_members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
non_compliant_members: ["71085", "71086", "71087", "71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Order any — I'll list in roster order.
Rate: 63.6363... → 63.6. Round half up to one decimal: 63.6363 → the second decimal is 3, so 63.6. Yes.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
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"got": [
"71085",
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"ok": true,
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{
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"want": [
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"got": [
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"ok": true,
"present": true
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{
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"want": [
"71081",
"71082",
"71084",
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],
"got": [
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"71091",
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"71100"
],
"ok": true,
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}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,448 tokens
Let me work through each member against the specification.
Measure QM-CRC: Colorectal cancer screening. MY 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 (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 (2017-2026).
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 MY.
Let me go member by member.
MEMBER 71081. DOB 1951-10-15, 75 on 2026-12-31. Age 75 — within 46-75. Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps of 23 and 29 days — TWO gaps. The continuous enrolment rule says "no more than one gap of up to 45 days." Two gaps violates it. So not eligible (fails continuous enrolment). Status: not_eligible. The screening history (FIT 2025-10-03) — note FIT in 2025 wouldn't count for N1 (needs during 2026) anyway. But regardless, not eligible.
MEMBER 71082. DOB 1981-09-15, 45 on 2026-12-31. Age 45 — below 46. Not eligible (age). Frailty + advanced illness documented but she's not 66+, so E4 wouldn't apply anyway; also exclusions only apply to eligible population members. Status: not_eligible.
MEMBER 71083. DOB 1971-06-11, 55. Age OK. Enrolment continuous full year. Screening: CT colonography 2026-08-02 (N4, during 2026 — counts), FIT 2026-09-02 (N1). No exclusions. Compliant. Status: compliant.
MEMBER 71084. DOB 1967-02-19, 59. Age OK. Enrolment: 2026-04-15 through 2026-12-31, not enrolled before. Not continuous for full MY — not eligible (enrolment). Even though gap? Actually there's no gap, but enrolment doesn't cover the full year. The requirement is "the full measurement year with no more than one gap of up to 45 days." Enrolling from 2026-04-15 means missing Jan 1 - Apr 14, which is more than a 45-day gap. So not eligible. Frailty documented 2026-03-11 — irrelevant, and age < 66 anyway. Status: not_eligible. Also screening: flex sig 2021-05-09 — outside 5-year window (2022-2026) anyway. But not eligible.
MEMBER 71085. DOB 1959-01-11, 67. Age OK (46-75). Enrolment continuous. No screening. No exclusions (no frailty/advanced illness, no hospice, no CRC, no colectomy). Status: non_compliant.
MEMBER 71086. DOB 1951-02-07, 75. Age OK (75 is included). Enrolment continuous. Screening: CT colonography 2020-08-11. N4 window: 2026 or four years prior = 2022-2026. 2020 is outside. No other screening. No exclusions. Status: non_compliant.
MEMBER 71087. DOB 1967-06-23, 59. Age OK. Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days (Apr 21 - May 22 = 32 days). One gap ≤ 45 days — eligible. Screening: CT colonography 2021-04-28. N4 window 2022-2026. 2021 outside. Not numerator. Exclusions: frailty 2026-05-25, advanced illness 2026-06-21 — both documented during MY. But E4 requires age 66+. He's 59. So no exclusion. Status: non_compliant.
Wait — let me double-check the gap. 2026-01-01 through 2026-04-20; then 2026-05-23 through 2026-12-31. Gap: April 21 to May 22 inclusive = 10 + 22 = 32 days. Yes, 32 days, one gap, ≤45. Eligible.
CT colonography 2021-04-28: window is "during 2026 or the four years prior (five-year window)". Four years prior to 2026 = 2022, 2023, 2024, 2025, plus 2026. 2021 is outside. Non_compliant.
MEMBER 71088. DOB 1976-06-16, 50. Age OK. Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31. Two gaps (17 and 14 days). Two gaps violates "no more than one gap." Not eligible. Status: not_eligible. Flex sig 2021-07-01 outside window anyway.
MEMBER 71089. DOB 1967-11-24, 59. Age OK. Enrolment continuous. No screening. No exclusions. Status: non_compliant.
MEMBER 71090. DOB 1950-05-28, 76. Age 76 — over 75. Not eligible (age). Status: not_eligible. FIT 2026-06-02 would be numerator but age excludes.
MEMBER 71091. DOB 1950-07-12, 76. Not eligible (age). Status: not_eligible.
MEMBER 71092. DOB 1971-06-21, 55. Age OK. Enrolment continuous. Screening: stool DNA 2023-02-25. N2 window: 2026 or two years prior = 2024, 2025, 2026. 2023 outside. Other history: C18.7 diagnosis 2024-10-06 — colorectal cancer (C18 is in C18-C21), any time on or before 2026-12-31. Exclusion E1 applies. She's in eligible population (age, enrolment OK), meets exclusion. Status: excluded.
MEMBER 71093. DOB 1976-11-04, 50. Age OK. Enrolment continuous. FIT 2026-07-02 — N1. Compliant. Status: compliant.
MEMBER 71094. DOB 1981-12-09, 45. Age 45 — below 46. Not eligible (age). Also gap of 51 days (>45), but age already disqualifies. Status: not_eligible.
MEMBER 71095. DOB 1979-11-11, 47. Age OK. Enrolment continuous. FIT 2026-05-26 — N1. Compliant. Status: compliant.
MEMBER 71096. DOB 1967-03-27, 59. Age OK. Enrolment continuous. Colonoscopy 2026-03-13 — N5. Compliant. Status: compliant.
MEMBER 71097. DOB 1951-08-03, 75. Age OK (75 included). Enrolment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. One gap: Apr 25 to May 15 = 21 days. One gap ≤ 45. Eligible. FIT 2026-10-11 — N1. Compliant. Status: compliant.
MEMBER 71098. DOB 1954-09-24, 72. Age OK. Enrolment continuous. Screening: flexible sigmoidoscopy 2023-04-14. N3 window: 2026 or four years prior (five-year window) = 2022-2026. 2023 is within. Numerator met. No exclusions (no frailty/advanced illness documented). Status: compliant.
MEMBER 71099. DOB 1979-09-26, 47. Age OK. Enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap: Jun 16 to Jul 24 = 39 days (as stated). One gap ≤ 45. Eligible. Screening: flex sig 2025-01-25. N3 window 2022-2026. 2025 within. Numerator met. No exclusions. Status: compliant.
MEMBER 71100. DOB 1979-01-17, 47. Age OK. Enrolment: 2026-03-16 through 2026-12-31, not enrolled before. Missing Jan 1 - Mar 15 = more than 45 days (73 days). Not eligible (enrolment). Advanced illness 2026-01-23 — irrelevant; age < 66 anyway. CT colonography 2020-11-17 — outside N4 window anyway (2022-2026). Status: not_eligible.
Now tally:
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7.
Non-compliant: 71085, 71086, 71087, 71089. That's 4.
Excluded: 71092. That's 1.
Not eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8.
Total: 7 + 4 + 1 + 8 = 20. ✓
Denominator = compliant + non_compliant = 7 + 4 = 11.
Numerator = 7.
Excluded = 1.
Not eligible = 8.
Rate = 7/11 × 100 = 63.6363...% → 63.6 (rounded half up to one decimal).
7/11 = 0.636363... × 100 = 63.6363... → 63.6.
Let me double check some edge cases:
71081: age 75 (OK), but two gaps (23 and 29 days). Rule: "no more than one gap of up to 45 days." Two gaps → fails continuous enrolment → not eligible. Correct.
71082: age 45. Age requirement is 46 through 75. 45 fails. Not eligible. Correct. (Also her frailty/advanced illness don't matter since E4 requires 66+.)
71086: age 75, continuous enrolment, CT colonography 2020-08-11. N4 window is 2026 + four prior years = 2022-2026. 2020 is outside. No other screening. Non-compliant. Correct.
71087: one gap of 32 days, eligible. CT colonography 2021-04-28 — outside 2022-2026. Frailty + advanced illness both documented in 2026 but age 59 < 66, so E4 doesn't apply. Non-compliant. Correct.
71090: age 76 — over 75, not eligible. Correct even though FIT during 2026. Note the roster says "so 76 years old on 2026-12-31." DOB 1950-05-28: on 2026-12-31, age = 2026 - 1950 = 76 (birthday May 28 passed). Yes 76.
71091: DOB 1950-07-12, 76 on 2026-12-31. Not eligible. Correct.
71092: C18.7 (malignant neoplasm of sigmoid colon) — C18 is within C18-C21. E1 applies. She's in eligible population (55, continuous). Stool DNA 2023 — outside N2 window (2024-2026), but exclusion takes precedence over numerator evaluation anyway; and even if she met numerator, exclusion wins. Excluded. Correct.
71094: age 45 (DOB 1981-12-09 → 45 on 2026-12-31), below 46. Not eligible. Also the gap: 2026-04-24 end, resume 2026-06-15 — gap Apr 25 to Jun 14 = 51 days > 45. Either way not eligible. Correct.
71098: flex sig 2023-04-14, within 2022-2026 five-year window. Age 72, no frailty/advanced illness, so no E4. Compliant. Correct.
71099: flex sig 2025-01-25, within window. Gap 39 days, one gap. Compliant. Correct.
71084: enrolment starts 2026-04-15 — not full year. Not eligible. Correct.
71100: enrolment starts 2026-03-16 — missing Jan 1 through Mar 15 = 73 days, exceeds 45. Not eligible. Correct.
71083: CT colonography 2026-08-02 (N4 during 2026) and FIT 2026-09-02 (N1 during 2026). Compliant. Age 55, continuous. Correct.
Rate: 7/11 × 100 = 63.636... → 63.6.
Now format the JSON:
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Let me verify counts match list lengths: compliant 7 ✓, non-compliant 4 ✓, excluded 1 ✓, not eligible 8 ✓. Total 20 ✓.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
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"ok": true,
"present": true
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{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
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"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,829 tokens
Let me work through each member carefully.
Measure: Colorectal cancer screening, MY 2026 (2026-01-01 through 2026-12-31).
Eligible population:
- Age 46 through 75 as of 2026-12-31.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
So: enrolment must cover the full year 2026, allowing at most one gap, and that gap must be ≤ 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).
- N3: Flexible sigmoidoscopy 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:
- 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 MY.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during MY.
Note: exclusions evaluated only for members in the eligible population. A member failing age, event, or enrolment is not_eligible even if exclusion also documented.
Now member by member:
MEMBER 71081: DOB 1951-10-15, 75 years old on 2026-12-31. Age OK (46–75, 75 inclusive).
Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Two gaps: 2026-03-22 to 2026-04-13 (23 days: from 03-22 to 04-13 inclusive is... 03-22,23,...,03-31 = 10 days, 04-01 to 04-13 = 13 days, total 23 days). Gap 2: 2026-07-24 to 2026-08-21: 07-24 to 07-31 = 8 days, 08-01 to 08-21 = 21 days, total 29 days. Two gaps — the rule says "no more than one gap of up to 45 days". Two gaps means not continuously enrolled. So 71081 is NOT eligible → not_eligible.
Wait — but the gaps described "Gaps of 23 and 29 days" — both under 45 days but there are two of them. The rule: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Two gaps > one gap allowed. So not eligible.
71081: not_eligible (enrolment). Even though they had FIT 2025-10-03 (which wouldn't count for 2026 anyway — N1 requires during 2026; 2025 FIT doesn't count).
MEMBER 71082: DOB 1981-09-15, 45 years old on 2026-12-31. Age 45 < 46 → not eligible. Age fails → not_eligible. (Frailty + advanced illness documented but age fails, and E4 also requires 66+; irrelevant.)
71082: not_eligible (age).
MEMBER 71083: DOB 1971-06-11, 55 on 2026-12-31. Age OK. Enrolment continuous full year. Numerator: CT colonography 2026-08-02 (N4, during 2026 — yes). FIT 2026-09-02 also. No exclusions. → compliant.
71083: compliant.
MEMBER 71084: DOB 1967-02-19, 59 on 2026-12-31. Age OK. Enrolment: 2026-04-15 through 2026-12-31, not enrolled before 2026-04-15. Not full year — enrolment doesn't cover full measurement year. There's no gap within enrolled period, but the member wasn't enrolled for the full year. The continuous enrolment requirement: "the full measurement year with no more than one gap of up to 45 days." Not enrolled from 2026-01-01 to 2026-04-14 — that's a lapse of ~103 days at the start. Hmm, how to treat? The member is enrolled 2026-04-15 through end of year. The requirement is enrolment for the full measurement year with no more than one gap of up to 45 days. Not being enrolled for the first 3.5 months means not continuously enrolled for the full year. That's more than a 45-day gap (well, it's not a "gap" within enrolment, it's just non-enrolment at start). Either way, the member doesn't have enrolment for the full measurement year, so not eligible.
71084: not_eligible (enrolment).
Note: This is like a typical HEDIS measure where continuous enrollment with gaps allowed would allow... actually in HEDIS, CRC allows one gap of up to 45 days. But enrolment must span the whole year. If not enrolled from Jan 1, not eligible.
Also, the frailty documented 2026-03-11 — during a period when not enrolled? Anyway, age 59, so E4 wouldn't apply (needs 66+). And enrolment fails first. not_eligible.
MEMBER 71085: DOB 1959-01-11, 67 on 2026-12-31. Age OK (46–75). Enrolment continuous. No screening on record → fails numerator. Exclusions: no CRC, no colectomy, no hospice, no frailty/advanced illness. E4 requires both frailty and advanced illness documented during MY — none documented. So no exclusion. → non_compliant.
71085: non_compliant.
MEMBER 71086: DOB 1951-02-07, 75 on 2026-12-31. Age OK (75 inclusive). Enrolment continuous. Screening: CT colonography 2020-08-11. N4 window: 2026 or four years prior → 2022-01-01 through 2026-12-31. 2020 is outside window (five-year window measured back from 2026-12-31: 2022, 2023, 2024, 2025, 2026). 2020-08-11 is more than five years prior. So no numerator. Exclusions: none. → non_compliant.
71086: non_compliant.
MEMBER 71087: DOB 1967-06-23, 59 on 2026-12-31. Age OK. Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap: 2026-04-21 to 2026-05-22 = 04-21 to 04-30 (10 days) + 05-01 to 05-22 (22 days) = 32 days. One gap ≤ 45 days → continuously enrolled, eligible.
Screening: CT colonography 2021-04-28. N4 window: 2022-01-01 through 2026-12-31. 2021-04-28 is before 2022-01-01 → outside window. Five-year window from 2026-12-31: 2022–2026. 2021-04-28 is more than five years back (about 5 years 8 months). So no numerator.
Exclusions: E4? Age 59, under 66 → no. Frailty and advanced illness documented during 2026, but E4 requires age 66+. So no exclusion. → non_compliant.
71087: non_compliant.
MEMBER 71088: DOB 1976-06-16, 50 on 2026-12-31. Age OK. Enrolment: three segments with gaps of 17 and 14 days — two gaps. Rule allows no more than one gap. Two gaps → not eligible.
71088: not_eligible (enrolment).
Screening: flex sig 2021-07-01 — outside N3 window anyway (2022–2026).
MEMBER 71089: DOB 1967-11-24, 59 on 2026-12-31. Age OK. Continuous enrolment. No screening. No exclusions. → non_compliant.
71089: non_compliant.
MEMBER 71090: DOB 1950-05-28, 76 on 2026-12-31. Age 76 > 75 → not eligible. Enrolment also has one gap of 28 days (that would be fine), but age fails. → not_eligible (age).
71090: not_eligible.
MEMBER 71091: DOB 1950-07-12, 76 on 2026-12-31. Age 76 > 75 → not_eligible. (Enrolment gap 39 days would be OK, but age fails.)
71091: not_eligible.
MEMBER 71092: DOB 1971-06-21, 55 on 2026-12-31. Age OK. Enrolment continuous. Screening: stool DNA 2023-02-25 — N2 window is three-year: 2024-01-01 through 2026-12-31. 2023-02-25 is outside (2024+). Wait — "Stool DNA test during 2026 or the two years prior (three-year window)". Two years prior to 2026: 2024 and 2025. So window = 2024-01-01 through 2026-12-31. 2023-02-25 is outside. So no numerator.
Exclusions: Diagnosis C18.7 (malignant neoplasm of sigmoid colon) 2024-10-06. E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. C18.7 is within C18 → E1 met. Member is in eligible population (age OK, enrolment OK). → excluded.
71092: excluded (E1).
MEMBER 71093: DOB 1976-11-04, 50 on 2026-12-31. Age OK. Enrolment continuous. FIT 2026-07-02 → N1 met. No exclusions. → compliant.
71093: compliant.
MEMBER 71094: DOB 1981-12-09, 45 on 2026-12-31. Age 45 < 46 → not_eligible. Also enrolment gap of 51 days (> 45) — also fails enrolment. Either way not_eligible.
71094: not_eligible.
MEMBER 71095: DOB 1979-11-11, 47 on 2026-12-31. Age OK. Continuous enrolment. FIT 2026-05-26 → N1 met. → compliant.
71095: compliant.
MEMBER 71096: DOB 1967-03-27, 59 on 2026-12-31. Age OK. Continuous enrolment. Colonoscopy 2026-03-13 → N5 met. → compliant.
71096: compliant.
MEMBER 71097: DOB 1951-08-03, 75 on 2026-12-31. Age OK (75). Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap: 2026-04-25 to 2026-05-15 = 04-25 to 04-30 (6 days) + 05-01 to 05-15 (15 days) = 21 days. One gap ≤ 45 → eligible. FIT 2026-10-11 → N1 met. → compliant.
71097: compliant.
MEMBER 71098: DOB 1954-09-24, 72 on 2026-12-31. Age OK. Continuous enrolment. Screening: flexible sigmoidoscopy 2023-04-14. N3 window: 2026 or four years prior → 2022-01-01 through 2026-12-31. 2023-04-14 within window → N3 met. No exclusions (age 72 but no frailty/advanced illness documented; E4 needs both). → compliant.
71098: compliant.
MEMBER 71099: DOB 1979-09-26, 47 on 2026-12-31. Age OK. Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap: 2026-06-16 to 2026-07-24 = 06-16 to 06-30 (15 days) + 07-01 to 07-24 (24 days) = 39 days. One gap ≤ 45 → eligible. Screening: flexible sigmoidoscopy 2025-01-25. N3 window 2022–2026 → within window → numerator met. → compliant.
71099: compliant.
MEMBER 71100: DOB 1979-01-17, 47 on 2026-12-31. Age OK. Enrolment: 2026-03-16 through 2026-12-31, not enrolled before. Not enrolled for full measurement year → not eligible. → not_eligible (enrolment).
71100: not_eligible.
Hmm wait, let me double check 71100: "Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16." Not enrolled for full year — Jan 1 to Mar 15 missing. That's a lapse of ~74 days, exceeding 45 days. Also not a "gap" within the year but effectively non-enrolment. Under HEDIS-style continuous enrollment, the member must be enrolled for the full MY with allowed gaps. Not enrolled Jan 1 – Mar 15 → fails. Also, in real HEDIS, the CRC measure actually requires continuous enrollment from... actually HEDIS CRC specifies continuous enrollment during the measurement year... with an allowed gap. The point here: fails enrolment → not_eligible.
Same for 71084: enrolled 2026-04-15 onward, not enrolled before → fails.
Now let me double-check 71081's gap count. Two gaps → "no more than one gap" → fails. Yes.
71088: two gaps (17 and 14 days) → fails. Both gaps individually under 45, but two gaps. "no more than one gap of up to 45 days" — one gap allowed max. Two gaps → fail. Yes.
Now, also double-check the age boundary: 46 through 75. 71082 is 45 → fail. 71094 is 45 → fail. 71090 and 71091 are 76 → fail. 71081, 71086, 71097 are 75 → OK (75 inclusive).
Now compile lists:
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members.
Non_compliant: 71085, 71086, 71087, 71089. That's 4 members.
Excluded: 71092. That's 1.
Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8 members.
Total: 7 + 4 + 1 + 8 = 20. ✓ All 20 accounted for.
Denominator = compliant + non_compliant = 7 + 4 = 11.
Numerator = 7.
Excluded = 1.
Not_eligible = 8.
Rate = 7 / 11 × 100 = 63.636...% → rounded half up to one decimal: 63.6.
Let me double check 7/11 = 0.636363... × 100 = 63.6363... → 63.6.
Now verify each compliant member's numerator again:
- 71083: CT colonography 2026-08-02 (during 2026) and FIT 2026-09-02. N1 and N4 both met. ✓
- 71093: FIT 2026-07-02. ✓
- 71095: FIT 2026-05-26. ✓
- 71096: Colonoscopy 2026-03-13. ✓
- 71097: FIT 2026-10-11. ✓
- 71098: Flex sig 2023-04-14, within 2022–2026 five-year window. ✓
- 71099: Flex sig 2025-01-25, within window. ✓
Non-compliant check:
- 71085: no screening. ✓
- 71086: CT colonography 2020-08-11 — window 2022–2026. 2020 outside. Five years back from 2026-12-31 is 2022-01-01 (approximately; "during 2026 or the four years prior" = 2022, 2023, 2024, 2025, 2026). 2020-08-11 not in window. ✓ non_compliant.
- 71087: CT colonography 2021-04-28 — outside 2022–2026 window. Frailty + advanced illness during 2026, but age 59 < 66, so E4 doesn't apply. Non-compliant. ✓
- 71089: no screening. ✓
Excluded check:
- 71092: CRC diagnosis C18.7 on 2024-10-06, "any time on or before 2026-12-31" → E1. Member is eligible population (age 55, continuous enrolment). Even though stool DNA 2023-02-25 is outside numerator window anyway, exclusion takes precedence. Excluded. ✓
Not eligible check:
- 71081: age 75 OK; enrolment two gaps → fail. not_eligible. Note: their FIT was 2025-10-03, which would be N1? No — N1 requires during 2026. 2025 FIT doesn't count. Anyway not_eligible.
- 71082: age 45 → fail. not_eligible.
- 71084: enrolment not full year → fail. not_eligible.
- 71088: two gaps → fail. not_eligible.
- 71090: age 76 → fail. not_eligible.
- 71091: age 76 → fail. not_eligible.
- 71094: age 45 → fail (also gap 51 days > 45). not_eligible.
- 71100: enrolment not full year → fail. not_eligible.
Counts:
denominator = 11
numerator = 7
excluded = 1
not_eligible = 8
rate = 63.6
Lists as strings:
compliant_members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
non_compliant_members: ["71085", "71086", "71087", "71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Double-check gap day counts just to be safe (in case any gap exceeds 45 and changes eligibility for members I counted as eligible):
71087: gap 2026-04-21 to 2026-05-22. Days: April 21–30 = 10 days; May 1–22 = 22 days; total 32. ≤45. ✓ Stated as 32 days.
71097: gap stated 21 days. ✓
71099: gap stated 39 days. ✓ ≤45.
All good.
One more consideration on 71084 and 71100: The measure spec says continuous enrolment "the full measurement year with no more than one gap of up to 45 days." Someone enrolled from April 15 through Dec 31 has no gap within their enrolment, but they weren't enrolled for the full year. In HEDIS measures, the CRC eligible population requires continuous enrollment... Actually, real HEDIS COL allows: "Continuous enrollment during the measurement year" with one gap... Actually the real HEDIS colorectal cancer screening specifies continuous enrollment from the member's enrollment start date? Let me not overthink: In this harness, the supplied spec governs: enrolment must cover the full measurement year with no more than one gap of up to 45 days. Both 71084 and 71100 were not enrolled for portions at the start of the year (103 days and 73 days respectively — 71084: Jan 1 to Apr 14 = 31+28+31+14 = 104 days; 71100: Jan 1 to Mar 15 = 31+28+15 = 74 days). Both exceed 45 days. So even treating the initial non-enrolment as a "gap," it exceeds 45 days. Either interpretation → not eligible. Good.
The roster even explicitly says "Not enrolled before 2026-04-15" and "Not enrolled before 2026-03-16," signaling that this matters.
So final answer:
denominator: 11
numerator: 7
excluded: 1
not_eligible: 8
rate: 63.6
compliant_members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
non_compliant_members: ["71085", "71086", "71087", "71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Output as a single JSON fenced block.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Max · Alibaba118.1s · 5,480 out | 115.2s · 5,435 out | 116.5s · 5,585 out
Reasoning · 5,192 tokens
We need answer user's request. Need produce JSON only. Need analyze measure QM-CRC for 20 members. Need classify each: compliant, non_compliant, excluded, not_eligible. Need counts, rate. Need careful age, enrollment gaps, exclusions, numerator windows.
Measurement year 2026-01-01 to 2026-12-31. Age 46 through 75 as of 2026-12-31. Continuous enrollment full year with no more than one gap up to 45 days.
Important: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Means must be enrolled Jan1-Dec31 except at most one gap <=45 days. If two gaps, not eligible regardless lengths? Yes no more than one gap. If one gap >45 not eligible. If not enrolled Jan 1 or Dec31? "full measurement year" likely requires coverage on Jan 1 and Dec 31 except gaps? Records with start after Jan 1 not enrolled before date: not eligible because not full year (gap from Jan1 >45? Could treat as one gap from Jan1 to start? Need interpret. For 71084 enrolled 2026-04-15 through Dec31, not enrolled before. Gap from Jan1 to Apr14 is 105 days? More than one? Not eligible. For 71100 enrolled Mar16-Dec31, gap Jan1-Mar15 75 days >45, not eligible. If continuous from date but missing Jan1, not full measurement year. Need likely not_eligible.
Exclusions evaluated only for eligible population (age+enrollment). If not eligible, ignore exclusion. 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 Dec31 AND both frailty and advanced illness documented during measurement year. Frailty alone or advanced illness alone no.
Numerator by look-back from 2026-12-31:
N1 FIT/FOBT during 2026 (2026-01-01 to 2026-12-31).
N2 stool DNA during 2026 or two years prior = three-year window. Need exact date boundaries? "during 2026 or the two years prior" measured back from 2026-12-31. Three-year window likely 2024-01-01 through 2026-12-31? But if measured back from Dec31 exactly 3 years could be 2023-12-31? Need infer. Usually HEDIS Colorectal Cancer Screening 2026: numerator: FIT/FOBT during measurement year; stool DNA during measurement year or two years prior (e.g., 2024-2026?); flex sig during MY or 4 years prior; CT colonography during MY or 4 years prior; colonoscopy during MY or 9 years prior. The prompt explicitly says look-back window measured back from 2026-12-31. For N2: during 2026 or the two years prior (three-year window). Measured back from 2026-12-31: 3-year window could be 2023-12-31 to 2026-12-31? Or 2024-01-01 to 2026-12-31? Need decide. They give member 71092 stool DNA 2023-02-25. If window starts 2024-01-01, not numerator. If exact 3 years back inclusive from 2023-12-31, also not. So irrelevant? It is before 2023-12-31. No stool DNA near boundary. Member no other. But 71092 has C18.7 so excluded if eligible. So not matter. For flex sig 5-year window: 2021-? Need exact. Members with flex sig 2021-05-09 (71084 not eligible), 2021-07-01 (71088), 2023-04-14 (71098), 2025-01-25 (71099). 5-year window measured back from 2026-12-31 could be from 2021-12-31 (if exact 5 years) or 2022-01-01? 2021-07-01 is outside either? If from 2021-12-31, 2021-07-01 outside. If from 2022-01-01, outside. So 71088 noncompliant if eligible. But check enrollment two gaps -> not eligible anyway. 71099 flex sig 2025 within. 71098 2023 within. CT colonography 5-year: 2020-08-11 (71086) outside; 2021-04-28 (71087) outside? If window starts 2021-12-31 or 2022-01-01, outside. 71083 CT 2026 inside. Colonoscopy 10-year: 2026 inside.
Need classify each.
Let's enumerate.
Member 71081: DOB 1951-10-15 age 75 on 2026-12-31 eligible age 46-75 inclusive. Enrollment: 2026-01-01 to 03-21; 04-14 to 07-23; 08-22 to 12-31. Gaps of 23 and 29 days. Two gaps. Continuous enrollment allows no more than one gap. So not_eligible. Even though FIT 2025 not numerator anyway (N1 requires 2026). Classification not_eligible.
71082: DOB 1981-09-15 age 45 on Dec31. Age below 46, not eligible. Enrollment continuous. Has frailty and advanced illness in 2026 but age 45; E4 requires >=66; and not eligible due age. So not_eligible.
71083: DOB 1971 age55, continuous. Eligible. No exclusions. Screening: CT colonography 2026-08-02 (N4 within 5yr), FIT 2026-09-02 (N1). Compliant.
71084: DOB 1967 age59. Enrollment from 2026-04-15 to Dec31, not enrolled before. Not full measurement year. Need determine if one gap from Jan1 to Apr14 is 105 days >45, not eligible. If maybe continuous enrollment only requires no more than one gap up to45 during year, but if not enrolled Jan1, that's a gap >45. not_eligible. Screening flex sig 2021-05-09; if eligible maybe outside window? 5-year from 2021-12-31/2022-01-01, outside; but not eligible. Frailty only not relevant.
71085: age67 continuous. Eligible. No exclusions (no frailty/advanced). No screening. Non_compliant.
71086: age75 continuous. Eligible. No exclusions. CT colonography 2020-08-11; 5-year window? From 2021-12-31 or 2022-01-01; outside. No other. Non_compliant.
71087: DOB 1967 age59. Enrollment one gap 32 days (2026-01-01 to 04-20; 05-23 to Dec31) <=45, eligible. Exclusion E4? Age 59 <66, no. Frailty and advanced illness both documented in 2026 but age not >=66, so not excluded. Screening CT colonography 2021-04-28, outside 5-year window. No other. Non_compliant. Need confirm gap count: one gap of 32 days. Yes.
71088: DOB 1976 age50. Enrollment: three segments with gaps 17 and 14 days. Two gaps -> not eligible. Even though each <=45, more than one. not_eligible. Flex sig 2021 outside maybe.
71089: age59 continuous eligible no exclusions no screening non_compliant.
71090: DOB 1950 age76 on Dec31. Age >75, not eligible. Enrollment one gap 28 but age fails. not_eligible. FIT 2026 irrelevant.
71091: DOB 1950 age76, not eligible. Enrollment one gap39. not_eligible. FITs irrelevant.
71092: DOB 1971 age55 continuous eligible. Exclusion E1: diagnosis C18.7 malignant neoplasm sigmoid colon on 2024-10-06 (on/before 2026-12-31) -> excluded. Even if stool DNA 2023 maybe not numerator; exclusion before numerator. excluded.
71093: age50 continuous eligible no exclusions FIT 2026-07-02 -> compliant.
71094: DOB 1981 age45, not eligible due age. Enrollment one gap 51 days >45 also not eligible. not_eligible. FIT irrelevant.
71095: age47 continuous eligible, FIT 2026-05-26 -> compliant.
71096: age59 continuous eligible, colonoscopy 2026-03-13 -> compliant.
71097: age75, enrollment two? 2026-01-01 to 04-24; 05-16 to 12-31. One gap 21 days. Eligible (age75, one gap <=45). No exclusions. FIT 2026-10-11 -> compliant.
71098: age72 continuous eligible. No exclusions. Flexible sigmoidoscopy 2023-04-14 within 5-year window (2026-12-31 back 5 years to 2021-12-31? 2023 date inside). Compliant.
71099: age47, enrollment one gap 39 days <=45 eligible. No exclusions. Flexible sigmoidoscopy 2025-01-25 within 5-year. Compliant.
71100: age47. Enrollment 2026-03-16 through Dec31, not before. Gap Jan1-Mar15 75 days >45? Not eligible. Advanced illness alone no; not eligible. CT 2020 outside anyway. not_eligible.
Need count: Let's tally.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. Maybe any others? 71087 no. 71086 no. 71085 no. Total 7.
Non_compliant: eligible not excluded no numerator: 71085, 71086, 71087, 71089. Total 4.
Excluded: 71092 only? Need check if any eligible with E4? 71087 has frailty+advanced but age59 no. 71082 age45 not eligible. 71100 not eligible. 71084 not eligible. No. Excluded=1.
Not_eligible: remaining 8? Total 20 -7-4-1=8. List: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. Yes 8.
Denominator = eligible after exclusions = compliant+non_compliant = 11. Numerator=7. Rate=7/11*100 = 63.6363... round half up one decimal = 63.6 (since third decimal 3? 7/11=0.6363636 *100=63.6363; one decimal 63.6 because hundredths digit 3 <5). If half up no issue.
Need ensure arrays string IDs. Need include all required keys exactly. JSON only.
Double-check continuous enrollment and gap counting.
Prompt: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." The roster says gaps explicitly. For 71081 gaps 23 and 29 -> two gaps -> fail. For 71088 gaps 17 and14 -> fail. For 71094 one gap 51 -> fail and age fail. For 71090/91 one gap <=45 but age fail. For 71084 and 71100: not enrolled before date. Does the prompt maybe consider continuous from Apr15 to Dec31 with no gaps, but not full measurement year; not eligible. Yes.
Could there be nuance: If enrollment starts after Jan1, maybe allowed one gap of up to45 from Jan1? For 71084 gap Jan1-Apr14 inclusive? Let's compute: Jan1 to Apr14. If enrollment starts Apr15, days not enrolled Jan1-Apr14: Jan 31? From Jan1 through Apr14 inclusive = 31+28+31+14=104? If gap measured between coverage segments maybe from Jan1? It's >45. 71100 Jan1-Mar15 = 31+28+15=74 >45. Fail. If they considered no gap because not enrolled before not a gap? But full measurement year requires enrolled Jan1. So fail.
Need check age calculation: "so X years old on 2026-12-31" given. We trust. Age 46 through 75 inclusive. 71081 75 eligible age but enrollment fail. 71086 75 eligible. 71097 75 eligible. 71090/91 76 fail. 71082/94 45 fail. Good.
Exclusions only for eligible. 71092 C18.7 excluded. Any total colectomy? none. Hospice none. E4: age 66+ and both frailty+advanced illness during measurement year. Check members age66+: 71085 67 no frailty/adv; 71086 75 no; 71090 76 not eligible; 71091 76 not eligible; 71097 75 no; 71098 72 no. 71087 age59 has both but not age. So no E4 exclusions. Good.
Numerator details:
N1 FIT/FOBT during 2026. Compliant members: 71083 has FIT 2026 and CT; 71093, 71095, 71097. Also 71090/91/94 have FIT but not eligible. 71081 FIT 2025 not N1; not eligible anyway. N2 stool DNA: 71092 2023-02-25. If three-year window includes 2023? Need think: measurement year 2026; two years prior = 2025 and 2024? "during 2026 or the two years prior (three-year window)." Usually "two years prior" means measurement year plus two prior years: 2024, 2025, 2026. So 2023 outside. If exact 3 years back from 2026-12-31 includes 2023-12-31 only; 2023-02 outside. So no. But excluded anyway.
N3 flex sig during 2026 or four years prior (five-year window). Four years prior means 2022-2026? If calendar years: 2022,2023,2024,2025,2026. If exact 5 years back from Dec31 includes from 2021-12-31. Dates:
- 71084 2021-05-09 outside, not eligible.
- 71088 2021-07-01 outside, not eligible.
- 71098 2023-04-14 inside.
- 71099 2025-01-25 inside.
N4 CT colonography 5-year: 71083 2026 inside. 71086 2020-08-11 outside. 71087 2021-04-28 outside. 71100 2020 outside, not eligible.
N5 colonoscopy 10-year: 71096 2026 inside. No other colonoscopy.
Could 71087's CT 2021-04-28 be within 5-year if window includes 2021-01-01? Prompt says during 2026 or the four years prior (five-year window). Four years prior to 2026 are 2022-2025, not 2021. So outside. If exact measured back from Dec31: five-year window maybe 2021-12-31 to 2026-12-31, still outside. Good.
Need consider if exclusions evaluated before numerator: 71092 excluded even if numerator maybe not. Good.
Need output JSON with keys: denominator integer, numerator integer, excluded, not_eligible, rate number, compliant_members array strings, non_compliant_members, excluded_members, not_eligible_members. No extra keys. Ensure rate number 63.6 not string.
Need maybe sort arrays? Any order. Could sort ascending for neat.
Let's verify counts by list:
Compliant: ["71083","71093","71095","71096","71097","71098","71099"] length 7.
Non: ["71085","71086","71087","71089"] length4.
Excluded: ["71092"] length1.
Not: ["71081","71082","71084","71088","71090","71091","71094","71100"] length8.
Sum20. Denom 11. Numer 7. Rate 63.6.
Double-check member 71083: CT colonography 2026-08-02 and FIT 2026-09-02. No exclusions. Compliant.
Member 71093 FIT 2026. Compliant.
Member 71095 FIT. Compliant.
Member 71096 colonoscopy. Compliant.
Member 71097 age75 one gap21, FIT. Compliant.
Member 71098 age72 flex sig 2023. Compliant. Need if flex sig during 2026 or four years prior. 2023 is within four years prior? Measurement year 2026, four years prior: 2025, 2024, 2023, 2022. Yes.
Member 71099 one gap39, flex sig 2025. Compliant.
Could member 71087 be excluded by E4? Age 66 or older as of 2026-12-31? DOB 1967-06-23 => 59. No.
Could member 71084 be eligible if enrollment gap from Jan1 to Apr14 considered one gap 105 days >45; fail. Also frailty only. If eligible, flex sig 2021 outside; noncompliant. But not eligible.
Potential nuance: "no more than one gap of up to 45 days" could mean gaps only between enrollment segments, not initial missing enrollment. But "full measurement year" means must be enrolled Jan1; records with not enrolled before fail. Good.
Potential nuance: Age through Dec31: 46-75. Member 71082 and 71094 45. Not eligible. Exclusion E4 only if eligible; not relevant.
Need final only fenced JSON. Ensure no commentary. Use JSON block.
Need maybe include rate as 63.6 exactly. If denominator zero? no.
Let's craft final.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,147 tokens
We need answer JSON only. Need solve measure population for 20 members. Need be careful. 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.
Important: "no more than one gap of up to 45 days" means if multiple gaps, not eligible? Wording: full measurement year with no more than one gap of up to 45 days. So allowed at most one gap, length <=45. If two gaps even if small, fail. Also if gap >45 fail. Need ensure enrollment covers 2026-01-01 through 2026-12-31 except allowed gap. If starts after Jan 1 or ends before Dec31 fail. Some have continuous from later date not enrolled before: fail.
Numerator windows measured back from 2026-12-31:
N1 FIT/FOBT during 2026 (2026-01-01 to 2026-12-31).
N2 stool DNA during 2026 or two years prior = three-year window. Need exact dates? From 2024-01-01? Measured back from 2026-12-31: 2026 or two years prior likely 2024-01-01 through 2026-12-31? HEDIS often 3-year lookback includes year and two prior years. We can use date >= 2024-01-01. But stool DNA on 2023-02-25 is outside. If exactly 3 years back from Dec31 2023-12-31? But spec says during 2026 or the two years prior, so 2024-2026. 2023-02-25 outside.
N3 flex sig during 2026 or four years prior = five-year window: likely 2022-01-01 through 2026-12-31? Or date >= 2022-01-01. Need evaluate dates: 2021-05-09, 2021-04-28, 2021-07-01 outside; 2023-04-14 inside; 2025-01-25 inside.
N4 CT colonography during 2026 or four years prior = 2022-01-01 onwards? Evaluate: 2026-08-02 inside; 2020-08-11 outside; 2021-04-28 outside; 2020-11-17 outside.
N5 colonoscopy during 2026 or nine years prior = ten-year window: 2017-01-01? 2026-03-13 inside.
Exclusions before numerator, only eligible: E1 colorectal cancer C18-C21 any time on/before 2026-12-31. E2 total colectomy. E3 hospice during measurement year. E4 age >=66 as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Frailty/advanced illness alone no exclude.
Note exclusions only for eligible. If not eligible due age/enrollment, even if exclusion documented => not_eligible.
Need classify all.
Let's list each.
Member 71081: DOB 1951-10-15, age 75 on 2026-12-31 -> age eligible (46-75 inclusive). Enrollment: 2026-01-01 to 2026-03-21; gap 2026-03-22 to 2026-04-13? Let's count: Mar22-Apr13 inclusive 23 days? Then 2026-04-14 to 2026-07-23; gap Jul24-Aug21? 29 days; then Aug22-Dec31. Two gaps 23 and 29. Rule no more than one gap, so not eligible. Even though both <=45, two gaps fail. Screening FIT 2025-10-03 not N1 because not 2026; no other. But not_eligible.
71082: DOB 1981-09-15, age 45 at 2026-12-31. Age fails (<46). Not eligible. Has frailty and advanced illness but age not 66, and not eligible anyway.
71083: age 55 eligible. Enrollment continuous. No exclusions. Screening: CT colonography 2026-08-02 (N4) and FIT 2026-09-02 (N1). Compliant.
71084: DOB 1967 age 59. Enrollment starts 2026-04-15, not enrolled before. Continuous enrollment full year fails. Not eligible. Frailty alone, flex sig 2021 outside, but not eligible.
71085: age 67 eligible. Continuous. No exclusions (no frailty etc). No screening. Non_compliant.
71086: age 75 eligible. Continuous. No exclusions. CT colonography 2020-08-11. N4 window during 2026 or four years prior. Four years prior: if calendar 2022-2026, 2020 outside. If exact 5-year from 2021-12-31? 2020 outside. Non_compliant.
71087: age 59. Enrollment one gap 32 days (allowed). Eligible. Exclusion E4? age 59 <66, so no. Frailty and advanced illness in 2026 but age not 66; not exclude. Screening CT colonography 2021-04-28. N4 five-year window? If five-year window measured back from 2026-12-31: during 2026 or four years prior. Could be from 2022-01-01 or exact 2021-12-31? 2021-04-28 is more than 5 years? From 2026-12-31 back 5 years is 2021-12-31? If "during 2026 or the four years prior" means 2022,2023,2024,2025,2026. 2021 not. Non_compliant. Need be careful: five-year window could include 2021-12-31? But date 2021-04-28 still outside if exact 5 years (2021-12-31 onward? Actually 5 years before 2026-12-31 is 2021-12-31; on/after 2021-12-31). 2021-04-28 before. So non_compliant.
71088: age 50. Enrollment has gaps 17 and 14 days, two gaps -> not eligible. No exclusion. Flex sig 2021 outside. Not_eligible.
71089: age 59, continuous, no exclusions, no screening. Non_compliant.
71090: DOB 1950-05-28 age 76 on 2026-12-31. Age fails >75. Not eligible. Even one gap 28, FIT 2026. Not eligible.
71091: age 76 fails. Not eligible. One gap 39. FIT 2026. Not eligible.
71092: age 55, continuous. Eligible. Exclusion E1: colorectal cancer diagnosis C18.7 on 2024-10-06, any time on/before 2026-12-31. Excluded. Stool DNA 2023 outside but irrelevant. Excluded.
71093: age 50, continuous, no exclusions, FIT 2026-07-02. Compliant.
71094: age 45 fails. Also enrollment one gap 51 >45. Not eligible. FIT 2026 irrelevant. Not eligible.
71095: age 47, continuous, no exclusions, FIT 2026-05-26. Compliant.
71096: age 59, continuous, no exclusions, colonoscopy 2026-03-13. Compliant.
71097: age 75, enrollment one gap 21 days <=45, eligible. No exclusions. FIT 2026-10-11. Compliant.
71098: age 72, continuous, no exclusions. Flex sig 2023-04-14. N3 five-year window during 2026 or four years prior. 2023 within. Compliant.
71099: age 47, enrollment one gap 39 <=45, eligible. No exclusions. Flex sig 2025-01-25 within five-year. Compliant.
71100: age 47. Enrollment starts 2026-03-16, not full year, fail. Not eligible. Advanced illness alone, CT 2020 outside. Not eligible.
Counts: eligible after exclusions = denominator = compliant + non_compliant. Excluded only eligible with exclusion. Let's tally.
Eligible:
71083 compliant
71085 non
71086 non
71087 non
71089 non
71092 excluded
71093 compliant
71095 compliant
71096 compliant
71097 compliant
71098 compliant
71099 compliant
Maybe any other eligible? 71081 no, 71084 no, 71088 no, 71090 no, 71091 no, 71094 no, 71100 no, 71082 no. That's 12 eligible: 8 compliant? Let's count compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7. Wait also maybe 71087? no. 71085, 71086, 71087, 71089 non =4. Excluded 71092 =1. Denominator after exclusions = compliant+non_compliant = 11? Spec denominator integer members in eligible population after exclusions removed (compliant + non_compliant). So denominator = 11. Numerator = 7. Excluded =1. Not eligible = 8? Total 20: 11+1+8=20. Rate = 7/11*100 = 63.6363 -> round half up one decimal = 63.6? 63.636 -> one decimal: 63.6 if third decimal 3? Let's compute: 7/11=0.6363636*100=63.63636. To one decimal, look hundredths: 63.6 with next digit 3? Actually 63.636: tenths=6, hundredths=3, so 63.6. Yes.
Need ensure no member excluded by E4: Only age >=66 with both frailty and advanced illness during measurement year. Check:
71081 age 75 no frailty/advanced.
71086 age 75 no.
71090 age 76 not eligible; no.
71091 age 76 not eligible; no.
71097 age 75 no.
71098 age 72 no.
71085 age 67 no.
71087 age 59 no. 71082 age 45 has both but not age and not eligible. 71084 frailty only not eligible. 71100 advanced illness only not eligible. So none E4.
Need double-check enrollment gaps and rule. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." For 71081 two gaps -> fail. 71088 two gaps -> fail. For gap lengths given? Need maybe compute if one gap >45? 71094 one gap 51 fail and age fail. 71084 starts late fail. 71100 starts late fail. Others one gap <=45 eligible if age: 71087, 71097, 71099. Also 71090/91 one gap <=45 but age fail. Good.
Potential ambiguity: Numerator windows exact dates. Need check stool DNA 2023-02-25 for 71092: if three-year window measured back from 2026-12-31 maybe includes 2023-12-31 onward, so no. But excluded anyway. Flex sig 2021 dates: if five-year window exact from 2021-12-31 or 2022-01-01, all 2021 dates outside. Good. CT 2020/2021 outside. Colonoscopy 2026 inside. FIT 2025 for 71081 not numerator because N1 during 2026 only. Good.
Need output JSON exactly with required keys. Member IDs strings. Any order. Need ensure counts match arrays. Let's produce.
But let's thoroughly audit each member to avoid mistakes.
Detailed:
71081: Age: 2026-12-31 minus 1951-10-15 = 75. Eligible age. Enrollment periods: Jan1-Mar21, Apr14-Jul23, Aug22-Dec31. Gaps: Mar22-Apr13 inclusive: March has 31 days; 22-31 =10 days, April 1-13=13, total 23. Jul24-Aug21: July 24-31=8, Aug1-21=21, total29. Two gaps. Not eligible. Could the rule mean no gap >45 and no more than one gap? Yes. Not eligible. If someone argued two gaps allowed if total? But wording "no more than one gap" explicit. So not eligible.
71082: 45. Not eligible. If age through 2026-12-31, DOB 1981-09-15, turns 45 in 2026, under 46. not eligible. Exclusion E4 requires age 66; no.
71083: 55, continuous, CT and FIT. No exclusion. compliant.
71084: Enrollment 2026-04-15 through Dec31. Missing Jan1-Apr14. Even if gap? Not full measurement year; not eligible. Age 59. Not eligible.
71085: Age 67, continuous. No screening. Non_compliant.
71086: Age 75 continuous. CT 2020-08-11. N4 5-year window. Let's define look-back measured back from 2026-12-31: during 2026 or four years prior. Four years prior = 2022,2023,2024,2025. 2020 not. Non_compliant.
71087: Enrollment Jan1-Apr20, May23-Dec31. Gap Apr21-May22 inclusive: Apr 21-30=10, May1-22=22, total32. One gap <=45. Eligible. Age59. Frailty and advanced illness in 2026 but E4 age >=66 false. CT 2021-04-28: five-year window? If four years prior plus 2026: 2022-2026. Not. Non_compliant.
71088: Enrollment Jan1-Feb16, Mar6-May13, May28-Dec31. Gaps Feb17-Mar5: Feb 17-28=12? 2026 not leap, Feb has 28. 17-28 inclusive 12 days, Mar1-5=5 =>17. Gap May14-May27: 14 days. Two gaps, fail. Not eligible. Age50. Flex sig 2021-07-01 outside anyway. Not eligible.
71089: Age59 continuous no screening non.
71090: Age76 fail. Enrollment one gap 28 (May28-Jun24? They said 28). Not eligible. FIT during 2026 but not eligible.
71091: Age76 fail. Gap 39. Not eligible. FITs 2026 but not eligible.
71092: Age55 continuous. CRC C18.7 2024-10-06 -> E1. Excluded. Stool DNA 2023 not numerator; even if had numerator, excluded. Good.
71093: Age50 continuous FIT 2026 compliant.
71094: Age45 fail; gap51 also fail. Not eligible.
71095: Age47 continuous FIT 2026 compliant.
71096: Age59 continuous colonoscopy 2026 compliant.
71097: Age75. Enrollment Jan1-Apr24, May16-Dec31; gap Apr25-May15: Apr25-30=6, May1-15=15 total21. One gap <=45. Eligible. FIT 2026 compliant.
71098: Age72 continuous. Flex sig 2023-04-14. Five-year window: 2023 inside. compliant.
71099: Age47. Enrollment Jan1-Jun15, Jul25-Dec31; gap Jun16-Jul24: Jun16-30=15, Jul1-24=24 total39. One gap <=45. Eligible. Flex sig 2025-01-25 within 2022-2026. compliant.
71100: Age47. Enrollment Mar16-Dec31, missing Jan1-Mar15. Not eligible. Advanced illness alone and not age 66. Not eligible.
Counts: not_eligible list: 71081,71082,71084,71088,71090,71091,71094,71100 = 8. Excluded: 71092 =1. non_compliant: 71085,71086,71087,71089 =4. compliant: 71083,71093,71095,71096,71097,71098,71099 =7. denominator=11. numerator=7. rate=63.6.
Need ensure JSON number rate one decimal. Could output 63.6. Use arrays strings. No extra keys. Final only fenced JSON. Ensure no trailing comments.
Double-check if denominator could include excluded? Task says denominator members in eligible population after exclusions removed (compliant + non_compliant). Yes 11. Some measure specs denominator initial eligible before exclusions? But required says after exclusions. Good.
Potential issue: Exclusion E1: colorectal cancer any time on or before 2026-12-31. Member 71092 diagnosis C18.7 malignant neoplasm of sigmoid colon. C18.7 within C18-C21. Excluded. Good.
Potential issue: total colectomy none.
Potential issue: Hospice none.
Potential issue: Frailty + advanced illness for age 66+ during measurement year. Member 71082 age45 has both but not eligible due age. Not excluded. Member 71084 frailty 2026-03-11 but not enrolled before Apr15, and not eligible. If he were eligible, frailty alone no exclude. Member 71100 advanced illness 2026-01-23 before enrollment? It says not enrolled before Mar16; but exclusion evaluated only if eligible. Not eligible. If he were eligible, advanced illness alone no exclude. Good.
Now final JSON. Need maybe order of IDs any. Include all required keys exactly. Ensure no extra key. Use integers. Rate number maybe 63.6. Final in fenced code block only.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,297 tokens
We need answer JSON only. Need analyze measure population for 20 members. Need be careful. 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: full measurement year with no more than one gap of up to 45 days. Means must be enrolled Jan 1 through Dec 31 except at most one gap, gap length <=45 days. If multiple gaps, not eligible even if each <=45? Wording "no more than one gap" yes at most one gap. Also must cover full measurement year? If enrollment starts after Jan 1 or ends before Dec 31, not eligible unless maybe gap at beginning/end? Usually continuous enrollment with gap: must be enrolled Jan 1-Dec 31 with allowable gap. If not enrolled before date after Jan 1 => gap from Jan 1 to start? Could count as a gap? Need decide. The examples include members not enrolled before 2026-04-15, continuous from that date. They likely have a gap from Jan 1 to Apr 14 = 104 days? If gap counts, >45 and not eligible. But could also not enrolled at start, fail continuous enrollment. We need evaluate. The prompt says "full measurement year with no more than one gap of up to 45 days." So if enrollment starts 2026-04-15, there's gap Jan 1-Apr 14 (104 days), fail. If starts 2026-03-16, gap Jan 1-Mar 15 = 74 days fail. So not eligible.
Exclusions evaluated before numerator only if eligible. Exclusions: E1 colorectal cancer any time on/before 2026-12-31. E2 total colectomy any time. 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 not exclude.
Numerator lookback from 2026-12-31:
N1 FIT/FOBT during 2026.
N2 stool DNA during 2026 or two years prior (3-year window). Need exact dates? "during 2026 or the two years prior (three-year window)" measured back from 2026-12-31. Three-year window likely 2024-01-01 through 2026-12-31? Or measured back: on or after 2024-01-01? If two years prior from 2026-12-31 = 2024-12-31? Hm. Need parse. It says during 2026 or the two years prior (three-year window). That is calendar years 2024, 2025, 2026? Typically HEDIS 2026 CRC: FIT/FOBT during 2026; stool DNA during 2024, 2025, 2026 (3-year window); flex sig during 2022-2026 (5-year); CT colonography 2022-2026; colonoscopy 2017-2026 (10-year). Since measurement year is calendar, use calendar-year windows: N2 on/after 2024-01-01; N3 on/after 2022-01-01; N4 on/after 2022-01-01; N5 on/after 2017-01-01. But phrase "look-back window measured back from 2026-12-31" could be exact 3 years = on/after 2023-12-31? But "during 2026 or the two years prior" strongly indicates two full calendar years prior (2025 and 2024) plus 2026. Need use that. Need see cases: Member 71092 stool DNA 2023-02-25. If 3-year window calendar 2024-2026, not numerator. If exact 3 years from 2026-12-31 (>=2023-12-31) also not. So irrelevant? Member 71099 flex sig 2025-01-25, within 5-year either. Member 71098 flex sig 2023-04-14, within 5-year either. Member 71088 flex sig 2021-07-01: calendar five-year 2022-2026 not; exact five years from 2026-12-31 >=2021-12-31? 2021-07-01 not. Member 71084 flex sig 2021-05-09 not. Member 71087 CT 2021-04-28 not. Member 71086 CT 2020-08-11 not. Member 71100 CT 2020 not. So exact vs calendar only perhaps stool DNA 2023 not in either. Good.
Need classify each member.
Let's enumerate.
Member 71081: DOB 1951-10-15 age 75 at 2026-12-31 (eligible age 46-75 inclusive). Enrollment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps: from 2026-03-22 to 2026-04-13? They say gaps of 23 and 29 days. Two gaps. Continuous enrollment requirement no more than one gap. Therefore not eligible. Even if gaps <=45, two gaps fail. Screening FIT 2025-10-03 not during 2026, irrelevant. Status not_eligible.
Member 71082: DOB 1981-09-15 age 45 on 2026-12-31. Age 46-75 required, so not eligible. Enrollment continuous. Has frailty and advanced illness in 2026 but exclusion only if eligible; age fails -> not_eligible. Note E4 age >=66, irrelevant. not_eligible.
Member 71083: DOB 1971 age 55 eligible. Continuous enrollment no gaps. No exclusions. Numerator: CT colonography 2026-08-02 N4 within 5-year, FIT 2026 N1. Compliant. denominator.
Member 71084: DOB 1967 age 59 eligible age. Enrollment starts 2026-04-15 through 12/31 continuous from that date, not enrolled before. Need continuous full measurement year with <=1 gap up to 45 days. Gap from Jan 1 to Apr 14? Count days not enrolled: Jan 1 through Apr 14 inclusive? Jan 31 + Feb 28 + Mar 31 + Apr 14 = 104 days (2026 not leap). >45, so not eligible. If one gap but >45 fail. Also if not full year fail. Screening flex sig 2021 not numerator. Frailty 2026-03-11 age 59 not E4. not_eligible.
Member 71085: DOB 1959 age 67 eligible age. Continuous enrollment. No exclusions (no cancer/colectomy/hospice; age >=66 but no frailty/advanced illness). Numerator no screening. Non_compliant. denominator.
Member 71086: DOB 1951 age 75 eligible. Continuous. No exclusions. CT colonography 2020-08-11. N4 window 5-year: during 2026 or four years prior. Calendar 2022-2026; 2020 too old. If exact measured back from 2026-12-31 four years prior = 2022-01? Actually 4 years prior date 2022-12-31? Either 2020 not. Non_compliant.
Member 71087: DOB 1967 age 59 eligible age. Enrollment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days (they say). <=45 and one gap, eligible. Exclusions: age 59 not E4, frailty+advanced illness but age <66, not excluded. No cancer etc. Numerator: CT colonography 2021-04-28. N4 window 5-year: 2022-2026? 2021 too old. If exact 5 years from 2026-12-31 maybe on/after 2021-12-31? 2021-04-28 too old. No 2026 screening. Non_compliant. Need note frailty+advanced illness does not exclude due age.
Member 71088: DOB 1976 age 50 eligible. Enrollment three segments: 2026-01-01 to 02-16; 03-06 to 05-13; 05-28 to 12-31. Gaps 17 and 14 days. Two gaps -> not eligible (no more than one gap). Also maybe continuous full year with multiple gaps fail. not_eligible. Screening flex sig 2021 not relevant.
Member 71089: DOB 1967 age 59 eligible, continuous, no exclusions, no screening. Non_compliant.
Member 71090: DOB 1950 age 76 at 2026-12-31. Age max 75, not eligible. Enrollment one gap 28 days, but age fails. not_eligible. FIT 2026 irrelevant.
Member 71091: DOB 1950 age 76 not eligible. not_eligible.
Member 71092: DOB 1971 age 55 eligible, continuous. Exclusion E1: colorectal cancer C18.7 diagnosed 2024-10-06, any time on/before 2026-12-31. Excluded. Exclusions before numerator. Stool DNA 2023 would not count anyway maybe, but excluded. excluded.
Member 71093: DOB 1976 age 50 eligible, continuous, no exclusions, FIT 2026-07-02 N1. Compliant.
Member 71094: DOB 1981 age 45 not eligible (age below 46). Enrollment one gap 51 days also fail but age first. not_eligible. FIT irrelevant.
Member 71095: DOB 1979 age 47 eligible, continuous, no exclusions, FIT 2026-05-26. Compliant.
Member 71096: DOB 1967 age 59 eligible, continuous, no exclusions, colonoscopy 2026-03-13 N5. Compliant.
Member 71097: DOB 1951 age 75 eligible. Enrollment one gap 21 days (from Apr 25 to May 15? They say one gap 21) <=45. Eligible. No exclusions. FIT 2026-10-11. Compliant.
Member 71098: DOB 1954 age 72 eligible, continuous, no exclusions. Flexible sigmoidoscopy 2023-04-14. N3 five-year window during 2026 or four years prior. If calendar years 2022-2026, 2023 qualifies. If measured back exact 5 years from 2026-12-31, on/after 2021-12-31? qualifies. Compliant.
Member 71099: DOB 1979 age 47 eligible. Enrollment one gap 39 days <=45. No exclusions. Flexible sigmoidoscopy 2025-01-25 within five-year. Compliant.
Member 71100: DOB 1979 age 47 eligible age. Enrollment starts 2026-03-16 through 12/31, not enrolled before. Gap Jan 1-Mar 15 = 74 days >45, fail continuous enrollment. not eligible. Advanced illness alone no exclusion; not eligible anyway. CT 2020 irrelevant.
Need tally.
Eligible denominator after exclusions:
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099? Also maybe 71087 no, 71085 no, 71086 no. Count 7.
Non_compliant: 71085, 71086, 71087, 71089. Count 4.
Denominator = 11.
Excluded: 71092 only. Count 1.
Not_eligible: remaining 20 - 11 -1 = 8: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. Count 8.
Rate = numerator/denominator *100 = 7/11*100 = 63.6363636. Rounded half up one decimal = 63.6? 63.636 -> one decimal 63.6 if hundredths 3? Actually 7/11=0.636363; *100=63.6363. To one decimal, look at second decimal: 63.6 with next digit 3 <5, so 63.6. If half-up no issue.
Need ensure no excluded due E4: members age >=66 with both frailty and advanced illness during measurement year. Check 71087 age 59 no. 71082 age 45 no. 71100 age 47 advanced illness only no. 71084 frailty only no. Any older with both? None. So only cancer exclusion.
Need double-check enrollment gap counts and eligibility. The spec: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." For member 71081: two gaps of 23 and 29. Not eligible because >1 gap. Member 71088 two gaps. Member 71084 and 71100 start late. Could there be interpretation that continuous enrollment from start date through Dec 31 and not enrolled before is not a gap but simply not full measurement year; still fail because not full measurement year. yes.
Need check member 71090 and 71091 age 76: DOB 1950, age on 2026-12-31? 1950-05-28 -> 76. yes. 1950-07-12 -> 76. Not eligible.
Member 71082 and 71094 age 45 on 2026-12-31; required 46 through 75; not eligible.
Need ensure member 71081 age 75, eligible age but enrollment two gaps. If two gaps each <=45, some measures allow at most one gap? Prompt says no more than one gap. yes not eligible.
Potential ambiguity: "full measurement year with no more than one gap of up to 45 days" could mean total gap days? No, no more than one gap. Good.
Potential issue: Numerator windows exact dates. Let's compute exact for N3 if "during 2026 or the four years prior (five-year window) measured back from 2026-12-31". Four years prior from 2026-12-31 could be 2022-01-01? Or 2022-12-31? Need if event on 2021-12-31 maybe. But no borderline except 2021 events. 2023 and 2025 qualify. 2021 not. N4 2021 events not. N2 2023 not. So no impact.
Need produce JSON exactly with required keys. Arrays strings. Rate number 63.6 (not string). denominator 11, numerator 7, excluded 1, not_eligible 8. compliant_members etc. Any order okay. Ensure each member exactly once.
Let's list all IDs:
71081 not_eligible
71082 not_eligible
71083 compliant
71084 not_eligible
71085 non_compliant
71086 non_compliant
71087 non_compliant
71088 not_eligible
71089 non_compliant
71090 not_eligible
71091 not_eligible
71092 excluded
71093 compliant
71094 not_eligible
71095 compliant
71096 compliant
71097 compliant
71098 compliant
71099 compliant
71100 not_eligible
Check counts: compliant: 71083,71093,71095,71096,71097,71098,71099 =7. non: 71085,71086,71087,71089=4. excluded: 71092=1. not: 71081,71082,71084,71088,71090,71091,71094,71100=8. total 20.
Need maybe member 71087: Has one gap 32 days from 2026-04-21 through 2026-05-22? Let's count: Apr 21-30 10 days, May 1-22 22 days =32. okay. Eligible. But has frailty and advanced illness during measurement year; age 59 so no E4. Noncompliant due CT 2021 too old. If CT colonography during 2026 or four years prior: 2021-04-28 is more than 4 years prior if window is 2022-01-01 onward; yes non. If exact from 2026-12-31 back 4 years = 2022-01-01? Actually four years prior to Dec 31 2026 is Dec 31 2022, five-year window could include Jan 1 2022? Let's not need. 2021 not.
Potential member 71084: Flex sig 2021-05-09. If exact five-year window measured back from 2026-12-31 maybe on/after 2021-12-31 or 2022-01-01; not. But not eligible anyway.
Potential member 71100: Enrollment gap Jan 1-Mar15. If not enrolled before, could not be considered gap but simply not enrolled full measurement year; fail. yes.
Now need final JSON only fenced. Ensure no extra text. But system says final answer exactly one fenced JSON code block. We can output.
Double-check rate rounding half up to one decimal. 63.636 -> 63.6. If using Python round? But half-up not matter. If 63.65 would need up. Good.
Need maybe denominator definition: "members in the eligible population after exclusions are removed (compliant + non_compliant)" = 11. Numerator = compliant = 7.
Could excluded member 71092 also fail numerator due stool DNA 2023 but excluded anyway. E1 any time on/before 2026-12-31, diagnosis C18.7 malignant neoplasm sigmoid colon. Colorectal cancer C18-C21. yes.
Any total colectomy? none. Hospice none.
Could advanced illness + frailty for member 71082 but age 45 not eligible; exclusions only for eligible. not_eligible.
Need consider member 71081 gaps: If "no more than one gap of up to 45 days" maybe two gaps if total gap <=45? It says no more than one gap; so fail. If they gave two gaps deliberately to test. yes.
Potential continuous enrollment and gap at beginning/end: For member 71090, age fails. For 71091 age fails. For 71094 age fails and gap 51; not eligible. For 71100 start late and advanced illness; not eligible. For 71084 start late; not eligible. Good.
Now final. Ensure JSON valid. Use arrays of strings. Rate as number maybe 63.6. No trailing comma.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GPT-5.6 Terra · OpenAI5.3s · 472 out | 4.6s · 410 out | 6.0s · 456 out
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100GLM-5.3 Flash · Z.ai43.3s · 2,483 out | 58.4s · 3,282 out | 56.4s · 3,187 out
Reasoning · 2,305 tokens
Let me work through each member against the QM-CRC spec.
Measurement year: 2026-01-01 to 2026-12-31.
Age 46–75 as of 2026-12-31.
Continuous enrolment: full measurement year, 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)" — three-year window means 2024, 2025, 2026. So stool DNA on or after 2024-01-01 (or perhaps 2023-12-31... typically HEDIS: during measurement year or two years prior → 2024–2026).
- 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: CRC any time on or before 2026-12-31.
- E2: Total colectomy.
- E3: Hospice during measurement year.
- E4: Age 66+ AND both frailty and advanced illness during measurement year.
Now members:
71081: DOB 1951-10-15, 75 as of 2026-12-31. Age OK. Enrolment gaps: 2026-03-21 to 2026-04-14 and 2026-07-23 to 2026-08-22. Let me compute gap days. Gap 1: 2026-03-22 through 2026-04-13? Enrolment ends 03-21, resumes 04-14. Gap days = days between: from 03-22 to 04-13 inclusive = 10 (Mar 22–31) + 13 (Apr 1–13) = 23 days. Gap 2: ends 07-23, resumes 08-22: 07-24 to 08-21 = 8 + 21 = 29 days. Two gaps — spec says "no more than one gap of up to 45 days". Two gaps → fails continuous enrolment → not_eligible.
Wait, but HEDIS actually allows multiple gaps up to 45 days total... but the spec here says "no more than one gap of up to 45 days". Take the spec as governing: two gaps, even though each ≤45 days, fails. So 71081 not_eligible (enrolment).
71082: DOB 1981-09-15, 45 years old as of 2026-12-31. Age fails (46–75). → not_eligible. Frailty/advanced illness irrelevant.
71083: 55, continuous. CT colonography 2026-08-02 → N4, within window. FIT 2026-09-02 → N1 too. Compliant.
71084: 59, enrolled from 2026-04-15 only — not enrolled full year. "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Being not enrolled from 01-01 to 04-14 is a gap of ~105 days (Jan 1 – Apr 14 = 104 days) > 45. Fails → not_eligible (enrolment). Frailty alone doesn't exclude, and he's not in eligible pop anyway.
71085: 67, continuous, no screening, no exclusions. → non_compliant.
71086: 75, continuous. CT colonography 2020-08-11. Window for CT colonography is five years: 2026 or four prior → 2022–2026. 2020 is outside. → non_compliant.
71087: 59 (age OK), one gap of 32 days (04-21 to 05-22: Apr 21–30 = 10, May 1–22 = 22 → 32 days, ≤45, one gap) → enrolment OK. CT colonography 2021-04-28 — outside five-year window (2022–2026). But exclusion E4: age 66+? He's 59, so no. Frailty 2026-05-25 and advanced illness 2026-06-21 — but age < 66, so E4 doesn't apply. No other exclusions. No qualifying screening → non_compliant.
71088: 50, gaps of 17 and 14 days — two gaps → fails enrolment → not_eligible.
71089: 59, continuous, no screening, no exclusions → non_compliant.
71090: 76 as of 2026-12-31 → age fails (46–75) → not_eligible. FIT in 2026 irrelevant.
71091: 76 → not_eligible.
71092: 55, continuous. Stool DNA 2023-02-25 — three-year window is 2024–2026, so outside. But exclusion E1: C18.7 diagnosis 2024-10-06, on or before 2026-12-31 → excluded. (E1 evaluated before numerator; even if stool DNA were in window, excluded.)
71093: 50, continuous, FIT 2026-07-02 → compliant.
71094: 45 → age fails → not_eligible.
71095: 47, continuous, FIT 2026-05-26 → compliant.
71096: 59, continuous, colonoscopy 2026-03-13 → N5 → compliant.
71097: 75, one gap of 21 days (04-25 to 05-15: Apr 25–30 = 6, May 1–15 = 15 → 21 days) → OK. FIT 2026-10-11 → compliant.
71098: 72, continuous. Flex sig 2023-04-14 — five-year window 2022–2026 → within. → compliant.
71099: 47, one gap of 39 days (06-16 to 07-24: Jun 16–30 = 15, Jul 1–24 = 24 → 39 days) → OK. Flex sig 2025-01-25 → within 2022–2026 → compliant.
71100: 47, but enrolled only from 2026-03-16. Gap from 01-01 to 03-15 = 31 + 28 + 15 = 74 days > 45 → fails enrolment → not_eligible. Advanced illness alone doesn't exclude anyway.
Now count:
not_eligible: 71081 (two gaps), 71082 (age 45), 71084 (enrolment), 71088 (two gaps), 71090 (76), 71091 (76), 71094 (45), 71100 (enrolment) → 8 members.
excluded: 71092 → 1 member.
Eligible after exclusions: 20 − 8 − 1 = 11.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 → 7.
Non-compliant: 71085, 71086, 71087, 71089 → 4.
Check: 7 + 4 = 11 ✓. 11 + 1 + 8 = 20 ✓.
Rate: 7/11 × 100 = 63.636... → 63.6.
Double-check age calculations as of 2026-12-31:
- 71081: 1951-10-15 → 75 ✓ (within 46–75).
- 71086: 1951-02-07 → 75 ✓.
- 71090: 1950-05-28 → 76 ✗.
- 71091: 1950-07-12 → 76 ✗.
- 71082: 1981-09-15 → 45 ✗.
- 71094: 1981-12-09 → 45 ✗.
- 71088: 1976-06-16 → 50 ✓ but two gaps.
- 71093: 1976-11-04 → 50 ✓.
Enrolment gaps recheck:
- 71081: two gaps (23, 29) → fails. Yes, spec says "no more than one gap of up to 45 days."
- 71087: one gap 32 days → passes.
- 71088: gaps 17 and 14 → fails.
- 71090: one gap 28 → passes but age fails.
- 71091: one gap 39 → passes but age fails.
- 71097: one gap 21 → passes.
- 71099: one gap 39 → passes.
- 71094: one gap 51 days (04-25 to 06-14: Apr 25–30 = 6, May 31, Jun 1–14 = 14 → 6+31+14 = 51) > 45, plus age 45 fails anyway → not_eligible.
71092: stool DNA 2023-02-25. Three-year window: "during 2026 or the two years prior (three-year window)" → 2024, 2025, 2026. 2023 outside. But excluded via E1 regardless.
Everything checks out.
Rate: 63.6.
Member ID lists:
- compliant: ["71083","71093","71095","71096","71097","71098","71099"]
- non_compliant: ["71085","71086","71087","71089"]
- excluded: ["71092"]
- not_eligible: ["71081","71082","71084","71088","71090","71091","71094","71100"]
Output JSON only.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,104 tokens
Let me work through each member carefully.
Measure QM-CRC, 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 (3-year window: 2024-01-01? Actually "three-year window" — measured back from 2026-12-31, so 2026 or the two years prior: 2024, 2025, 2026. Any date in 2024 through 2026 presumably; actually the window would be from 2024-01-01? Hmm. "during 2026 or the two years prior (three-year window)". Two years prior to 2026 are 2025 and 2024. So stool DNA on/after 2024-01-01? But some measures use exact look-back (2024-01-01... actually HEDIS uses Dec 31 of measurement year minus... HEDIS COL: stool DNA within 3 years, i.e., since 3 years before end of measurement year). But the spec here says "during 2026 or the two years prior (three-year window)". So calendar years 2024, 2025, 2026. Stool DNA 2023-02-25 would NOT qualify (that's three years prior).
Wait — but let me check: "N2. Stool DNA test during 2026 or the two years prior (three-year window)." So the window covers 2026, 2025, 2024. A 2023 test is outside. Member 71092 has stool DNA 2023-02-25 — outside window, but also has colorectal cancer C18.7 in 2024 → excluded via E1.
- N3: Flex sig during 2026 or four years prior (five-year window): 2022–2026. So 2021 flex sig is outside; 2022+ qualifies.
- N4: CT colonography 2022–2026.
- N5: Colonoscopy 2017–2026.
Exclusions:
- E1: colorectal cancer any time on or before 2026-12-31.
- E2: total colectomy any time.
- E3: hospice during measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Enrolment: full measurement year with no more than one gap of up to 45 days. So members not enrolled at the start (mid-year starts) fail continuous enrolment. Members with two gaps fail (even if each ≤45). Members with one gap >45 days fail.
Also age: 46–75 as of 2026-12-31.
Let me go member by member.
**71081**: DOB 1951-10-15, age 75 on 2026-12-31 (turns 75 on 2026-10-15). Age 75 → eligible age range (46–75 inclusive). Enrolment: gaps of 23 and 29 days — that's two gaps. "no more than one gap of up to 45 days" — two gaps means fails continuous enrolment → not_eligible.
Wait, check gap lengths: 2026-03-21 to 2026-04-14: gap. From 03-21 (last day enrolled) to 04-14 (first day re-enrolled): days between = March 22–April 13 = 10 + 13 = 23 days. Yes 23. Second gap: 07-23 to 08-22: July 24–Aug 21 = 8 + 21 = 29 days. Two gaps → fails. Not eligible.
Screening: FIT 2025-10-03 — during 2026? No, 2025. FIT is N1 only during 2026. So wouldn't meet numerator anyway. But status is not_eligible due to enrolment.
**71082**: DOB 1981-09-15, age 45 on 2026-12-31. Fails age (46–75). → not_eligible. Even though frailty + advanced illness documented, exclusion evaluated only for eligible members; "a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented." So not_eligible.
**71083**: Age 55, continuous enrolment. Screening: CT colonography 2026-08-02 (N4, within window), FIT 2026-09-02 (N1). Meets numerator. No exclusions. → compliant.
**71084**: Age 59. Enrolment: starts 2026-04-15, not enrolled before. Fails continuous enrolment (not enrolled full year) → not_eligible. Flex sig 2021-05-09 outside 5-year window anyway. Frailty alone doesn't exclude, and age <66 anyway. → not_eligible.
**71085**: Age 67, continuous. No screening, no exclusions. → non_compliant.
**71086**: Age 75 (DOB 1951-02-07; on 2026-12-31 she is 75). Continuous enrolment. CT colonography 2020-08-11 — N4 window is 2022–2026 (2026 or four years prior: 2025, 2024, 2023, 2022). 2020 is outside. So no qualifying screening → non_compliant. No exclusions. → non_compliant.
**71087**: Age 59. Enrolment: one gap of 32 days (04-20 to 05-23: April 21–May 22 = 10 + 22 = 32 days). One gap ≤45 → continuous enrolment OK. Screening: CT colonography 2021-04-28 — outside 5-year window (2022–2026). So no qualifying screening. Exclusions: age 59 <66, so E4 doesn't apply (requires 66+). Frailty and advanced illness documented but E4 requires age 66+. → in denominator, no numerator → non_compliant.
**71088**: Age 50. Enrolment: gaps 17 and 14 days — two gaps → fails. → not_eligible. Flex sig 2021-07-01 outside window anyway (5-year window 2022–2026). Not eligible.
**71089**: Age 59, continuous, no screening, no exclusions → non_compliant.
**71090**: Age 76 on 2026-12-31 (DOB 1950-05-28). Fails age → not_eligible. (FIT in 2026 irrelevant.)
**71091**: Age 76 (DOB 1950-07-12). Fails age → not_eligible.
**71092**: Age 55, continuous. Stool DNA 2023-02-25 — N2 window is 2024–2026, so outside. But colorectal cancer C18.7 diagnosed 2024-10-06 → E1 exclusion (any time on or before 2026-12-31). In eligible population (age OK, enrolment OK) → excluded.
**71093**: Age 50, continuous, FIT 2026-07-02 → N1. → compliant.
**71094**: Age 45 on 2026-12-31 (DOB 1981-12-09). Fails age → not_eligible. Also gap of 51 days fails enrolment, but age fails first; status still not_eligible.
**71095**: Age 47, continuous, FIT 2026-05-26 → compliant.
**71096**: Age 59, continuous, colonoscopy 2026-03-13 → N5 → compliant.
**71097**: Age 75 (DOB 1951-08-03). Enrolment: one gap of 21 days (04-24 to 05-16: April 25–May 15 = 6 + 15 = 21 days). OK. FIT 2026-10-11 → N1 → compliant.
**71098**: Age 72, continuous. Flex sig 2023-04-14 — N3 window: 2026 or four years prior = 2022, 2023, 2024, 2025, 2026. 2023-04-14 is within. → compliant.
**71099**: Age 47. Enrolment: 01-01 to 06-15; 07-25 to 12-31. Gap: June 16–July 24 = 15 + 24 = 39 days. One gap ≤45 → OK. Screening: flex sig 2025-01-25 — N3 window 2022–2026. 2025-01-25 is within → meets numerator. → compliant.
**71100**: Age 47. Enrolment: starts 2026-03-16, not enrolled before → fails continuous enrolment (not full year) → not_eligible. CT colonography 2020 outside window anyway; advanced illness alone doesn't exclude.
Now count:
not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 → 8 members.
excluded: 71092 → 1 member.
Remaining: 71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099 → 11 members in denominator.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 → 7 members.
Non-compliant: 71085, 71086, 71087, 71089 → 4 members.
Check: 7 + 4 + 1 + 8 = 20. ✓
Rate: 7/11 × 100 = 63.636... → 63.6 (rounded half up to one decimal: 63.6363... → 63.6).
Let me double-check each borderline call.
71081: two gaps (23, 29). Spec: "no more than one gap of up to 45 days." Two gaps, even short ones, fails. → not_eligible. Correct.
Hmm, is that right? HEDIS continuous enrolment allows gaps up to 45 days total in some measures; here spec says "no more than one gap of up to 45 days." So two gaps fails. Yes.
71087: one gap 32 days → OK. CT colonography 2021-04-28: 5-year window back from 2026-12-31. "during 2026 or the four years prior (five-year window)". Four years prior to 2026: 2025, 2024, 2023, 2022. So window = 2022-01-01 through 2026-12-31. 2021 is outside. → non_compliant. Also E4: frailty 2026-05-25 and advanced illness 2026-06-21 both during measurement year — but age 59 < 66, so E4 doesn't apply. → non_compliant. Correct.
71086: CT colonography 2020-08-11: outside. → non_compliant. Age 75 OK, continuous. Correct.
71092: stool DNA 2023-02-25 — three-year window: 2026 or two years prior = 2025, 2024. 2023 outside. But E1: C18.7 2024-10-06 → excluded. Correct.
71098: flex sig 2023-04-14 within 5-year window → compliant. Correct.
71099: flex sig 2025-01-25 within window → compliant. Enrolment gap 39 days ≤45, one gap → OK. Correct.
71097: gap 21 days, age 75, FIT 2026 → compliant. Correct.
71090, 71091: age 76 → not_eligible. Correct. Note 71091 has two FITs in 2026 but age fails first — not_eligible takes precedence per the instructions ("a member who fails age, event, or enrolment is not_eligible even if an exclusion is also documented" — and similarly numerator doesn't matter).
71094: age 45, also 51-day gap. not_eligible.
71100: mid-year start → not_eligible.
71084: mid-year start → not_eligible.
71082: age 45 → not_eligible.
71088: two gaps → not_eligible.
Counts verified.
Rate: numerator 7, denominator 11 → 63.636363...% → 63.6.
Output JSON:
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,009 tokens
Let me work through each member carefully.
Measure QM-CRC, 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 to 2026-12-31? Actually "three-year window" measured back from 2026-12-31: three years = 2024, 2025, 2026. Let me be careful. N2: stool DNA test during 2026 or the two years prior (three-year window). Two years prior to 2026 = 2025 and 2024. So window 2024-01-01 through 2026-12-31. Actually the standard NCQA spec: stool DNA-FIT within the measurement year or 2 years prior (3 total years). But note this spec says "stool DNA test" not "stool DNA-FIT". Fine.
- N3: Flex sig during 2026 or four years prior (five-year window): 2022-01-01 through 2026-12-31.
- N4: CT colonography same: 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.
Hmm, but for windows, should it be date-based from 2026-12-31? E.g., flex sig on 2021-05-09: five-year window from 2026-12-31 would be 2021-12-31 onward? Typically HEDS uses measurement year + prior N years, i.e., 2022–2026 for 5-year. But the spec says "2026 or the four years prior (five-year window)" — four years prior to 2026 are 2025, 2024, 2023, 2022. So window is 2022-01-01 to 2026-12-31. A 2021-05-09 flex sig is outside. Good — the spec explicitly frames it as calendar years, so I'll use that.
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 during measurement year.
- E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year.
Now members:
1. MEMBER 71081. DOB 1951-10-15 → 75 as of 2026-12-31. In age range.
Enrolment: gaps of 23 and 29 days → two gaps. Requirement: no more than one gap of up to 45 days. Two gaps → fails continuous enrolment → not_eligible.
Wait — careful: "no more than one gap of up to 45 days." Two gaps, even though each ≤45 days, means more than one gap. So fails. Not eligible.
Screening: FIT 2025-10-03 — would not count anyway (2025 not in 2026 for FOBT; N1 requires during 2026). But irrelevant since not eligible.
2. MEMBER 71082. DOB 1981-09-15 → 45 years old on 2026-12-31. Age 45 < 46 → not_eligible. (Frailty + advanced illness don't matter; also E4 requires 66+.) Not eligible due to age.
3. MEMBER 71083. DOB 1971-06-11 → 55. Continuous enrolment. CT colonography 2026-08-02 (N4, during 2026) → numerator. FIT 2026-09-02 also. No exclusions. → compliant.
4. MEMBER 71084. DOB 1967-02-19 → 59. Enrolment: 2026-04-15 through 2026-12-31, not enrolled before. Fails continuous enrolment (full measurement year required) → not_eligible.
Frailty documented but no advanced illness, and under 66 anyway — E4 wouldn't apply even if in eligible population. But enrolment fails first.
5. MEMBER 71085. DOB 1959-01-11 → 67. Continuous. No screening. No exclusions. → non_compliant.
6. MEMBER 71086. DOB 1951-02-07 → 75. Continuous. CT colonography 2020-08-11. N4 window: 2022–2026. 2020 is outside (6 years prior). Not numerator. No exclusions. → non_compliant.
7. MEMBER 71087. DOB 1967-06-23 → 59. Enrolment: one gap of 32 days (2026-04-21 to 2026-05-22). Let me check: enrolled through 2026-04-20, resumed 2026-05-23. Gap days: April 21–30 (10 days) + May 1–22 (22 days) = 32 days. One gap ≤45 → meets continuous enrolment.
Age 59 → in eligible population.
Screening: CT colonography 2021-04-28. N4 window 2022–2026 → outside. Not numerator.
Exclusions: E4 requires age 66+; member is 59 → not excluded despite frailty + advanced illness during the year.
→ non_compliant.
8. MEMBER 71088. DOB 1976-06-16 → 50. Enrolment: gaps of 17 and 14 days → two gaps → fails continuous enrolment → not_eligible.
Screening: flex sig 2021-07-01, outside 5-year window anyway.
9. MEMBER 71089. DOB 1967-11-24 → 59. Continuous. No screening. No exclusions. → non_compliant.
10. MEMBER 71090. DOB 1950-05-28 → 76 as of 2026-12-31. Age 76 > 75 → not_eligible. (Also the roster says "so 76 years old on 2026-12-31".) Even though enrolment has one gap of 28 days (OK), age fails. FIT 2026-06-02 would be numerator, but age excludes from eligible population.
11. MEMBER 71091. DOB 1950-07-12 → 76. Age fails → not_eligible. FITs during 2026 but too old.
12. MEMBER 71092. DOB 1971-06-21 → 55. Continuous. Stool DNA 2023-02-25: N2 window is 2024–2026 (2026 + two years prior = 2025, 2024). 2023 is outside. So no numerator met. Other history: 2024-10-06 diagnosis C18.7 (sigmoid colon cancer) → E1 exclusion, any time on or before 2026-12-31 → excluded.
Note: exclusion evaluated before numerator → excluded.
13. MEMBER 71093. DOB 1976-11-04 → 50. Continuous. FIT 2026-07-02 → N1. No exclusions. → compliant.
14. MEMBER 71094. DOB 1981-12-09 → 45. Age fails → not_eligible. (Also gap of 51 days > 45 fails enrolment.) FIT 2026-06-06 irrelevant.
15. MEMBER 71095. DOB 1979-11-11 → 47. Continuous. FIT 2026-05-26 → N1. → compliant.
16. MEMBER 71096. DOB 1967-03-27 → 59. Continuous. Colonoscopy 2026-03-13 → N5. → compliant.
17. MEMBER 71097. DOB 1951-08-03 → 75. Enrolment: through 2026-04-24, resumed 2026-05-16. Gap: Apr 25–30 (6) + May 1–15 (15) = 21 days. One gap ≤45 → OK. Age 75 ≤ 75 → in range. FIT 2026-10-11 → N1. → compliant.
18. MEMBER 71098. DOB 1954-09-24 → 72. Continuous. Flex sig 2023-04-14: N3 window 2022–2026 → within (2023 is within four years prior). → numerator met → compliant.
19. MEMBER 71099. DOB 1979-09-26 → 47. Enrolment: through 2026-06-15, resumed 2026-07-25. Gap: Jun 16–30 (15) + Jul 1–24 (24) = 39 days. One gap ≤45 → OK. Flex sig 2025-01-25: N3 window 2022–2026 → 2025 is within. → compliant.
20. MEMBER 71100. DOB 1979-01-17 → 47. Enrolment: 2026-03-16 through 2026-12-31, not enrolled before → fails continuous enrolment (not enrolled for full year) → not_eligible.
CT colonography 2020-11-17 outside window anyway. Advanced illness alone doesn't exclude.
Now tally:
not_eligible: 71081 (two gaps), 71082 (age 45), 71084 (not enrolled full year), 71088 (two gaps), 71090 (age 76), 71091 (age 76), 71094 (age 45; also 51-day gap), 71100 (not enrolled full year) → 8 members.
excluded: 71092 → 1 member.
compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 → 7 members.
non_compliant: 71085, 71086, 71087, 71089 → 4 members.
Total: 8 + 1 + 7 + 4 = 20. ✓
Denominator = compliant + non_compliant = 11.
Numerator = 7.
Rate = 7/11 × 100 = 63.636... → 63.6 (rounded half up to one decimal).
7/11 = 0.636363..., ×100 = 63.6363... → 63.6.
Double-check some edge cases:
- 71081: gaps of 23 and 29 days — confirmed two gaps. Fails "no more than one gap."
- 71086: CT colonography 2020-08-11. Five-year window back from 2026: 2022–2026. 2020 is 6 years prior → outside → non-compliant. Correct.
- 71087: frailty + advanced illness but age 59 → E4 not applicable. Non-compliant (CT colonography 2021 outside window). Correct.
- 71098: flex sig 2023-04-14 within 2022–2026 → compliant. Correct.
- 71099: flex sig 2025-01-25 within window → compliant. Correct.
- 71092: stool DNA 2023-02-25 — window for N2 is 2024–2026. Outside. But excluded via E1 (C18.7 in 2024). Excluded takes precedence anyway. Correct.
Age calculations: spec says "as of 2026-12-31" and the roster helpfully states each age. Use roster's stated ages.
71081: 75 — in range (46–75 inclusive). But enrolment fails.
71090, 71091: 76 — out of range.
Enrolment gap checks:
- 71087: one gap of 32 days — OK.
- 71097: one gap of 21 days — OK.
- 71099: one gap of 39 days — OK.
- 71090: one gap of 28 days — OK on enrolment but age fails.
- 71091: one gap of 39 days — OK on enrolment but age fails.
- 71094: one gap of 51 days — fails enrolment too, plus age. Either way not_eligible.
Final answer:
denominator: 11
numerator: 7
excluded: 1
not_eligible: 8
rate: 63.6
compliant_members: ["71083","71093","71095","71096","71097","71098","71099"]
non_compliant_members: ["71085","71086","71087","71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"]json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Hunyuan 4 · Tencent184.1s · 12,352 out | 191.7s · 12,760 out | 187.5s · 12,336 out
Reasoning · 12,186 tokens
We need answer JSON for measure population. Need carefully evaluate each member. Task: 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: full measurement year with no more than one gap of up to 45 days.
Interpretation: continuous enrolment for the full measurement year with no more than one gap of up to 45 days. Means must be enrolled for entire year except possibly one gap ≤45 days (i.e., total gap days <=45, and only one gap allowed). If two gaps, not eligible? It says "no more than one gap of up to 45 days." So allowed: zero gaps, or one gap of ≤45 days. If two gaps (regardless of lengths?) not eligible. Also if not enrolled for the whole year (e.g., start late or end early) not eligible? Need parse: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Means enrolment must span full measurement year (Jan 1 - Dec 31) with allowance for at most one gap of up to 45 days. If member not enrolled before Apr 15 (71084), they were not enrolled Jan 1-Apr 14, that's not a gap; that's not enrolled for part of year before start. The "full measurement year" implies must be enrolled on Jan 1? Usually HEDIS continuous enrollment: enrolled during the measurement year with no gaps >45 days (or one gap). Here says "the full measurement year with no more than one gap of up to 45 days." Could mean enrolled the entire year, allowing single gap. If start after Jan 1 or end before Dec 31, not full year, so not eligible. Let's check roster examples to see.
Member 71084: Enrolment: 2026-04-15 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-15. Age 59 (born 1967-02-19). Screening: 2021-05-09 flexible sigmoidoscopy (outside 5-year window? Five-year window means during 2026 or four years prior: 2022,2023,2024,2025? Wait look-back window measured back from 2026-12-31. For N3 flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Measured back from 2026-12-31: 2026, 2025, 2024, 2023, 2022? Or including 2021? Let's compute. Measurement year 2026. "During 2026 or the four years prior (five-year window)." The four years prior to 2026 are 2025, 2024, 2023, 2022. So dates from 2022-01-01 through 2026-12-31. For N5 colonoscopy during 2026 or the nine years prior (ten-year window): nine years prior to 2026 are 2025 down to 2017? Wait 2026 plus nine prior years = 2026,2025,2024,2023,2022,2021,2020,2019,2018,2017? Actually nine years prior to 2026: 2025,2024,2023,2022,2021,2020,2019,2018,2017. That is ten-year window from 2017-01-01 through 2026-12-31. Yes.
N2 stool DNA during 2026 or two years prior (three-year window): 2026, 2025, 2024. So 2024-01-01 through 2026-12-31.
N1 FOBT/FIT during 2026: calendar year 2026 only.
N4 CT colonography during 2026 or four years prior (five-year window): 2022-01-01 through 2026-12-31.
For 71084 sigmoidoscopy 2021-05-09, outside 5-year window (since 2021 > four years prior? Actually 2021 is five years prior? Wait 2026 - 5 = 2021. The window is "during 2026 or the four years prior (five-year window)". If measurement year is 2026, four years prior are 2025, 2024, 2023, 2022. There is no 2021. So 2021 is 5 years before 2026 (2026-5=2021). The five-year window includes 2026 + 4 prior years = 5 years total: 2022, 2023, 2024, 2025, 2026. Yes 2021 excluded. So not numerator.
Continuous enrolment: Not enrolled Jan 1-Apr 14. Is that a gap? It's not a gap in enrollment; they just start Apr 15. The requirement: "the full measurement year" means Jan 1-Dec 31. Since not enrolled before Apr 15, not full year, so not eligible. Also there is a single gap? Actually there is no gap; they are continuously enrolled from Apr 15 to Dec 31. But missing first 3.5 months. The phrase: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This could be interpreted as: enrolled for the full measurement year (i.e., from Jan 1 to Dec 31), but if there is a gap, only one gap up to 45 days allowed. If you start late, you weren't enrolled at beginning, so not full year => not eligible. So 71084 should be not_eligible (fails enrolment). We'll treat as not_eligible.
Similarly 71100: Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Starts Mar 16, missing Jan 1-Mar 15. Not full year, so not_eligible? Wait enrolment requirement: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Starting Mar 16 means not enrolled for first 74 days of year. That's not a gap, it's not enrolled. So fails continuous enrolment for full year. So not_eligible. But let's verify if any members start late and are considered eligible? The spec says "the full measurement year" so yes must be enrolled entire year. 71084 and 71100 not eligible due to not enrolled before start. Also check member with enrolment ending? None end early. All others start Jan 1.
Now evaluate all 20.
Let's list member, DOB, age on 2026-12-31, gender (irrelevant), enrolment, screening, exclusions.
Age eligibility: 46 through 75 inclusive as of 2026-12-31. So if age 45 or younger -> not eligible (fails age). If 76 or older -> not eligible (fails age). Age computed:
71081: DOB 1951-10-15. On 2026-12-31, age = 2026-1951 = 75, birthday Oct 15 has passed, so 75. Eligible age (46-75). Yes exactly 75.
71082: 1981-09-15 -> age 45 on 2026-12-31? 2026-1981=45, birthday Sep 15 passed, so 45. Age 45 <46, not eligible (fails age). Even though continuous enrolment, not eligible. Also E4 age 66+ frailty+advanced illness: age 45, so no.
71083: 1971-06-11 -> 55 (2026-1971=55, birthday passed). Eligible.
71084: 1967-02-19 -> 59 (2026-1967=59, birthday Feb 19 passed before Dec 31). Eligible age. Enrolment issue.
71085: 1959-01-11 -> 67 (2026-1959=67, birthday Jan 11 passed). Eligible.
71086: 1951-02-07 -> 75 (2026-1951=75, birthday Feb 7 passed). Age 75, eligible.
71087: 1967-06-23 -> 59. Eligible.
71088: 1976-06-16 -> 50. Eligible.
71089: 1967-11-24 -> 59. Eligible.
71090: 1950-05-28 -> 76 (2026-1950=76, birthday May 28 passed). Age 76 >75, not eligible (fails age). Even though screening FIT in 2026? Wait 71090 has FIT 2026-06-02. Age 76, not eligible.
71091: 1950-07-12 -> 76 (2026-1950=76, birthday Jul 12 passed). Age 76, not eligible (fails age).
71092: 1971-06-21 -> 55. Eligible. Has diagnosis C18.7 (colorectal cancer) in 2024-10-06. Exclusion E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. So excluded. Also screening history: 2023-02-25 Stool DNA test. But exclusion evaluated before numerator: excluded, not compliant. So excluded.
71093: 1976-11-04 -> 50 (2026-1976=50, birthday Nov 4 passed). Eligible.
71094: 1981-12-09 -> 45 (2026-1981=45, birthday Dec 9, on Dec 31 age 45? Wait born Dec 9, 1981. On 2026-12-31, birthday Dec 9 has passed, so age = 45? Let's compute: 2026 - 1981 = 45. If birthday is Dec 9 and date is Dec 31, they turned 45 on Dec 9, 2026. So age is 45. Wait hold on: If born in 1981, on Dec 9, 2026 they turn 45 (since 2026-1981=45). Yes age 45. Actually starting from birth: at birth age 0; on first birthday 1982 age 1; ... on 2026 birthday age 45. So age 45. Under 46, not eligible. Also enrolment: Jan 1-Apr 24, gap 51 days (Apr 25-Jun 14? Let's compute: end Apr 24, next start Jun 15. Gap days: Apr 25-30 = 6 days? Wait April has 30 days. From Apr 25 to Apr 30 inclusive is 6 days if counting days not enrolled? Need "gap of up to 45 days". Gap length between Apr 24 and Jun 15: The number of days not enrolled? Typically gap = days between end date and next start date. If disenrolled end of Apr 24, next start Jun 15. Days in between: Apr 25 through Jun 14. Let's count: April 25-30 = 6 days (25,26,27,28,29,30). May = 31 days. June 1-14 = 14 days. Total 6+31+14 = 51 days. Yes gap 51 days. So >45, and only one gap but >45, so fails continuous enrolment. So 71094 not eligible for two reasons: age 45, and enrolment gap 51 days. But age fails first, so not_eligible. Wait check age: if DOB 1981-12-09, on 2026-12-31 they are 45 (since birthday Dec 9 2026, turned 45). Yes <46. not eligible.
Wait earlier I thought 71094 is 45? Yes. The roster says "Date of birth 1981-12-09, so 45 years old on 2026-12-31." The roster explicitly says "so 45 years old". Great. So not eligible age. Good.
71095: 1979-11-11 -> 47 (2026-1979=47, birthday Nov 11 passed). Eligible.
71096: 1967-03-27 -> 59. Eligible.
71097: 1951-08-03 -> 75 (2026-1951=75, birthday Aug 3 passed). Eligible age 75.
71098: 1954-09-24 -> 72 (2026-1954=72, birthday Sep 24 passed). Eligible.
71099: 1979-09-26 -> 47 (2026-1979=47, birthday Sep 26 passed). Eligible.
71100: 1979-01-17 -> 47 (2026-1979=47, birthday Jan 17 passed). Eligible age. Enrolment start Mar 16, not full year. Not eligible.
Now continuous enrolment for those starting Jan 1 (except 71084, 71100, maybe 71094 starts Jan 1). Let's check enrolment details for each Jan 1 starter:
71081: Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days. Two gaps! Requirement: no more than one gap of up to 45 days. Since two gaps, not eligible (fails continuous enrolment). Even though each <=45, number of gaps >1, so fails. So 71081 not_eligible (enrolment). Wait age is 75, eligible age, but two gaps -> not eligible. Yes.
71082: Jan 1-Dec 31 continuous no gaps. Age 45, not eligible (fails age). Also note frailty 2026-11-13 and advanced illness 2026-06-12. E4 requires age 66 or older as of 2026-12-31 AND both frailty and advanced illness during MY. Age 45, so E4 not met. No E1-E3. But age fails, so not_eligible. (Even if age eligible, no screening? Actually screening history none, so if eligible would be non_compliant, but not eligible due age.)
71083: Jan 1-Dec 31 continuous, no gaps. Age 55. No exclusions. Screening: 2026-08-02 CT colonography (N4 meets, in 2026) and 2026-09-02 FIT (N1 meets). So meets numerator. Compliant.
71084: Age 59, enrolment starts 2026-04-15 through 2026-12-31 continuous from that date, not enrolled before. Not full year -> not eligible. Screening: 2021-05-09 flexible sigmoidoscopy (outside window). Other history frailty 2026-03-11. E4? Age 59, not 66+, so no. So not_eligible due enrolment. Correct.
71085: Age 67. Continuous Jan 1-Dec 31 no gaps. No exclusions (no CRC, colectomy, hospice, no frailty/advanced illness). Screening: No colorectal screening on record. So in denominator, not excluded, does not meet numerator -> non_compliant. Wait check age 67, so E4 age 66+ but requires both frailty and advanced illness documented. None documented. So no exclusion. So non_compliant.
71086: Age 75 (born 1951-02-07). Continuous Jan 1-Dec 31. No exclusions. Screening: 2020-08-11 CT colonography. N4 window: during 2026 or four years prior (2022-2026). 2020 is outside (2020 is six years prior? Let's compute: 2026,2025,2024,2023,2022 included. 2021 and 2020 not). So CT colonography in 2020 does NOT meet N4. Any other screening? No. So non_compliant. Wait check N5 colonoscopy? No. FIT? No. So non_compliant. Is there any exclusion? No. So non_compliant.
71087: Age 59. Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days. Allowed? One gap ≤45 days, so continuous enrolment met. Age eligible. Screening: 2021-04-28 CT colonography. N4 window 2022-2026, 2021 outside. So no. Any others? No. Exclusions: Other history: Frailty 2026-05-25, Advanced illness 2026-06-21. E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness during MY. Age 59, not 66+, so E4 not met. No CRC/colectomy/hospice. So no exclusion. Not meeting numerator -> non_compliant. Wait check: flexible sigmoidoscopy? No. So non_compliant.
But hold on: enrolment gap: Jan 1-Apr 20, then May 23-Dec 31. Gap from Apr 21 to May 22. Count days: April 21-30 = 10 days (21-30 inclusive: 30-21+1=10). May 1-22 = 22 days. Total = 32 days. Yes one gap 32 ≤45, so enrolment OK. Good.
71088: Age 50. Enrolment: Jan 1-Feb 16; Mar 6-May 13; May 28-Dec 31. Gaps of 17 and 14 days. That's two gaps. Each ≤45, but two gaps -> fails "no more than one gap". So not eligible (fails enrolment). Age eligible. Screening: 2021-07-01 flexible sigmoidoscopy (outside 5-year window; 2021 not included). No exclusions. So not_eligible due enrolment (two gaps). Yes.
71089: Age 59. Continuous Jan 1-Dec 31, no gaps. No exclusions. No screening -> non_compliant.
71090: Age 76 (DOB 1950-05-28). Not eligible age >75. Enrolment: Jan 1-May 27; Jun 25-Dec 31. One gap of 28 days (allowed). Screening FIT 2026-06-02 (would be compliant if eligible). But age fails, so not_eligible.
71091: Age 76. Not eligible age. Enrolment: Jan 1-Apr 24; Jun 3-Dec 31. One gap of 39 days (allowed). Has two FITs in 2026. Age fails, not_eligible.
71092: Age 55. Continuous Jan 1-Dec 31. Diagnosis C18.7 in 2024-10-06. Exclusion E1 colorectal cancer (C18-C21) any time on or before 2026-12-31. So excluded. No need numerator (they had stool DNA 2023-02-25, which is in N2 window: 2024-2026? Wait 2023 is two years prior? Let's check: N2 stool DNA during 2026 or the two years prior (three-year window). Two years prior to 2026 are 2025 and 2024. So window is 2024-01-01 to 2026-12-31. 2023-02-25 is outside! Actually 2023 is three years prior? 2026-3=2023. The window says during 2026 or the two years prior: 2026, 2025, 2024. So 2023 not included. So even if not excluded, 2023 stool DNA would NOT meet numerator. But exclusion evaluated first, so excluded. Good.
71093: Age 50. Continuous. No exclusions. Screening: 2026-07-02 FIT. Meets N1 (during 2026). So compliant.
71094: Age 45 (per roster). Not eligible age. Also enrolment gap 51 days. Not eligible. Screening FIT 2026-06-06. Not eligible. So not_eligible.
71095: Age 47. Continuous Jan 1-Dec 31. No exclusions. Screening: 2026-05-26 FIT (N1). Compliant.
71096: Age 59. Continuous. Screening: 2026-03-13 Colonoscopy. N5 colonoscopy during 2026 or nine years prior (ten-year window includes 2026). So meets. Compliant. (No exclusions). Compliant.
71097: Age 75. Enrolment: Jan 1-Apr 24; May 16-Dec 31. One gap of 21 days. Allowed. Age 75 eligible. No exclusions. Screening: 2026-10-11 FIT (N1). Compliant. Wait check gap: Jan 1-Apr 24, then May 16-Dec 31. Gap Apr 25 to May 15. Count: April 25-30 = 6 days. May 1-15 = 15 days. Total 21 days. Yes one gap 21 ≤45. Enrolment OK. So compliant.
71098: Age 72. Continuous Jan 1-Dec 31. No exclusions. Screening: 2023-04-14 Flexible sigmoidoscopy. N3 window: during 2026 or four years prior: 2022-2026. 2023 is within window (four years prior includes 2022,2023,2024,2025). Yes 2023 is in window. So meets N3. Compliant. Wait verify: 2023 is a year prior to 2026. The four years prior to 2026 are 2025, 2024, 2023, 2022. Yes 2023 is included. So compliant.
71099: Age 47. Enrolment: Jan 1-Jun 15; Jul 25-Dec 31. One gap of 39 days (Jun 16-Jul 24). Count: June 16-30 = 15 days (30-16+1=15). July 1-24 = 24 days. Total 39. Allowed (≤45). Age eligible. No exclusions. Screening: 2025-01-25 Flexible sigmoidoscopy. N3 window: during 2026 or four years prior = 2022-2026. 2025 is within window (2025 is one year prior). Yes meets N3. Compliant. Wait check: 2025-01-25 is in 2025, which is within the five-year window (2022-2026). Yes. So compliant.
71100: Age 47. Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Fails full year. Not eligible. Screening: 2020-11-17 CT colonography. N4 window 2022-2026, 2020 outside. Other history: Advanced illness 2026-01-23. E4 requires age 66+ and both frailty and advanced illness; age 47, so no. So not_eligible due enrolment (not full year). Also does not meet numerator anyway, but not eligible.
Need also check 71080? Roster starts 71081 through 71100 = 20 members. IDs: 71081, 71082, 71083, 71084, 71085, 71086, 71087, 71088, 71089, 71090, 71091, 71092, 71093, 71094, 71095, 71096, 71097, 71098, 71099, 71100. Yes 20.
Now classify each:
71081: age 75 eligible, enrolment two gaps -> not_eligible. List not_eligible.
71082: age 45 -> not_eligible.
71083: eligible, no exclusion, numerator met -> compliant.
71084: enrolment not full year (start Apr 15) -> not_eligible.
71085: eligible, no screening -> non_compliant.
71086: eligible, CT 2020 outside window -> non_compliant.
71087: eligible, one gap 32 ok, CT 2021 outside window, age<66 so no E4, no numerator -> non_compliant.
71088: two gaps -> not_eligible.
71089: eligible, no screening -> non_compliant.
71090: age 76 -> not_eligible.
71091: age 76 -> not_eligible.
71092: exclusion E1 CRC -> excluded.
71093: compliant (FIT 2026).
71094: age 45 -> not_eligible.
71095: compliant (FIT 2026).
71096: compliant (colonoscopy 2026).
71097: compliant (FIT 2026, gap 21).
71098: compliant (flex sig 2023 in window).
71099: compliant (flex sig 2025 in window).
71100: enrolment start Mar 16 -> not_eligible.
Let's double-check 71087: any chance CT colonography 2021-04-28 is within five-year window? Wait I need recalc: Look-back window measured back from 2026-12-31. N4: "CT colonography during 2026 or the four years prior (five-year window)." If measurement year is 2026, "the four years prior" are the four calendar years before 2026: 2025, 2024, 2023, 2022. So dates from 2022-01-01 through 2026-12-31. 2021 is five years prior? Actually 2026 minus 5 years = 2021. The five-year window is 2022-2026 inclusive? Wait count: 2026 (1), 2025 (2), 2024 (3), 2023 (4), 2022 (5). Yes five years: 2022, 2023, 2024, 2025, 2026. So 2021 is not included. Good.
But hold on: Sometimes look-back windows are defined as "during the measurement year or the four years prior" meaning if measurement year is 2026, the four years prior are 2025, 2024, 2023, 2022. Yes. So date must be on or after 2022-01-01? Since during 2022 counts. If service on 2021-12-31, outside. Our dates: 2021-04-28 outside. 2020-08-11 outside. Good.
Check N5 colonoscopy: 2026 or nine years prior (ten-year window). Nine years prior: 2025,2024,2023,2022,2021,2020,2019,2018,2017. So window 2017-01-01 through 2026-12-31. 71096 colonoscopy 2026-03-13 inside. Good.
Check N2 stool DNA: 2026 or two years prior (three-year window). Two years prior: 2025, 2024. Window 2024-01-01 - 2026-12-31. 71092 stool DNA 2023-02-25 outside. So even if not excluded, non_compliant. But excluded.
Check N3 flexible sigmoidoscopy: 2026 or four years prior (five-year window): 2022-2026. 71098 2023-04-14 inside. 71099 2025-01-25 inside. 71088 2021-07-01 outside. 71084 2021-05-09 outside. Good.
Check N1 FIT during 2026: any date in 2026. 71083 has CT and FIT, compliant. 71093 FIT 2026-07-02. 71095 FIT 2026-05-26. 71097 FIT 2026-10-11. 71090 (not eligible) FIT 2026-06-02. 71091 (not eligible) FITs 2026-02-09 and 2026-05-24. 71094 (not eligible) FIT 2026-06-06. Good.
Now check 71081 screening: 2025-10-03 FIT. N1 requires during 2026. FIT in 2025 does NOT count for N1 (only during 2026). Does it count for any other? No, FIT is only N1 (FOBT or FIT during 2026). So 71081 would be non_compliant if eligible, but not eligible due two gaps. Yes.
Wait, check 71081 enrolment: gaps of 23 and 29 days. Two gaps -> not eligible. Yes.
71088 enrolment: gaps of 17 and 14 days. Two gaps -> not eligible. Yes.
Check 71085: no screening, age 67. Could E4 apply? Age 67 (>=66). Frailty? No. Advanced illness? No. So no exclusion. non_compliant.
Check 71086: age 75. CT 2020. No frailty/advanced. non_compliant.
Check 71089: age 59. No screening, no exclusions. non_compliant.
Now let's check members with frailty/advanced illness for E4:
Exclusion 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, advanced illness alone does not exclude.
Who has frailty/advanced illness?
- 71082: age 45, frailty 2026-11-13, advanced illness json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 12,593 tokens
We need answer with JSON only. Need evaluate 20 members against QM-CRC measure.
We need be careful: measurement year 2026-01-01 through 2026-12-31.
Eligible population denominator:
- Age 46 through 75 years as of 2026-12-31. Need compute age on 2026-12-31. Roster gives "so X years old on 2026-12-31". We can trust but verify maybe. Let's check: age inclusive 46 to 75. If 76 => not_eligible. If 45 => not_eligible. If within 46-75 eligible (subject to enrolment).
- Continuous enrolment: full measurement year with no more than one gap of up to 45 days. Means must be enrolled for full year? Let's parse: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." In HEDIS-like, continuous enrollment is typically enrolled during measurement year with allowed gap(s). Here: "the full measurement year with no more than one gap of up to 45 days." Means they must be enrolled from 2026-01-01 through 2026-12-31 (i.e., full year) but there can be at most one gap, and that gap can be up to 45 days. That means total enrollment coverage? Actually if there is a gap, then not enrolled during gap. They say "full measurement year with no more than one gap of up to 45 days." This likely means member must be enrolled for the entire year except possibly one gap not exceeding 45 days. So if one gap <=45 days, still meets continuous enrolment. If more than one gap (i.e., two or more separate gaps) or a single gap >45 days, fails continuous enrolment => not_eligible. Also if not enrolled for part of year at start or end? "full measurement year" suggests must be enrolled on 2026-01-01 and 2026-12-31? Let's read examples:
MEMBER 71081: Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps of 23 and 29 days. There are two gaps. So fails because more than one gap. Also age 75 (eligible age). It has FIT 2025-10-03. But 2025 not in 2026 for N1. N1 requires FIT during 2026. FIT on 2025-10-03 is not in 2026. Not eligible due to enrolment? It has two gaps, so not_eligible. Age 75 within 46-75. So not_eligible.
MEMBER 71094: Enrolment gaps one gap of 51 days (2026-04-24 to 2026-06-15?). Actually 2026-01-01 through 2026-04-24; 2026-06-15 through 2026-12-31. One gap of 51 days (from Apr 25 to Jun 14? Let's compute: Apr 24 to Jun 15 gap: April 25-30 =6, May=31, June 1-14=14 total 51? Yes). Gap >45 days => fails continuous enrolment. Age 45 => not_eligible anyway (age 45 outside 46-75). So not_eligible.
Need carefully classify each member:
Let's list members: 71081 to 71100 (20). We'll compute age, enrolment, numerator, exclusions.
Measure numerator look-back windows measured back from 2026-12-31:
- N1: Faecal occult blood test (FOBT) or FIT during 2026 (the measurement year). So any date in 2026. (Not prior years). So FIT/FOBT in 2026 qualifies.
- N2: Stool DNA test during 2026 or two years prior (three-year window: 2024, 2025, 2026? Wait measured back from 2026-12-31. "during 2026 or the two years prior (three-year window)." Two years prior to 2026 are 2025 and 2024? Let's parse: Measurement year 2026. During 2026 or the two years prior: 2026, 2025, 2024. That's a three-year window: 2024-01-01 through 2026-12-31. Yes because 2026 (year 0), 2025 (1 year prior), 2024 (2 years prior). If date in 2024, 2025, or 2026 qualifies. If 2023 not.
- N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Four years prior to 2026: 2025, 2024, 2023, 2022. Plus 2026 = window 2022-01-01 through 2026-12-31. Check: If measured back from 2026-12-31, 5-year window includes 2022, 2023, 2024, 2025, 2026. Yes.
- N4: CT colonography during 2026 or the four years prior (five-year window): same window 2022 through 2026.
- N5: Colonoscopy during 2026 or the nine years prior (ten-year window): nine years prior to 2026: 2025 down to 2017. Plus 2026 = 2017 through 2026 (10 years). Specifically window 2017-01-01 through 2026-12-31. Check: 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017 = 10 calendar years. Yes colonoscopy in 2017 or later through 2026 qualifies. A colonoscopy in 2016 would not.
Exclusions:
E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31. So diagnosis of C18-C21 at any time up to end of MY. If yes => excluded (if in eligible population). Need check codes. Member 71092 has 2024-10-06 Diagnosis C18.7 (malignant neoplasm of sigmoid colon). C18.7 is within C18-C21. So E1 met. Age 55, continuous enrolment no gaps. In denominator before exclusion; then excluded. Not counted in numerator even if screening. It had stool DNA 2023-02-25, which is outside N2? Wait N2 window 2024-2026, 2023 is not in window. But it doesn't matter because excluded. However check if stool DNA in 2023? Actually date 2023-02-25 is within five-year? Stool DNA is N2 three-year window (2024-2026). 2023 is outside. So no numerator anyway. But excluded due to colorectal cancer.
E2. Total colectomy any time on or before 2026-12-31. None mentioned? Need check members: No colectomy documented for any? Let's scan: everyone says "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." Except some with frailty/advanced illness. None say total colectomy. So E2 none.
E3. Hospice at any time during the measurement year. None? All say no hospice. So none.
E4. Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during the measurement year. Need evaluate. Age >=66 on 2026-12-31 (i.e., 66,67,...). Must have frailty documented during MY (2026) AND advanced illness documented during MY (2026). Both required. Frailty alone or advanced illness alone does not exclude. Also documentation during measurement year (dates in 2026). Let's list members with frailty/advanced illness:
- 71082: DOB 1981-09-15, age 45 on 2026-12-31. Not in age 46-75, so not_eligible. Also has frailty 2026-11-13, advanced illness 2026-06-12. But age 45, not eligible. Even if E4? Age not >=66 and not in eligible age. So not_eligible.
- 71084: DOB 1967-02-19, age 59. Frailty documented 2026-03-11. No advanced illness? It says "Other history: 2026-03-11 Frailty documented..." It does not mention advanced illness. So only frailty. E4 requires both frailty and advanced illness. Thus not excluded by E4. Need check age: 59, not >=66 anyway. So no E4. Enrolment: 2026-04-15 through 2026-12-31 continuous from that date. Not enrolled before 2026-04-15. The continuous enrolment requirement: full measurement year with no more than one gap of up to 45 days. This member is NOT enrolled from Jan 1 to Apr 14. That's a gap of? They are not enrolled at start of year until Apr 15. Is that considered a gap? The requirement says "full measurement year" meaning enrolled for the entire year; if not enrolled before April 15, there is a gap from 2026-01-01 to 2026-04-14 (103 days). That's more than one gap? It's one continuous non-enrollment period of >45 days at start. Does that count as a gap? They were not enrolled for the beginning of the year. The allowance: "no more than one gap of up to 45 days." A period of non-enrollment is a gap. If it's >45 days, fails. Also if it's at start, it's still a gap in coverage of the full year. Since they were not enrolled 01-01 through 04-14, that is a gap of 103 days >45, so fails continuous enrolment. Therefore not_eligible. Wait but let's verify with other members: 71100 Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Gap from Jan 1 to Mar 15 = 73 days >45, fails continuous enrolment. 71084 similar but from Apr 15 (103 days). So not_eligible due to enrolment. Also 71084 has screening 2021-05-09 Flexible sigmoidoscopy. For N3 window 2022-2026; 2021 is outside five-year window (needs 2022 or later). So even if eligible, not numerator. But not_eligible due to enrolment.
- 71087: DOB 1967-06-23, age 59 on 2026-12-31. Enrolment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days (Apr 21? to May 22? Let's compute: Apr 21-30 =10, May 1-22=22 total 32). One gap <=45, so meets continuous enrolment (one gap of up to 45 days). Age 59 in 46-75. So eligible population (unless exclusion). Has other history: 2026-05-25 Frailty documented, 2026-06-21 Advanced illness documented. Age is 59, not >=66. E4 requires age 66 or older. So E4 not met (age criterion fails). Thus not excluded. Screening: 2021-04-28 CT colonography. N4 window: CT colonography during 2026 or four years prior => 2022-2026. 2021 is outside (five-year window is 2022-2026). Wait check: four years prior to 2026: 2025 (1), 2024 (2), 2023 (3), 2022 (4). Plus 2026. So 2021 is 5 years prior, not included. So no numerator from CT colonography. No other screening. So non_compliant. Need check: Does member have any other screening? Only 2021-04-28 CT colonography. So non_compliant. Not excluded. So in denominator, not numerator => non_compliant.
- 71082 already not_eligible (age 45). Also has both frailty and advanced illness but age 45, so not E4. Not in denominator.
- 71085: age 67 (>=66). DOB 1959-01-11. No screening. It says "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So no frailty/advanced illness. Therefore E4 not met (needs both). Not excluded. Enrolment continuous no gaps. Age 67 eligible. Numerator? No colorectal screening on record. So non_compliant.
- 71090: DOB 1950-05-28, age 76 on 2026-12-31. Age >75, so not_eligible. Enrolment: one gap of 28 days (Jan 1-May27? Actually enrolment 2026-01-01 through 2026-05-27; 2026-06-25 through 2026-12-31. Gap May 28 to Jun 24? Let's count: May 28-31=4, Jun 1-24=24 total 28. One gap <=45, so enrolment OK, but age 76 fails age. So not_eligible. Screening 2026-06-02 FIT. That would be numerator if eligible, but not. Also no exclusions. Not_eligible.
- 71091: DOB 1950-07-12, age 76. Not_eligible (age). Enrolment one gap 39 days (Jan 1-Apr24; Jun3-Dec31; gap Apr25-Jun2: April 25-30=6, May=31, Jun1-2=2 total 39). One gap <=45, enrolment OK, but age 76 => not_eligible. Screenings FIT 2026-02-09 and 2026-05-24 (both in 2026) would be compliant, but not eligible. Also note 71091 is 76, outside 46-75. Not_eligible.
- 71097: DOB 1951-08-03, age 75 (since turns 75 in 2026? DOB 1951-08-03, on 2026-12-31 age = 75 (2026-1951=75, birthday Aug 3 passed). Within 46-75 (75 inclusive). Enrolment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days (Apr25 to May15? Apr 25-30=6, May1-15=15 total 21). One gap <=45, so continuous enrolment met. Age 75 eligible. Screening: 2026-10-11 FIT. N1 FIT during 2026 => meets numerator. No exclusions (no CRC/colectomy/hospice/frailty/advanced illness). So compliant.
- 71081: age 75. Enrolment: two gaps (23 and 29 days). More than one gap. The requirement: no more than one gap. So fails continuous enrolment. So not_eligible, regardless of numerator. Screening FIT 2025-10-03, not in 2026, so even if enrolment ok, non_compliant. But not_eligible.
- 71086: DOB 1951-02-07, age 75 on 2026-12-31. Continuous enrolment no gaps. Age eligible. Screening: 2020-08-11 CT colonography. N4 window: CT colonography during 2026 or four years prior (2022-2026). 2020 is outside (six years prior). So no numerator. Any other screening? No. So non_compliant. Check exclusions none. Not age >=66? Age 75, but no frailty/advanced illness documented, so E4 not met. So non_compliant.
- 71088: DOB 1976-06-16, age 50. Enrolment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31. Gaps of 17 and 14 days. That's two gaps. More than one gap -> fails continuous enrolment (no more than one gap). Even though each gap <=45, there are two gaps. So not_eligible. Age 50 within range, but enrolment fails. Screening: 2021-07-01 Flexible sigmoidoscopy. N3 window 2022-2026; 2021 outside. So wouldn't be numerator anyway. Not_eligible.
- 71083: DOB 1971-06-11, age 55. Continuous enrolment no gaps. Age eligible. Screenings: 2026-08-02 CT colonography (in 2026, qualifies N4), and 2026-09-02 FIT (qualifies N1). So meets numerator. No exclusions. Compliant.
- 71093: DOB 1976-11-04, age 50. Continuous enrolment. Screening: 2026-07-02 FIT. N1 qualifies. No exclusions. Compliant.
- 71095: DOB 1979-11-11, age 47. Continuous. Screening: 2026-05-26 FIT. N1 qualifies. Compliant.
- 71096: DOB 1967-03-27, age 59. Continuous. Screening: 2026-03-13 Colonoscopy. N5 colonoscopy during 2026 qualifies (within ten-year window). Compliant.
- 71098: DOB 1954-09-24, age 72. Continuous. Screening: 2023-04-14 Flexible sigmoidoscopy. N3 window: flexible sigmoidoscopy during 2026 or four years prior (2022-2026). 2023 is within window (2022,2023,2024,2025,2026). Yes, 2023 is three years prior, within five-year window. So meets numerator. No exclusions. Compliant. Need verify age 72 eligible. Yes.
- 71099: DOB 1979-09-26, age 47. Enrolment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days (Jun16 to Jul24? Jun16-30=15, Jul1-24=24 total 39). One gap <=45, continuous enrolment met. Age 47 eligible. Screening: 2025-01-25 Flexible sigmoidoscopy. N3 window: 2022-2026. 2025 is within window (one year prior). So meets numerator. No exclusions. Compliant.
- 71100: DOB 1979-01-17, age 47. Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Gap from 2026-01-01 to 2026-03-15. Let's compute days: Jan (31) + Feb (28, 2026 not leap? 2026 is not leap; Feb 28) + Mar 1-15 (15) = 31+28+15 = 74 days. One gap of 74 days >45. Since it's a single gap but >45 days, fails continuous enrolment (must be no more than one gap of up to 45 days). So not_eligible. Age 47 within, but enrolment fails. Other history: 2026-01-23 Advanced illness documented (heart failure). No frailty mentioned. So only advanced illness, no frailty. E4 requires both and age>=66; not met anyway. Screening: 2020-11-17 CT colonography. N4 window 2022-2026, 2020 outside. Not numerator. Not_eligible.
- 71092: age 55, continuous enrolment. Diagnosis C18.7 in 2024 -> E1 colorectal cancer (C18-C21) any time on or before 2026-12-31. Yes. So excluded. Need check if meets numerator? Stool DNA test 2023-02-25. N2 window is 2024-2026; 2023 is outside (three-year window measured back from 2026-12-31: 2026, 2025, 2024). So 2023 not in window. So no numerator. But regardless, E1 exclusion applies. Excluded member. Must be in eligible population before exclusion: age 55, continuous enrolment yes. So excluded.
- 71085: age 67, continuous, no screening, no frailty/advanced illness. Non_compliant. Wait check E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during MY. Member has no frailty/advanced illness documented. So not excluded. Non_compliant.
- 71089: DOB 1967-11-24, age 59. Continuous enrolment no gaps. Screening: No colorectal screening on record. No exclusions. Non_compliant.
- 71090, 71091 not_eligible age 76.
- 71082 not_eligible age 45.
- 71094 not_eligible age 45 and gap 51 days. Age 45 => not_eligible. Also screening FIT 2026-06-06 would be numerator but not eligible.
Let's double-check ages and birthdates:
Measure age 46 through 75 as of 2026-12-31.
Compute ages:
71081 1951-10-15 => on 2026-12-31, 2026-1951=75, birthday Oct 15 passed, age 75. eligible age.
71082 1981-09-15 => 2026-1981=45, age 45. not eligible (<46). Yes.
71083 1971-06-11 => age 55. eligible.
71084 1967-02-19 => 2026-1967=59. eligible age.
71085 1959-01-11 => 2026-1959=67. eligible age (67).
71086 1951-02-07 => age 75 (Feb 07 passed). eligible.
71087 1967-06-23 => age 59. eligible.
71088 1976-06-16 => 2026-1976=50. eligible age.
71089 1967-11-24 => age 59. eligible.
71090 1950-05-28 => 2026-1950=76. age 76. not eligible.
71091 1950-07-12 => age 76. not eligible.
71092 1971-06-21 => age 55. eligible.
71093 1976-11-04 => age 50. eligible.
71094 1981-12-09 => 2026-1981=45 (birthday Dec 09; on Dec 31 age 45? Wait DOB 1981-12-09. In 2026, on Dec 31, they have turned 45 on Dec 9, 2026. So age = 2026-1981 = 45. Yes, 45. Not eligible (must be 46-75). Good.
71095 1979-11-11 => age 47. eligible.
71096 1967-03-27 => age 59. eligible.
71097 1951-08-03 => age 75. eligible.
71098 1954-09-24 => age 72. eligible.
71099 1979-09-26 => age 47. eligible.
71100 1979-01-17 => age 47. eligible age.
Now continuous enrolment details:
Definition: "the full measurement year with no more than one gap of up to 45 days." I need interpret "full measurement year" precisely. In HEDIS, continuous enrollment usually allows a gap of no more than 45 days, but the member must be enrolled on the anchor date? Actually for many measures, the continuous enrollment criteria: "Enrolled continuously during the measurement year, with no more than one gap in enrollment of up to 45 days." This means the member must be enrolled for the entire year except for at most one gap of up to 45 days. It does not require enrollment on Jan 1? Wait if there is a gap, they are not enrolled during gap. At start, if they enroll late, that's a gap from Jan 1 to enrollment start. At end, if they disenroll before Dec 31, gap to Dec 31. The total non-enrollment segments: if they start late, that's one gap at beginning; if they have a mid-year gap, that's another. The phrase "no more than one gap" means at most one continuous period of non-enrollment. The gap length can be up to 45 days. So if member is not enrolled from Jan 1 to Mar 15 (74 days) and then enrolled through Dec 31, that's ONE gap of 74 days. Is that allowed? It says "no more than one gap of up to 45 days." That means the (single) gap is allowed only if it is up to 45 days. If the gap is 74 days, it's more than 45, so not allowed. Thus fails. If member has two gaps (like 71081: two gaps of 23 and 29), that's more than one gap, so fails even though each <=45. Yes.
Let's test each enrolment:
- 71081: Segments: Jan1-Mar21, gap 23 days (Mar22-Apr13?), then Apr14-Jul23, gap 29 days (Jul24-Aug21?), then Aug22-Dec31. Two gaps. Fails (more than one). Not_eligible.
- 71082: continuous no gaps. Eligible age? No, age 45. So not_eligible.
- 71083: continuous. Eligible.
- 71084: enrolled Apr15-Dec31. Not enrolled Jan1-Apr14: gap length? Jan (31) + Feb (28) + Mar (31) + Apr 1-14 (14) = 31+28+31+14 = 104 days? Wait enrolment starts 2026-04-15, so last non-covered day is Apr 14. So Jan 1-Apr 14 inclusive = 31+28+31+14 = 104 days. Let's compute: Jan 31, Feb 28 (2026 not leap), Mar 31, Apr 1-14 = 14. Total 104. Definitely >45. One gap but >45 days. Fails continuous enrolment. Not_eligible. (Also N3 screening 2021 outside window). Good.
- 71085: continuous. Eligible.
- 71086: continuous. Eligible.
- 71087: Jan1-Apr20, gap 32 days (Apr21-May22? Let's verify: enrolment resumes 2026-05-23. Gap from Apr21 to May22 inclusive: Apr 21-30 =10, May 1-22=22, total 32. Yes one gap <=45. Then May23-Dec31. So exactly one gap of 32. Meets continuous enrolment (full measurement year with no more than one gap of up to 45 days). Eligible. Good.
- 71088: Jan1-Feb16, gap 17 days (Feb17-Mar5? resumes Mar6. Gap Feb17 to Mar5: Feb 17-28 =12 (2026 Feb has 28 days, so 28-16=12), Mar1-5=5, total 17). Then Mar6-May13, gap 14 days (May14-May27? resumes May28. May 14-27 =14). Then May28-Dec31. That's two gaps (17 and 14). More than one gap. Fails. Not_eligible. Even though both <=45, count >1. Good.
- 71089: continuous. Eligible.
- 71090: Jan1-May27, gap 28 days (May28-Jun24? resumes Jun25. May 28-31=4, Jun1-24=24 total 28). One gap <=45. Enrolment OK. But age 76 => not_eligible. So not_eligible.
- 71091: Jan1-Apr24, gap 39 days (Apr25-Jun2? resumes Jun3. Apr 25-30=6, May=31, Jun1-2=2 total 39). One gap <=45. Enrolment OK. Age 76 => not_eligible. Not_eligible.
- 71092: continuous. Eligible (age 55). Excluded E1.
- 71093: continuous. Eligible.
- 71094: Jan1-Apr24, gap 51 days (Apr25-Jun14? resumes Jun15. Apr 25-30=6, May=31, Jun1-14=14 total 51). One gap but 51 >45, fails json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 12,169 tokens
We need to classify 20 members into compliant/non_compliant/excluded/not_eligible based on measure QM-CRC.
Let's parse measure:
Measurement year: 2026-01-01 through 2026-12-31.
Eligible population (denominator):
- Age: 46 through 75 years as of 2026-12-31. That means age on 2026-12-31 must be 46, 47, ..., 75. If born such that on 2026-12-31 age is 45 or 76, not eligible. Need to compute ages. We are given "so X years old on 2026-12-31". Use those.
Check: 46 through 75 inclusive. So 45 not eligible, 76 not eligible.
- Continuous enrolment: the full measurement year with no more than one gap of up to 45 days.
Interpretation: Enrolled for the full measurement year? "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Means the member must be enrolled for the entire year (2026-01-01 to 2026-12-31), except they can have at most one gap (a period of non-enrolment) that lasts up to 45 days. If they have zero gaps, continuous. If they have one gap <=45 days, still meets continuous enrolment. If they have two or more gaps, or one gap >45 days, they do NOT meet continuous enrolment. Also, what about not enrolled at start or end? The requirement "full measurement year" means they must be enrolled from 2026-01-01 through 2026-12-31, except allowed gap. If enrolment starts after 2026-01-01 or ends before 2026-12-31, that's a gap at the boundary? Usually continuous enrolment requires enrolled on first day and last day? Let's examine examples.
Member 71084: Enrolment: 2026-04-15 through 2026-12-31, continuous from that date. Not enrolled before 2026-04-15. That is not enrolled from Jan 1 to Apr 14, which is a gap of more than 45 days (about 104 days). So fails continuous enrolment (enrolment does not start at beginning of year). It says "full measurement year with no more than one gap of up to 45 days." The gap at the start (not enrolled before April 15) is >45 days, so not eligible. Age 59 (eligible age), but enrolment fails => not_eligible.
Member 71100: Enrolment: 2026-03-16 through 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Gap from Jan 1 to Mar 15 = 73 days? Let's compute: Jan 1 to Mar 15 inclusive? Actually enrolment starts Mar 16, so not enrolled Jan 1 - Mar 15. Days: Jan has 31, Feb 28 (2026 not leap), Mar 1-15 = 15 days => 74 days gap. >45 days. Also age 47 (eligible). So enrolment fails -> not_eligible. Also has advanced illness but no frailty, so no exclusion anyway. But enrolment excludes.
What about member 71090: Age 76 (DOB 1950-05-28, 76 on 2026-12-31). Age >75, so not_eligible regardless of enrolment and screening. Similarly 71091 age 76 not_eligible. Let's list all with ages:
71081: 75 (eligible age, since 46-75 inclusive)
71082: 45 (not eligible)
71083: 55 (eligible)
71084: 59 (eligible age, enrolment fails -> not_eligible)
71085: 67 (eligible)
71086: 75 (eligible)
71087: 59 (eligible)
71088: 50 (eligible)
71089: 59 (eligible)
71090: 76 (not eligible age)
71091: 76 (not eligible age)
71092: 55 (eligible)
71093: 50 (eligible)
71094: 45 (not eligible age)
71095: 47 (eligible)
71096: 59 (eligible)
71097: 75 (eligible)
71098: 72 (eligible)
71099: 47 (eligible)
71100: 47 (eligible age, but enrolment fails -> not_eligible)
Check 71082: 45, not eligible due to age. Also has frailty and advanced illness but age 45 so not eligible (never enters eligible population). Note: E4 requires age 66+ AND frailty + advanced illness. But age 45 fails age anyway, so not_eligible. Exclusions evaluated only for members in eligible population. So 71082 not_eligible.
71094: 45, not eligible age. Also enrolment gap 51 days (>45) so also fails enrolment. But age fails, not_eligible.
Now for those with age eligible (46-75), check continuous enrolment: allowed "no more than one gap of up to 45 days". Let's examine each enrolment:
71081: Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps: between Mar 21 and Apr 14: gap length? Not enrolled Mar 22 through Apr 13? Let's compute: Last day enrolled Mar 21. Next enrolment Apr 14. Gap days = from Mar 22 to Apr 13 inclusive. March has 31 days, so Mar 22-31 = 10 days. Apr 1-13 = 13 days. Total 23 days. Matches "Gaps of 23 and 29 days" given. Second gap: Jul 23 to Aug 22. Last day Jul 23, next Aug 22. Gap: Jul 24-31 = 8 days (since Jul has 31 days, 31-23=8), Aug 1-21 = 21 days, total 29 days. So TWO gaps (23 and 29 days). The spec says "no more than one gap of up to 45 days." This member has two gaps. Therefore does NOT meet continuous enrolment. Even though each gap <=45 days, there are two gaps. "no more than one gap" means at most one gap. So fails continuous enrolment. Age 75 eligible, but enrolment fails -> not_eligible. Wait, check: 71081 age 75 eligible. Enrolment has two gaps => not continuous. So not_eligible. Need to ensure: The measure says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That means you can have zero gaps (continuous) or exactly one gap that is <=45 days. Two gaps => fails. So 71081 not_eligible. (Even though had FIT in 2025, numerator not relevant.)
71083: Enrolment continuous no gaps. Meets.
71084: started 2026-04-15, not enrolled before. That's one gap from Jan 1 to Apr 14 of 104 days >45, also it's a gap at start. Fails enrolment. Not_eligible.
71085: continuous no gaps.
71086: continuous no gaps.
71087: Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days. Let's verify: Apr 20 to May 23. Gap days: Apr 21-30 = 10 days, May 1-22 = 22 days => 32 days. Yes one gap, 32 <=45. Meets continuous enrolment (one gap up to 45 days). Age 59 eligible. So in eligible population (denominator before exclusions). Now check exclusions: E4: Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Member is 59, so not age 66+. Thus E4 does not apply. No colorectal cancer, no colectomy, no hospice mentioned. So no exclusion. Evaluate numerator: Screening history: 2021-04-28 CT colonography. Look-back for CT colonography (N4): during 2026 or the four years prior (five-year window) measured back from 2026-12-31. Five-year window includes 2022, 2023, 2024, 2025, 2026? Let's define: "during 2026 or the four years prior (five-year window)" measured back from 2026-12-31. That means the test date must be on or after 2022-01-01? Let's compute: four years prior to 2026-12-31 would be 2022-12-31? Actually "during 2026 or the four years prior" means years 2026, 2025, 2024, 2023, 2022. Wait, if measurement year is 2026, "2026 or the four years prior" = 2026, 2025, 2024, 2023, 2022 (that's 2026 + four prior years = 2022-2026 inclusive, five-year window). The look-back measured back from 2026-12-31: five-year window means from 2022-01-01? Or 2021-12-31? Need to be precise: N4: "CT colonography during 2026 or the four years prior (five-year window)." If we measure back from 2026-12-31, a five-year window would cover the period 2022-01-01 through 2026-12-31? Let's count years: 2026 (year 0), 2025 (1 year prior), 2024 (2), 2023 (3), 2022 (4 years prior). So the earliest year is 2022. So a test in 2022, 2023, 2024, 2025, or 2026 qualifies. A test in 2021 is five years prior? Let's check: 2026 - 5 = 2021. "four years prior" means 2022 is four years prior to 2026? Let's list prior years: 1 year prior = 2025, 2 years prior = 2024, 3 years prior = 2023, 4 years prior = 2022. So the four years prior are 2025, 2024, 2023, 2022. Plus 2026 gives 2022-2026. So 2021 is not included. Thus a CT colonography in 2021-04-28 is outside the five-year window (it's in the fifth year prior? Actually 2021 is five years prior to 2026). The colonoscopy N5 is "during 2026 or the nine years prior (ten-year window)" -> 2017-2026. Sigmoidoscopy N3: "during 2026 or the four years prior (five-year window)" -> 2022-2026. FIT/FOBT N1: during 2026 only. Stool DNA N2: during 2026 or two years prior (three-year window) -> 2024-2026? Wait: 2026 + two years prior (2025, 2024) = three-year window 2024-2026. Check: "during 2026 or the two years prior (three-year window)" -> years 2026, 2025, 2024. Yes.
For 71087: CT colonography 2021-04-28. That is in 2021, which is not within 2022-2026. So N4 not met. No other screenings. So numerator not met. Member is in denominator (eligible, no exclusion), not met numerator => non_compliant. Wait, check exclusion E4: age 66+? No, 59. Frailty and advanced illness documented but age <66, so no exclusion. So non_compliant.
71088: Age 50. Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31. Gaps: first gap Feb 16 to Mar 6: 17 days (Feb 17-28? 2026 Feb has 28 days, so Feb 17-28 =12 days, Mar 1-5=5, total 17). Second gap May 13 to May 28: 14 days (May 14-27 =14). So TWO gaps (17 and 14 days). Even though each <=45, there are two gaps, so fails "no more than one gap". Therefore not continuously enrolled. Age eligible (50). Enrolment fails -> not_eligible. (Screening: 2021 flexible sigmoidoscopy. Sigmoidoscopy N3 five-year window 2022-2026; 2021 is outside, wouldn't meet anyway. But not_eligible first.)
71089: Age 59, continuous no gaps. Eligible. No screenings ("No colorectal screening on record"). No exclusions. Numerator not met => non_compliant.
71090: Age 76 -> not_eligible (age). Enrolment: one gap 28 days, but age fails. Not_eligible.
71091: Age 76 -> not_eligible (age). Enrolment one gap 39 days, age fails. Not_eligible.
71092: Age 55, continuous no gaps. Eligible population? Yes. Check exclusions: E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31. Other history: 2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon. C18 is colon cancer, code C18.7 is malignant neoplasm of sigmoid colon. This is within C18-C21 (C18 is malignant neoplasm of colon). So E1 exclusion met (colorectal cancer). Therefore excluded. Note: even though screening history: 2023-02-25 Stool DNA test. Let's see if numerator met? Stool DNA N2: during 2026 or two years prior (three-year window: 2024-2026). Wait 2023-02-25 is in 2023. The three-year window is 2024, 2025, 2026? Let's recalc: "during 2026 or the two years prior (three-year window)". Two years prior to 2026 are 2025 and 2024. So window = 2024, 2025, 2026. 2023 is three years prior? Actually 2023 is three years before 2026 (2026-3=2023). The window is three years: 2026, 2025, 2024. So 2023 is not in window. So numerator not met. But because E1 exclusion met, member is excluded (exclusions evaluated before numerator, and meet exclusion => excluded). So status: excluded. Good.
71093: Age 50, continuous no gaps. Eligible. Screening: 2026-07-02 Faecal immunochemical test. N1: FIT during 2026. Yes, met numerator. No exclusions. So compliant.
71094: Age 45 -> not_eligible (age). Also enrolment gap 51 days >45, but age already fails. Not_eligible.
71095: Age 47, continuous no gaps. Eligible. Screening: 2026-05-26 FIT. N1 met. No exclusions. Compliant.
71096: Age 59, continuous no gaps. Eligible. Screening: 2026-03-13 Colonoscopy. N5: colonoscopy during 2026 or nine years prior (ten-year window: 2017-2026). 2026 is in window, so met numerator. Compliant.
71097: Age 75, enrolment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. One gap of 21 days (Apr 24 to May 16: Apr 25-30 = 6 days, May 1-15 = 15, total 21). One gap <=45, so continuous enrolment met. Age 75 eligible (included, since 46-75 includes 75). Screening: 2026-10-11 FIT. N1 met (during 2026). No exclusions (no cancer, colectomy, hospice; age 75 but E4 requires frailty AND advanced illness; none documented). So compliant. Wait check: any frailty/advanced illness? "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." So no E4. Compliant.
71098: Age 72, continuous no gaps. Eligible. Screening: 2023-04-14 Flexible sigmoidoscopy. N3: flexible sigmoidoscopy during 2026 or the four years prior (five-year window: 2022-2026). 2023 is within window. So numerator met. No exclusions. Compliant.
71099: Age 47, enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap of 39 days (Jun 15 to Jul 25: Jun 16-30 = 15 days, Jul 1-24 = 24 days, total 39). One gap <=45, meets continuous enrolment. Age 47 eligible. Screening: 2025-01-25 Flexible sigmoidoscopy. N3 five-year window: 2022-2026. 2025 is within window, so numerator met. No exclusions. Compliant. Wait, check date: 2025-01-25 is during 2025, which is one year prior to 2026, definitely in 2022-2026. So compliant.
71100: Age 47, enrolment start 2026-03-16, not enrolled Jan 1 - Mar 15. That's a gap of 74 days >45. Also fails continuous enrolment. So not_eligible. Also advanced illness documented but no frailty, age 47, no exclusion anyway. Not_eligible.
Now double-check 71081 again: two gaps (23 and 29 days). So two gaps, fails continuous enrolment. Not_eligible. Age 75 eligible, but enrolment fails.
71088: two gaps (17 and 14 days). Fails continuous enrolment. Not_eligible.
71084: enrolment start Apr 15, gap 104 days >45, fails. Not_eligible.
Now let's verify each member's age calculation from DOB to ensure the given ages are correct and our eligibility判断 is right.
Given DOBs:
71081: 1951-10-15. On 2026-12-31: 2026-1951 = 75. Birthday Oct 15, so by Dec 31 he is 75. Eligible (75).
71082: 1981-09-15. 2026-1981 = 45. Birthday Sep 15, so on Dec 31 is 45. Not eligible (must be 46+). Given 45. Correct.
71083: 1971-06-11 -> 55. Eligible.
71084: 1967-02-19 -> 59. Eligible age.
71085: 1959-01-11 -> 67. Eligible.
71086: 1951-02-07 -> 75. On Dec 31, birthday Feb 7 passed, so 75. Eligible.
71087: 1967-06-23 -> 59. Eligible.
71088: 1976-06-16 -> 50. Eligible.
71089: 1967-11-24 -> 59. Eligible.
71090: 1950-05-28 -> 76. Not eligible.
71091: 1950-07-12 -> 76. Not eligible.
71092: 1971-06-21 -> 55. Eligible.
71093: 1976-11-04 -> 50. Eligible.
71094: 1981-12-09 -> 45 (birthday Dec 9, 2026, so turned 45 on Dec 9, 2026. On Dec 31 is 45). Not eligible.
71095: 1979-11-11 -> 47. Eligible.
71096: 1967-03-27 -> 59. Eligible.
71097: 1951-08-03 -> 75. Eligible.
71098: 1954-09-24 -> 72. Eligible.
71099: 1979-09-26 -> 47. Eligible.
71100: 1979-01-17 -> 47. Eligible.
Check 71094 enrolment: 2026-01-01 to 2026-04-24; 2026-06-15 to 2026-12-31. Gap: Apr 24 to Jun 15. Apr 25-30 = 6, May 31 days = 31, Jun 1-14 = 14, total 51 days. The text says "One gap of 51 days." Yes. So >45, also fails enrolment, but age 45 fails first. Not_eligible.
Now ensure exclusions for each eligible member (those who passed age and enrolment).
List of members who passed age (46-75) and continuous enrolment (zero or one gap <=45, enrolled full year except gap(s)):
Let's list all 20 and mark:
71081: Age OK. Enrol: two gaps -> FAIL enrol. => not_eligible.
71082: Age FAIL (45). => not_eligible.
71083: Age OK, Enrol OK (continuous). => Denominator candidate. Check excl: none. Numerator: CT colonography 2026-08-02 (in 2026, N4 met) and FIT 2026-09-02 (N1 met). So compliant.
71084: Age OK, Enrol FAIL (start Apr 15, gap >45). => not_eligible.
71085: Age OK, Enrol OK. No screening. No excl. => non_compliant.
71086: Age OK, Enrol OK. Screening: 2020-08-11 CT colonography. N4 window 2022-2026. 2020 is outside (four years prior are 2022-2025? Wait need recalc carefully! Let's double-check N4 window. "CT colonography during 2026 or the four years prior (five-year window)." Measurement year 2026. Four years prior to 2026 are 2022, 2023, 2024, 2025? Let's list: 1 year prior = 2025, 2 = 2024, 3 = 2023, 4 = 2022. So the years included are 2026, 2025, 2024, 2023, 2022. Yes, 2020 is not included. So 2020 CT colonography does NOT meet N4. No other screening. So non_compliant. Wait, but check: Is 2020 eight years prior? Actually 2026 - 2020 = 6 years. So definitely outside five-year window. So non_compliant.
71087: Age OK, Enrol OK (one gap 32). Excl: age 59 <66, so E4 no. Screening: 2021-04-28 CT colonography. N4 window 2022-2026, 2021 is outside (5 years prior? 2026-2021=5, so it's the fifth year prior, not included because only four years prior). So non_compliant.
71088: Age OK, Enrol FAIL (two gaps). => not_eligible.
71089: Age OK, Enrol OK. No screening. => non_compliant.
71090: Age FAIL (76). => not_eligible.
71091: Age FAIL (76). => not_eligible.
71092: Age OK, Enrol OK. Excl E1: colorectal cancer C18.7. Yes. => excluded.
71093: Age OK, Enrol OK. FIT 2026. => compliant.
71094: Age FAIL (45). => not_eligible. (Enrol also fails but not needed)
71095: Age OK, Enrol OK. FIT 2026. => compliant.
71096: Age OK, Enrol OK. Colonoscopy 2026. => compliant.
71097: Age OK, Enrol OK (one gap 21). FIT 2026. => compliant.
71098: Age OK, Enrol OK. Flex sig 2023 (in 2022-2026). => compliant.
71099: Age OK, Enrol OK (one gap 39). Flex sig 2025 (in window). => compliant.
71100: Age OK, Enrol FAIL (start Mar 16, gap 74). => not_eligible.
Now check if any other exclusions apply:
E3: Hospice at any time during measurement year. None of the members have hospice (all state "no hospice" except maybe not mentioned? Let's scan: All say "No colorectal cancer, no colectomy, no hospice, no frailty or advanced illness documented." Or specific history. None have hospice.
E2: Total colectomy any time on or before 2026-12-31. None have colectomy.
E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year. Let's check members age 66+:
- 71085: 67, but no frailty/advanced illness documented. So no.
- 71086: 75, none documented.
- 71081: 75, not_eligible (enrolment). Even if, no frailty/adv.
- 71097: 75, none documented.
- 71098: 72, none documented.
- 71092: 55, no.
- 71087: 59, has frailty and advanced illness but age 59, so not 66+. So no E4. (If age were 66+, it would be excluded, but it's not.)
- 71082: age 45, has frailty and advanced illness, but not eligible due to age, and also not 66+.
- 71084: age 59, frailty documented but no advanced illness? Actually 71084 has "2026-03-11 Frailty documented" but no advanced illness. And age 59 <66. So no E4. Also not_eligible due enrolment.
- 71100: age 47, advanced illness only, no frailty, age <66.
So only E1 for 71092.
Now compile lists:
Compliant members (numerator met, in denominator, not excluded):
71083 (CT colonography 2026 and FIT 2026) -> compliant.
71093 (FIT 2026) -> compliant.
71095 (FIT 2026) -> compliant.
71096 (Colonoscopy 2026) -> compliant.
71097 (FIT 2026) -> compliant.
71098 (Flex sig 2023) -> compliant.
71099 (Flex sig 2025) -> compliant.
Let's verify 71086 again: CT colonography 2020-08-11. Is the five-year window possibly 2021-2026? Let's be absolutely sure about "during 2026 or the four years prior (five-year window)". If measurement year is 2026, "four years prior" could mean the four calendar years before 2026, i.e., 2025, 2024, 2023, 2022. Yes that's what we did. So 2021 is five years prior, not included. If someone argues "five-year window" measured back from 2026-12-31 means five years before that date, i.e., back to 2021-12-31? Wait, let's examine carefully: "look-back window measured back from 2026-12-31". For N4: "CT colonography during 2026 or the four years prior (five-year window)." They explicitly say "five-year window". If you measure back from 2026-12-31 by five years, you get to 2021-12-31. Does "five-year window" mean any service from 2021-12-31 through 2026-12-31? Let's test with N5: "Colonoscopy during 2026 or the nine years prior (ten-year window)." Ten-year window measured back from 2026-12-31 would be back to 2016-12-31. That means a colonoscopy in 2017 or 2016? If window is 2016-12-31 to 2026-12-31, then a test on 2016-12-31 would be exactly 10 years prior? Let's see: 2026-12-31 minus 10 years = 2016-12-31. So a test on 2016-12-31 is within 10 years? Usually "during 2026 or the nine years prior" means years 2026, 2025, 2024, 2023, 2022, 2021, 2020, 2019, 2018, 2017? Wait, count: 2026 is the measurement year. "Nine years prior" to 2026 are 2025 (1), 2024 (2), 2023 (3), 2022 (4), 202json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
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"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
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"ok": true,
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},
{
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"ok": true,
"present": true
},
{
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{
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"ok": true,
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{
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{
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"want": [
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"got": [
"71085",
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"ok": true,
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{
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"want": [
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"got": [
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"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
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"71100"
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"got": [
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"71088",
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"71100"
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"ok": true,
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}
],
"fabricated": false,
"abstained": false
}100Qwen3.8 Flash · Alibaba101.8s · 6,775 out | 45.7s · 5,309 out
Reasoning · 6,487 tokens
We need answer JSON only. Need analyze thoroughly. We have measure QM-CRC. Need classify 20 members. Need compute denominator numerator excluded not eligible rate lists.
Need apply spec:
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.
Need parse age: "46 through 75 years as of 2026-12-31." Records give ages. If age 75 OK. 76 not eligible. 45 not eligible. 46+ OK.
Enrolment: full measurement year with no more than one gap of up to 45 days.
This is tricky: Need not enrolled entire year unless continuous or one gap <=45 days. Does a gap mean missing enrollment within measurement year, not partial before/after? For members not enrolled from 2026-01-01 to end? If enrolment starts after 2026-01-01 or ends before 2026-12-31, is that a gap? They need continuous enrolment full measurement year with no more than one gap of up to 45 days. Typically gap of <45 days in enrollment? But if not enrolled Jan 1-Apr14, that's a 104-day pre-gap -> not full year, not eligible. Records explicitly: "continuous from that date. Not enrolled before ...". Should be not_eligible. For 71084 start 04-15 through 12-31. Not eligible. 71100 start 03-16 through 12-31 not eligible. Others have multiple gaps? Need check continuous requirement "no more than one gap of up to 45 days". Multiple gaps even each small -> not eligible? It says full measurement year with no more than one gap of up to 45 days. Therefore two gaps fail. Also one gap >45 fails. Need inspect records.
Members:
71081 DOB 1951-10-15, age 75 on 2026-12-31 OK. Enrolment: 2026-01-01-03-21; 2026-04-14-07-23; 2026-08-22-12-31. Gaps of 23 and 29 days? Let's check gaps: 03-22 to 04-13 = 23? yes, then 07-24 to 08-21 = 29? yes. Two gaps. Spec allows no more than one gap. Not eligible? Need think: "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This means if more than one gap, not eligible, even if short. Yes. So 71081 not_eligible. Screening history FIT 2025-10-03. FIT only during 2026 per N1. Not numerator if eligible anyway. Excluded? no. Not eligible due enrolment.
71082 age 45 -> not eligible, even continuous. Frailty+AI but age not eligible, not exclusion because never eligible. not_eligible.
71083 age 55, continuous. Screening CT colonography 2026-08-02 qualifies N4 five-year window. Also FIT 2026 qualifies N1. no exclusions. compliant.
71084 age 59. Enrolment starts 2026-04-15 not full year; not_eligible. Flexible sigmoidoscopy 2021-05-09: five-year window by 2026-12-31 includes 2022? Let's check: during 2026 or four years prior -> 2022-2026? Date 2021-05-09 outside five-year window (would be 5.6 years). Even if eligible no numerator. Frailty documented before enrolment? no. not_eligible. Need ensure age 59 OK.
71085 age 67 continuous no screening no exclusions -> non_compliant (denominator, no exclusion).
71086 age 75 continuous CT colonography 2020-08-11: five-year window 2022? Actually during 2026 or four years prior: 2026,2025,2024,2023,2022? Depending measured back from 2026-12-31: if five-year window means on or after 2022-01-01 (calendar years) or 2021-12-31? For 2020 is outside 5 years (6 years). So non_compliant.
71087 age 59. Enrolment: 01-01-04-20; 05-23-12-31. One gap of 32 days? Gap 04-21 to 05-22 = 32 days. <=45. OK eligible. Screening CT colonography 2021-04-28. N4 5-year window: if calendar years includes 2022-2026, not qualify. If exact five years measured back from 2026-12-31 window start 2021-12-31? 2021-04-28 outside. Need determine. Usually NCQA: CT colonography in the measurement year or the four years prior: CY 2022-2026 for MY2026? "during 2026 or the four years prior (five-year window)" means 2022,2023,2024,2025,2026. 2021-04-28 not in window. Exclusions: 2026-05-25 frailty, 2026-06-21 advanced illness both during measurement year and age 59 (<66), E4 requires 66 or older; no. So eligible non_compliant (no exclusions). Need consider if CT colonography within five years by 2026-12-31 maybe if date 2021-04-28 plus 5 years = 2026-04-27, not within. So non_compliant.
71088 age 50. Enrolment multiple gaps: 01-01-02-16; 03-06-05-13; 05-28-12-31. Gaps 17 and 14 days, two gaps -> not eligible. Screening flexible sigmoidoscopy 2021-07-01 outside 5-year anyway. not_eligible. Need note if gap between 02-17-03-05 17 days; second 05-14-05-27 14 days. two >1 fail.
71089 age 59 continuous no screening no exclusions -> non_compliant.
71090 age 76 -> not eligible. FIT 2026-06-02 but fail age. Enrol one gap 28 days OK. not_eligible.
71091 age 76 -> not eligible. FIT 2026-02-09 and 05-24. not_eligible.
71092 age 55 continuous. Stool DNA test 2023-02-25. N2 three-year window 2024-2026? or three years prior? "during 2026 or the two years prior (three-year window)" = 2024,2025,2026. 2023 outside. Also diagnosis C18.7 colorectal cancer 2024-10-06. E1 required exclusion colorectal cancer any time on/before 2026-12-31. Exclusions evaluated before numerator, only for eligible. So excluded. Denominator excludes. even if not numerator. Need not eligible? no eligible age/enrol. excluded.
71093 age 50 continuous FIT 2026 qualifies N1. no exclusions. compliant.
71094 age 45 -> not eligible. Enrol one gap 51 days also fail but age first. FIT during gap 06-06? Anyway not_eligible. Need not exclusion.
71095 age 47 continuous FIT 2026 qualifies. no exclusions. compliant.
71096 age 59 continuous colonoscopy 2026-03-13 qualifies N5. compliant.
71097 age 75 continuous? 01-01-04-24; 05-16-12-31. One gap 21 days OK. FIT 2026-10-11 qualifies. compliant.
71098 age 72 continuous. Flexible sigmoidoscopy 2023-04-14 within 2026 or four years prior 2022-2026 -> qualifies N3. compliant. (Even age 72 no frailty AI.)
71099 age 47? DOB 1979-09-26 -> 47 on Dec 31 2026. Enrol: 01-01-06-15; 07-25-12-31 one gap 39 days. Eligible. Flexible sigmoidoscopy 2025-01-25 within 2026 or four years prior -> qualifies. no exclusions. compliant.
71100 age 47? DOB 1979-01-17 -> 47. Enrol start 2026-03-16 not eligible (not full measurement year, gap from Jan1?). Screening CT 2020 outside. Advanced illness 2026-01-23 no frailty and age 47 not E4. not_eligible.
Need counts: denominator = eligible after exclusions (compliant + non_compliant). numerator compliant count. excluded count. not_eligible count. Rate = numerator/denom*100 round half up to one decimal. Lists.
Let's classify list:
71081 not_eligible
71082 not_eligible
71083 compliant
71084 not_eligible
71085 non_compliant
71086 non_compliant
71087 non_compliant
71088 not_eligible
71089 non_compliant
71090 not_eligible
71091 not_eligible
71092 excluded
71093 compliant
71094 not_eligible
71095 compliant
71096 compliant
71097 compliant
71098 compliant
71099 compliant
71100 not_eligible
Count compliant: 71083,71093,71095,71096,71097,71098,71099 = 7.
Non_compliant: 71085,71086,71087,71089 = 4.
Denominator = 11. Excluded=1. Not eligible = 8? Let's count not_eligible: 71081,71082,71084,71088,71090,71091,71094,71100 =8. Total 7+4+1+8=20. Good.
Rate=7/11*100=63.63636 -> 63.6 (one decimal). Half up: 63.6.
Need be careful: Does age 75 through: 71081 75; 71086 75; 71097 75; yes eligible if enrolment? 71081 two gaps fail. 71086 continuous. 71097 one gap <=45.
What about 71081: record says Gaps of 23 and 29 days. The phrase "no more than one gap of up to 45 days" likely not_eligible. Need ensure not "continuous enrolment full measurement year with no more than one gap of up to 45 days" might mean if more than one gap but each up to 45? no, one gap only.
Could there be interpretation: continuous full year means no gaps >45 days, multiple allowed? Let's parse. They list "no more than one gap" explicitly. So multiple fail. Good.
Need ensure E1 for 71092: "colorectal cancer (C18-C21) any time on or before 2026-12-31." C18.7 is within C18-C21. Excluded. Denominator excludes. If excluded, numerator maybe stool DNA outside window but irrelevant.
Potential tricky: numerator look-back windows measured back from 2026-12-31. Need exact date windows, not calendar years? Let's assess each screening if date falls in exact lookback from 2026-12-31:
N3 flex sig during 2026 or four years prior (five-year window). Could mean within five years of 2026-12-31 inclusive, so start date = 2021-12-31? For 71087 CT 2021-04-28 outside; 71088 flex sig 2021-07-01 outside (if not eligible anyway); 71084 flex 2021-05-09 outside; 71098 2023 within; 71099 2025 within.
N4 CT five-year: 71086 2020 outside; 71087 2021-04-28 outside; 71100 2020 outside. 71083 2026 inside.
N5 colonoscopy ten-year: 71096 2026 inside. If any 2017? none.
N2 stool DNA three-year: start 2023-12-31? 71092 2023-02-25 outside either exact/calendar; no numerator if not excluded.
N1 FIT during 2026: 71083 yes; 71093, 71095, 71097 yes; 71090, 71091, 71094 not eligible due age. Good.
Need ensure not_eligible order: if age fail plus exclusion: 71090 age 76 no exclusions. 71091. 71094 no. 71082 age 45 with frailty/advanced illness but age fail -> not eligible. 71081? age ok enrol fail. 71084 enrol fail; has frailty but age not. 71087 age 59 with frailty+AI but age fail; not excluded. 71092 excluded despite eligible. 71100 enrol fail, advanced illness alone no.
Potential nuance: For eligible population age 46 through 75 "as of 2026-12-31". Record says 71082 45 years old. Need if born 1981-09-15 age on 2026-12-31 = 45. Yes. 71094 born 1981-12-09 = 45 on Dec 31? yes. 71095 1979-11-11 age 47. Good.
Potential nuance: enrolment "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Could mean eligible if at least 11 months continuous? But says full measurement year; starting after 01-01 not full, but the initial period before enrolment could be a gap >45? For 71084 not enrolled before Apr 15: missing 104 days before measurement year; that is not a gap? Could consider a gap of 104 days from 01-01 to 04-14, so fail. 71100 fail. Good.
But what if start after measurement year? no.
Need output JSON exactly. Keys required. Ensure rate number one decimal maybe 63.6 not "63.6"? JSON number.
Need no extra text.
Let's double-check all members:
71081: Enrolment: Jan 1-Mar 21, Apr14-Jul23, Aug22-Dec31. Two gaps of 23/29. Does the middle gap 29 and first 23? Wait after first gap from Mar22 to Apr13 inclusive = 23 days; second Jul24 to Aug21 inclusive = 29. So two gaps. Spec: no more than one gap -> not eligible. What if "no more than one gap of up to 45 days" could allow multiple gaps if each <=45? No. The phrase "no more than one gap" singular. If there were multiple, fails. Good. Screening FIT 2025-10-03 not within 2026. not_eligible.
71082: Age 45 not eligible. Also if age 45, fail before exclusions. Good.
71083: compliant.
71084: age 59, enrol 4/15 onward. Not eligible. Could there be interpretation full measurement year means enrolled for 12 months? no. Good.
71085: age 67, continuous, no screen. Excluded? none. non_compliant. Need consider age >66 requires frailty and AI; none.
71086: age 75 continuous, CT 2020. If CT exact 5-year lookback from 2026-12-31: start 2021-12-31; 2020 fail. Non_compliant.
71087: age 59 one gap 32, CT 2021 fail (if exact start 2021-12-31, fail; if calendar 2022 fail). Frailty + AI but age 59. No E1/2/3. non_compliant.
71088: two gaps, fail. Even if age. not_eligible.
71089: age 59 continuous no screen. non_compliant.
71090: age 76 fail. not_eligible.
71091: age 76 fail. not_eligible.
71092: age55 continuous, cancer exclusion. Excluded. Denominator excludes. Good.
71093: age50 continuous FIT 2026 compliant.
71094: age45 and gap 51 fail. not_eligible.
71095: age47 continuous FIT 2026 compliant.
71096: age59 continuous colonoscopy compliant.
71097: age75 continuous? gap 04-25 to 05-15 = 21? Let's count: after Apr24: Apr25-May15 inclusive 21 days (May15-24=10 + Apr25-30=6 total 16? Wait gap between enrolment periods: first 04-24, second starts 05-16. Days not enrolled: Apr25-Apr30 6, May1-May15 15 =>21. record says one gap 21. <=45 eligible. FIT Oct 2026 compliant. Good.
71098: age72 continuous, flex 2023 compliant.
71099: age47 continuous? first 01-01 to 06-15, second starts 07-25. Gap 06-16 to 07-24 inclusive = 39. record. <=45. Flex 2025 compliant. Good.
71100: age47 start 03-16, not full year; not eligible. Need if gap before enrolment is 74 days? Jan1-Mar15 inclusive 74? fail >45. Not eligible. Also advanced illness no frailty age. CT 2020 fail.
Counts: denominator eligible after exclusions: eligible total = 12? Excluded 1, non_compliant 4, compliant 7 =12. Yes 12 eligible before exclusions? 7+4+1 =12. Not eligible 8. Exclusions: 71092. Denominator 11. numerator 7.
Potential scoring for excluded_members list: Only eligible and meets required exclusion. 71092 yes. What about 71082 has both frailty and advanced illness but age 45 fails age. Rule: a member who fails age... not_eligible even if exclusion documented. So not excluded. Good.
71087 frailty+advanced but age59 fails E4. Not excluded. Good.
71081 FIT 2025 if age? no.
Rate: 63.636 -> half up to one decimal. 63.6. If Python round? 63.636 -> 63.6. Good.
Need final:
```json
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083","71093","71095","71096","71097","71098","71099"],
"non_compliant_members": ["71085","71086","71087","71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081","71082","71084","71088","71090","71091","71094","71100"]
}
```
Need consider if member IDs must be strings with numbers after MEMBER; yes.
No trailing text.
Double-check if any member in denominator should be excluded due to colectomy? none. Hospice none.
Potential subtle: N1 says "Faecal occult blood test or faecal immunochemical test during 2026." If FIT date 2025-10-03 outside. Good.
Potential subtle: E1 colorectal cancer C18-C21 any time on or before 2026-12-31. Member 71092 diagnosis 2024-10-06 C18.7. Exclude. Good.
Potential subtle: CT colonography five-year window: "during 2026 or the four years prior" if measured back from 2026-12-31. For 71086 CT 2020-08-11. Five-year prior would be 2021-12-31 through 2026-12-31. Fail. If calendar year prior 2022 onward. Fail. Good.
For 71087 CT 2021-04-28. Fail. Good.
For 71100 CT 2020 fail.
Potential subtle: Continuous enrolment with no more than one gap: Do gaps of 23 and 29 for 71081 both <=45 but two. fail. Good.
Let's ensure no issue with 71088: gap of 17 and 14; two gaps fail. Good. But could second gap 05-14 to 05-27 =14; yes.
Potential issue: 71099 age 47; DOB 1979-09-26: On 2026-12-31 is 47 (turned 47 Sep 2026). eligible. Good.
Potential issue: 71095 age 47; DOB 1979-11-11, on 2026-12-31 47. eligible. Good.
Potential issue: 71094 age 45 (turned 45 in 2026? DOB 1981-12-09, on Dec31 2026 45). Age <46 -> not eligible. Good.
Potential issue: 71082 45; not eligible.
Potential issue: 71081: Age 75? DOB 1951-10-15, turns 75 Oct 2026. If eligible through age 75 inclusive. Good.
Could measure exclude 75 and older? no through 75.
Need maybe "not_eligible" includes those not enrolled full measurement year? yes.
Now final output only fenced json. Ensure JSON valid: no comments. Rate number 63.6.
But before final, perhaps need check if there is any ambiguity with "the full measurement year with no more than one gap of up to 45 days." Could be read as enrolment must cover measurement year except any gaps <=45; "no more than one" is explicit, so no. If they meant allowed one gap per enrolment period? no.
Let's think if 71081 could still eligible if there are multiple gaps but total gap <=45? No, says no more than one gap. The record even says "Gaps of 23 and 29 days" plural. So designed to test two gap fail. Good.
Let's verify numerator list order not required. Good.
Potential issue: 71092 stool DNA 2023-02-25 if exact three-year from 2026-12-31 start 2023-12-31 fail. If calendar years prior (2024,2025,2026) fail. Not numerator. But exclusion overrides anyway. Good.
Potential issue: 71097 age 75 and gap 21, FIT 2026, compliant. E4 age 66+ requires frailty and advanced illness; no. Good.
Potential issue: 71086 age 75, CT colonography 2020; if CT colonography ten-year? No spec says N4 five-year. Good.
Potential issue: 71085 age 67, no frailty/advanced, non_compliant. Good.
Need include every required key. Do we include only required keys? Yes. No extra.
Let's compose final.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 5,021 tokens
We need answer JSON only. Need evaluate each member against measure spec. Let's reason carefully.
Task: QM-CRC measurement year 2026-01-01 to 2026-12-31.
Eligible: age 46 through 75 as of 2026-12-31; continuous enrolment full measurement year with no more than one gap of up to 45 days.
Numerator any by look-back from 2026-12-31:
N1 FIT/FOBT during 2026.
N2 Stool DNA during 2026 or two prior (3-year window). Need define 3-year window back from 2026-12-31 likely 2024-01-01 through 2026-12-31? "during 2026 or the two years prior" = 2024,2025,2026.
N3 flexible sigmoidoscopy during 2026 or four years prior (five-year): 2022-2026 inclusive.
N4 CT colonography during 2026 or four years prior: 2022-2026 inclusive.
N5 colonoscopy during 2026 or nine years prior: 2017-2026 inclusive.
Exclusions: E1 CRC C18-C21 any time <= 2026-12-31. E2 total colectomy <=2026-12-31. E3 hospice any time during measurement year. E4 age 66+ on 2026-12-31 AND both frailty and advanced illness documented during measurement year. Exclusions evaluated after eligibility and only eligible; numerator excluded if exclusion.
Need classify each roster 20. Member ID numbers after MEMBER as strings.
Let's parse each.
71081: DOB 1951-10-15 age 75 eligible age. Enrolment gaps: 2026-01-01-03-21; 04-14-07-23; 08-22-12-31. Gaps of 23 and 29 days. Spec: no more than one gap of up to 45 days. This has two gaps -> not continuous enrolment? It says full measurement year with no more than one gap up to 45 days. Two gaps -> not eligible. Age okay but enrolment fail => not_eligible. Screening 2025 FIT irrelevant numerator only 2026. So 71081 not_eligible.
71082: age 45 on 2026-12-31. Eligible age fail (<46) => not_eligible regardless frailty+advanced illness? Exclusions only for eligible. So not_eligible.
71083: age 55. Enrolment continuous. No exclusions. Numerator: CT colonography 2026 => N4; FIT 2026 N1. compliant.
71084: age 59. Enrolment 2026-04-15 through 12-31 not full measurement year -> not eligible. Not eligible despite flex sig 2021 (outside 5-year anyway? 2021 before 2022, so non-compliant if eligible). Frailty outside measurement? 2026-03-11 during but not eligible. So not_eligible.
71085: age 67 continuous. No exclusions. No screening -> non_compliant. Check E4 age 66+ but no frailty/advanced illness. So denominator, non_compliant.
71086: age 75 continuous. CT colonography 2020-08-11. Lookback five-year 2022-2026 (or during 2026 or four years prior; from 2026-12-31 back? 2020 not). No numerator -> non_compliant. Need age 75 eligible; no exclusions.
71087: age 59. Enrolment gap 32 one allowed? continuous full year with no more than one gap up to 45 days. Yes eligible. Screening CT colonography 2021-04-28. Five-year window likely 2022-2026, so fail. Exclusion? age 59 no E4. Frailty and advanced illness during but age <66 so no E4. non_compliant. Check E3? none. E1/E2 none. Denom non_compliant.
71088: age 50. Enrolment: 01-01-02-16; 03-06-05-13; 05-28-12-31. Gaps 17 and 14 days. Two gaps => not eligible (no more than one). Screen flexible sigmoidoscopy 2021 outside 5-year. Not_eligible.
71089: age 59 continuous, no screening -> non_compliant.
71090: age 76 -> fails age >75 => not_eligible. Enrolment gap? one 28 but age fail. FIT 2026. Not eligible.
71091: age 76 fail age -> not_eligible.
71092: age 55 continuous. CRC diagnosis C18.7 2024-10-06 on/before 2026-12-31 => E1 exclusion. Stool DNA 2023? Three-year window: during 2026 or two years prior: 2024-2026? If 2023 outside. But excluded regardless. So excluded.
71093: age 50 continuous. FIT 2026-07-02 => compliant.
71094: age 45? DOB 1981-12-09, age 45 on 2026-12-31 (as stated) fails age. Also gap 51 >45 and not full? Not eligible. Need choose fail age first? not_eligible.
71095: age 47 continuous. FIT 2026-05-26 => compliant.
71096: age 59 continuous. Colonoscopy 2026-03-13 => compliant.
71097: age 75 continuous with one 21 day gap, eligible. FIT 2026-10-11 => compliant.
71098: age 72 continuous. Flexible sigmoidoscopy 2023-04-14. Five-year window 2022-2026 inclusive => meets N3. No exclusions. compliant. Check E4 age 66+ requires both frailty and advanced illness, not present.
71099: age 47. Enrolment gap 39 one allowed? 01-01-06-15, 07-25-12-31. gap of 39 days. Continuous? "no more than one gap of up to 45 days" yes. Screening flexible sigmoidoscopy 2025-01-25. Five-year window 2022-2026 inclusive => meets N3. compliant.
71100: age 47. Enrolment not full, starts 03-16 -> not eligible. Screening CT 2020 outside anyway. Advanced illness during but not eligible. not_eligible.
Now counts:
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7.
Non_compliant: 71085, 71086, 71087, 71089 = 4? Check maybe 71084? no not_eligible; 71081 not; 71088 not; etc. So 4.
Excluded: 71092 = 1.
Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 = 8. Total 20. Denominator = compliant + noncompliant = 11. Numerator 7. Rate 7/11*100 = 63.636... rounded half up to one decimal: 63.6? 63.636 to one decimal -> 63.6 (since hundredth 3? Actually 63.636: one decimal is 63.6, next digit 3 (<5). If exact 63.63636, one decimal: 63.6). Need ensure rounding half up, yes.
But need scrutinize enrolment: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Does this allow a gap at beginning/end? It says full measurement year with no more than one gap up to 45 days. Typically NCQA: enrolled on Jan 1 and Dec 31 with no gap > 60? But here explicit no more than one gap of up to 45 days. The examples 71084 and 71100 not enrolled at start. They fail full measurement year. 71081 has two gaps. 71088 two gaps. 71094 gap 51. Good.
Need examine date windows exactly. "by the look-back window measured back from 2026-12-31". For years, flexible sigmoidoscopy during 2026 or the four years prior (five-year window). Could mean any date from 2022-01-01 through 2026-12-31 (calendar years). Or exact date minus 5 years? If exact back from 2026-12-31: 2021-12-31 through 2026-12-31? But phrase "during 2026 or the four years prior" likely calendar years 2022-2026. Need check each: 71098 flex sig 2023-04-14 in both; 71099 2025 in both; 71087 2021 outside both; 71084 2021 not eligible; 71088 2021 not eligible; no ambiguous maybe 2021? If exact 5 years from 2026-12-31: starts 2021-12-31, 2021-07-01 outside. Calendar 2022-2026 outside 2021. Fine.
Stool DNA: 71092 2023. If exact 3 years back from 2026-12-31: 2023-12-31 through 2026-12-31; 2023-02-25 outside. Calendar two years prior = 2024? Wait during 2026 or the two years prior: 2025 and 2024? "during 2026 or the two years prior" could be 2024-2026 (including 2026 and previous two calendar years) = 3-year window. 2023 is outside both. If exact 3-year window from 2023-12-31; outside. But excluded anyway. No matter for numerator, exclusion.
Colonoscopy 10-year: none except 71096 2026.
CT: 71083 2026; 71086 2020 outside; 71087 2021 outside; 71100 2020 not eligible. If exact 5-year from 2021-12-31: 2021-04 outside. calendar outside. Good.
FIT: 2025 not numerator for eligible 71081; if exact one year? during 2026 only. Good.
Need consider E1 diagnosis C18.7 malignant neoplasm sigmoid colon. C18 is in C18-C21? Yes. Exclude regardless of screening. Good.
Potential pitfall: exclusions evaluated before numerator only for eligible. Not_eligible not excluded. 71082 age 45 with frailty and advanced illness not eligible. Good.
Potential issue: 71090 and 71091 age 76 not eligible though maybe age "46 through 75 as of 2026-12-31". Age stated 76. Good.
Potential issue: 71094 age 45 and gap 51: not eligible. Good.
Potential issue: 71084 enrolment 04-15-12-31 gap? not enrolled 01-01-04-14, >45? Not eligible. Good.
Potential issue: 71100 not enrolled before 03-16; not eligible. Advanced illness only no exclusion, not eligible.
Now need output JSON only, no extra. Ensure all required keys. Member IDs strings. Order any.
Need be careful with denominator count: 11, numerator 7, excluded 1, not_eligible 8, rate 63.6.
Let's re-evaluate each member systematically to ensure no missed eligible/exclusion.
List:
71081 not_eligible due two gaps; age 75 eligible, FIT 2025 outside; no exclusion. If two gaps could be considered gaps within allowed? The rule "no more than one gap of up to 45 days" => no.
71082 not_eligible due age 45; frailty+AI but E4 requires age 66+, so would not exclude if age eligible? Age 45 anyway not eligible.
71083 compliant. Continuous, age 55, no exclusion, CT/FIT 2026.
71084 not_eligible due not full measurement year, despite flex sig 2021 (not numerator), frailty in measurement. Good.
71085 non_compliant. Age 67 eligible, continuous, no screen, no exclusion.
71086 non_compliant. Age 75 eligible, continuous, CT 2020 fail, no exclusion.
71087 non_compliant. Age 59 eligible, one 32 gap, CT 2021 fail, E4 age not 66.
71088 not_eligible two gaps; age 50; flex sig 2021 fail.
71089 non_compliant age 59 continuous no screen.
71090 not_eligible age 76 (though FIT 2026). Good.
71091 not_eligible age 76.
71092 excluded: age 55 continuous, CRC 2024. Stool DNA 2023 maybe if window different? But excluded.
71093 compliant age 50 continuous FIT 2026.
71094 not_eligible age 45/gap >45. FIT 2026.
71095 compliant age 47 continuous FIT 2026.
71096 compliant age 59 continuous colonoscopy 2026.
71097 compliant age 75 continuous one 21 gap FIT 2026.
71098 compliant age 72 continuous flex sig 2023 (in 5y). Good.
71099 compliant age 47 continuous one 39 gap flex sig 2025. Good.
71100 not_eligible not full year; CT 2020. Good.
Double-check E4 age: "Age 66 or older as of 2026-12-31 AND both frailty and advanced illness documented during measurement year." Does 71087 age 59 no. 71082 age 45 not eligible. If not eligible, not excluded. If it was eligible? no.
Could there be a nuance: "no more than one gap of up to 45 days" maybe the gaps listed are days not covered? For 71081 gap dates:
03-21 to 04-14 inclusive? The given gap 23; 07-23 to 08-22 gap 29. Two gaps. Not eligible. For 71088 two gaps. Good.
For 71084 continuous from 04-15; if start gap 01-01 to 04-14 maybe counted as one gap? It says not enrolled before date; no more than one gap of up to 45 days, start gap length? 2026-01-01 to 2026-04-14 inclusive maybe 104 days? Not eligible. 71100 start gap 2026-01-01 to 03-15 74 days? not eligible. Even if one gap allowed but >45? fail. Good.
71094 one gap of 51 >45 fail age also.
71087 gap 32 allowed. 71097 21. 71099 39. 71090 gap 28 but age fail; 71091 gap 39 age fail.
Need produce JSON with numbers. Rate could be 63.6, not string.
Let's consider if denominator includes excluded? Definition: "denominator integer — members in the eligible population after exclusions are removed (compliant + non_compliant)". yes.
Check JSON syntax: fenced code block only.
Need no commentary outside code. Ensure lists all strings. Let's decide order:
compliant_members: ["71083","71093","71095","71096","71097","71098","71099"]
non_compliant_members: ["71085","71086","71087","71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"]
Counts match.
Potential issue: Member 71086 CT colonography 2020-08-11. Ten-year colonoscopy? no. CT 5-year: during 2026 or four years prior. From measurement year end, if "look-back window measured back from 2026-12-31" maybe five-year exact window = 2022-01-01 through 2026-12-31? 2020 outside. Good.
Potential issue: 71087 CT 2021-04-28. If exact window: 2021-12-31 to 2026-12-31 (5 years back?) outside. If inclusive of 2021 as four prior years? "2026 or four years prior" = 2022,2023,2024,2025? Wait if counting prior calendar years: 2026 is one; four years prior are 2025,2024,2023,2022. 2021 not. Good.
Potential issue: 71088 flex sig 2021-07-01. Same outside, but not eligible. 71084 2021-05-09 outside; not eligible. Good.
Potential issue: 71099 flex sig 2025-01-25. within five-year. Good.
Potential issue: 71098 flex sig 2023-04-14. within. Good.
Could 71081's FIT 2025-10-03 be considered within annual FIT? No N1 only during 2026. Good.
Need think if E3 hospice "any time during measurement year" but no one has hospice.
Need output final only. But let's ensure if we need mention insufficient? no.
Need maybe consider "frailty and advanced illness" both during measurement year for E4. 71082 has both but age 45. 71087 both age 59. 71084 frailty only, not eligible. 71100 advanced only, not eligible. None eligible 66+ both. Good.
Now final.
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}100Kimi K2.6 · Moonshot162.5s · 9,231 out | 153.3s · 9,436 out | 161.1s · 9,594 out
Reasoning · 9,102 tokens
We need to parse the roster of 20 members, apply the measure QM-CRC specification.
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: any one of N1-N5, look-back from 2026-12-31.
- N1. Faecal occult blood test (FOBT) or faecal immunochemical test (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).
Required exclusions (evaluated after eligible, before numerator):
- E1. Colorectal cancer (C18-C21) any time on or before 2026-12-31.
- E2. Total colectomy any time on or before 2026-12-31.
- E3. Hospice at any time during 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, advanced illness alone does not exclude.
We need to process each member.
Let's list members:
71081: DOB 1951-10-15. Age 75 on 2026-12-31. (75 inclusive, within 46-75). Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps: between 03-21 and 04-14 is 24 days (March 22 to April 13). Between 07-23 and 08-22 is 30 days (July 24 to August 21). Two gaps. Spec: full measurement year with no more than one gap of up to 45 days. Two gaps > not continuous. So not eligible? Let's verify: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This member has two gaps. So fails continuous enrolment. Thus not_eligible. However, check age: 75 is eligible age. But enrolment fails.
Check whether gap counting includes start and end? Usually gap between coverage periods. 2026-03-21 to 2026-04-14: the next day after 03-21 is 03-22, up to 04-13 is 23 days? Let's calculate precisely.
Gap 1: 2026-03-22 through 2026-04-13 inclusive? The phrasing: "Enrolment: 2026-01-01 through 2026-03-21; 2026-04-14 through ..." If coverage ends 03-21 and resumes 04-14, then uncovered days are 03-22, 03-23, ..., 04-13. Count = (April 14 - March 22) = 23 days. Let's compute: March has 31 days, so days in March uncovered: 31-21 = 10 days (22-31). Days in April uncovered before 14: 13 days (1-13). Total = 10+13 = 23 days. So gap is 23 days.
Gap 2: ends 07-23, resumes 08-22. Uncovered: July 24-31 = 8 days. August 1-21 = 21 days. Total = 29 days. So two gaps.
More than one gap, so not eligible. Not_eligible_members.
71082: DOB 1981-09-15. Age 45 on 2026-12-31. Age requirement: 46 through 75. So 45 is not eligible. Not_eligible. Even though she has frailty and advanced illness, age fails first, so not_eligible. Not_eligible_members.
71083: DOB 1971-06-11. Age 55 on 2026-12-31. Eligible age. Enrolment: continuous no gaps. Eligible population. Now exclusions: none. Numerator? Screening: 2026-08-02 CT colonography (N4, lookback 2022-01-01 to 2026-12-31. 2026 is in window). Also 2026-09-02 FIT (N1). So numerator met. Compliant.
71084: DOB 1967-02-19. Age 59 on 2026-12-31. Eligible age. Enrolment: 2026-04-15 through 2026-12-31 continuous from that date. Not enrolled before 2026-04-15. So missing Jan 1 to Apr 14. That is a gap from 01-01 to 04-14 (more than 45 days). Also only one gap but it is 104 days. So fails continuous enrolment. Not_eligible. (Even though frailty documented, not eligible due to enrolment). Not_eligible_members.
71085: DOB 1959-01-11. Age 67 on 2026-12-31. Eligible age. Enrolment: continuous full year. Eligible. Exclusions: none. Numerator: no screening on record. So non_compliant. However, check exclusion E4: age 66+ (67) AND both frailty and advanced illness. He has neither. Not excluded. So non_compliant_members.
71086: DOB 1951-02-07. Age 75 on 2026-12-31. Eligible age. Enrolment: continuous. Eligible. Exclusions: none. Numerator: 2020-08-11 CT colonography. Look-back for CT colonography: 2022-01-01 to 2026-12-31 (five-year window). 2020-08-11 is before 2022-01-01, so outside window. So not N4. No other screening. So non_compliant. Wait, check if any other lookback: N5 colonoscopy during 2017-01-01 to 2026-12-31. CT colonography is not colonoscopy. So no. Non_compliant.
71087: DOB 1967-06-23. Age 59. Eligible age. Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap of 32 days (Apr 21 to May 22). That's ≤45 days and only one gap. So continuous enrolment satisfied. Eligible. Now exclusions: any colorectal cancer? No. Colectomy? No. Hospice? No. E4: age 66+? He is 59, so no. Not excluded. Numerator: screening: 2021-04-28 CT colonography. Look-back window for CT colonography: 2022-01-01 to 2026-12-31. 2021 is before 2022, so outside. No other screening. So non_compliant. Non_compliant_members.
71088: DOB 1976-06-16. Age 50. Eligible. Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31. Gaps: Feb 17 to Mar 5 =? Feb has 28 days in 2026? 2026 not a leap year. So Feb 17-28 = 12 days. Mar 1-5 = 5 days. Total 17 days. Next gap: May 14 to May 27 = 14 days. Two gaps. More than one gap. So fails continuous enrolment. Not_eligible. Note: screening history includes 2021-07-01 flexible sigmoidoscopy, but enrolment fails. So not_eligible.
71089: DOB 1967-11-24. Age 59. Eligible age. Enrolment: continuous full year. Eligible. No exclusions. No screening. Non_compliant.
71090: DOB 1950-05-28. Age 76. Age >75. Not eligible age. Enrolment: Jan 1 to May 27; Jun 25 to Dec 31. One gap of 28 days (May 28 to Jun 24). But age fails. Not_eligible.
71091: DOB 1950-07-12. Age 76. Age >75. Not eligible. Enrolment: Jan1 to Apr24; Jun3 to Dec31. Gap of 39 days. But age fails. Not_eligible.
71092: DOB 1971-06-21. Age 55. Eligible age. Enrolment: continuous full year. Eligible. Exclusions: E1: diagnosis C18.7 on 2024-10-06. Colorectal cancer C18-C21 any time on or before 2026-12-31. C18.7 is malignant neoplasm of sigmoid colon, which is colorectal cancer. So excluded. Numerator: has 2023-02-25 stool DNA test. But exclusions evaluated before numerator. So excluded_members.
71093: DOB 1976-11-04. Age 50. Eligible. Enrolment: continuous. No exclusions. Screening: 2026-07-02 FIT. Numerator N1. Compliant.
71094: DOB 1981-12-09. Age 45 on 2026-12-31? Let's compute: DOB 1981-12-09. As of 2026-12-31, age = 2026-12-31 minus 1981-12-09 = 45 years, 22 days? Actually, if born Dec 9, 1981, on Dec 9, 2026 they turn 45. On Dec 31, 2026 they are still 45. Age requirement is 46 through 75. So 45 is not eligible. Not_eligible. Even though they have a screening and a gap of 51 days (one gap but >45). Age fails anyway.
71095: DOB 1979-11-11. Age 47. Eligible. Enrolment: continuous. No exclusions. Screening: 2026-05-26 FIT. Compliant.
71096: DOB 1967-03-27. Age 59. Eligible. Enrolment: continuous. No exclusions. Screening: 2026-03-13 Colonoscopy. Compliant (N5).
71097: DOB 1951-08-03. Age 75. Eligible age (75 is within 46-75). Enrolment: Jan1 to Apr24; May16 to Dec31. One gap: Apr25 to May15 = 21 days. That is ≤45 days and only one gap. So eligible. No exclusions. Screening: 2026-10-11 FIT. Compliant.
71098: DOB 1954-09-24. Age 72. Eligible. Enrolment: continuous. No exclusions. Screening: 2023-04-14 Flexible sigmoidoscopy. Look-back: five-year window: 2022-01-01 to 2026-12-31. 2023-04-14 is within that. So N3. Compliant.
71099: DOB 1979-09-26. Age 47. Eligible. Enrolment: Jan1 to Jun15; Jul25 to Dec31. One gap: Jun16 to Jul24 = 39 days. ≤45 days. So eligible. No exclusions. Screening: 2025-01-25 Flexible sigmoidoscopy. Look-back for flexible sigmoidoscopy: five-year window 2022-01-01 to 2026-12-31. 2025-01-25 is within that. So N3. Compliant.
71100: DOB 1979-01-17. Age 47. Eligible. Enrolment: Mar16 to Dec31 continuous from that date. Not enrolled before Mar16. Missing Jan1 to Mar15. That's a gap of 74 days (Jan 1 to Mar 15). More than 45 days. Also not enrolled before 2026-03-16. So fails continuous enrolment. Not_eligible. Other history: advanced illness, but not eligible anyway.
Now let's enumerate all 20 members with classification:
71081: not_eligible (enrolment: 2 gaps)
71082: not_eligible (age 45)
71083: compliant
71084: not_eligible (enrolment gap too large and not full year)
71085: non_compliant
71086: non_compliant
71087: non_compliant
71088: not_eligible (2 gaps)
71089: non_compliant
71090: not_eligible (age 76)
71091: not_eligible (age 76)
71092: excluded (colorectal cancer history)
71093: compliant
71094: not_eligible (age 45)
71095: compliant
71096: compliant
71097: compliant
71098: compliant
71099: compliant
71100: not_eligible (enrolment gap >45 days / missing start)
Wait, check 71084: Enrolment starts 2026-04-15. Not enrolled before. So gap from 2026-01-01 to 2026-04-14. Even if we treat it as one gap, it's 104 days >45. So fails. So not_eligible.
Check 71088: two gaps (17 and 14 days) -> more than one gap. So not_eligible.
Check 71081: two gaps (23 and 29 days). More than one gap. not_eligible.
Let's double-check age calculations precisely.
Measure age: "Age: 46 through 75 years as of 2026-12-31." This means on Dec 31, 2026, the member's age must be at least 46 and at most 75 inclusive.
Compute age: floor of (2026-12-31 - DOB). For DOB 1951-10-15: 2026-1951 = 75, but has birthday passed? Oct 15 < Dec 31, so 75. Good.
1981-09-15: 2026-1981 = 45. Birthday Sep 15 < Dec 31, so turns 45 in 2026? Wait, 1981 to 2026 difference is 45 years. 2026-1981=45. Born Sep 15, 1981. On Sep 15, 2026 they turn 45. On Dec 31, 2026 they are 45. So age 45, not eligible.
1971-06-11: 2026-1971 = 55. Jun 11 < Dec 31, age 55. Eligible.
1967-02-19: 2026-1967 = 59. Feb 19 < Dec 31, age 59. Eligible.
1959-01-11: 2026-1959 = 67. Jan 11 < Dec 31, age 67. Eligible.
1951-02-07: 2026-1951 = 75. Feb 7 < Dec 31, age 75. Eligible.
1967-06-23: 2026-1967 = 59. Jun 23 < Dec 31, age 59. Eligible.
1976-06-16: 2026-1976 = 50. Jun 16 < Dec 31, age 50. Eligible.
1967-11-24: 2026-1967 = 59. Nov 24 < Dec 31, age 59. Eligible.
1950-05-28: 2026-1950 = 76. May 28 < Dec 31, age 76. Not eligible.
1950-07-12: 2026-1950 = 76. Jul 12 < Dec 31, age 76. Not eligible.
1971-06-21: 2026-1971 = 55. Jun 21 < Dec 31, age 55. Eligible.
1976-11-04: 2026-1976 = 50. Nov 4 < Dec 31, age 50. Eligible.
1981-12-09: 2026-1981 = 45. Dec 9 < Dec 31, age 45. Not eligible.
1979-11-11: 2026-1979 = 47. Nov 11 < Dec 31, age 47. Eligible.
1967-03-27: 2026-1967 = 59. Mar 27 < Dec 31, age 59. Eligible.
1951-08-03: 2026-1951 = 75. Aug 3 < Dec 31, age 75. Eligible.
1954-09-24: 2026-1954 = 72. Sep 24 < Dec 31, age 72. Eligible.
1979-09-26: 2026-1979 = 47. Sep 26 < Dec 31, age 47. Eligible.
1979-01-17: 2026-1979 = 47. Jan 17 < Dec 31, age 47. Eligible.
Wait, 1981-12-09: 2026-12-31 minus DOB = 45 years + 22 days. Age 45. Not eligible. Correct.
Now enrolment: requirement is "full measurement year with no more than one gap of up to 45 days." The measurement year is 2026-01-01 through 2026-12-31. Full measurement year means enrolled from Jan 1 to Dec 31? Usually continuous enrolment means enrolled for the entire measurement period, allowing one gap up to 45 days. So to be "full measurement year", the member must be enrolled from Jan 1 through Dec 31 except possibly one gap of up to 45 days. If the member starts later than Jan 1 or ends before Dec 31, is that considered a gap? Typically yes: missing the start is a gap from Jan 1 to the start date, missing the end is a gap from end date to Dec 31. The specification says "full measurement year with no more than one gap of up to 45 days." This implies the total time not enrolled during the measurement year cannot exceed one gap of ≤45 days. Starting on Mar 16 creates a gap from Jan 1 to Mar 15, which is >45 days, so fails. Starting on Apr 15 creates gap >45 days. Ending early also fails. Having two gaps of any length fails.
Let's verify each member's enrolment.
71081: Enrolment segments: Jan1-Mar21 (81 days?), Apr14-Jul23 (101 days?), Aug22-Dec31 (132 days?). Gaps: Mar22-Apr13 (23 days), Jul24-Aug21 (29 days). Two gaps. Fails.
71082: full year. Pass.
71083: full year. Pass.
71084: Apr15-Dec31. Missing Jan1-Apr14. That's a gap of 104 days (or 105?). Compute: Jan1 to Apr14 inclusive? The gap is the days not enrolled between Jan1 and Apr15. If enrolled starts Apr15, the uncovered period is Jan1 through Apr14. Number of days: Jan(31) + Feb(28) + Mar(31) + Apr(14) = 104 days. So >45. Fails.
71085: full year. Pass.
71086: full year. Pass.
71087: Jan1-Apr20; May23-Dec31. Gap Apr21-May22. Apr21-Apr30 (10 days) + May1-May22 (22 days) = 32 days. One gap ≤45. Pass.
71088: Jan1-Feb16; Mar6-May13; May28-Dec31. Gaps: Feb17-Mar5 (17 days), May14-May27 (14 days). Two gaps. Fails.
71089: full year. Pass.
71090: Jan1-May27; Jun25-Dec31. Gap May28-Jun24. May28-May31 (4 days) + Jun1-Jun24 (24 days) = 28 days. One gap ≤45. But age 76. Fails age.
71091: Jan1-Apr24; Jun3-Dec31. Gap Apr25-Jun2. Apr25-Apr30 (6) + May (31) + Jun1-Jun2 (2) = 39 days. One gap ≤45. But age 76. Fails age.
71092: full year. Pass.
71093: full year. Pass.
71094: Jan1-Apr24; Jun15-Dec31. Gap Apr25-Jun14. Apr25-Apr30 (6) + May31 + Jun1-Jun14 (14) = 51 days. One gap >45. Also age 45. Fails. Even if age passed, enrolment fails.
71095: full year. Pass.
71096: full year. Pass.
71097: Jan1-Apr24; May16-Dec31. Gap Apr25-May15. Apr25-Apr30 (6) + May1-May15 (15) = 21 days. One gap ≤45. Pass.
71098: full year. Pass.
71099: Jan1-Jun15; Jul25-Dec31. Gap Jun16-Jul24. Jun16-Jun30 (15) + Jul1-Jul24 (24) = 39 days. One gap ≤45. Pass.
71100: Mar16-Dec31. Missing Jan1-Mar15. Jan(31)+Feb(28)+Mar(1-15)=31+28+15=74 days. >45. Also only one segment, but gap from start of year is 74 days. Fails.
So the enrolment failures: 71081, 71084, 71088, 71100, and also 71094 (51 days gap), but age already fails for 71094. 71090 age fails but enrolment passes. 71091 age fails but enrolment passes.
Not_eligible due to age: 71082 (45), 71090 (76), 71091 (76), 71094 (45). So four members not eligible due to age.
Not_eligible due to enrolment: 71081 (two gaps), 71084 (gap >45 / missing start), 71088 (two gaps), 71100 (gap >45 / missing start). Also check if any age-eligible members have enrolment gaps: 71087 passes, 71099 passes, 71097 passes. 71094 age 45 and enrolment gap >45. Since age fails, not_eligible regardless. So we count 71094 in not_eligible.
Thus total not_eligible should be: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8 members.
Wait, also 71084 is age 59 but enrolment fails. Yes.
Now exclusions: 71092 only? Let's check others.
71085: age 67, no frailty or advanced illness. No E4.
71086: age 75, no frailty or advanced illness. No E4.
71087: age 59, has frailty and advanced illness, but age <66. E4 requires age 66+. So not excluded.
Any other member with exclusion history? Let's check all for E1, E2, E3.
71081: no cancer, no colectomy, no hospice.
71082: no cancer, no colectomy, no hospice.
71083: none.
71084: no cancer, no colectomy, no hospice.
71085: none.
71086: none.
71087: none.
71088: none.
71089: none.
71090: none.
71091: none.
71092: C18.7 in 2024. Excluded.
71093: none.
71094: none.
71095: none.
71096: none.
71097: none.
71098: none.
71099: none.
71100: none.
Wait, any hospice? None listed. Any total colectomy? None listed.
So only excluded member: 71092. Excluded count = 1.
Now denominator = eligible - excluded. Compliant + non_compliant = denominator.
Eligible members are those who meet age and enrolment. Let's list all 20 and classify:
1. 71081: not_eligible (enrolment)
2. 71082: not_eligible (age)
3. 71083: compliant
4. 71084: not_eligible (enrolment)
5. 71085: non_compliant
6. 71086: non_compliant
7. 71087: non_compliant
8. 71088: not_eligible (enrolment)
9. 71089: non_compliant
10. 71090: not_eligible (age)
11. 71091: not_eligible (age)
12. 71092: excluded
13. 71093: compliant
14. 71094: not_eligible (age)
15. 71095: compliant
16. 71096: compliant
17. 71097: compliant
18. 71098: compliant
19. 71099: compliant
20. 71100: not_eligible (enrolment)
Now count each bucket.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members. Wait, also any others?
71083 yes.
71093 yes.
71095 yes.
71096 yes.
71097 yes.
71098 yes.
71099 yes.
Total 7.
Non_compliant: 71085, 71086, 71087, 71089. That's 4 members. Are there any others?
71085 no screening.
71086 CT colonography 2020, too old.
71087 CT colonography 2021, too old.
71089 no screening.
So 4 non_compliant.
Excluded: 71092. Count 1.
Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. Count 8.
Denominator = compliant + non_compliant = 7 + 4 = 11. (Alternatively eligible - excluded = (7+4+1) -1 = 11). Eligible total = 7+4+1 = 12.
Rate = numerator / denominator * 100 = 7 / 11 * 100 = 63.6363... Round half up to one decimal place: 63.6? Let's compute: 7/11 = 0.6363636. Multiply by 100 = 63.63636... Round to one decimal: 63.6. Because the second decimal is 3 (<5). Wait, 63.636... the first decimal is 6, second is 3, third is 6. Rounding to one decimal: look at second decimal digit 3, which is less than 5, so round down. Thus 63.6.
But double-check: 7/11 exactly = 0.636363... * 100 = 63.6363... So yes 63.6.
Now let's verify each compliant member's numerator claim carefully against look-back windows.
Measure says look-back window measured back from 2026-12-31.
N1. Faecal occult blood test or faecal immunochemical test during 2026.
- 71083 has FIT 2026-09-02. Yes.
- 71093 has FIT 2026-07-02. Yes.
- 71095 has FIT 2026-05-26. Yes.
- 71097 has FIT 2026-10-11. Yes.
N2. Stool DNA test during 2026 or two years prior (three-year window: 2024-01-01 to 2026-12-31).
- None in compliant members. 71092 has stool DNA 2023-02-25, but that's excluded.
N3. Flexible sigmoidoscopy during 2026 or four years prior (five-year window: 2022-01-01 to 2026-12-31).
- 71098: 2023-04-14. Within 2022-2026. Yes.
- 71099: 2025-01-25. Within 2022-2026. Yes.
Check no others? 71088 had 2021-07-01, but not eligible. 71084 had 2021-05-09, not eligible. So correct.
N4. CT colonography during 2026 or four years prior (2022-2021? No, 2022-01-01 to 2026-12-31).
- 71083: 2026-08-02. Yes (N4 or N1).
- 71086: 2020-08-11. Outside. Not compliant.
- 71087: 2021-04-28. Outside. Not compliant.
N5. Colonoscopy during 2026 or nine years prior (2017-01-01 to 2026-12-31).
- 71096: 2026-03-13. Yes.
So compliant members: 71083 (N1/N4), 71093 (N1), 71095 (N1), 71096 (N5), 71097 (N1), 71098 (N3), 71099 (N3). 7 total.
Now check excluded member 71092. Exclusion E1: colorectal cancer C18-C21 any time on or before 2026-12-31. He has C18.7 on 2024-10-06. So excluded. Even though he also has a stool DNA test in 2023, which would be N2? Wait N2 is stool DNA during 2026 or two years prior (three-year window: 2024-01-01 to 2026-12-31). The test is 2023-02-25, which is outside (before 2024). So not numerator anyway. But exclusion supersedes.
Check if any other member might have an exclusion from E4.
E4: Age 66+ as of 2026-12-31 AND both frailty and advanced illness documented during measurement year.
Members age 66+: 71081 (75), 71084 (59, no), 71085 (67), 71086 (75), 71087 (59), 71090 (76, not eligible), 71091 (76, not eligible), 71092 (55), 71096 (59), 71097 (75), 71098 (72).
Now check those with both frailty and advanced illness during 2026:
- 71085: no frailty or advanced illness.
- 71086: none.
- 71097: none.
- 71098: none.
Check 71087: age 59, has both frailty and advanced illness, but age <66. So not excluded.
Are there any members with frailty or advanced illness documented?
71082: frailty (2026-11-13) and advanced illness (2026-06-12). But age 45, not eligible.
71084: frailty documented (2026-03-1json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 9,340 tokens
We need to apply the measure QM-CRC to 20 members. Let's parse each member, determine eligibility (age 46-75 as of 2026-12-31, continuous enrollment in 2026 with <=1 gap up to 45 days). Then check exclusions (colorectal cancer C18-C21 any time on or before 2026-12-31; total colectomy any time; hospice during measurement year; age >=66 AND both frailty and advanced illness documented during measurement year). Then check numerator (any one of N1-N5 by lookback from 2026-12-31).
We need to output JSON with denominator, numerator, excluded, not_eligible counts, rate, and arrays of member IDs.
Let's go member by member.
Member 71081:
DOB 1951-10-15. Age as of 2026-12-31: 75. (Born 1951-10-15, so on 2026-10-15 turns 75; by 2026-12-31, 75). Age 75 falls in 46-75 inclusive. Good.
Enrollment: 2026-01-01 to 2026-03-21 (gap starts 2026-03-22); 2026-04-14 to 2026-07-23 (gap starts 2026-07-24); 2026-08-22 to 2026-12-31.
Gaps: between 2026-03-21 and 2026-04-14. Let's calculate days. 2026 is not a leap year. March has 31 days. From March 22 to April 13 inclusive? Wait, the gap is the days not enrolled. If enrolled through 2026-03-21 and resumes 2026-04-14, the gap is 2026-03-22 to 2026-04-13 inclusive? But specification says "no more than one gap of up to 45 days". Usually gap length is measured in days between end date and start date. If coverage ends on 03-21 and resumes on 04-14, gap is 24 days (April 14 minus March 21 = 24 days). Let's verify: March 22,23,24,25,26,27,28,29,30,31 = 10 days; April 1-13 = 13 days; total 23 days? Actually March 22 to March 31 inclusive is 10 days. April 1 to April 13 inclusive is 13 days. Total 23 days. The common way: start date resume minus end date = 24 days (since 4/14 - 3/21 = 24). But sometimes gap counted as days without coverage: from 3/22 to 4/13 inclusive = 23 days. The specification likely means gap of up to 45 days means the period between disenrollment and re-enrollment is <=45 days. So 24 or 23 either way <=45.
Second gap: ends 2026-07-23, resumes 2026-08-22. Gap = 2026-07-24 to 2026-08-21. July 24-31 = 8 days. August 1-21 = 21 days. Total 29 days. So two gaps: 24 and 29 days. The rule says "no more than one gap of up to 45 days". This member has two gaps. So fails continuous enrollment. Therefore not eligible.
But let's double-check: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." That means at most one gap, each gap <=45 days. Two gaps disqualify. So 71081 is not_eligible.
Check exclusions? Since not eligible, we don't need to check, but for completeness: no exclusion. Not_eligible.
Member 71082:
DOB 1981-09-15. Age as of 2026-12-31: 45. Measure requires 46 through 75. So 45 is too young. Not eligible.
Check anyway: age 45. Not eligible. Also, frailty and advanced illness documented, but age under 66, so exclusion E4 would not apply (requires age 66+). Even if it did, not eligible supersedes.
Member 71083:
DOB 1971-06-11. Age 55. Eligible age.
Enrollment: continuous full year, no gaps. Good.
Exclusions: none.
Numerator: screening history: 2026-08-02 CT colonography (N4, lookback 2022-01-01 to 2026-12-31? Actually lookback from 2026-12-31: CT colonography during 2026 or four years prior = 2022-01-01 to 2026-12-31). 2026-08-02 falls in 2026, so meets N4. Also 2026-09-02 FIT (N1). So numerator yes.
Compliant.
Member 71084:
DOB 1967-02-19. Age 59. Eligible.
Enrollment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15. Measurement year is 2026-01-01 to 2026-12-31. So missing Jan 1 - Apr 14. That's a gap >45 days? Actually it's a single gap (or initial non-enrollment). The continuous enrollment requirement is full measurement year. He is not enrolled for the first ~3.5 months. That is a gap of 104 days (Jan 1 to Apr 14?). If the rule says "the full measurement year with no more than one gap of up to 45 days", does it allow starting after the measurement year begins? Usually for HEDIS etc., continuous enrollment for the full year means enrolled from Jan 1 to Dec 31, allowing one gap of up to 45 days. If you start on Apr 15, you have an initial gap from Jan 1 to Apr 14, which is >45 days. So not eligible.
Also has frailty documented, but age 59 (<66), so E4 not applicable.
Not eligible.
Member 71085:
DOB 1959-01-11. Age 67 as of 2026-12-31? Let's calculate: 2026-1959 = 67. Born Jan 11, so on 2026-01-11 turns 67. By Dec 31, 2026, age 67. Yes, 67. Eligible.
Enrollment: continuous, no gaps. Good.
Exclusions: none (no cancer, colectomy, hospice, frailty, or advanced illness).
Numerator: No screening on record. So non_compliant.
Member 71086:
DOB 1951-02-07. Age 75. Eligible.
Enrollment: continuous, no gaps.
Exclusions: none.
Numerator: 2020-08-11 CT colonography. Lookback for N4: 2022-01-01 through 2026-12-31. 2020 is too old. So does not meet N4. No other screening. Non_compliant.
Member 71087:
DOB 1967-06-23. Age 59. Eligible.
Enrollment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. One gap: from 4/21 to 5/22. April 21-30 = 10 days, May 1-22 = 22 days, total 32 days. Or using date diff: 5/23 - 4/20 = 33 days? Let's compute properly: If enrolled through 4/20 and resumes 5/23, days without coverage: 4/21,4/22,...4/30 (10), 5/1 to 5/22 (22) => 32 days. That's <=45. Only one gap. Good.
Exclusions: Age 59 (<66), so E4 not applicable. No cancer, colectomy, hospice.
But there is frailty and advanced illness documented during measurement year. However age <66, so E4 does not apply. Not excluded.
Numerator: 2021-04-28 CT colonography. Lookback for N4: 2022-01-01 through 2026-12-31. 2021 is before 2022, so too old. No other screening. So non_compliant.
Wait, check N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window). 2021 is within 2022-? No, lookback from 2026-12-31: 2022-01-01 to 2026-12-31. Actually 2026 minus 4 years = 2022. So 2021 is outside.
N5: colonoscopy during 2026 or nine years prior (ten-year window): 2017-01-01 to 2026-12-31. No colonoscopy listed.
So non_compliant.
Member 71088:
DOB 1976-06-16. Age 50. Eligible.
Enrollment: 2026-01-01-2026-02-16; 2026-03-06-2026-05-13; 2026-05-28-2026-12-31.
Gaps: 2/17 to 3/5 => Feb 17-28 (12), Mar 1-5 (5) = 17 days. Next gap: 5/14 to 5/27 => May 14-31 (18), May? Wait May has 31 days. Actually gap starts after 5/13, resumes 5/28. So days without: 5/14-5/27 = 14 days. Two gaps: 17 and 14 days. Rule allows no more than one gap. So fails continuous enrollment. Not eligible.
Member 71089:
DOB 1967-11-24. Age 59. Eligible.
Enrollment: continuous full year.
Exclusions: none.
Numerator: No screening. Non_compliant.
Member 71090:
DOB 1950-05-28. Age 76. Measure age 46-75. 76 is outside. Not eligible.
Enrollment: 2026-01-01-2026-05-27; 2026-06-25-2026-12-31. One gap of 28 days (5/28-6/24). But age excludes anyway.
Not eligible.
Member 71091:
DOB 1950-07-12. Age 76. Outside range. Not eligible.
Enrollment gap 39 days, but age already excludes.
Not eligible.
Member 71092:
DOB 1971-06-21. Age 55. Eligible.
Enrollment: continuous full year.
Other history: 2024-10-06 Diagnosis C18.7 (malignant neoplasm of sigmoid colon). Colorectal cancer C18-C21 any time on or before 2026-12-31. Yes, C18.7 is in range. So exclusion E1 applies. Excluded.
Even though there is a screening (2023-02-25 Stool DNA test) that would have met N2 (2024-2026 window? N2: Stool DNA test during 2026 or two years prior (three-year window). 2023-02-25 is before 2024? Wait two years prior from 2026-12-31 means 2024-01-01 to 2026-12-31. 2023 is outside. But exclusion takes precedence. Excluded.
Member 71093:
DOB 1976-11-04. Age 50. Eligible.
Enrollment: continuous.
Exclusions: none.
Numerator: 2026-07-02 FIT (N1). Compliant.
Member 71094:
DOB 1981-12-09. Age 45. Not eligible (must be 46-75). Age 45.
Enrollment gap of 51 days (Apr 24 to Jun 15). Two gaps? Actually one gap of 51 days. But age already not eligible.
Not eligible.
Member 71095:
DOB 1979-11-11. Age 47. Eligible.
Enrollment: continuous.
Exclusions: none.
Numerator: 2026-05-26 FIT. Compliant.
Member 71096:
DOB 1967-03-27. Age 59. Eligible.
Enrollment: continuous.
Exclusions: none.
Numerator: 2026-03-13 colonoscopy (N5, within 2026). Compliant.
Member 71097:
DOB 1951-08-03. Age 75. Eligible.
Enrollment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. One gap: 4/25 to 5/15. April 25-30 (6), May 1-15 (15) = 21 days. Or date diff 5/16 - 4/24 = 22 days. Either way <=45. So continuous enrollment satisfied.
Exclusions: none.
Numerator: 2026-10-11 FIT. Compliant.
Member 71098:
DOB 1954-09-24. Age 72. Eligible.
Enrollment: continuous.
Exclusions: none.
Numerator: 2023-04-14 Flexible sigmoidoscopy. Lookback for N3: 2022-01-01 to 2026-12-31. 2023 falls within. So meets N3. Compliant.
Member 71099:
DOB 1979-09-26. Age 47. Eligible.
Enrollment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. One gap: 6/16 to 7/24. June 16-30 (15), July 1-24 (24) = 39 days. <=45. Good.
Exclusions: none.
Numerator: 2025-01-25 Flexible sigmoidoscopy. Lookback for N3: 2022-01-01 to 2026-12-31. 2025 is within. So meets N3. Compliant.
Member 71100:
DOB 1979-01-17. Age 47. Eligible.
Enrollment: 2026-03-16 to 2026-12-31. Not enrolled before 2026-03-16. Initial gap from Jan 1 to Mar 15. That's >45 days. So not eligible.
Other history: advanced illness documented 2026-01-23. Age 47 (<66), so E4 not applicable anyway. Not eligible.
Now let's tally.
We need to be careful about age calculations.
Let's recompute ages precisely as of 2026-12-31:
- 71081: DOB 1951-10-15. As of 2026-12-31, age = 2026-1951 = 75, but since birthday in Oct and date is Dec, already turned 75. So 75.0.
- 71082: DOB 1981-09-15. 2026-1981 = 45, birthday in Sep, date in Dec, turned 45 in Sep. So age 45.
- 71083: DOB 1971-06-11. 2026-1971 = 55. Birthday June, so by Dec 31, 55.
- 71084: DOB 1967-02-19. 2026-1967 = 59. Birthday Feb, so 59.
- 71085: DOB 1959-01-11. 2026-1959 = 67. Birthday Jan, so 67.
- 71086: DOB 1951-02-07. 2026-1951 = 75. Birthday Feb, so 75.
- 71087: DOB 1967-06-23. 2026-1967 = 59. Birthday June, so 59.
- 71088: DOB 1976-06-16. 2026-1976 = 50. Birthday June, so 50.
- 71089: DOB 1967-11-24. 2026-1967 = 59. Birthday Nov, so 59.
- 71090: DOB 1950-05-28. 2026-1950 = 76. Birthday May, so 76.
- 71091: DOB 1950-07-12. 2026-1950 = 76. Birthday July, so 76.
- 71092: DOB 1971-06-21. 2026-1971 = 55. Birthday June, so 55.
- 71093: DOB 1976-11-04. 2026-1976 = 50. Birthday Nov, so 50.
- 71094: DOB 1981-12-09. 2026-1981 = 45. Birthday Dec, so 45 (turns 45 on Dec 9, 2026; by Dec 31, 45).
- 71095: DOB 1979-11-11. 2026-1979 = 47. Birthday Nov, so 47.
- 71096: DOB 1967-03-27. 2026-1967 = 59. Birthday March, so 59.
- 71097: DOB 1951-08-03. 2026-1951 = 75. Birthday Aug, so 75.
- 71098: DOB 1954-09-24. 2026-1954 = 72. Birthday Sep, so 72.
- 71099: DOB 1979-09-26. 2026-1979 = 47. Birthday Sep, so 47.
- 71100: DOB 1979-01-17. 2026-1979 = 47. Birthday Jan, so 47.
So ages: 71081(75), 71082(45), 71083(55), 71084(59), 71085(67), 71086(75), 71087(59), 71088(50), 71089(59), 71090(76), 71091(76), 71092(55), 71093(50), 71094(45), 71095(47), 71096(59), 71097(75), 71098(72), 71099(47), 71100(47).
Eligible ages (46-75 inclusive): All except 45 and 76. So not eligible by age: 71082 (45), 71090 (76), 71091 (76), 71094 (45). Also 71081 (75) is eligible, 71086 (75) eligible, 71097 (75) eligible.
Now continuous enrollment. Let's examine those who are age-eligible.
Age-eligible list: 71081, 71083, 71084, 71085, 71086, 71087, 71088, 71089, 71090, 71091, 71092, 71093, 71095, 71096, 71097, 71098, 71099, 71100. (18 members)
Wait, also 71084 (59), 71088 (50), 71100 (47). Yes.
Now check continuous enrollment for each:
General rule: Full measurement year 2026-01-01 to 2026-12-31, with no more than one gap of up to 45 days.
Definition of gap: A period of non-enrollment. If there are multiple enrollment segments, the gaps are between them. If enrollment starts after Jan 1, is that a gap? Typically yes, the period from Jan 1 to start date. If ends before Dec 31, gap from end date to Dec 31. The spec says "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." This implies you can have at most one gap, and its length must be <=45 days. Starting after Jan 1 creates an initial gap; ending before Dec 31 creates a terminal gap.
71081: Gaps: 3/21-4/14 (23 or 24 days), 7/23-8/22 (29 days). Two gaps. Not eligible.
71083: No gaps. Eligible.
71084: Enrolled 4/15-12/31. Initial gap: 1/1 to 4/14. That's 104 days. >45. Not eligible. Even if we consider no gap because no prior segment? It's a single gap >45 days. Not eligible.
71085: Continuous. Eligible.
71086: Continuous. Eligible.
71087: Gap: 4/20-5/23. Let's compute exactly. Enrolled through 4/20. Resumes 5/23. Days not covered: April 21,22,23,24,25,26,27,28,29,30 (10 days); May 1-22 (22 days). Total 32 days. One gap, <=45. Eligible.
71088: Gaps: 2/16-3/06; 5/13-5/28. Let's compute first gap: Feb 17-28 (12 days), Mar 1-5 (5 days) = 17 days. Second gap: May 14-27 (14 days). Two gaps. Not eligible.
71089: Continuous. Eligible.
71090: Age 76 -> not eligible regardless. But for completeness: gap 5/27-6/25: May 28-31 (4), June 1-24 (24) = 28 days. One gap. But age out.
71091: Age 76 -> not eligible.
71092: Continuous. Eligible.
71093: Continuous. Eligible.
71095: Continuous. Eligible.
71096: Continuous. Eligible.
71097: Gap: 4/24-5/16. Days not covered: April 25-30 (6), May 1-15 (15) = 21 days. One gap <=45. Eligible.
71098: Continuous. Eligible.
71099: Gap: 6/15-7/25. Days not covered: June 16-30 (15), July 1-24 (24) = 39 days. One gap <=45. Eligible.
71100: Enrolled 3/16-12/31. Initial gap: 1/1 to 3/15. Jan 1-31 (31), Feb 1-28 (28) = 59, Mar 1-15 (15) = 74 days? Wait 31+28+15 = 74. Actually 2026 is not a leap year, Feb has 28. Jan 1-31 inclusive is 31 days? Let's count days without coverage. If not enrolled until 3/16, period of non-enrollment is Jan 1 through Mar 15 inclusive? The coverage starts on 3/16. So days without: Jan 1-31 (31), Feb 1-28 (28), Mar 1-15 (15) = 74 days. >45. Not eligible.
So the eligible population (denominator candidates) are those age-eligible and continuous enrollment eligible: 71083, 71085, 71086, 71087, 71089, 71092, 71093, 71095, 71096, 71097, 71098, 71099.
Wait, also 71084? No, not continuous. 71088? No. 71100? No.
Let's list all 20 and status:
1. 71081: Age 75 eligible, but 2 gaps >1. Not eligible.
2. 71082: Age 45. Not eligible.
3. 71083: Age 55, continuous. Eligible. Exclusions? No. Numerator? Yes (CT colonography 2026-08-02). Compliant.
4. 71084: Age 59, but not continuous (initial gap >45). Not eligible.
5. 71085: Age 67, continuous. Eligible. Exclusions? No. Numerator? No screening. Non-compliant.
6. 71086: Age 75, continuous. Eligible. Exclusions? No. Numerator? CT colonography 2020-08-11. Lookback N4: 2022-2026. Too old. Non-compliant.
7. 71087: Age 59, continuous (one gap 32d). Eligible. Exclusions? Age <66, so E4 N/A. No cancer etc. Numerator? CT colonography 2021-04-28. Lookback N4: 2022-2026. Too old. Non-compliant.
8. 71088: Age 50, two gaps. Not eligible.
9. 71089: Age 59, continuous. Eligible. Exclusions? None. Numerator? No screening. Non-compliant.
10. 71090: Age 76. Not eligible.
11. 71091: Age 76. Not eligible.
12. 71092: Age 55, continuous. Eligible. Exclusions? C18.7 diagnosis 2024-10-06. That's colorectal cancer (C18). Excluded.
13. 71093: Age 50, continuous. Eligible. Exclusions? None. Numerator? FIT 2026-07-02. Compliant.
14. 71094: Age 45. Not eligible.
15. 71095: Age 47, continuous. Eligible. Exclusions? None. Numerator? FIT 2026-05-26. Compliant.
16. 71096: Age 59, continuous. Eligible. Exclusions? None. Numerator? Colonoscopy 2026-03-13. Compliant.
17. 71097: Age 75, continuous (one gap 21d). Eligible. Exclusions? None. Numerator? FIT 2026-10-11. Compliant.
18. 71098: Age 72, continuous. Eligible. Exclusions? None. Numerator? Flexible sigmoidoscopy 2023-04-14. Lookback N3: 2022-2026. Yes. Compliant.
19. 71099: Age 47, continuous (one gap 39d). Eligible. Exclusions? None. Numerator? Flexible sigmoidoscopy 2025-01-25. Lookback N3: 2022-2026. Yes. Compliant.
20. 71100: Age 47, not continuous (initial gap 74d). Not eligible.
So:
Not eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8 members.
Excluded: 71092. That's 1 member.
Eligible (denominator) = total 20 - not eligible 8 - excluded 1 = 11.
Wait, denominator is eligible population after exclusions removed. So denominator = members who are eligible and not excluded. That includes compliant and non-compliant.
Let's list denominator members: 71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099. That's 11 members.
Compliant among them: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members.
Non-compliant: 71085, 71086, 71087, 71089. That's 4 members.
Check 71086: Age 75, CT colonography 2020-08-11. N4 lookback: 2026-12-31 minus 4 years = 2022-12-31? Actually "during 2026 or the four years prior (five-year window)". That means from 2022-01-01 to 2026-12-31 inclusive? Typically "the four years prior" means 2022, 2023, 2024, 2025. Wait, if during 2026 or the four years prior, that is 2022-2026. 2020 is not included. So no. What about N5: colonoscopy during 2026 or nine years prior (ten-year window): 2017-2026. No colonoscopy. N3: Flexible sigmoidoscopy during 2026 or four years prior (five-year window). None. N2: Stool DNA 2024-2026. None. N1: FIT during 2026. None. So non-compliant. Correct.
Check 71087: CT colonography 2021-04-28. 2021 is outside 2022-2026. So no. Non-compliant. No other screening. Yes.
Check 71089: No screening. Non-compliant.
Now check 71085: Age 67, no screening. Non-compliant. Could E4 exclude? Age 67 >=66. Frailty? Not documented. Advanced illness? Not documented. So no exclusion.
Check 71098: Flexible sigmoidoscopy 2023-04-14. N3 says during 2026 or four years prior. Four years prior: 2022, 2023, 2024, 2025? Actually "during 2026 or the four years prior (five-year window)". So if measurement year is 2026, four years prior means 2022, 2023, 2024, 2025. Wait, that would be four years: 2022, 2023, 2024, 2025. Plus 2026 = five-year window. But 2023 is included. So 2023-04-14 qualifies. Good.
Check 71099: Flexible sigmoidoscopy 2025-01-25. 2025 is within four years prior (2022-2025). Yes.
Check 71083: CT colonography 2026-08-02. Yes.
Wait, I should also verify N4 window for 71086's 2020 CT: four years prior are 2022-2025. 2020 is outside. So non-compliant.
Now double-check 71081: Age 75, but not continuous. Two gaps. Not eligible. Even though FIT 2025-10-03 (which would be N1? N1 requires during 2026. So no. N2 requires 2024-2026. 2025 fits N2? Wait N2 is Stool DNA test. It's a FIT, not stool DNA. N3: sigmoidoscopy 2022-2026. No. N4: CT colonography 2022-2026. No. N5: colonoscopy 2017-2026. No. So even if eligible, not numerator. But not eligible anyway.
Double-check 71088: Age 50, gap of 17 days and 14 days. Two gaps. Not eligible. Screening: 2021-07-01 flexible sigmoidoscopy. N3 lookback 2022-2026. 2021 outside. So no.
Double-check 71100: Age 47, CT colonography 2020-11-17. N4 lookback 2022-2026. Outside. Not eligible anyway.
Double-check 71084: Age 59, frailty documented 2026-03-11. But enrollment starts 2026-04-15. Since not enrolled before 4/15, is the frailty documented during measurement year but maybe not during enrollment? Exclusion doesn't require enrollment at the time. But not eligible anyway due to enrollment gap >45. Also age 59 (<66), E4 wouldn't apply even if we considered.
Double-check 71082: Age 45, not eligible.
Double-check 71094: Age 45, not eligible. Also gap 51 days >45. Not eligible.
Double-check 71090: Age 76. Not eligible. But has FIT 2026-06-02. If eligible, would be compliant. But age out.
Double-check 71091: Age 76. Not eligible. But has FIT 2026. Age out.
So final counts:
Denominator = 11
Numerator = 7
Excluded = 1
Not eligible = 8
Rate = numerator / denominator * 100 = 7 / 11 * 100 =json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
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"fabricated": false,
"abstained": false
}Reasoning · 9,500 tokens
We need to parse the roster of 20 members for measure QM-CRC (Colorectal Cancer Screening) for measurement year 2026-01-01 through 2026-12-31.
Definitions:
- 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.
- Numerator: any one of:
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).
- Required Exclusions (only evaluated for members in eligible population; i.e., must first meet denominator criteria):
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; advanced illness alone does not exclude.
Status:
- not_eligible: fails age, enrollment, or event. Even if exclusion documented, if not eligible, status is not_eligible.
- excluded: in eligible population but meets a required exclusion.
- compliant: in denominator, not excluded, meets numerator.
- non_compliant: in denominator, not excluded, does not meet numerator.
- denominator = compliant + non_compliant.
- numerator = compliant.
We need to check each member.
Let's go one by one.
First, compute age as of 2026-12-31.
The prompt gives each member's age as of 2026-12-31? Let's check. In the roster text:
"MEMBER 71081. Date of birth 1951-10-15, so 75 years old on 2026-12-31. Male." Yes, they state it.
Let's verify each age if needed.
Enrollment continuous check: full measurement year means Jan 1 to Dec 31, 2026. Gaps allowed: no more than one gap of up to 45 days. So if there are multiple gaps, each must be <=45 days? The wording: "no more than one gap of up to 45 days." Means if there are two gaps, that's more than one gap, so fails. Also gap length must be <=45 days.
So:
Member 71081:
Age 75. That fits 46-75 inclusive.
Enrollment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31.
Gaps: between 03-21 and 04-14: let's calculate. March has 31 days. 21 to 31 = 10 days remaining in March? Actually gap days count between end date and start date. Usually gap = start of next - end of previous - 1 day? Need to be precise. The prompt says "Gaps of 23 and 29 days." So we can rely on the prompt's numbers. Gap1 = 23 days, gap2 = 29 days. There are two gaps, so fails continuous enrollment (more than one gap). So not eligible.
We should verify: they explicitly say "Gaps of 23 and 29 days." So enrollment fails. Not eligible.
Screening history: 2025-10-03 FIT. Date is in 2025, not 2026. Does it matter? Not eligible anyway.
Exclusions: none relevant, but not eligible supersedes.
So 71081: not_eligible.
Member 71082:
DOB 1981-09-15, age 45 on 2026-12-31. Wait prompt says 45. Age 45 is less than 46, so not eligible.
Even if they have frailty and advanced illness, age <46 => not_eligible. Not in eligible population.
Enrollment: continuous, but age fails.
So 71082: not_eligible.
Member 71083:
DOB 1971-06-11, age 55. Eligible age.
Enrollment: continuous, no gaps.
Screening: 2026-08-02 CT colonography (N4, within 2026). Also 2026-09-02 FIT (N1). So meets numerator.
Check exclusions: no cancer, no colectomy, no hospice, no frailty/illness.
Age 55 <66, so E4 irrelevant.
So 71083: compliant.
Member 71084:
DOB 1967-02-19, age 59. Eligible age.
Enrollment: 2026-04-15 through 2026-12-31. Not enrolled before 2026-04-15. So not enrolled for full measurement year (missing Jan 1 to Apr 14). That is a single gap of 104 days? Actually the gap is from Jan 1 to Apr 15. Enrollment starts Apr 15. That's a gap of 104 days (Jan1-Apr14). More than 45 days. So fails continuous enrollment. Not eligible.
Even though they have a screening 2021-05-09 sigmoidoscopy, irrelevant.
Other history: frailty documented 2026-03-11. But since not eligible, not_eligible.
So 71084: not_eligible.
Member 71085:
DOB 1959-01-11, age 67. Eligible age.
Enrollment: continuous, no gaps.
Screening: none on record.
Exclusions: no cancer, no colectomy, no hospice. Age >=66, but no frailty or advanced illness documented. So no exclusion.
So 71085: non_compliant.
Member 71086:
DOB 1951-02-07, age 75. Eligible age.
Enrollment: continuous, no gaps.
Screening: 2020-08-11 CT colonography.
Check numerator: N4 CT colonography during 2026 or prior four years (i.e., lookback to 2022-01-01). 2020 is too old. No other screening. So no numerator.
Exclusions: none. Age 75 >=66, but no frailty or advanced illness. Not excluded.
So 71086: non_compliant.
Member 71087:
DOB 1967-06-23, age 59. Eligible age.
Enrollment: 2026-01-01 through 2026-04-20; 2026-05-23 through 2026-12-31. One gap of 32 days. That's within 45 days and only one gap. So continuous.
Screening: 2021-04-28 CT colonography. Lookback for CT colonography is 2022-01-01 onward. 2021 is too old. No numerator.
Exclusions:
- Frailty documented 2026-05-25.
- Advanced illness documented 2026-06-21.
- Age 59 <66, so E4 (age 66+ AND both frailty and advanced illness) does NOT apply because age <66. So no exclusion.
So 71087: non_compliant.
Wait, what about E1 cancer? None.
E2 colectomy? None.
E3 hospice? None.
E4 requires age >=66. He is 59, so not excluded.
So non_compliant.
Member 71088:
DOB 1976-06-16, age 50. Eligible.
Enrollment: 2026-01-01 through 2026-02-16; 2026-03-06 through 2026-05-13; 2026-05-28 through 2026-12-31.
Gaps: between 02-16 and 03-06: how many days? Feb 16 to Mar 6. The prompt says "Gaps of 17 and 14 days." So two gaps. But continuous enrollment allows no more than one gap. So fails. Not eligible.
Screening: 2021-07-01 flexible sigmoidoscopy. Irrelevant.
So 71088: not_eligible.
Member 71089:
DOB 1967-11-24, age 59. Eligible age.
Enrollment: continuous, no gaps.
Screening: no screening on record.
Exclusions: none. Age <66, so E4 irrelevant.
So 71089: non_compliant.
Member 71090:
DOB 1950-05-28, age 76. Age >75. The eligible age is 46 through 75. So age 76 is not eligible.
Enrollment: 2026-01-01 through 2026-05-27; 2026-06-25 through 2026-12-31. One gap of 28 days. But age fails anyway.
Screening: 2026-06-02 FIT. Not relevant because not eligible.
So 71090: not_eligible.
Member 71091:
DOB 1950-07-12, age 76. >75. Not eligible age.
Enrollment: 2026-01-01 through 2026-04-24; 2026-06-03 through 2026-12-31. Gap of 39 days. One gap, okay. But age >75.
Screening: 2026-02-09 FIT and 2026-05-24 FIT. But age >75.
So 71091: not_eligible.
Member 71092:
DOB 1971-06-21, age 55. Eligible age.
Enrollment: continuous, no gaps.
Screening: 2023-02-25 Stool DNA test. Lookback for stool DNA: during 2026 or two years prior (2024-01-01 to 2026-12-31). 2023 is too old. So no numerator.
Other history: 2024-10-06 Diagnosis C18.7, malignant neoplasm of sigmoid colon. This is colorectal cancer (C18-C21). E1 excludes "any time on or before 2026-12-31". The diagnosis is 2024-10-06, which is before end of 2026. So excluded.
Check: the member is in eligible population (age and enrollment ok). So excluded.
So 71092: excluded.
Member 71093:
DOB 1976-11-04, age 50. Eligible.
Enrollment: continuous, no gaps.
Screening: 2026-07-02 FIT. This is N1. So compliant.
Exclusions: none.
So 71093: compliant.
Member 71094:
DOB 1981-12-09, age 45. Age <46. Not eligible.
Enrollment: 2026-01-01 through 2026-04-24; 2026-06-15 through 2026-12-31. One gap of 51 days? Prompt says "One gap of 51 days." That's >45 days, so even if age eligible, enrollment would fail. But age <46 anyway.
Screening: 2026-06-06 FIT. Not eligible.
So 71094: not_eligible.
Member 71095:
DOB 1979-11-11, age 47. Eligible.
Enrollment: continuous, no gaps.
Screening: 2026-05-26 FIT. Compliant.
Exclusions: none.
So 71095: compliant.
Member 71096:
DOB 1967-03-27, age 59. Eligible.
Enrollment: continuous, no gaps.
Screening: 2026-03-13 Colonoscopy. N5 (colonoscopy during 2026 or nine years prior). 2026 qualifies. So compliant.
Exclusions: none.
So 71096: compliant.
Member 71097:
DOB 1951-08-03, age 75. Eligible.
Enrollment: 2026-01-01 through 2026-04-24; 2026-05-16 through 2026-12-31. One gap of 21 days. Okay.
Screening: 2026-10-11 FIT. Compliant.
Exclusions: none. Age >=66 but no frailty or advanced illness.
So 71097: compliant.
Member 71098:
DOB 1954-09-24, age 72. Eligible.
Enrollment: continuous, no gaps.
Screening: 2023-04-14 Flexible sigmoidoscopy. Lookback for sigmoidoscopy: 2022-01-01 to 2026-12-31. 2023 falls in that window. So N3. Compliant.
Exclusions: none. Age >=66 but no frailty or illness.
So 71098: compliant.
Member 71099:
DOB 1979-09-26, age 47. Eligible.
Enrollment: 2026-01-01 through 2026-06-15; 2026-07-25 through 2026-12-31. One gap of 39 days. Within 45 days. So OK.
Screening: 2025-01-25 Flexible sigmoidoscopy. Lookback for sigmoidoscopy: five-year window 2022-01-01 to 2026-12-31. 2025-01-25 is in that window. So N3. Compliant.
Exclusions: none.
So 71099: compliant.
Member 71100:
DOB 1979-01-17, age 47. Eligible.
Enrollment: 2026-03-16 through 2026-12-31. Not enrolled before March 16. Gap from Jan 1 to Mar 15? Actually the prompt says "Not enrolled before 2026-03-16." That means missing Jan 1 to Mar 15: 74 days (Jan 31 + Feb 28 + Mar 15 = 74). That's >45 days. So fails continuous enrollment. Not eligible.
Other history: advanced illness on 2026-01-23. But not eligible.
Screening: 2020-11-17 CT colonography. Not relevant.
So 71100: not_eligible.
Now let's tally up.
List of all members: 71081, 71082, 71083, 71084, 71085, 71086, 71087, 71088, 71089, 71090, 71091, 71092, 71093, 71094, 71095, 71096, 71097, 71098, 71099, 71100.
Categorize each:
Compliant (in denominator, numerator met):
- 71083 (CT colonography in 2026)
- 71093 (FIT in 2026)
- 71095 (FIT in 2026)
- 71096 (Colonoscopy in 2026)
- 71097 (FIT in 2026)
- 71098 (Flexible sigmoidoscopy in 2023 within 5-yr window)
- 71099 (Flexible sigmoidoscopy in 2025 within 5-yr window)
Wait, check 71098: age 72. Sigmoidoscopy 2023-04-14. Window for N3 is 2026 or four years prior = five-year window. That means from 2022-01-01 to 2026-12-31. Yes, 2023 is within. Compliant.
71099: age 47. Sigmoidoscopy 2025-01-25. Window 2022-01-01 to 2026-12-31. Yes.
So compliant members: 71083, 71093, 71095, 71096, 71097, 71098, 71099.
Count = 7.
Non-compliant (in denominator, no numerator, not excluded):
- 71085 (age 67, enrollment OK, no screening, no exclusion)
- 71086 (age 75, enrollment OK, no screening within window, no exclusion)
- 71087 (age 59, enrollment OK, no screening within window, no exclusion)
- 71089 (age 59, enrollment OK, no screening, no exclusion)
Wait, 71086: age 75, CT colonography 2020-08-11. Window is 2022-01-01 to 2026-12-31. 2020 is outside. No other screening. So non-compliant. Correct.
71087: CT colonography 2021-04-28. Window 2022-01-01 onward. Outside. Non-compliant.
Are there any others that are in denominator but non-compliant? Let's check.
71092 is excluded.
71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 are not_eligible.
So non-compliant count = 4: 71085, 71086, 71087, 71089.
Wait, check 71085: age 67, continuous enrollment, no screening, no exclusions. Yes, non-compliant.
71086: age 75, continuous enrollment, no screening (2020 CT too old), no exclusions. Non-compliant.
71087: age 59, enrollment OK, no screening in window, no exclusions. Non-compliant.
71089: age 59, enrollment OK, no screening, no exclusions. Non-compliant.
Total denominator = compliant + non_compliant = 7 + 4 = 11.
Excluded:
- 71092 (C18.7 colorectal cancer in 2024)
Count excluded = 1.
Not eligible:
- 71081: two gaps >1 gap.
- 71082: age 45.
- 71084: not enrolled full year (starts Apr 15).
- 71088: two gaps.
- 71090: age 76.
- 71091: age 76.
- 71094: age 45 and gap 51 days (both, but anyway not eligible).
- 71100: not enrolled full year (starts Mar 16) and gap >45.
Wait, also: 71090 age 76, not eligible. 71091 age 76, not eligible.
Let's list all 20 and confirm each one:
1. 71081: not_eligible (enrollment gap count >1)
2. 71082: not_eligible (age 45)
3. 71083: compliant
4. 71084: not_eligible (enrollment not full year)
5. 71085: non_compliant
6. 71086: non_compliant
7. 71087: non_compliant
8. 71088: not_eligible (two gaps)
9. 71089: non_compliant
10. 71090: not_eligible (age 76)
11. 71091: not_eligible (age 76)
12. 71092: excluded (cancer)
13. 71093: compliant
14. 71094: not_eligible (age 45 + gap >45)
15. 71095: compliant
16. 71096: compliant
17. 71097: compliant
18. 71098: compliant
19. 71099: compliant
20. 71100: not_eligible (enrollment starts too late)
Counts:
compliant = 7
non_compliant = 4
excluded = 1
not_eligible = 8
Total 7+4+1+8 = 20. Good.
Check 71081: Age 75, enrollment has two gaps (23 and 29 days). So fails continuous enrollment. Not eligible. Even though they have a FIT in 2025, doesn't matter.
Check 71090: Age 76. The age band is 46 through 75. So not eligible. Prompt says "so 76 years old". Yes.
Check 71091: Age 76. Not eligible.
Check 71094: Age 45. Not eligible. Also gap 51 days, but age alone disqualifies.
Check 71084: Age 59, but enrollment starts 2026-04-15. Since not enrolled before that, they are missing Jan 1 to Apr 14. The continuous enrollment rule requires full measurement year. The prompt says "Not enrolled before 2026-04-15." So they miss over 45 days. Not eligible.
Check 71100: Age 47, but enrollment starts 2026-03-16. Not eligible due to enrollment.
Check 71088: Age 50, two gaps of 17 and 14 days. More than one gap. Not eligible.
Check 71082: Age 45 (<46). Not eligible.
Double-check 71087: Age 59. Enrollment Jan 1 to Apr 20, then May 23 to Dec 31. One gap of 32 days. OK. No screening in window. No exclusion because age <66. So non_compliant. But we should also check if the frailty and advanced illness could trigger some other exclusion? No, because E4 requires age >=66. So fine.
Double-check 71085: Age 67. Enrollment continuous. No screening. Could he be excluded under E4? Frailty and advanced illness need BOTH. He has neither. So non_compliant.
Double-check 71086: Age 75. Enrollment continuous. No screening in window. No frailty/illness. Non_compliant.
Double-check 71089: Age 59. Enrollment continuous. No screening. Non_compliant.
Double-check 71098: Age 72. Enrollment continuous. Flexible sigmoidoscopy on 2023-04-14. That's within 5-year window (2022-01-01 to 2026-12-31). So compliant. He could technically also be excluded if he had something but no.
Double-check 71099: Age 47. Flexible sigmoidoscopy on 2025-01-25. Within window. Compliant.
Check 71095: FIT on 2026-05-26. Compliant.
Check 71083: CT colonography 2026-08-02 (window 2022-2026). Also FIT 2026-09-02. Either way compliant.
Check 71093: FIT 2026-07-02. Compliant.
Check 71096: Colonoscopy 2026-03-13. Compliant.
Check 71097: FIT 2026-10-11. Compliant.
Now compute rate: numerator / denominator * 100, rounded half up to one decimal place.
Numerator = 7.
Denominator = 11.
7 / 11 = 0.6363636...
*100 = 63.63636...
Rounded half up to one decimal = 63.6? Wait, half up to one decimal place: look at second decimal place. It's 3. 63.636... First decimal is 6. Second is 3. Since 3 < 5, round down to 63.6. However, standard rounding: look at the digit in the hundredths place. 63.63..., the hundredths digit is 3. So round to 63.6. But wait, the exact fraction 7/11 = 0.6363636363... Multiply by 100 -> 63.6363636... Round to one decimal: 63.6.
But let's verify: 63.636... the first decimal place is 6 (tenths). The next digit (hundredths) is 3. Since 3 < 5, we keep 63.6. If it were exactly 63.65, half up would go to 63.7. So 63.6.
Wait, the prompt says "rounded half up to one decimal place (e.g. 62.5)". So yes.
Now check lists:
compliant_members: ["71083","71093","71095","71096","71097","71098","71099"]
non_compliant_members: ["71085","71086","71087","71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"]
Need to ensure member IDs are strings. Order can be any.
Let's verify again each member thoroughly, ensuring no missed exclusions or enrollment subtleties.
Member 71081:
- Age 75: eligible.
- Enrollment: 2026-01-01 through 2026-03-21; 2026-04-14 through 2026-07-23; 2026-08-22 through 2026-12-31. Gaps: 23 and 29 days. Two gaps. The rule says "no more than one gap of up to 45 days." Two gaps violates. Not eligible.
- What if the gaps are counted differently? E.g., if enrollment segments are exclusive/inclusive? But the prompt explicitly says "Gaps of 23 and 29 days." So definitely two gaps. Not eligible.
Member 71082:
- Age 45: not eligible (<46). So not_eligible.
- Even though they have frailty and advanced illness, age fails.
Member 71083:
- Age 55: OK.
- Enrollment continuous: OK.
- Screening CT 2026-08-02 (N4) and FIT 2026-09-02 (N1). So compliant.
Member 71084:
- Age 59: OK.
- Enrollment: starts 2026-04-15. That's not full measurement year. The prompt explicitly says "Not enrolled before 2026-04-15." So gap from Jan 1 to Apr 14 is >45 days. Not eligible.
- Also has frailty, but irrelevant.
Member 71085:
- Age 67: OK.
- Enrollment continuous: OK.
- No screening: no numerator.
- No exclusions: no cancer, no colectomy, no hospice. Age >=66 but no frailty or illness. Non_compliant.
Member 71086:
- Age 75: OK.
- Enrollment continuous: OK.
- CT colonography 2020-08-11. N4 window: 2022-01-01 to 2026-12-31. 2020 is outside. So no numerator.
- No exclusions. Non_compliant.
Member 71087:
- Age 59: OK.
- Enrollment: one gap of 32 days. OK.
- CT colonography 2021-04-28. N4 window starts 2022-01-01. Outside. No numerator.
- Frailty and advanced illness documented, but age <66. So E4 not met. No other exclusions. Non_compliant.
Member 71088:
- Age 50: OK.
- Enrollment: two gaps (17 and 14 days). More than one gap. Not eligible.
- Sigmoidoscopy 2021-07-01. Irrelevant.
Member 71089:
- Age 59: OK.
- Enrollment continuous: OK.
- No screening. Non_compliant.
Member 71090:
- Age 76: >75. Not eligible.
- Enrollment: one gap 28 days. But age fails.
- FIT 2026-06-02. Not eligible.
Member 71091:
- Age 76: >75. Not eligible.
- Enrollment: gap 39 days. Age fails.
- FIT 2026. Not eligible.
Member 71092:
- Age 55: OK.
- Enrollment continuous: OK.
- Stool DNA 2023-02-25. N2 window: 2024-01-01 to 2026-12-31. 2023 is outside. No numerator.
- Diagnosis C18.7 on 2024-10-06. This is colorectal cancer (C18-C21). E1 applies. Excluded.
Member 71093:
- Age 50: OK.
- Enrollment continuous: OK.
- FIT 2026-07-02. Compliant.
Member 71094:
- Age 45: <46. Not eligible.
- Enrollment: gap 51 days. Also fails. Not eligible.
Member 71095:
- Age 47: OK.
- Enrollment continuous: OK.
- FIT 2026-05-26. Compliant.
Member 71096:
- Age 59: OK.
- Enrollment continuous: OK.
- Colonoscopy 2026-03-13. Compliant.
Member 71097:
- Age 75: OK.
- Enrollment: one gap 21 days. OK.
- FIT 2026-10-11. Compliant.
Member 71098:
- Age 72: OK.
- Enrollment continuous: OK.
- Flexible sigmoidoscopy 2023-04-14. N3 window: 2022-01-01 to 2026-12-31. Inside. Compliant.
Member 71099:
- Age 47: OK.
- Enrollment: one gap 39 days. OK (<=45 and only one).
- Flexible sigmoidoscopy 2025-01-25. Inside window. Compliant.
Member 71100:
- Age 47: OK.
- Enrollment: starts 2026-03-16. Not full measurement year. Not eligible.
- Advanced illness 2026-01-23, but irrelevant.
Looks solid.
Double-check E4 for 71085 (age 67): He is >=66. Need both frailty and advanced illness documented during measurement year. Neither documented. So not excluded.
Double-check E4 for 71090 (age 76): Not in denominator because age >75. So not_eligible, not excluded.
Doubljson{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
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"fabricated": false,
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}100DeepSeek V4 Pro · DeepSeek48.3s · 4,113 out | 61.7s · 5,093 out | 47.4s · 4,098 out
Reasoning · 3,951 tokens
We need to evaluate each member against the measure QM-CRC (Colorectal Cancer Screening) for measurement year 2026. The eligible population: age 46-75 as of 2026-12-31, continuous enrolment with no more than one gap of up to 45 days. 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+ plus both frailty and advanced illness documented during measurement year. Then numerator: any one of the specified screening tests in specified look-back windows.
We need to classify each member: not_eligible (doesn't meet age, enrolment, etc.), excluded (eligible but meets exclusion), compliant (eligible, not excluded, and meets numerator), non_compliant (eligible, not excluded, does not meet numerator). Evaluate in order: eligibility first (age, continuous enrolment). If not eligible, done. Then exclusions. If excluded, done. Then numerator.
Let's process each member.
MEMBER 71081: DOB 1951-10-15, age 75 on 2026-12-31 (since 2026-10-15 turns 75, so yes 75). Age 46-75 inclusive, so eligible by age. Enrolment: 2026-01-01 to 2026-03-21 (gap 23 days from 3/22 to 4/13? Actually gap: end 3/21, start 4/14, gap 3/22 to 4/13 = 23 days? Let's compute: 3/22 to 4/13 inclusive: March has 31 days, so 3/22-3/31 = 10 days, April 1-13 = 13 days, total 23 days. Next segment: 2026-04-14 to 2026-07-23, then gap to 2026-08-22: 7/24 to 8/21 = 29 days? July 24-31 = 8 days, August 1-21 = 21 days, total 29 days. So two gaps: 23 and 29 days. Each gap ≤45 days, and only one gap allowed? The rule: "no more than one gap of up to 45 days." So having two gaps makes the member not continuously enrolled? Actually "no more than one gap of up to 45 days" means at most one gap, and that gap must be ≤45 days. So if there are two gaps, even if each ≤45, it's not eligible. So 71081 has two gaps, so fails continuous enrolment. Not eligible. Check: any other reason? Not needed. So not_eligible.
MEMBER 71082: DOB 1981-09-15, age 45 on 2026-12-31 (since birthday 2026-09-15, turns 45, so 45 as of 12/31). Age 45 is below 46. So not eligible. Age requirement is 46-75. So not_eligible.
MEMBER 71083: DOB 1971-06-11, age 55 on 2026-12-31 (2026-06-11 turns 55). Age eligible. Continuous enrolment no gaps. Exclusions: No colorectal cancer, no colectomy, no hospice, no frailty/advanced illness. So not excluded. Numerator: CT colonography 2026-08-02, which is during 2026, so meets N4 (CT colonography during 2026 or 4 years prior). So compliant. Also has FIT, but one is enough. So compliant.
MEMBER 71084: DOB 1967-02-19, age 59 on 2026-12-31 (2026-02-19 turns 59). Age eligible. Enrolment: 2026-04-15 to 2026-12-31, continuous from that date. But not enrolled before 4/15. So enrolled from 4/15 onward, no gaps. The continuous enrolment requirement: full measurement year with no more than one gap of up to 45 days. Here, member is not enrolled from 1/1 to 4/14. That is a gap? Actually, it's a period of non-enrolment at the start. The rule says "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Typically, if a member is not enrolled at the beginning of the year, it's not a "gap" but a late enrollment. The measure definition: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." Some interpretations might consider that the member must be enrolled for the entire year, with allowance for one gap, but if they aren't enrolled at all at the start, that's more than a gap. I think the standard HEDIS-like definition for continuous enrollment requires enrollment for the full measurement year, with no more than one gap in enrollment of up to 45 days. If the member is not enrolled from Jan 1, that's a gap from Jan 1 to the enrollment start? Actually, the measure eligibility period is the measurement year, and they must be continuously enrolled during that year. Typically, "continuous enrollment" means the member is enrolled for the entire period, with no breaks in enrollment, or with a single break of up to 45 days. If the member is not enrolled for the first 4 months, that's a break of more than 45 days (Jan 1 - Apr 14 = 104 days? Actually, from Jan 1 to Apr 14 is 104 days? Let's calculate: Jan 31, Feb 28 (2026 not leap year), Mar 31, Apr 14 = 31+28+31+14 = 104 days. So that's a gap of 104 days, which exceeds 45 days. So not eligible. So 71084 is not eligible due to enrollment gap >45 days. So not_eligible.
MEMBER 71085: DOB 1959-01-11, age 67 on 2026-12-31 (2026-01-11 turns 67). Age eligible. Continuous enrollment, no gaps. No colorectal cancer, no colectomy, no hospice. No frailty or advanced illness documented. So no exclusion. Numerator: no screening on record. So non_compliant.
MEMBER 71086: DOB 1951-02-07, age 75 on 2026-12-31 (2026-02-07 turns 75). Age eligible. Continuous, no gaps. No exclusions. Screening: CT colonography 2020-08-11. N4: CT colonography during 2026 or the four years prior (five-year window). 2026 minus 4 years = 2022. So 2020 is older than 2022, so not within window. Check other possibilities: no other screenings. So not compliant. So non_compliant.
MEMBER 71087: DOB 1967-06-23, age 59 on 2026-12-31. Age eligible. Enrolment: 2026-01-01 to 2026-04-20; then gap 2026-04-21 to 2026-05-22 (32 days? Let's compute: after 4/20, gap starts 4/21, and next start 5/23. So gap days: 4/21 to 5/22 inclusive. April 21-30 = 10 days, May 1-22 = 22 days, total 32 days. So one gap of 32 days, which is ≤45. So continuous enrollment OK. Exclusions: no colorectal cancer, no colectomy, no hospice. Now check E4: age 66+? 71087 is 59, so not 66+. So E4 doesn't apply. No exclusion. Numerator: CT colonography 2021-04-28. N4: CT colonography during 2026 or 4 years prior (2022-2026). 2021 is outside (2021 is before 2022). So not compliant. Even though frailty and advanced illness documented, no exclusion because age not 66+. So non_compliant.
MEMBER 71088: DOB 1976-06-16, age 50 (2026-06-16 turns 50). Age eligible. Enrolment: 2026-01-01 to 2026-02-16; gap 2/17-3/5 (17 days? 2/17-2/28 = 12 days (leap? 2026 not leap, Feb 28 days), plus March 1-5 = 5 days, total 17 days). Then 2026-03-06 to 2026-05-13; gap 5/14-5/27 (14 days: May 14-27 = 14 days). Then 2026-05-28 to 12-31. So two gaps: 17 and 14 days. More than one gap, so not eligible. So not_eligible.
MEMBER 71089: DOB 1967-11-24, age 59 (2026-11-24 turns 59). Age eligible. Continuous, no gaps. No exclusions. No screening. So non_compliant.
MEMBER 71090: DOB 1950-05-28, age 76 on 2026-12-31 (2026-05-28 turns 76). Age 76 > 75, so not eligible. So not_eligible.
MEMBER 71091: DOB 1950-07-12, age 76 on 2026-12-31 (2026-07-12 turns 76). Not eligible. So not_eligible.
MEMBER 71092: DOB 1971-06-21, age 55 (2026-06-21 turns 55). Age eligible. Continuous, no gaps. Check exclusions: E1 colorectal cancer (C18-C21) any time on or before 2026-12-31. Diagnosis 2024-10-06 C18.7, malignant neoplasm of sigmoid colon. So meets exclusion. So excluded. No need to check numerator.
MEMBER 71093: DOB 1976-11-04, age 50 (2026-11-04 turns 50). Age eligible. Continuous, no gaps. No exclusions. Screening: FIT 2026-07-02, meets N1 (FOBT or FIT during 2026). So compliant.
MEMBER 71094: DOB 1981-12-09, age 45 on 2026-12-31 (2026-12-09 turns 45). Age 45, not 46, so not eligible. So not_eligible.
MEMBER 71095: DOB 1979-11-11, age 47 (2026-11-11 turns 47). Age eligible. Continuous, no gaps. No exclusions. Screening: FIT 2026-05-26, meets N1. So compliant.
MEMBER 71096: DOB 1967-03-27, age 59 (2026-03-27 turns 59). Age eligible. Continuous, no gaps. No exclusions. Screening: colonoscopy 2026-03-13, meets N5 (colonoscopy during 2026 or 9 years prior, so 2026 is within). So compliant.
MEMBER 71097: DOB 1951-08-03, age 75 (2026-08-03 turns 75). Age eligible. Enrolment: 2026-01-01 to 2026-04-24; gap 4/25-5/15 (21 days: April 25-30 = 6 days, May 1-15 = 15 days, total 21 days). Then 2026-05-16 to 2026-12-31. One gap of 21 days, okay. So continuous enrollment. No exclusions. Screening: FIT 2026-10-11, meets N1. So compliant.
MEMBER 71098: DOB 1954-09-24, age 72 (2026-09-24 turns 72). Age eligible. Continuous, no gaps. No exclusions. Screening: flexible sigmoidoscopy 2023-04-14. N3: flexible sigmoidoscopy during 2026 or 4 years prior (2022-2026). 2023 is within 2022-2026? 2023 is within 4 years prior? 2026 - 4 = 2022. So 2023 is in the window. Yes, 2023 is within the 5-year window. So meets N3. Compliant.
MEMBER 71099: DOB 1979-09-26, age 47 (2026-09-26 turns 47). Age eligible. Enrolment: 2026-01-01 to 2026-06-15; gap 6/16-7/24 (39 days: June 16-30 = 15 days, July 1-24 = 24 days, total 39 days). Then 2026-07-25 to 12-31. One gap of 39 days, okay. No exclusions. Screening: flexible sigmoidoscopy 2025-01-25. N3 window: 2026 or 4 years prior (2022-2026). 2025 is within 2022-2026, so yes, compliant. Wait: 2025 is within 4 years prior? 2026-4 = 2022. So 2025 is in the window. So compliant.
MEMBER 71100: DOB 1979-01-17, age 47 (2026-01-17 turns 47). Age eligible. Enrolment: 2026-03-16 to 2026-12-31, continuous from that date. Not enrolled before 3/16. So gap from 1/1 to 3/15 = 74 days? 2026 is not leap year, Jan 31, Feb 28, Mar 15 = 31+28+15 = 74 days. More than 45 days, so not eligible. So not_eligible.
Now, let's compile lists:
Not eligible:
- 71081: age ok but two enrollment gaps.
- 71082: age 45 not eligible.
- 71084: enrollment gap >45 days.
- 71088: two enrollment gaps.
- 71090: age 76.
- 71091: age 76.
- 71094: age 45.
- 71100: enrollment gap >45 days.
Check if any other not eligible: 71087 is eligible, 71086 eligible, etc. So not eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100. That's 8 members.
Excluded:
- 71092: colorectal cancer. Only one so far.
Compliant:
- 71083: CT colonography 2026.
- 71093: FIT 2026.
- 71095: FIT 2026.
- 71096: colonoscopy 2026.
- 71097: FIT 2026.
- 71098: flexible sigmoidoscopy 2023 (within 5-year window).
- 71099: flexible sigmoidoscopy 2025 (within 5-year window).
So 7 compliant.
Non-compliant:
- 71085: no screening.
- 71086: CT colonography 2020 (outside window).
- 71087: CT colonography 2021 (outside window, and no exclusion).
- 71089: no screening.
So 4 non-compliant.
Check totals: 8 not eligible + 1 excluded + 7 compliant + 4 non-compliant = 20. Good.
Denominator = compliant + non_compliant = 7+4=11. Numerator = 7. Excluded = 1, Not eligible = 8. Rate = 7/11 * 100 = 63.636... rounded half up to one decimal: 63.6? 63.636... third decimal 6, so round up to 63.6? Wait, 63.636... 63.636, the hundredths digit is 3, thousandths is 6, so round half up: at the first decimal place, we look at the second decimal: 63.6 (since 63.63, the second decimal is 3, so first decimal is 6, rounding to 63.6? Actually, 7/11 = 0.636363..., multiply by 100 = 63.636363... To one decimal, we look at the second decimal: 3 (since 63.63...). The second decimal is 3, which is less than 5, so we round down to 63.6. But half up rounding: if it's exactly halfway, we round up. 63.636 is not exactly halfway. So 63.6. But let's double-check: 7/11 = 0.636363..., percentage = 63.636363... The first decimal is 6, the second is 3, third is 6. Since the second decimal is 3 < 5, we round down to 63.6. So rate = 63.6.
Now produce JSON with lists of member IDs as strings. Ensure all members are in exactly one list. Not eligible: 71081,71082,71084,71088,71090,71091,71094,71100. Excluded: 71092. Compliant: 71083,71093,71095,71096,71097,71098,71099. Non-compliant: 71085,71086,71087,71089.
Check 71086: non-compliant, yes. 71087: non-compliant. 71089: non-compliant. 71085: non-compliant. All good.
Now output.
Important: Output exactly a JSON block. Use null for nothing. So final.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 4,931 tokens
We need to evaluate each member against the measure QM-CRC definitions. The measure: eligible population: age 46-75 as of 2026-12-31, continuous enrollment in 2026 with no more than one gap of up to 45 days. Exclusions: E1 colorectal cancer anytime on or before 12/31/2026; E2 total colectomy; E3 hospice any time during 2026; E4 age 66+ AND both frailty and advanced illness documented during measurement year. Numerator: one of the screening tests within specified look-back windows from 2026-12-31.
Let's go member by member:
MEMBER 71081: DOB 1951-10-15 -> age on 2026-12-31: 2026-1951=75, October birthday, so already 75? Actually, 2026 - 1951 = 75, and birthday is Oct 15, so on Dec 31, 2026, he is 75 years old. So age eligible (46-75 inclusive). Enrollment: 2026-01-01 to 03-21, then 04-14 to 07-23, then 08-22 to 12-31. Gaps: first gap from 03-22 to 04-13 = 23 days? Let's count: March 22 to April 13 inclusive? 22 days? Actually, from 03-22 to 04-13 is 23 days? Let's compute: March has 31 days, from 22 to 31 inclusive is 10 days (22,23,24,25,26,27,28,29,30,31) = 10 days. Then April 1-13 = 13 days, total 23 days. So first gap 23 days. Second gap from 07-24 to 08-21: July 24-31 = 8 days (24,25,26,27,28,29,30,31) = 8 days; August 1-21 = 21 days, total 29 days. So two gaps of 23 and 29 days. The rule: "no more than one gap of up to 45 days". Since there are two gaps, each up to 45 but more than one gap? The phrasing: "with no more than one gap of up to 45 days." That means the enrollment can have at most one gap, and that gap must be ≤45 days. If there are multiple gaps, even if each ≤45, it's not allowed. So this member has two gaps, so fails continuous enrollment. Therefore not eligible. (Even if we misinterpreted, it's two gaps). So not_eligible.
Screening history is irrelevant. So not eligible.
MEMBER 71082: DOB 1981-09-15 -> age on 2026-12-31: 2026-1981 = 45, birthday Sep 15, so she is 45 years old. Eligible age (46-75? Actually 46 through 75, so 45 not eligible). Age 45 is below 46. So not eligible due to age. So not_eligible.
MEMBER 71083: DOB 1971-06-11 -> 2026-1971=55, age 55 on Dec 31, 2026. Eligible age. Enrollment continuous, no gaps. So eligible population. Exclusions: no colorectal cancer, no colectomy, no hospice. Frailty/advanced illness not documented. Age 55 <66, so E4 doesn't apply. No exclusions. So in denominator. Numerator: Screening history: 2026-08-02 CT colonography. CT colonography is N4: during 2026 or the four years prior (five-year window). Since it's in 2026, it counts. So compliant. Also 2026-09-02 FIT, but either is fine. So compliant.
MEMBER 71084: DOB 1967-02-19 -> 2026-1967=59, age 59. Eligible age. Enrollment: 2026-04-15 through 2026-12-31, continuous from that date. But not enrolled before 04-15. So there is a gap from 01-01 to 04-14 (about 104 days). That is a gap of more than 45 days? The rule: "continuous enrolment: the full measurement year with no more than one gap of up to 45 days." So the member must be enrolled for the full year with at most one gap of ≤45 days. If they are not enrolled at the start, that's a gap from 01-01 until enrollment start? Or is enrollment considered from the start? The measure likely requires enrollment from 01-01 to 12-31, with possible gaps but no more than one gap of up to 45 days. If the member enrolled later, they are missing coverage from Jan 1 to April 14, which is more than 45 days. So they fail continuous enrollment. Not eligible. So not_eligible.
MEMBER 71085: DOB 1959-01-11 -> 2026-1959=67, age 67 on Dec 31. Eligible age. Enrollment continuous, no gaps. So eligible. Exclusions: No colorectal cancer, colectomy, hospice. Age 66+, so check E4: frailty and advanced illness both documented during measurement year? Record says "No frailty or advanced illness documented." So E4 not met. No exclusions. So in denominator. Numerator: screening history: No colorectal screening on record. So non_compliant.
MEMBER 71086: DOB 1951-02-07 -> 2026-1951=75, age 75 on Dec 31. Eligible. Enrollment continuous. Exclusions: none (no cancer, colectomy, hospice, frailty/advanced). In denominator. Screening: 2020-08-11 CT colonography. N4: CT colonography during 2026 or the four years prior (2022-2026). 2020 is outside the 5-year window (2022-2026). So not numerator. Also check other tests: no other. So non_compliant.
MEMBER 71087: DOB 1967-06-23 -> age 59. Enrollment: 2026-01-01 to 04-20, then 05-23 to 12-31. One gap of 32 days. That's one gap ≤45, so continuous enrollment OK. So eligible. Exclusions: Age 59 <66, so E4 doesn't apply. No colorectal cancer, no colectomy, no hospice. Frailty and advanced illness documented but age <66, so E4 not triggered. So no exclusion. In denominator. Screening: 2021-04-28 CT colonography. That's outside the 5-year window (2022-2026). So not numerator. So non_compliant.
MEMBER 71088: DOB 1976-06-16 -> age 50. Enrollment: 2026-01-01 to 02-16; 03-06 to 05-13; 05-28 to 12-31. Gaps: first gap 02-17 to 03-05 (17 days? Let's count: Feb 17-28/29: 2026 is not leap year, so Feb has 28 days. Feb 17-28 = 12 days? Actually Feb 17-28 inclusive: 17,18,19,20,21,22,23,24,25,26,27,28 = 12 days. Then March 1-5 = 5 days, total 17 days. Second gap: 05-14 to 05-27 = 14 days. So two gaps, each ≤45, but two gaps. So not continuous enrollment. So not eligible.
MEMBER 71089: DOB 1967-11-24 -> age 59. Enrollment continuous. Eligible. Exclusions: none. Denominator. Screening: none. Non_compliant.
MEMBER 71090: DOB 1950-05-28 -> age on 2026-12-31: 2026-1950=76. Age 76 is not within 46-75. So not eligible due to age. Not_eligible.
MEMBER 71091: DOB 1950-07-12 -> age 76. Not eligible. Not_eligible.
MEMBER 71092: DOB 1971-06-21 -> age 55. Enrollment continuous. Eligible. Exclusions: Has colorectal cancer diagnosis C18.7 on 2024-10-06. That is anytime on or before 2026-12-31, so E1 exclusion applies. So excluded. (Even if she had screening, excluded). So excluded.
MEMBER 71093: DOB 1976-11-04 -> age 50. Enrollment continuous. Eligible. Exclusions: none. Screening: 2026-07-02 FIT, which is N1 (FIT during 2026). So compliant.
MEMBER 71094: DOB 1981-12-09 -> 2026-1981=45, age 45 on Dec 31. Not eligible age (46-75). So not_eligible.
MEMBER 71095: DOB 1979-11-11 -> age 47. Enrollment continuous. Eligible. Exclusions: none. Screening: 2026-05-26 FIT. Compliant.
MEMBER 71096: DOB 1967-03-27 -> age 59. Enrollment continuous. Eligible. Exclusions: none. Screening: 2026-03-13 Colonoscopy. N5: colonoscopy during 2026 or 9 years prior (2017-2026). So compliant.
MEMBER 71097: DOB 1951-08-03 -> age 75. Enrollment: 2026-01-01 to 04-24; 05-16 to 12-31. One gap of 21 days (04-25 to 05-15). That's one gap ≤45, so continuous enrollment OK. Eligible. Exclusions: none. Screening: 2026-10-11 FIT. Compliant.
MEMBER 71098: DOB 1954-09-24 -> age 72. Enrollment continuous. Eligible. Exclusions: none (age 66+, but no frailty/advanced illness documented). Screening: 2023-04-14 Flexible sigmoidoscopy. N3: flexible sigmoidoscopy during 2026 or the four years prior (2022-2026). 2023 is within 2022-2026? Yes, 2023 is within the 5-year window (2022, 2023, 2024, 2025, 2026). So it counts. So compliant.
MEMBER 71099: DOB 1979-09-26 -> age 47. Enrollment: 2026-01-01 to 06-15; 07-25 to 12-31. One gap of 39 days (06-16 to 07-24). That's one gap ≤45, so continuous enrollment OK. Eligible. Exclusions: none. Screening: 2025-01-25 Flexible sigmoidoscopy. 2025 is within the 5-year window (2022-2026). So compliant? Wait, N3: flexible sigmoidoscopy during 2026 or the four years prior (five-year window). 2025 is within the four years prior to 2026? The window is from 2022-2026 inclusive. So 2025 counts. So compliant.
MEMBER 71100: DOB 1979-01-17 -> age 47. Enrollment: 2026-03-16 to 12-31, continuous from that date. Not enrolled before 03-16. So gap from 01-01 to 03-15 is about 74 days (Jan 1 to Mar 15). More than 45 days, so not continuous enrollment. Not eligible. Also had advanced illness documented but not relevant. So not_eligible.
Now let's compile lists:
Not eligible members: 71081 (enrollment gap), 71082 (age), 71084 (enrollment), 71088 (enrollment), 71090 (age), 71091 (age), 71094 (age), 71100 (enrollment). That's 8 members.
Excluded: 71092 (colorectal cancer). Only one.
Denominator: eligible population after exclusions. Eligible population: those who met age and enrollment, not excluded. Let's count eligible before exclusions: from the roster, who are age 46-75 and continuous enrollment? We'll list all members and check:
71081: age 75, enrollment fails -> not eligible.
71082: age 45 -> not eligible.
71083: age 55, enrollment OK -> eligible, no exclusion -> in denominator.
71084: age 59, enrollment fails -> not eligible.
71085: age 67, enrollment OK -> eligible, no exclusion -> denominator.
71086: age 75, enrollment OK -> eligible, no exclusion -> denominator.
71087: age 59, enrollment OK -> eligible, no exclusion -> denominator.
71088: age 50, enrollment fails -> not eligible.
71089: age 59, enrollment OK -> eligible, no exclusion -> denominator.
71090: age 76 -> not eligible.
71091: age 76 -> not eligible.
71092: age 55, enrollment OK -> eligible but excluded (E1) -> excluded, not denominator.
71093: age 50, enrollment OK -> eligible, no exclusion -> denominator.
71094: age 45 -> not eligible.
71095: age 47, enrollment OK -> eligible, no exclusion -> denominator.
71096: age 59, enrollment OK -> eligible, no exclusion -> denominator.
71097: age 75, enrollment OK -> eligible, no exclusion -> denominator.
71098: age 72, enrollment OK -> eligible, no exclusion -> denominator.
71099: age 47, enrollment OK -> eligible, no exclusion -> denominator.
71100: age 47, enrollment fails -> not eligible.
So eligible before exclusions: 71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099. That's 11 members. Exclude 71092, so denominator = 11 - 1 = 10? Wait, 71092 was eligible but excluded, so the denominator is the eligible population after exclusions, so 11 - 1 = 10 members. But we must check if any other exclusions apply to any of the 10? Let's verify each:
71083: no exclusions.
71085: age 67, no frailty/advanced illness, so no E4.
71086: age 75, no frailty/advanced illness.
71087: age 59, no frailty/advanced illness (though documented, age <66 so not E4).
71089: no issues.
71093: no.
71095: no.
71096: no.
71097: no.
71098: no.
71099: no.
So denominator = 10.
Now numerator: compliant among those denominator members. We need to check each of those 10 for numerator compliance.
71083: CT colonography 2026-08-02 -> compliant.
71085: no screening -> non_compliant.
71086: CT colonography 2020 -> not within window -> non_compliant.
71087: CT colonography 2021 -> not within window -> non_compliant.
71089: no screening -> non_compliant.
71093: FIT 2026-07-02 -> compliant.
71095: FIT 2026-05-26 -> compliant.
71096: colonoscopy 2026-03-13 -> compliant.
71097: FIT 2026-10-11 -> compliant.
71098: flexible sigmoidoscopy 2023-04-14 -> within 2022-2026? Yes, 2023 is within the four years prior (2026 minus 4 = 2022, so 2022-2026). So compliant.
71099: flexible sigmoidoscopy 2025-01-25 -> compliant.
So compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members. Non_compliant: 71085, 71086, 71087, 71089. That's 4 members. Total denominator = 7+4 = 11? Wait, I counted 10 denominator members, but now I list 11 members? Let's recount the denominator list I had: 71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099. That's 11 members. I had 11 eligible before exclusions. But I said denominator = 11 - 1 = 10 because I excluded 71092. But 71092 was already excluded, so the eligible before exclusions is 11, then after removing excluded 71092, we have 11? Wait, 71092 was eligible by age and enrollment, but excluded. So the denominator is the eligible population after exclusions, which is the 11 minus the excluded 71092 = 10? No, the 11 I listed as eligible before exclusions included 71092? Let's re-check: I listed eligible before exclusions: 71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099. That's 11, and I did not include 71092. So 71092 was not in that list because I mistakenly counted 71092 as eligible? I need to correct: 71092 is age 55, enrollment continuous, so eligible. So the eligible before exclusions should include 71092. So the set of members who meet age and enrollment criteria is: 71083, 71085, 71086, 71087, 71089, 71092, 71093, 71095, 71096, 71097, 71098, 71099. That's 12 members. Then exclusions: 71092 is excluded for colorectal cancer. So denominator = 12 - 1 = 11 members. My earlier list of 11 was missing 71092. So denominator is 11, consistent with the list I just gave for denominator (71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099). That's 11 members. Good.
Now numerator: compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7 members. Non_compliant: 71085, 71086, 71087, 71089 = 4 members. 7+4=11. So denominator=11, numerator=7, excluded=1 (71092), not_eligible=8 (71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100). Let's double-check not_eligible: we have 8 members, and total roster 20, so 1 excluded + 8 not_eligible = 9, plus 11 denominator = 20. Correct.
Now rate: numerator/denominator * 100 = 7/11 * 100 = 63.636363... rounded half up to one decimal place: 63.6 (since the next digit is 3, no rounding up). So rate = 63.6.
Now lists: compliant_members: ["71083","71093","71095","71096","71097","71098","71099"] (any order). non_compliant_members: ["71085","71086","71087","71089"]. excluded_members: ["71092"]. not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"].
Check each member again for any nuance:
- 71081: enrollment gaps: 23 and 29 days. Two gaps, so not continuous. Not eligible.
- 71082: age 45, not 46-75. Not eligible.
- 71084: enrolled from 04-15, missing over 45 days. Not eligible.
- 71088: enrollment gaps of 17 and 14 days, two gaps. Not eligible.
- 71090: age 76. Not eligible.
- 71091: age 76. Not eligible.
- 71094: age 45. Not eligible.
- 71100: enrollment from 03-16, missing 74 days. Not eligible.
Excluded: 71092: colorectal cancer diagnosis C18.7. This is E1 exclusion. So excluded.
All others are in denominator.
Now check numerator windows carefully:
- 71083: CT colonography 2026-08-02: within 2026, so N4. OK.
- 71093: FIT 2026-07-02: N1 (FIT during 2026). OK.
- 71095: FIT 2026-05-26: N1.
- 71096: colonoscopy 2026-03-13: N5 (colonoscopy during 2026). OK.
- 71097: FIT 2026-10-11: N1.
- 71098: flexible sigmoidoscopy 2023-04-14: N3 flexible sigmoidoscopy during 2026 or the four years prior. The four years prior to 2026 are 2025, 2024, 2023, 2022. So 2023 is within. OK.
- 71099: flexible sigmoidoscopy 2025-01-25: within 2022-2026. OK.
Non-compliant: 71085 no screening; 71086 CT colonography 2020 is outside 2022-2026; 71087 CT colonography 2021 is outside 2022-2026; 71089 no screening.
Check 71087: 2021-04-28 CT colonography. N4 window is 2026 or the four years prior (2022-2026). 2021 is not in the window. So non-compliant.
71086: 2020-08-11 CT colonography, not in window.
Everything seems correct.
Now output JSON.
We need to put member IDs as strings. So arrays of strings.
Rate: 63.6.
So final JSON.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 3,904 tokens
We need to evaluate each member against the QM-CRC measure for the measurement year 2026. We'll examine each member's age, continuous enrolment with gaps ≤45 days, exclusions, and numerator compliance.
First, age: 46 through 75 as of 2026-12-31. So birth year must be between 1951-01-01 and 1980-12-31? Actually, age 46 means birth date between 1951-01-01 and 1980-12-31? Let's compute: If age 46 as of 2026-12-31, then born on or after 1971-01-01? Wait: Age = measurement year date - birth date. For 2026-12-31, if born 1980-12-31, age 46 exactly. If born 1981-01-01, age 45 on 2026-12-31 (since 2026-12-31 - 1981-01-01 = 45 years, 11 months, 30 days? Actually, 1981-01-01 to 2026-12-31 is 45 years, 11 months, 30 days. So age is 45 at end of year. The measure says 46 through 75 years as of 2026-12-31. So must be age 46 to 75 inclusive. That means birth date range: from 1951-01-01 to 1980-12-31. Let's check: born 1951-01-01, age 75 on 2026-12-31 (since 2026-12-31 - 1951-01-01 = 75 years, 11 months, 30 days? Actually, 1951-01-01 to 2026-12-31 is 75 years and 364 days? More precisely, age computed as year difference, adjusted if birthday not yet passed. Typically, you take the year of measurement date minus year of birth, and if birthday occurs after measurement date, subtract 1. So for 2026-12-31, if born 1951-01-01, birthday is 01-01, so already passed, age = 2026 - 1951 = 75. If born 1951-12-31, birthday 12-31, day of measurement, age = 75. So effective birth years: 1951 to 1980 inclusive. So members born in 1950 or earlier (age 76+) are not eligible. Members born 1981 (age 45) are not eligible. So:
- 71081: born 1951-10-15, age 75 -> eligible.
- 71082: born 1981-09-15, age 45 -> not eligible.
- 71083: born 1971-06-11, age 55 -> eligible.
- 71084: born 1967-02-19, age 59 -> eligible.
- 71085: born 1959-01-11, age 67 -> eligible.
- 71086: born 1951-02-07, age 75 -> eligible.
- 71087: born 1967-06-23, age 59 -> eligible.
- 71088: born 1976-06-16, age 50 -> eligible.
- 71089: born 1967-11-24, age 59 -> eligible.
- 71090: born 1950-05-28, age 76 -> not eligible.
- 71091: born 1950-07-12, age 76 -> not eligible.
- 71092: born 1971-06-21, age 55 -> eligible.
- 71093: born 1976-11-04, age 50 -> eligible.
- 71094: born 1981-12-09, age 45 -> not eligible.
- 71095: born 1979-11-11, age 47 -> eligible.
- 71096: born 1967-03-27, age 59 -> eligible.
- 71097: born 1951-08-03, age 75 -> eligible.
- 71098: born 1954-09-24, age 72 -> eligible.
- 71099: born 1979-09-26, age 47 -> eligible.
- 71100: born 1979-01-17, age 47 -> eligible.
Now continuous enrolment: full measurement year (2026-01-01 to 2026-12-31) with no more than one gap of up to 45 days. The rule: "with no more than one gap of up to 45 days." Interpretation: The member must be enrolled for the entire year, but gaps are allowed if there is at most one gap and that gap is ≤45 days. If there are multiple gaps, even if each ≤45 days, the member is not eligible. So we need to check each eligible member's enrolment periods.
For each, we'll list the enrolment spans and count gaps.
- 71081: Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31. Gaps: 03-22 to 04-13 (23 days), 07-24 to 08-21 (29 days). Two gaps, so not eligible (multiple gaps). So not eligible.
- 71082: not eligible by age.
- 71083: 2026-01-01 to 2026-12-31, continuous, no gaps. Eligible.
- 71084: Enrolment: 2026-04-15 to 2026-12-31, continuous from that date. Not enrolled before 2026-04-15. So missing 2026-01-01 to 2026-04-14. That is a gap from the start of the year? The rule says continuous enrolment for the full measurement year. If the member is not enrolled at all at the start, that is not a gap but a lack of enrollment. The measure requires continuous enrolment for the full year. If the member was not enrolled on 2026-01-01, then they are not continuously enrolled for the full year. The text: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." The phrase "gap" typically refers to a break in coverage during the year. If the member is not enrolled at the beginning, that is a gap of missing coverage from 2026-01-01 until the enrollment starts. That would be a gap of 104 days (from 01-01 to 04-14). That exceeds 45 days, so not eligible. So 71084: not enrolled from 01-01 to 04-14, so gap of 104 days >45, not eligible.
- 71085: continuous, no gaps. Eligible.
- 71086: continuous, no gaps. Eligible.
- 71087: Enrolment: 2026-01-01 to 2026-04-20; 2026-05-23 to 2026-12-31. Gap: 04-21 to 05-22 (32 days). One gap of 32 days ≤45, so eligible.
- 71088: Enrolment: 2026-01-01 to 2026-02-16; 2026-03-06 to 2026-05-13; 2026-05-28 to 2026-12-31. Gaps: 02-17 to 03-05 (17 days), 05-14 to 05-27 (14 days). Two gaps, so not eligible.
- 71089: continuous, no gaps. Eligible.
- 71090: not eligible (age 76).
- 71091: not eligible (age 76).
- 71092: continuous, no gaps. Eligible.
- 71093: continuous, no gaps. Eligible.
- 71094: not eligible (age 45).
- 71095: continuous, no gaps. Eligible.
- 71096: continuous, no gaps. Eligible.
- 71097: Enrolment: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31. Gap: 04-25 to 05-15 (21 days). One gap ≤45, eligible.
- 71098: continuous, no gaps. Eligible.
- 71099: Enrolment: 2026-01-01 to 2026-06-15; 2026-07-25 to 2026-12-31. Gap: 06-16 to 07-24 (39 days). One gap ≤45, eligible.
- 71100: Enrolment: 2026-03-16 to 2026-12-31, continuous from that date. Not enrolled before 2026-03-16. Gap from 2026-01-01 to 2026-03-15 is 74 days? Actually, if not enrolled, the gap is from 2026-01-01 to 2026-03-15, which is 74 days? 01-01 to 03-15 is 31+28+15 = 74 days (since 2026 is not a leap year, Jan 31, Feb 28, Mar 15). So >45 days, not eligible.
So eligible members after age and enrolment: 71083, 71085, 71086, 71087, 71089, 71092, 71093, 71095, 71096, 71097, 71098, 71099. That's 12 members.
Now we need to evaluate exclusions for these 12.
Exclusions: E1 colorectal cancer (C18-C21) any time on or before 2026-12-31. E2 total colectomy any time. 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.
Check each:
- 71083: age 55, no cancer, no colectomy, no hospice, no frailty or advanced illness. No exclusions.
- 71085: age 67 (born 1959-01-11, age 67). So age 66+. Any frailty and advanced illness? No frailty, no advanced illness documented. So E4 not met. No other exclusions. So not excluded.
- 71086: age 75 (born 1951-02-07). Age 66+. No frailty, no advanced illness. So E4 not met. No other exclusions. Not excluded.
- 71087: age 59, not 66+, so E4 not applicable. No cancer, no colectomy, no hospice. So not excluded.
- 71089: age 59, no exclusions.
- 71092: age 55, but has diagnosis C18.7 (colorectal cancer) on 2024-10-06. That is E1: colorectal cancer any time on or before 2026-12-31. So excluded.
- 71093: age 50, no exclusions.
- 71095: age 47, no exclusions.
- 71096: age 59, no exclusions.
- 71097: age 75 (born 1951-08-03). Age 66+. No frailty or advanced illness. So not excluded.
- 71098: age 72 (born 1954-09-24). Age 66+. No frailty, no advanced illness. Not excluded.
- 71099: age 47, no exclusions.
So excluded: 71092 only. The rest of the 12 (11 members) remain in denominator.
Now we need to evaluate numerator for the remaining 11.
Numerator: any one of the specified screening tests with appropriate look-back windows from 2026-12-31.
N1: FOBT or FIT during 2026 (i.e., service date in 2026).
N2: Stool DNA test during 2026 or the two years prior (2024, 2025, 2026? Actually three-year window: "during 2026 or the two years prior" means 2024-01-01 to 2026-12-31? The spec: "Stool DNA test during 2026 or the two years prior (three-year window)." So from 2024-01-01 to 2026-12-31 inclusive.
N3: Flexible sigmoidoscopy during 2026 or the four years prior (five-year window). So 2022-01-01 to 2026-12-31.
N4: CT colonography during 2026 or the four years prior (five-year window). So 2022-01-01 to 2026-12-31.
N5: Colonoscopy during 2026 or the nine years prior (ten-year window). So 2017-01-01 to 2026-12-31.
We'll check each member's screening history.
- 71083: Screenings: 2026-08-02 CT colonography; 2026-09-02 FIT. Both qualify. So compliant.
- 71085: No colorectal screening on record. So non-compliant.
- 71086: Screening: 2020-08-11 CT colonography. Window for CT colonography is 2022-01-01 to 2026-12-31. 2020 is outside that window. So no other screenings. Non-compliant.
- 71087: Screening: 2021-04-28 CT colonography. Again, 2021 outside 2022-2026 window. Non-compliant.
- 71089: No screening. Non-compliant.
- 71093: 2026-07-02 FIT. That's in 2026, so N1 met. Compliant.
- 71095: 2026-05-26 FIT. Compliant.
- 71096: 2026-03-13 Colonoscopy. N5: colonoscopy within 2017-2026. 2026 qualifies. Compliant.
- 71097: 2026-10-11 FIT. Compliant.
- 71098: 2023-04-14 Flexible sigmoidoscopy. Window for flexible sigmoidoscopy is 2022-2026. 2023 is within. So N3 met. Compliant.
- 71099: 2025-01-25 Flexible sigmoidoscopy. That's in 2025, within 2022-2026. So compliant.
So all except 71085, 71086, 71087, 71089 are compliant. So compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099. That's 7 members. Non-compliant: 71085, 71086, 71087, 71089 — 4 members.
Now, we need to compile the population lists. We have not_eligible members from age and enrolment failures. Not_eligible: 71081 (enrolment gaps), 71082 (age), 71084 (enrolment gap >45), 71088 (enrolment gaps), 71090 (age), 71091 (age), 71094 (age), 71100 (enrolment gap). That's 8 members: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100.
Excluded: 71092 (cancer). 1 member.
Denominator: 11 members (71083, 71085, 71086, 71087, 71089, 71093, 71095, 71096, 71097, 71098, 71099). Numerator: 7 (71083, 71093, 71095, 71096, 71097, 71098, 71099). Non-compliant: 4 (71085, 71086, 71087, 71089).
Check age: 71086 is 75, born 1951-02-07, non-compliant. 71085 is 67, non-compliant. 71087 is 59, non-compliant. 71089 is 59, non-compliant. All fine.
Now compute rate: numerator/denominator * 100 = 7/11 * 100 = 63.636363... rounded half up to one decimal place: 63.6? 63.636... the digit after first decimal is 3, so round down to 63.6. Actually, half up: 63.636, the hundredths digit is 6, so after one decimal, we look at the second decimal: 3, so round down, 63.6. But 63.636 rounded to one decimal: 63.6 (since 3 < 5). So rate = 63.6.
Denominator = 11, numerator = 7, excluded = 1, not_eligible = 8.
Now produce JSON with the required keys. Member IDs as strings. Lists can be in any order.
Let's compile:
compliant_members: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
non_compliant_members: ["71085", "71086", "71087", "71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Check counts: 7+4+1+8=20, all members.
Now output JSON.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"non_compliant_members": [
"71085",
"71086",
"71087",
"71089"
],
"excluded_members": [
"71092"
],
"not_eligible_members": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}67DeepSeek V4 Flash · DeepSeek76.0s · 4,241 out | 136.4s · 2,396 out | 107.8s · 3,089 out
Reasoning · 4,101 tokens
We need to process 20 members against measure QM-CRC. Need to determine eligibility: age 46-75 as of 2026-12-31, continuous enrolment full year with no more than one gap up to 45 days. Then exclusions: colorectal cancer C18-C21 any time, total colectomy, hospice during year, age 66+ with both frailty and advanced illness during year. Then numerator: any screening within windows.
Let's go member by member.
Member 71081: DOB 1951-10-15 => as of 2026-12-31, age 75 (since birthday Oct 15, 2026, age 75). Age in range. Enrolment: gaps: from 03-21 to 04-14 = 24 days? Actually 2026-03-21 end, start 04-14: gap from 03-22 to 04-13 inclusive? Let's compute: 03-21 to 04-14, difference in days: March has 31 days, so from 3/22 to 4/14? Usually gap is days not enrolled. Let's define gap as number of days between end and next start minus 1? For continuous enrolment with gap of up to 45 days, the gap length is days from termination to reenrollment? Typically the gap is the number of days that are not covered. For discontinuity: if coverage ends on day X and resumes on day Y, the gap is Y - X - 1? Or sometimes it's Y - X? Let's examine examples: The roster says "Gaps of 23 and 29 days." For member 71081: enrollment: 2026-01-01 through 2026-03-21; then 2026-04-14 through 2026-07-23; then 2026-08-22 through 2026-12-31. Gap 1: from 03-22 to 04-13 inclusive? That is 23 days? Let's count: March 22-31 = 10 days, April 1-13 = 13 days, total 23 days. Yes, so gap length is days from day after end to day before next start. So it's Y - X - 1 where X=Mar21, Y=Apr14 => difference in days? Let's calculate: March 22 to April 13 inclusive. That's 23 days. So the gap length is Y - X - 1 if both ends are dates? Actually from Mar22 to Apr14 exclusive of start? Let's use date difference: between Mar22 and Apr14 = 23 days (since Mar22->Apr14 is 23 days? Let's do actual: March has 31 days, so from Mar22 to Mar31 = 10 days, Apr1-14 = 14 days? That gives 24? Let's do proper: Date difference between 3/22 and 4/14 is 23 days if we count 3/22 as day 0? Better: The gap in coverage is the number of days with no coverage. If coverage ends on 3/21, then 3/22 is first uncovered day. Coverage resumes on 4/14, so 4/13 is last uncovered day. Count days from 3/22 through 4/13 inclusive: March 22-31 = 10, April 1-13 = 13 -> total 23. So gap = (next start - previous end) - 1 days. For 3/21 to 4/14, difference is 24 days? 3/21 to 4/14 is 24 days (3/22,23,...4/14? Actually 3/21 to 4/14 inclusive? Let's use a date calculator: from 3/21 to 4/14 is 24 days if you count the end? But transition: from end date to start date is difference in days? Let's verify with second gap: second: end 7/23, start 8/22. Gap from 7/24 to 8/21 inclusive. July 24-31 = 8 days, August 1-21 = 21 days total 29 days. So that matches "Gaps of 23 and 29 days" indeed. So gap length = (start - end) - 1.
So for member 71081, gaps are 23 and 29. Both <=45, but there are two gaps. The criterion says no more than one gap of up to 45 days. So two gaps, even if each <=45, is more than one gap? The wording: "no more than one gap of up to 45 days" means at most one gap, and that gap (if any) must be <=45. So if there are two gaps, that's more than one gap, so not continuous. Even if each is <=45, having two gaps violates. So member 71081 is not eligible due to more than one gap. Therefore not_eligible.
Check other criteria? Age yes. But non-continuous. So not_eligible.
Member 71082: Age 45 on 2026-12-31? DOB 1981-09-15, so on 2026-12-31, age 45 (since birthday passed). Age range 46-75. 45 is below 46, so not eligible age-wise. So not_eligible, even though enrolment continuous. So not_eligible.
Member 71083: DOB 1971-06-11 => age 55 on 2026-12-31. In range. Enrolment continuous. Screening: CT colonography 2026-08-02 and FIT 2026-09-02. Need numerator: N1 FIT in 2026 qualifies. So compliant. Check exclusions: no cancer, no colectomy, no hospice, no frailty/advanced. So compliant.
Member 71084: DOB 1967-02-19 => age 59 on 2026-12-31. In range. Enrolment: started 2026-04-15, not enrolled before. Continuous enrolment for full year means they must be enrolled for the full measurement year, with allowed gap. The spec: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days." If they were not enrolled at start of year, that's a gap from Jan1 to Apr14? That gap length? Actually member not enrolled before 2026-04-15 means they were not covered from Jan1 to Apr14, which is >45 days (103 days). So not continuous. So not_eligible. Also note they had frailty documented but age 59, frailty doesn't matter.
Member 71085: Age 67, continuous, no screening. Exclusions? No cancer, etc. Age 67 means E4 applies if both frailty and advanced illness documented during measurement year. But none documented. So not excluded. No numerator. So non_compliant.
Member 71086: Age 75, continuous. Screening: CT colonography on 2020-08-11. For CT colonography, window is 2026 or 4 years prior, i.e., 2022-2026? Actually five-year window: during 2026 or the four years prior (i.e., 2022-2025 inclusive) So 2020 is outside. So no numerator. Exclusions? No cancer etc. So non_compliant.
Member 71087: Age 59, enrolment: two periods with one gap of 32 days (from 4/20 to 5/23? Let's compute: end 4/20, start 5/23 => gap from 4/21 to 5/22 inclusive: April 21-30=10 days, May 1-22=22 days total 32 days. One gap <=45, so continuous requirement met. Screening: CT colonography on 2021-04-28. For CT, window 2022-2026? 2021 is outside (five-year window from 2022-2026). So not numerator. Exclusions: has frailty and advanced illness during 2026 (May 25 and June 21). Age 59, not 66+, so E4 doesn't apply. No cancer/colectomy/hospice. So not excluded. So non_compliant.
Member 71088: Age 50, enrolment: three periods with gaps of 17 and 14 days. That's two gaps. More than one gap, so not continuous (even though each <=45). So not_eligible. Screening flexible sigmoidoscopy 2021-07-01. But irrelevant. not_eligible.
Member 71089: Age 59, continuous. No screening. No exclusions. non_compliant.
Member 71090: Age 76 (DOB 1950-05-28, so on 2026-12-31 age 76). Age >75, not eligible. So not_eligible regardless of enrolment. Even though gap 28 days. So not_eligible.
Member 71091: Age 76 (DOB 1950-07-12, age 76). Not eligible age >75. So not_eligible.
Member 71092: Age 55, continuous. Screening: stool DNA test 2023-02-25. For stool DNA, window is 2026 or two years prior (three-year window): 2024-2026? Actually "during 2026 or the two years prior" means 2024, 2025, 2026. 2023 is outside. So no numerator. Exclusions: has diagnosis C18.7 (colorectal cancer) in 2024. So meets E1. Since in eligible population (age, enrolment), exclusion applies. So excluded. Even if no numerator, but exclusion removes from denominator. So excluded.
Member 71093: Age 50, continuous. FIT 2026-07-02 in 2026, so compliant. No exclusions.
Member 71094: Age 45 (DOB 1981-12-09, so on 2026-12-31 age 45). Age below 46, not eligible. Also gap 51 days >45 anyway. But age fails first. So not_eligible.
Member 71095: Age 47, continuous. FIT 2026-05-26, compliant. No exclusions.
Member 71096: Age 59, continuous. Colonoscopy 2026-03-13, within 10-year window (2026 or prior 9 years: 2017-2026), so compliant. No exclusions.
Member 71097: Age 75, continuous? Enrolment: 2026-01-01 through 2026-04-24; then 05-16 through 12-31. Gap from 4/25 to 5/15? That's 20 days? Let's count: April 25-30 = 6 days, May 1-15 = 15 days total 21 days? Actually the roster says "One gap of 21 days." So yes one gap <=45. So continuous. FIT on 2026-10-11, compliant. No exclusions.
Member 71098: Age 72, continuous. Flexible sigmoidoscopy 2023-04-14. For flexible sig, window 2026 or 4 years prior (2022-2025). 2023 is within, so numerator met. No exclusions. Compliant.
Member 71099: Age 47, enrolment: two periods with one gap of 39 days (from 6/15 to 7/25? Actually 6/15 end, 7/25 start, gap 6/16-7/24 inclusive: June 16-30=15 days, July 1-24=24 days total 39). One gap <=45, so continuous. Screening: flexible sigmoidoscopy 2025-01-25. Window: 2026 or 2022-2025? For N3, window is 2026 or the four years prior (2022-2025). 2025 is within, so numerator met. Compliant.
Member 71100: Age 47, enrolment: started 2026-03-16, not enrolled before. Gap from Jan1 to Mar15? That's >45 (about 73 days). So not continuous. Not eligible. Also has advanced illness documented but age not 66+. So not_eligible.
Now tally:
Let's list each member and category:
71081: not_eligible (multiple gaps)
71082: not_eligible (age <46)
71083: compliant
71084: not_eligible (not continuous)
71085: non_compliant
71086: non_compliant
71087: non_compliant (no numerator, not excluded)
71088: not_eligible (multiple gaps)
71089: non_compliant
71090: not_eligible (age >75)
71091: not_eligible (age >75)
71092: excluded (cancer)
71093: compliant
71094: not_eligible (age <46, also gap)
71095: compliant
71096: compliant
71097: compliant
71098: compliant
71099: compliant
71100: not_eligible (not continuous)
Now count:
Denominator = eligible after exclusions removed: compliant + non_compliant. Excluded are not in denominator. Not_eligible are not in denominator.
So compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = that's 7? Let's list carefully:
- 71083 compliant
- 71093 compliant
- 71095 compliant
- 71096 compliant
- 71097 compliant
- 71098 compliant
- 71099 compliant
Also any others? Check 71092 is excluded, not compliant. 71085 non_compliant. 71086 non_compliant. 71087 non_compliant. 71089 non_compliant.
Non_compliant: 71085, 71086, 71087, 71089 = 4.
So denominator = 11.
Numerator = compliant = 7.
Excluded: 71092 only = 1.
Not_eligible: the rest: total 20 - 11 - 1 = 8. Let's list not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 = 8.
Check each: 71081 (multiple gaps), 71082 (age), 71084 (not continuous), 71088 (multiple gaps), 71090 (age), 71091 (age), 71094 (age), 71100 (not continuous). Yes.
Rate = 7/11 * 100 = 63.636... round half up to one decimal: 63.6 (since .636... -> round to 63.6? Actually 63.636... -> 63.6 if rounding to nearest tenth, but warning: "rounded half up to one decimal place" meaning standard rounding. 63.636 rounds to 63.6 because the second decimal is 3? Wait 63.636 -> hundredths digit is 3, so round down to 63.6. But we need one decimal: 63.6. However 7/11 = 0.636363..., so 63.636363... to one decimal is 63.6 (since the hundredths digit 3 <5). So rate = 63.6.
Now produce JSON arrays.
We must output only JSON, no extra text.
Let's construct:
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Check ordering: any order fine.
Let's verify all members are included: 7+4+1+8=20. Yes.
Double-check each classification:
71081: age 75, but enrolment has two gaps. The spec says "no more than one gap of up to 45 days" means if there is any gap, it must be at most one. So two gaps disqualifies. Correct.
71082: age 45, not 46. Not eligible.
71083: age 55, continuous, FIT in 2026 -> numerator.
71084: age 59, but not enrolled before April 15, so gap >45 from Jan1 to Apr14? Actually Jan1 to Apr14 is 104 days? Let's compute: Jan31-? Jan1 to Apr14 inclusive? The gap from Jan1 to Apr14 if not covered before Apr15? Actually coverage starts Apr15, so not covered from Jan1 through Apr14, that's 104 days. So violates continuous.
71085: age 67, continuous, no screening, no exclusions -> non_compliant.
71086: age 75, continuous, CT 2020 not in window -> non_compliant.
71087: age 59, continuous (one gap 32), CT 2021 not in window, frailty+advanced but not age 66+ -> non_compliant.
71088: age 50, two gaps -> not continuous.
71089: age 59, continuous, no screening -> non_compliant.
71090: age >75 -> not eligible.
71091: age >75 -> not eligible.
71092: age 55, continuous, stool DNA 2023 not in window, but has cancer diagnosis -> excluded.
71093: age 50, continuous, FIT 2026 -> compliant.
71094: age <46 -> not eligible.
71095: age 47, continuous, FIT 2026 -> compliant.
71096: age 59, continuous, colonoscopy 2026 -> compliant.
71097: age 75, continuous (one gap 21), FIT 2026 -> compliant.
71098: age 72, continuous, flexible sig 2023 within 5-year window (2022-2026?) Actually window: 2026 or four years prior: 2022,2023,2024,2025,2026. 2023 qualifies. So compliant.
71099: age 47, continuous (one gap 39), flexible sig 2025 within window -> compliant.
71100: age 47, but not enrolled before Mar16, gap >45 -> not eligible.
All good.
Now output JSON.{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 1,659 tokens
We need place each member. Need be careful with exclusions: colorectal cancer, total colectomy, hospice, age>=66 + both frailty and advanced illness during MY. Also denominator age 46-75 as of 2026-12-31 and continuous enrolment full MY with no more than one gap up to 45 days.
Let's go one by one.
Member 71081: DOB 1951-10-15, age on 2026-12-31: 75 (since 75th birthday 2026-10-15). Age 46-75 yes. Enrolment: 1/1-3/21 (80 days? Actually Jan31+Feb28+Mar21 = 80 days), gap 3/22-4/13 = 23 days; 4/14-7/23 (Apr 17 days? Apr14-30=17, May31, June30, July23 = 101), gap 7/24-8/21 = 29 days; 8/22-12/31. Two gaps, each <=45 but spec says no more than one gap of up to 45 days. Two gaps -> not continuous enrolment. So not_eligible. Even though screened FIT 2025-10-03 (not in 2026; FIT only during 2026). So not_eligible.
Member 71082: DOB 1981-09-15, age 45 on 2026-12-31. Age 45 <46 -> not eligible. Also has frailty and advanced illness but age not 66+, and anyway not eligible due age. not_eligible.
71083: 1971-06-11 age 55. Continuous. Screening: CT colonography 2026-08-02 within 5-year window (2021-2026? N4: 2026 or 4 prior, so 2022-2026, yes). Also FIT 2026. Compliant.
71084: 1967-02-19 age 59. Enrolment starts 2026-04-15, not enrolled before, so not continuous full MY, more than one gap? Actually only one gap of 104 days? From Jan1 to Apr14 = 104 days, but not enrolled at all before Apr15. The spec requires continuous enrolment full MY with no more than one gap up to 45 days. Having a gap >45 days or not enrolled for entire year fails. So not_eligible. Screening 2021 flex sig (outside 5-year? N3 window 2021? 2026 or four prior: 2022-2026. 2021 not within). Not eligible anyway.
71085: 1959-01-11 age 67. Continuous. No screening. No exclusions. Not compliant. Note age 67, but no frailty/advanced illness. So non_compliant.
71086: 1951-02-07 age 75 (turns 75 2026-02-07). Continuous. Screening CT colonography 2020-08-11. N4 window: 2026 or four prior (2022-2025? Actually 2026 minus 5 years? "during 2026 or the four years prior (five-year window)" so 2022-2026 inclusive. 2020 not within. No other screening. Non_compliant. No exclusions.
71087: 1967-06-23 age 59. Enrolment: two periods with one gap 4/21-5/22 = 32 days. Continuous with one gap <=45 OK. Screening CT colonography 2021-04-28. N4 window 2022-2026, so not within. Also frailty 2026-05-25 and advanced illness 2026-06-21 both during MY, age 59 not >=66, so E4 only applies age>=66. No exclusion. Non_compliant.
71088: 1976-06-16 age 50. Enrolment: gaps 17 and 14 days, two gaps -> not eligible (no more than one gap). Screening 2021-07-01 flex sig, N3 window 2022-2026, not within. Not eligible.
71089: 1967-11-24 age 59. Continuous. No screening. No exclusions. Non_compliant.
71090: 1950-05-28 age 76 on 2026-12-31 (turned 76 2026-05-28). Age >75 -> not eligible. Enrolment gap 28 days one gap, but age fails. Also screening FIT 2026-06-02, but not eligible. So not_eligible.
71091: 1950-07-12 age 76. Age >75 -> not eligible. Even though gaps and screening. Not eligible.
71092: 1971-06-21 age 55. Continuous. Screening 2023-02-25 stool DNA, N2 window: 2026 or two prior (2024-2026? Actually "during 2026 or the two years prior (three-year window)" so 2024-2026. 2023 not within) so not compliant via that. Other history: Diagnosis C18.7 on 2024-10-06, colorectal cancer C18-C21 any time on or before 2026-12-31 -> exclusion E1. Also meets not numerator anyway. So excluded.
71093: 1976-11-04 age 50. Continuous. FIT 2026-07-02 within 2026 -> compliant.
71094: 1981-12-09 age 45. Age 45 <46 -> not eligible. Gap 51 days anyway. Not eligible.
71095: 1979-11-11 age 47. Continuous. FIT 2026-05-26 -> compliant.
71096: 1967-03-27 age 59. Continuous. Colonoscopy 2026-03-13 within 10-year window -> compliant.
71097: 1951-08-03 age 75. Enrolment gap 21 days one gap OK. FIT 2026-10-11 -> compliant.
71098: 1954-09-24 age 72. Continuous. Flex sig 2023-04-14. N3 window: 2022-2026? Yes, 2023 within 5-year (2026 or four prior = 2022-2026). So compliant. Note also age 72 but no frailty/advanced illness. Compliant.
71099: 1979-09-26 age 47. Enrolment: one gap 6/16-7/24 = 39 days OK. Screening 2025-01-25 flex sig. N3 window 2022-2026, 2025 within. Compliant.
71100: 1979-01-17 age 47. Enrolment starts 2026-03-16, not enrolled before, so not continuous full year. Not eligible. Screening CT 2020 not within anyway. Also advanced illness only, but age not 66+. Not eligible.
Now counts.
Let's categorize all 20.
List:
71081 not_eligible
71082 not_eligible
71083 compliant
71084 not_eligible
71085 non_compliant
71086 non_compliant
71087 non_compliant
71088 not_eligible
71089 non_compliant
71090 not_eligible
71091 not_eligible
71092 excluded
71093 compliant
71094 not_eligible
71095 compliant
71096 compliant
71097 compliant
71098 compliant
71099 compliant
71100 not_eligible
Need verify all.
Denominator = members in eligible population after exclusions removed. Eligible population = age 46-75 and continuous enrolment with <=1 gap<=45. Then exclusions removed. So denominator = compliant + non_compliant.
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7? Count: 71083, 71093, 71095, 71096, 71097, 71098, 71099 = 7.
Non_compliant: 71085, 71086, 71087, 71089 = 4.
Denominator = 11.
Excluded: 71092 = 1. Note 71092 is in eligible population? Age 55, continuous enrolment yes, so eligible then E1 excluded. Yes.
Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100 = 8. Check 71088 two gaps, not eligible. 71081 two gaps. 71084 not enrolled full year. 71090 age 76. 71091 age 76. 71094 age 45. 71100 not full year. 71082 age 45. That's 8.
Total 20: 11 denominator + 1 excluded + 8 not_eligible = 20. Good.
Rate = numerator/denominator*100 = 7/11 = 63.6363... rounded half up to one decimal = 63.6. (Since third decimal 6, round up 63.6? Actually 63.636 -> one decimal 63.6? 63.6 because 63.636 rounds to 63.6? Wait 63.636: hundredths 3, so 63.6? Let's compute: 7/11 = 0.636363... *100 = 63.63636... Rounded to one decimal: 63.6 because first decimal 6, second decimal 3 (since 63.636... decimal digits: .6 3 6 -> second digit 3 <5, so 63.6). Yes.
Now arrays with member ID strings.
compliant_members: ["71083","71093","71095","71096","71097","71098","71099"]
non_compliant_members: ["71085","71086","71087","71089"]
excluded_members: ["71092"]
not_eligible_members: ["71081","71082","71084","71088","71090","71091","71094","71100"]
Need ensure no extra keys.
Output JSON with these.json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 11,
"ok": true,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 63.6,
"ok": true,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"ok": true,
"present": true
}
],
"fabricated": false,
"abstained": false
}Reasoning · 2,975 tokens
We need to process each member.
Measure QM-CRC: Colorectal Cancer Screening.
Eligible: Age 46-75 as of 2026-12-31. Continuous enrolment full year with no more than one gap of up to 45 days.
Numerator: any screening in specified windows.
Exclusions: colorectal cancer, total colectomy, hospice during measurement year, E4: Age 66+ AND both frailty and advanced illness documented during measurement year.
Evaluate each member.
Let's list members:
71081: DOB 1951-10-15, age on 2026-12-31: 75 (turns 75 on 2026-10-15, so age 75). Eligible age. Enrolment: gaps? 2026-01-01 to 03-21, then 04-14 to 07-23, gap 23 days (03-22 to 04-13? Actually gap between 03-21 and 04-14: 23 days? Let's count: March 22-31 = 10 days, April 1-13 = 13 days, total 23. Then gap between 07-23 and 08-22: July 24-31 = 8 days, August 1-21 = 21 days, total 29 days. So two gaps: 23 and 29 days. That's more than one gap? The rule says no more than one gap of up to 45 days. Two gaps, even if each <=45, is disallowed. Also total gap? It says no more than one gap of up to 45 days, so two gaps fails. So not continuously enrolled. Thus not_eligible.
But check: The wording: "no more than one gap of up to 45 days" means at most one gap, and that gap can be up to 45 days. Two gaps are not allowed. So 71081 fails continuous enrolment. Not eligible. Even though screening history: FIT in 2025, not relevant.
71082: DOB 1981-09-15, age on 2026-12-31: 45 (turns 45 on 2026-09-15? Actually 1981 to 2026 is 45 years if birthday passed? On 2026-12-31, age 45 years, because born Sept, so already had 45th birthday. Age 45. Eligible age: 46-75, so 45 is too young. Not eligible.
71083: DOB 1971-06-11, age on 2026-12-31: 55 (turns 55 on June 11, so age 55). Eligible. Continuous enrolment full year. Screening: CT colonography on 2026-08-02, within 2026 or 4 years prior (5-year window). Numerator met. No exclusions. So compliant.
71084: DOB 1967-02-19, age on 2026-12-31: 59 (turns 59 Feb 19, so age 59). Eligible. Enrolment: 2026-04-15 through 2026-12-31. Not enrolled before 04-15, so continuous enrolment failure? The rule: continuous enrolment full measurement year with no more than one gap of up to 45 days. Starting late is a gap? Typically continuous enrolment requires enrollment for the entire measurement year. Here not enrolled before 04-15, so not continuous. So not eligible. Screening: flexible sigmoidoscopy on 2021-05-09, that's within 5-year window? Look-back from 2026-12-31: 2021-05-09 is 5 years, 7 months earlier? Let's compute: 2026-12-31 minus 2021-05-09 = 5 years 7 months 22 days, so it's beyond 5 years (5-year window means within the last 5 years, i.e., on or after 2021-12-31? Actually five-year look-back: procedure on or after 2021-12-31? For CTC, window is 2026 or 4 years prior: 2026-01-01 through 2026-12-31, plus 2022-01-01 through 2025-12-31? Let's read: "during 2026 or the four years prior (five-year window)." Four years prior to 2026 means 2022, 2023, 2024, 2025. So window is 2022-01-01 through 2026-12-31. 2021-05-09 is outside. So even if enrolled, not compliant. But enrolment fails first. Not eligible.
71085: DOB 1959-01-11, age on 2026-12-31: 67 (turns 67 Jan 11). Eligible age. Continuous enrolment. No screening. No exclusions. So non_compliant.
71086: DOB 1951-02-07, age on 2026-12-31: 75 (turns 75 Feb 7). Eligible. Continuous. Screening: CT colonography on 2020-08-11. That's within 5-year window? 2020 is before 2022, so outside. No. So non_compliant? Check exclusions: age 66+ and both frailty and advanced illness? None. So non_compliant.
71087: DOB 1967-06-23, age on 2026-12-31: 59 (turns 59 June 23). Eligible. Enrolment: 2026-01-01 to 04-20, then 05-23 to 12-31, gap 32 days (April 21 to May 22). One gap <=45 days. So continuous enrolment satisfied. Screening: CT colonography on 2021-04-28. That's outside 5-year window (2022-2026). So not numerator. But check exclusions: age 59, not 66+, so E4 not applicable. No cancer etc. So non_compliant.
71088: DOB 1976-06-16, age on 2026-12-31: 50 (turns 50 June 16). Eligible. Enrolment: gaps: 02-16 to 03-05? Actually enrollment: 01-01 to 02-16, then 03-06 to 05-13, then 05-28 to 12-31. Gaps: 02-17 to 03-05 = 17 days? Feb 17-28 = 12 days, March 1-5 = 5 days, total 17. Second gap: 05-14 to 05-27 = 14 days (May 14-27 inclusive? 14 days). So two gaps, both <=45, but two gaps not allowed. So continuous enrolment fails. Not eligible.
71089: DOB 1967-11-24, age on 2026-12-31: 59 (turns 59 Nov 24). Eligible. Continuous. No screening. No exclusions. Non_compliant.
71090: DOB 1950-05-28, age on 2026-12-31: 76 (turns 76 May 28). Age 76, not eligible (over 75). Not eligible.
71091: DOB 1950-07-12, age on 2026-12-31: 76 (turns 76 July 12). Over 75, not eligible.
71092: DOB 1971-06-21, age on 2026-12-31: 55. Eligible. Continuous. Screening: Stool DNA 2023-02-25, within 3-year window? 2026 or two years prior: 2024-2026? Actually "during 2026 or the two years prior (three-year window)" means 2024, 2025, 2026. 2023 is outside. Not numerator. But exclusion: Diagnosis C18.7 in 2024, that's colorectal cancer. That is an exclusion. So even though numerator not met, exclusion applies. Since eligible population, exclusion -> excluded. So excluded.
71093: DOB 1976-11-04, age on 2026-12-31: 50. Eligible. Continuous. FIT 2026-07-02, within 2026. Numerator. No exclusions. Compliant.
71094: DOB 1981-12-09, age on 2026-12-31: 45 (turns 45 Dec 9, so age 45). Not eligible.
71095: DOB 1979-11-11, age on 2026-12-31: 47 (turns 47 Nov 11). Eligible. Continuous? Enrolment: 2026-03-16 through 2026-12-31, not enrolled before. So not continuous. Not eligible.
Wait, the roster only has 20 members? Let's count: We have 71081, 71082, 71083, 71084, 71085, 71086, 71087, 71088, 71089, 71090, 71091, 71092, 71093, 71094, 71095. That's 15. But maybe there are more? The prompt says 20 members but list seems truncated? Actually after 71095 the text says " 2020-11-17 CT colonography.
Other history:
2026-01-23 Advanced illness documented (heart failure, I50.22)." That appears to be continuation of member 71095's record? Actually 71095 has DOB 1979-11-11, etc. Then the text continues with screening history 2020-11-17 CT colonography and advanced illness. So that is part of 71095. But we have only 15 members? Let's count again:
The list:
71081, 71082, 71083, 71084, 71085, 71086, 71087, 71088, 71089, 71090, 71091, 71092, 71093, 71094, 71095. That's 15. The prompt says 20 members, but maybe there are more after? Actually the text provided ends with that. Perhaps the remaining 5 are omitted? But the task says roster of 20 members, but we have 15. Let me re-read the prompt carefully.
The prompt: "ROSTER — 20 members" then lists members. It appears the last member 71095 has details including CT colonography 2020-11-17 and advanced illness. That's all. So perhaps there are only 15? Maybe the count is incorrect? But we must handle all given members. We'll process all listed.
Let's verify each member carefully.
We have 15 members. We'll proceed.
Let's tabulate:
71081: age 75, two gaps -> not_eligible.
71082: age 45 -> not_eligible.
71083: age 55, continuous, CTC 2026 -> compliant.
71084: age 59, not continuous (started 04-15) -> not_eligible.
71085: age 67, continuous, no screening -> non_compliant.
71086: age 75, continuous, CTC 2020 -> not within 5-year window? Actually CTC window is 2022-2026, so 2020 outside -> non_compliant.
71087: age 59, one gap 32 days -> continuous, CTC 2021 outside -> non_compliant.
71088: age 50, two gaps -> not_eligible.
71089: age 59, continuous, no screening -> non_compliant.
71090: age 76 -> not_eligible.
71091: age 76 -> not_eligible.
71092: age 55, continuous, exclusion cancer -> excluded.
71093: age 50, continuous, FIT 2026 -> compliant.
71094: age 45 -> not_eligible.
71095: age? DOB 1979-11-11, age on 2026-12-31 = 47. Eligible. Enrolment: 2026-03-16 through 2026-12-31, not continuous full year -> not_eligible. But also has advanced illness but age 47 not 66+ so E4 not apply anyway. But not eligible due to enrolment.
Thus totals:
Compliant: 71083, 71093 -> 2
Non_compliant: 71085, 71086, 71087, 71089 -> 4
Excluded: 71092 -> 1
Not_eligible: 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71095 -> that's 8.
Count: 2+4+1+8=15. Good.
Denominator = compliant + non_compliant = 2+4=6.
Numerator = 2.
Rate = 2/6 = 33.3333 -> 33.3.
Now output JSON.
Check exclusions for 71086: age 75, but no frailty/advanced illness. So non_compliant.
Check 71087: age 59, no exclusion.
All good.
Now produce JSON.
Keys: denominator, numerator, excluded, not_eligible, rate, compliant_members, non_compliant_members, excluded_members, not_eligible_members.
Lists of strings.
Let's write.json{
"denominator": 6,
"numerator": 2,
"excluded": 1,
"not_eligible": 8,
"rate": 33.3,
"compliant_members": ["71083", "71093"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71095"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 6,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 2,
"ok": false,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 8,
"ok": true,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 33.3,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093"
],
"ok": false,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71085",
"71086",
"71087",
"71089"
],
"ok": true,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71095"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}33Claude Haiku 4.5 · Anthropic53.5s · 6,416 out | 85.8s · 10,057 out | 78.5s · 8,745 out
Reasoning · 6,243 tokens
Let me work through this systematically for each member against the QM-CRC measure.
**Measure requirements:**
- Measurement year: 2026-01-01 through 2026-12-31
- Age eligibility: 46-75 years old on 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:
- 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+ as of 2026-12-31 AND both frailty and advanced illness during measurement year
Let me go through each member:
**MEMBER 71081**
- DOB: 1951-10-15, Age on 2026-12-31: 75 years old
- Age eligible: YES (46-75)
- Enrolment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31
- Gap 1: 2026-03-22 to 2026-04-13 = 23 days, within 45-day limit
- Gap 2: 2026-07-24 to 2026-08-21 = 29 days, within limit
- Two gaps present though — need to check if more than one gap disqualifies continuous enrolment
- No colorectal cancer, colectomy, or hospice found
- Age 75 qualifies for E4 age threshold (66+), so need to check both frailty and advanced illness status to determine exclusion
No frailty documented, no advanced illness documented, so E4 doesn't apply anyway. No exclusions apply overall.
Checking numerator options: FOBT/FIT only on 2025-10-03, outside the 2026 window — doesn't count. No stool DNA test in 2026 or prior two years. No flex sig in 2026 or prior four years. No CT colonography in that timeframe either. No colonoscopy within nine years. All numerator paths fail, so this member is non_compliant.
Moving to member 71082: DOB 1981-09-15, turns 45 by end of 2026. Doesn't meet the minimum age requirement for this measure.
**MEMBER 71083**
DOB 1971-06-11, turning 55. Age eligible. Enrolled continuously for the full year with no gaps. No disqualifying conditions (cancer, colectomy, hospice), no frailty or advanced illness flags. No exclusions apply.
FOBT/FIT completed 2026-09-02 satisfies the numerator directly. Compliant.
**MEMBER 71084**
DOB 1967-02-19, turning 59, age eligible. However enrollment only starts 2026-04-15, meaning coverage doesn't span the entire measurement year — this fails the continuous enrollment requirement.
Not eligible.
**MEMBER 71085**
DOB 1959-01-11, turning 67, age eligible with full-year continuous enrollment and no gaps. No cancer, colectomy, or hospice history. Though age ≥66, frailty and advanced illness are both absent, so exclusion E4 doesn't apply. No exclusions.
Checking all numerator pathways — FOBT/FIT, stool DNA, flex sig, CT colonography, colonoscopy — none found within their respective lookback windows. Numerator not met. Non-compliant.
**MEMBER 71086**
DOB 1951-02-07, turning 75, age eligible, continuous enrollment throughout 2026. No disqualifying diagnoses; frailty/advanced illness both absent so E4 exclusion doesn't apply. No exclusions.
For numerator: no FOBT/FIT, no stool DNA, no flex sig. CT colonography on 2020-08-11 falls outside the 4-year window (cutoff 2022-12-31), so N4 doesn't count either.
**MEMBER 71087**
DOB 1967-06-23, age 59, eligible range. Enrollment has one 32-day gap (04-21 to 05-22), still within allowed threshold — continuous enrollment satisfied. No exclusionary conditions present. Since member is under 66, the frailty/advanced illness exclusion (E4) is moot regardless of the 2026-05-25 frailty and 2026-06-21 advanced illness indicators.
Checking numerator: no FOBT/FIT, no stool DNA, no flex sig. CT colonography from 2021-04-28 falls outside the 4-year lookback (cutoff 2022-12-31), so N4 fails. No colonoscopy on record. All numerator options fail → **non_compliant**.
**MEMBER 71088**
DOB 1976-06-16, age 50, eligible. Reviewing enrollment next.
Stool DNA test during 2026 or prior two years? No
- N3: Flexible sigmoidoscopy in 2026 or prior four years? Check 2021-07-01 against the four-year lookback window ending 2026-12-31.
- Four years prior = 2022-12-31, so 2021-07-01 falls outside this window
gives NO for N3.
- N4: CT colonography, 2026 or prior four years? No
- N5: Colonoscopy, 2026 or prior nine years? No
- Numerator fails overall
- Status: **non_compliant**
**MEMBER 71089**
- DOB: 1967-11-24, turns 59 by end of 2026
- Age eligible: YES (46-75)
- Enrolment: full year 2026, continuous, no gaps
- No exclusion criteria met (no CRC, colectomy, hospice, frailty/advanced illness)
- Checking numerator:
- N1: FOBT/FIT in 2026? No
**MEMBER 71090**
- DOB: 1950-05-28, turns 76 by end of 2026
- Age eligible: NO, exceeds upper bound of 75
- Status: **not_eligible**
**MEMBER 71091**
- DOB: 1950-07-12, turns 76 by end of 2026
- Age eligible: NO, same as above
- Status: **not_eligible**
**MEMBER 71092**
- DOB: 1971-06-21, turns 55 by end of 2026
- Age eligible: YES
- Enrolment continuous through 2026, no gaps
- Exclusion found: colorectal cancer diagnosis dated 2024-10
-06, code C18.7 (sigmoid colon malignancy), falls under C18 colon cancer category
- E1 exclusion triggered
- Status: **excluded**
**MEMBER 71093**
- DOB: 1976-11-04, turns 50 by end of 2026
- Age eligible: YES
- Continuous enrolment confirmed, no gaps
- No exclusions present
- Numerator: FOBT/FIT completed 2026-07-02, satisfies N1
- Status: **compliant**
**MEMBER 71094**
- DOB: 1981-12-09, turns 45 by year-end 2026 - falls short of the 46-75 requirement
- Status: **not_eligible**
**MEMBER 71095**
- DOB: 1979-11-11, turns 47 by end of 2026 - meets age criteria
- Continuous enrolment throughout 2026, no gaps
- No exclusions found
- Numerator satisfied via FOBT/FIT on 2026-05-26
- Status: **compliant**
**MEMBER 71096**
- DOB: 1967-03-27, checking age as of 2026-12
-31: 59 years old, meets 46-75 range
- Continuous 2026 enrolment confirmed, no exclusions apply
- FOBT/FIT: no; stool DNA: no; sigmoidoscopy: no; CT colonography: no; colonoscopy on 2026-03-13 satisfies the nine-year window ✓
- Status: **compliant**
**MEMBER 71097**
- DOB: 1951-08-03, turns 75 by end of 2026 - just meets the age ceiling
Enrolment gap of 21 days (2026-04-25 to 2026-05-15) still qualifies as continuous, no exclusions triggered. FOBT/FIT done 2026-10-11 satisfies the numerator.
- Status: **compliant**
**MEMBER 71098**
- DOB: 1954-09-24, 72 years old, age eligible
- Continuous full-year enrolment, no colorectal cancer history noted so far
, no colectomy, no hospice, frailty or advanced illness. Age 72 with no frailty/advanced illness indicators means E4 exclusion doesn't apply. No exclusions overall.
- Checking numerator: FOBT/FIT in 2026? No. Stool DNA in 2026 or prior two years? No. Flex sig within 4 years - 2023-04-14 falls after the 2022-12-31 cutoff, so this qualifies.
- Status: **compliant**
**MEMBER 71099**
DOB 1979-09-26, turning 47 by end of 2026 - age eligible. Enrollment spans two periods with a 39-day gap (2026-06-16 to 2026-07-24), still meeting continuous enrollment requirements. No exclusion criteria present (cancer, colectomy, hospice, frailty/illness). Numerator: no FOBT/FIT, no stool DNA, but flex sig on 2025-01-25 falls within the 4-year lookback window after 2022-12-31 - qualifies.
- Status: **compliant**
MEMBER 71100
- DOB 1979-01-17, 47 years old - age eligible
- Enrollment only begins 2026-03-16, not from year start, so continuous enrollment fails
- Status: **not_eligible**
Tallying results now:
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 — 7 total
Non-compliant: 71081, 71085, 71086, 71087, 71088, 71089 — 6 total
Excluded: 71092 — 1 total
Not eligible: 71082
Adding 71084, 71090, 71091, 71094, 71100 to the not-eligible list — 6 total.
Denominator = compliant + non_compliant = 7 + 6 = 13
Numerator = 7
Rate = 7/13 × 100 ≈ 53.8%
Verifying 71081: age 75 fits range, enrollment gaps of 23/29 days acceptable, no exclusions, only FOBT dated 2025-10-03 which falls outside 2026 so doesn't satisfy screening requirement — correctly non-compliant.
71082: age 45, below threshold, excluded. 71083: age 55, enrollment intact, no exclusions, FIT dated 2026-09-02 satisfies criteria — compliant. 71084: enrollment starts 2026-04-15 rather than 2026-01-01, fails continuous enrollment requirement — not eligible. 71085: age 67, enrolled continuously, but no screening tests found — non-compliant. 71086: age 75, continuous enrollment, checking CT colonography from 2020-08-11 against the 4-year lookback window (2022-12-31 onward) — falls short, need to continue evaluating.
55 ✓. Continuous enrollment ✓. Colorectal cancer diagnosis (C18.7) on 2024-10-06 triggers E1. Excluded ✓
**71093:** Age 50 ✓. Continuous enrollment ✓. No exclusions ✓. FIT 2026-07-02 meets N1 ✓. Compliant ✓
**71094:** Age 45, below range. Not eligible ✓
**71095:** Age 47 ✓. Continuous enrollment ✓. No exclusions ✓. FIT 2026-05-26 meets N1 ✓. Compliant ✓
**71096:** Age 59 ✓. Continuous enrollment ✓. No exclusions ✓. Colonoscopy 2026-03-13 meets N5 ✓. Compliant ✓
**71097:** Age 75 ✓. Continuous enrollment (21-day gap allowed) ✓. No exclusions ✓. FIT 2026-10-11 meets N1 ✓. Compliant ✓
**71098:** Age 72 ✓. Continuous enrollment ✓. No frailty, so E4 doesn't apply despite age 66+. Sigmoidoscopy 2023-04-14 falls within the 4-year window (after 2022-12-31), satisfying N3 ✓. Compliant ✓
**71099:** Age 47
continuous enrollment with 39-day gap ✓, no exclusions ✓. Sigmoidoscopy 2025-01-25 satisfies N3 ✓. Compliant.
**71100:** enrollment starts 2026-03-16, so not eligible—no need to consider the later advanced illness diagnosis.
Final tallies: denominator 13, numerator 7, rate 53.8%. Compliant: 71083, 71093, 71095-71099. Non-compliant: 71081, 71085-71089. Excluded: 71092. Not eligible: 71082, 71084, 71090, 71091, 71100.
json{
"denominator": 13,
"numerator": 7,
"excluded": 1,
"not_eligible": 6,
"rate": 53.8,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71081", "71085", "71086", "71087", "71088", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71082", "71084", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 13,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 6,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 53.8,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71081",
"71085",
"71086",
"71087",
"71088",
"71089"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71082",
"71084",
"71090",
"71091",
"71094",
"71100"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}Reasoning · 9,883 tokens
Let me work through each member systematically against the measure specification.
The measurement year is 2026-01-01 through 2026-12-31.
**ELIGIBLE POPULATION CRITERIA:**
1. Age: 46-75 years as of 2026-12-31
2. Continuous enrollment: full measurement year with no more than one gap of up to 45 days
**EXCLUSIONS (evaluated for eligible members only):**
- 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+ as of 2026-12-31 AND both frailty AND advanced illness during measurement year
**NUMERATOR:**
At least one of:
- N1: FOBT or FIT during 2026
- N2: Stool DNA test during 2026 or prior two years (2024-2026)
- N3: Flexible sigmoidoscopy during 2026 or prior four years (2022-2026)
- N4: CT colonography during 2026 or prior four years (2022-2026)
- N5: Colonoscopy during 2026 or prior nine years (2017-2026)
Let me evaluate each member:
---
**MEMBER 71081**
- DOB: 1951-10-15, age on 2026-12-31: 75 years
- Age eligible: YES (46-75)
- Enrollment: 2026-01-01 to 2026-03-21; 2026-04-14 to 2026-07-23; 2026-08-22 to 2026-12-31
- Gap 1: 23 days, Gap 2: 29 days, both under 45 — continuous enrollment holds
- Eligible for denominator: YES
Exclusions check: no colorectal cancer, no colectomy, no hospice. Age 75 triggers E4 review, but frailty and advanced illness are both absent, so E4 doesn't apply — member remains in denominator.
Screening: only a 2025-10-03 FIT, which falls outside the 2026 measurement year. No qualifying screening found.
Result: **non_compliant**
---
**MEMBER 71082**: DOB 1981-09-15, turns 45 by year-end 2026 — falls short of the 46-75 age requirement despite continuous enrollment.
Status: **not_eligible**
---
**MEMBER 71083**: DOB 1971-06-11, age 55 — meets age criteria, enrollment continuous all year, denominator eligible. Checking exclusions: no colorectal cancer confirmed.
No colectomy, no hospice, and age 55 doesn't trigger the ≥66 exclusion (E4). Clear of all exclusions.
For screening, found a CT colonography dated 2026-08-02, satisfying N4's requirement (current year or prior four years).
Status: **compliant**
---
**MEMBER 71084**: DOB 1967-02-19, age 59 at year-end. However enrollment only starts 2026-04-15, missing the full-year requirement.
Status: **not_eligible**
---
**MEMBER 71085**: DOB 1959-01-11, age 67, continuous full-year enrollment. No colorectal cancer, colectomy, or hospice; age ≥66 alone doesn't exclude without frailty/advanced illness. No screening found on record.
Status: **non_compliant**
---
**MEMBER 71086**: DOB 1951-02-07, age 75, continuous enrollment. Clear of exclusions (no cancer/colectomy/hospice, age alone insufficient for E4). Checking screening record - found CT colonography dated 2020-08-11, which is outside the required 2026-or-prior-four-years window for N4.
Status: **non_compliant**
---
**MEMBER 71087**: DOB 1967-06-23, age 59. Enrollment has a 32-day gap (4/21-5/22) but stays continuous. Meets denominator eligibility. No cancer, colectomy, or hospice found.
Gap 2: 2026-05-14 to 2026-05-27 = 14 days ✓ - continuous enrollment confirmed. Eligible for denominator: YES.
Exclusions all clear (no cancer, no colectomy, no hospice, age 50 not ≥66).
Screening: 2021-07-01 flex sig falls outside the 2022-2026 window, so doesn't count. Numerator: NO.
Status: non_compliant.
Member 71089: age 59, continuous 2026 enrollment, denominator eligible, no exclusions apply. No screening on record → non_compliant.
Member 71090: age 76, exceeds upper bound (46-75) → not_eligible.
Member 71091 next.
**MEMBER 71091**
DOB 1950-07-12, age 76 on 2026-12-31 → exceeds age range → not_eligible.
---
**MEMBER 71092**
DOB 1971-06-21, age 55, continuous enrollment → denominator eligible.
Exclusion check: C18.7 diagnosis (2024-10-06) falls under colorectal cancer codes C18-C21 → E1 exclusion applies.
Status: **excluded** (E1)
---
**MEMBER 71093**
DOB 1976-11-04, age 50, continuous enrollment → denominator eligible.
No cancer, colectomy, or hospice; age 50 doesn't trigger E4.
FIT test found 2026-07-02 → satisfies N1.
Status: **compliant**
---
**MEMBER 71094**
DOB 1981-12-09, age 45 on 2026-12-31 — below the 46-75 range, so checking this carefully.
Status: **not_eligible** (age)
---
**MEMBER 71095**
DOB 1979-11-11, age 47.
Age eligible; enrolled full year. Denominator eligible: YES.
Exclusions all clear (no CRC, colectomy, hospice; age 47 doesn't trigger E4).
Screening found: FIT test 2026-05-26. N1 met.
Status: **compliant**
---
**MEMBER 71096**
DOB 1967-03-27, age 59, eligible, enrolled 2026-01-01 through 2026-
12-31, continuous
- Eligible for denominator: YES
Exclusions all clear (no CRC, colectomy, hospice; age under 66 so E4 doesn't apply).
Screening: colonoscopy 2026-03-13, satisfies N5 (within 10-year window).
Status: **compliant**
---
**MEMBER 71097**
DOB 1951-08-03, age 75, eligible. Enrollment has a gap: 2026-01-01 to 2026-04-24; 2026-05-16 to 2026-12-31.
Gap 2026-04-25 to 2026-05-15 = 21 days ✓, continuous enrollment holds.
Exclusions: none apply—no CRC/colectomy/hospice, and no frailty/advanced illness despite age ≥66.
Screening: FIT 2026-10-11 satisfies N1.
Status: **compliant**
---
**MEMBER 71098**
DOB 1954-09-24, age 72, eligible. Continuous enrollment all year.
E1-E3 clear. Checking E4 next given age ≥66.
cancer ✓, no colectomy ✓, no hospice ✓, age 47 not ≥66 so E4 doesn't apply. Not excluded.
Screening: 2025-01-25 flexible sigmoidoscopy falls in 2022-2026 window ✓
N3: YES
Status: **compliant**
---
**MEMBER 71100**
- DOB: 1979-01-17, age on 2026-12-31: 47 years
- Age eligible: YES
- Enrollment: 2026-03-16
Not enrolled for the full year - starts mid-year, so continuous enrollment fails.
Status: **not_eligible** (enrollment)
---
**SUMMARY:**
Compliant (7): 71083, 71093, 71095, 71096, 71097, 71098, 71099
Non-compliant (6): 71081, 71085, 71086, 71087, 71088, 71089
Excluded (1): 71092 (colorectal cancer history)
Not Eligible: 71082 (age 45, outside 46-75 range)
Adding to that list: 71084, 71090, 71091, 71094, 71100 - mix of age outliers (76 is too old, 45 too young) and enrollment gaps mid-year. Total not-eligible = 6.
Denominator: 7 + 6 = 13
Numerator: 7 (compliant)
Rate: 7/13 = 53.8%
Now verifying member 71081's age calculation from their 1951 DOB against the 2026-12-31 measurement date.
+21 = 29 days ✓, both gaps within 45-day tolerance
- Eligible: YES, no exclusions apply
- Screening: 2025-10-03 FIT falls outside 2026 measurement year, no qualifying screening
- Non-compliant
Member 71082: DOB 1981-09-15, turns 45 by 2026-12-31, doesn't meet 46-75 age requirement, not eligible
Member 71083: DOB 1971-06-11
Age 55 on 2026-12-31, continuous enrollment, no exclusions. Screenings include CT colonography (08-02) and FIT (09-02) - CT colonography satisfies N4 requirement. Compliant.
Member 71084 has enrollment starting 2026-04-15 rather than 2026-01-01, failing the continuous enrollment requirement - not eligible.
Member 71085: DOB 1959-01-11, turns 67 by 2026-12-31.
Enrollment has a 32-day gap, still fine. No exclusions since age is under 66. Screening on 2021-04-28 was a CT colonography but falls outside the required window. Non-compliant.
**MEMBER 71088** - RECHECK
- DOB: 1976-06-16, age 50 on 2026-12-31 ✓
- Enrollment: gaps of 17 and 14 days, acceptable ✓
- No exclusions ✓
- Screening: 2021-07-01 flexible sigmoidoscopy, window needs 2022-01-01 or later, so this doesn't qualify
- Non-compliant ✓
**MEMBER 71089** - RECHECK
- DOB: 1967
Age turns 59 by end of 2026. Enrollment continuous, no exclusions found, no screening on record. Non-compliant.
**MEMBER 71090** - RECHECK
DOB 1950-05-28 puts age at 76, exceeding the 46-75 range. Not eligible.
**MEMBER 71091** - RECHECK
Same situation - DOB 1950-07-12 means age 76, outside eligible range. Not eligible.
**MEMBER 71092** - RECHECK
Age 55, continuous enrollment. Found E1: 2024-10-06 diagnosis C18.7, malignant neoplasm of sigmoid colon - falls within C18-C21 colorectal cancer range. Excluded.
**MEMBER 71093** - RECHECK
Age 50, enrollment continuous, no exclusions. FIT test 2026-07-02 satisfies N1 requirement. Compliant.
**MEMBER 71094** - RECHECK
DOB 1981-12-09 - birthday hasn't occurred yet relative to year-end calc, so age is 45, below the 46 threshold. Not eligible.
**MEMBER 71095** - RECHECK
Age 47, continuous enrollment, no exclusions. FIT completed 2026-05-26 meets N1. Compliant.
**MEMBER 71096** - RECHECK
DOB 1967-03-27 gives age 59 by end of 2026.
---
**MEMBER 71096** continued
Enrollment continuous, no exclusions. Colonoscopy on 2026-03-13 satisfies N5. Compliant.
---
**MEMBER 71097** - RECHECK
Age 75 exactly. Gap check from 04-25 to 05-15: 6 remaining April days + 15 May days = 21-day gap, acceptable. No exclusions. FIT on 2026-10-11 satisfies N1. Compliant.
---
**MEMBER 71098** - RECHECK
DOB 1954-09-24, calculating age for 2026.
Turns 72 on 2026-12-31. Enrollment continuous, no exclusions. Flex sig on 2023-04-14 falls within the 2022-2026 window, satisfying N3. Compliant.
---
**MEMBER 71099** - RECHECK
Age 47 on 2026-12-31. Checking enrollment gap from 06-16 to 07-24: 15 remaining June days + 24 July days = 39-day gap. No exclusions. Flex sig on 2025-01-25 fits within the 2022-2026 window, satisfying N3.
Compliant ✓
---
**MEMBER 71100** - RECHECK
Age 47. Enrollment starts 2026-03-16, so not enrolled for the full measurement year.
Not eligible ✓
---
**FINAL COUNTS:**
Compliant: 71083, 71093, 71095, 71096, 71097, 71098, 71099 (7 members)
Non-compliant: 71081, 71085, 71086, 71087, 71088, 71089 (6 members)
Excluded: 71092 (1 member)
Not eligible: 71082, 71084, 71090, 71091, 71094, 71100 (6 members)
Denominator = 13, Numerator = 7, giving a rate of 7/13 ×
100 = 53.846...%, which rounds to 53.8% since the hundredths digit (4) is below 5. Double-checking my member list to confirm nothing was miscounted.
. 71098 - compliant
19. 71099 - compliant
20. 71100 - not_eligible
That covers all 20 members. Now tallying the categories for the final count.
Compliant: 7 (71083, 71093, 71095, 71096, 71097, 71098, 71099)
Non-compliant: 6 (71081, 71085, 71086, 71087, 71088, 71089)
Excluded: 1 (71092)
Not eligible: 6 (71082, 71084, 71090, 71091, 71094, 71100)
7+6+1+6=20, checks out.
Denominator = 13 (compliant + non-compliant), numerator = 7, so rate = 7/13 ≈ 53.8%.
Let me double-check enrollment continuity for 71084 and 71100 given the requirement of full-year enrollment with no more than one gap ≤45 days.
**71084**: enrolled 2026-04-15 through 2026-12-31, nothing before that date
- Missing coverage from 2026-01-01 to 2026-04-14, roughly 105 days (31+29+31+14) — way over the 45-day threshold.
- Fails the continuous enrollment requirement.
- NOT ELIGIBLE ✓
**71100**: enrolled 2026-03-16 through 2026-12-31, nothing before that date
- Missing coverage from 2026-01-01 to 2026-03-15, about 75 days (31+29+15).
- Also exceeds the 45-day gap allowance.
- NOT ELIGIBLE ✓
Both correctly flagged as not_eligible.
Let me double-check the continuous enrollment rule itself: "the full measurement year with no more than one gap of up to 45 days." This reads as: member should be enrolled the whole year 2026-01-01 through 2026-12-31, allowing a single gap of at most 45 days somewhere within that span.
For 71084, the gap is at the start and far exceeds 45 days, so it's disqualifying regardless of interpretation.
For 71100, same reasoning applies - the missing period at the start of the year is too large to satisfy either interpretation of the rule.
Now confirming the screening look-back windows for each test type:
- N1 (FOBT/FIT): 2026 only
- N2 (Stool DNA): 2024-2026
- N3 (Flex sig): 2022-2026
- N4 (CT colonography):
✓
71098: sigmoidoscopy 2023-04-14, after 2022-01-01 threshold → compliant.
71099: sigmoidoscopy 2025-01-25, after threshold → compliant.
Everything checks out. Compiling final JSON: denominator 13, numerator 7.
Let me verify rate = 7/13 × 100.
7 ÷ 13 = 0.538461538...
× 100 = 53.8461538...
Second decimal digit is 4, less than 5, so round down: 53.8 confirmed.
Double-checking category counts: Compliant 7, Non-compliant 6, Excluded 1, Not eligible 6 — sums to 20. Everything checks out.
json{
"denominator": 13,
"numerator": 7,
"excluded": 1,
"not_eligible": 6,
"rate": 53.8,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71081", "71085", "71086", "71087", "71088", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71082", "71084", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 13,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
"present": true
},
{
"field": "excluded",
"want": 1,
"got": 1,
"ok": true,
"present": true
},
{
"field": "not_eligible",
"want": 8,
"got": 6,
"ok": false,
"present": true
},
{
"field": "rate",
"want": 63.6,
"got": 53.8,
"ok": false,
"present": true
},
{
"field": "compliant_members",
"want": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"got": [
"71083",
"71093",
"71095",
"71096",
"71097",
"71098",
"71099"
],
"ok": true,
"present": true
},
{
"field": "non_compliant_members",
"want": [
"71085",
"71086",
"71087",
"71089"
],
"got": [
"71081",
"71085",
"71086",
"71087",
"71088",
"71089"
],
"ok": false,
"present": true
},
{
"field": "excluded_members",
"want": [
"71092"
],
"got": [
"71092"
],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
"71084",
"71088",
"71090",
"71091",
"71094",
"71100"
],
"got": [
"71082",
"71084",
"71090",
"71091",
"71094",
"71100"
],
"ok": false,
"present": true
}
],
"fabricated": true,
"abstained": false
}Reasoning · 8,572 tokens
Let me work through each member systematically against the measure specification.
**MEASURE QM-CRC — COLORECTAL CANCER SCREENING**
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/FIT during 2026
- N2: Stool DNA test during 2026 or two years prior (3-year window: 2024-01-01 to 2026-12-31)
- N3: Flexible sigmoidoscopy during 2026 or four years prior (5-year window: 2022-01-01 to 2026-12-31)
- N4: CT colonography during 2026 or four years prior (5-year window: 2022-01-01 to 2026-12-31)
- N5: Colonoscopy during 2026 or nine years prior (10-year window: 2017-01-01 to 2026-12-31)
**REQUIRED EXCLUSIONS** (evaluated before numerator):
- E1: Colorectal cancer (C18-C21) any time on or before 2026-12-31
- E2: Total colectomy any time on or before 2026-12-31
- E3: Hospice at any time during measurement year
- E4: Age 66+ AND both frailty AND advanced illness during measurement year
Now let me evaluate each member:
---
**MEMBER 71081**
- DOB: 1951-10-15, age on 2026-12-31: 75 years ✓ (within 46-75)
- Enrolment: 2026-01-01 to 2026-03-21 (81 days); gap of 23 days; 2026-04-14 to 2026-07-23 (101 days); gap of 29 days; 2026-08-22 to 2026-12-31 (132 days)
- Two gaps: 23 and 29 days each, but the spec allows only ONE gap up to 45 days ✗ — this member has two separate gaps, so continuous enrolment fails.
means at most one gap, up to 45 days if it exists. Member 71081 has two gaps (23 and 29 days), violating this - not_eligible.
MEMBER 71082: DOB 1981-09-15, turns 45 by 2026-12-31 - below the 46-75 range, not_eligible.
MEMBER 71083: DOB 1971-06-11, age 55 ✓, continuous enrolment ✓, screening 2026-08-02 CT on record.
Checking exclusions - no CRC, no colectomy, no hospice, age under 66 so E4 doesn't apply. Numerator satisfied via FIT on 2026-09-02 (N1), plus CT colonography also within window (N4). Compliant.
MEMBER 71084: DOB 1967-02-19, age 59 ✓, enrolment starts 2026-04-15 through year-end, continuous from
that date but not enrolled before 2026-04-15, so fails full-year enrolment requirement. Not eligible.
MEMBER 71085: age 67, continuous enrolment, no screening on record. Exclusions all clear - no CRC, no colectomy, no hospice, and although age triggers E4 check, no frailty/advanced illness documented so exclusion doesn't apply. No numerator evidence found → non_compliant.
MEMBER 71086: age 75, continuous enrolment. Has 2020-08-11 CT colonography but that falls outside the 5-year window (2022-2026), too old to count. Exclusions clear. No qualifying screening → non_compliant.
MEMBER 71087: age 59, enrolment has one 32-day gap (Apr 21-May 22), acceptable. Screening 2021-04-28 CT colonography also predates the 2022-2026 window ✗. Notes frailty 2026-05-25 and advanced illness 2026-06-21 exist but age 59 doesn't meet the ≥66 threshold for E4 exclusion anyway.
Numerator fails — no valid screening. Status: **non_compliant**
**MEMBER 71088**
- DOB 1976-06-16, age 50
- Enrolment has two gaps (17 days, 14 days) — fails continuous enrolment
- Status: **not_eligible**
**MEMBER 71089**
- DOB 1967-11-24, age 59 on 2026-12-31
Enrolment continuous, no exclusions, but no screening found. Status: **non_compliant**
**MEMBER 71090**
- DOB 1950-05-28, age 76 — exceeds upper bound of 75. Status: **not_eligible**
**MEMBER 71091**
- DOB 1950-07-12, age 76 — same issue. Status: **not_eligible**
**MEMBER 71092**
- DOB 1971-06...
-21, age 55, enrolment continuous. Found 2023 stool DNA test but also a 2024 sigmoid colon cancer diagnosis (C18.7), triggering E1 exclusion. Status: **excluded**
**MEMBER 71093**
- DOB 1976-11-04, age 50, continuous enrolment, 2026-07-02 FIT test noted.
No exclusions found. FIT satisfies N1. Status: **compliant**
**MEMBER 71094**
- DOB 1981-12-09, age 45 on 2026-12-31 - fails 46-75 range. Status: **not_eligible**
**MEMBER 71095**
- DOB 1979-11-11, age 47, continuous enrolment, FIT on 2026-05-26 satisfies N1, no exclusions. Status: **compliant**
**MEMBER 71096**
- DOB 1967-03-27, age 59, continuous enrolment, Colonoscopy 2026-03-13 satisfies N5 (10-year window), no exclusions. Status: **compliant**
**MEMBER 71097**
- DOB 1951-08-03, age 75, enrolment split 2026-01-01 to 2026-04-24 and 2026-05-16 to 2026-12-31, checking gap length (Apr 25 to
May 15) ✓ - single gap ≤45 days, meets requirement. FIT test on 2026-10-11 covers N1, no exclusions apply. Status: **compliant**
**MEMBER 71098**
- DOB 1954-09-24, age 72, continuous enrolment. Flexible sigmoidoscopy from 2023-04-14 falls within the 5-year look-back window (2022-01-01 to 2026-12-31), satisfying N
3). No exclusions found. Numerator met via flexible sigmoidoscopy. Status: **compliant**
**MEMBER 71099**
- DOB 1979-09-26, age 47. Enrolment split into two periods with a 39-day gap (Jun 16–Jul 24), still within the single ≤45-day allowance. Flexible sigmoidoscopy on 2025-01-25 falls inside the 5-year look-back range, satisfying the numerator condition.
**MEMBER 71100**
- DOB 1979-01-17, age 47. Enrolment only starts 2026-03-16, so not continuously enrolled all year → **not_eligible**.
Tallying compliant members so far: 71083, 71093, 71095, 71096, 71097, 71098, and now 71099 need to be added to the list — continuing to check totals against the full member set.
71094 (age 45 < 46)
- 71100 (enrollment started mid-year)
Total: 8
Denominator = 7 + 4 = 11, Numerator = 7, Rate = 7/11 = 63.6%
Verifying: 71081 has two gaps (23, 29 days) - only one gap allowed, so not_eligible. 71082 age 45 fails the 46-75 range. Moving to check 71083 at age 55.
✓, continuous, FIT done in Sept 2026, no exclusions - compliant.
71084 starts enrollment April 2026, missing Jan-mid-April - not_eligible for continuity.
71085 age 67, continuous, no screening done, no exclusions - non_compliant.
71086 age 75, continuous, but CT colonography from 2020 falls outside the 5-year window (needs to be after 2022-01-01) - non_compliant.
71087 age 59, has one 32-day gap, checking next.
71088: CT colonography from 2021 also outside window, no exclusions since under 66 - non_compliant.
71088 has two coverage gaps (17 and 14 days) - not_eligible.
71089 age 59, continuous, no screening, no exclusions - non_compliant.
71090 and 71091 both exceed age 75 - not_eligible.
71092 age 55, continuous, but has colorectal cancer diagnosis (C18.7) from Oct 2024 - excluded under E1.
71093 age 50, continuous, FIT completed July 2026, no exclusions - compliant.
71094 age 45, falls outside 46-75 range - not_eligible.
71095 age 47, continuous, FIT May 2026, clean - compliant.
71096 age 59, continuous coverage, colonoscopy March 2026 - compliant.
71097 age 75, single 21-day gap tolerated, FIT October 2026 - compliant.
71098 age 72, continuous, flex sig from 2023 falls within the 5-year window - compliant.
71099 age 47, 39-day gap acceptable, flex sig January 2025 within window, checking exclusions next.
compliant.
71100 age 47 but enrollment starts mid-March 2026, missing over two months at the start of the year - not continuous, not_eligible.
Tallying: compliant = 71083, 71093, 71095, 71096, 71097, 71098, 71099 (7); non-compliant = 71085, 71086, 71087, 71089 (4); excluded = 71092; not_eligible = 71081, 71082, 71084, 71088, 71090, 71091, 71094, 71100.
Denominator 11, numerator 7, rate 63.6%.
Need to double-check 71087 - the "Other history" note dated 2026-05-25 needs closer review.
frailty (R26.2) plus advanced illness (heart failure I50.22) both documented, but member is only 59, so the E4 exclusion (age 66+) doesn't apply. No exclusion, no qualifying screening found - stays non_compliant.
Rechecking look-back windows: N2 stool DNA covers 2026 plus two prior years (2024-2026), N3 flexible sigmoidoscopy...
sigmoidoscopy covers 2022-2026, N4 CT colonography same 2022-2026, N5 colonoscopy spans 2017-2026 (ten-year window).
Checking specific members: 71083 has CT colonography 2026-08-02 and FIT 2026-09-02, both compliant. 71086 has CT colonography from 2020-08-11, which falls outside the 2022-2026 window - need to check if any other qualifying test exists for this member.
B 1951-10-15: age 75 as of 2026-12-31 ✓ within 46-75
71082 DOB 1981-09-15: age 45, below range → not_eligible
71090 DOB 1950-05-28: age 76, above range →
not_eligible
71091 DOB 1950-07-12: age 76 → not_eligible
71094 DOB 1981-12-09: age 45 → not_eligible
All checks confirmed. Now reconsidering "continuous enrolment" - full measurement year with no more than one gap up to 45 days. Need to clarify whether this requires enrollment throughout the entire year or allows the specified gap.
My reading: the member needs coverage across the full measurement year, but up to one gap is permitted, and that gap can't exceed 45 days.
So: zero gaps = fine, one gap ≤45 days = fine, two+ gaps or any gap >45 days = fails. This matches "no more than one gap" (cap of 1) combined with "up to 45 days" (cap on gap length).
Checking cases: 71081 has two gaps (23, 29 days) → not_eligible. 71087 has one 32-day gap → passes. 71088 has two gaps (17, 14 days) → not_eligible. 71091's 39-day gap → passes. 71097's 21-day gap → passes. 71099's 39-day gap → passes. All consistent with this rule.
Verifying 71081's gap calculations: March 22-31 (10 days) + April 1-13 (13 days) = 23 days for the first gap. Then July 24-31 (8 days) + August 1-21 (21 days) = 29 days for the second gap.
Now checking 71088: enrolment runs 2026-01-01 through 2026-02-16, then a gap. 2026 isn't a leap year (not divisible by 4), so February has 28 days. Feb 17-28 (12 days) + March 1-5 (5 days) = 17 days for this gap. Next period runs 2026-03-06 through 2026-05-13, followed by another gap to calculate for May 14-27.
May 14-27 = 14 days ✓ Then coverage resumes 2026-05-28 through 2026-12-31. Confirmed: two gaps of 17 and 14 days each.
Summarizing findings:
- Denominator: 11
- Numerator: 7
- Rate: 63.6
- Compliant: ["71083", "71093", "71095", "71096", "71097", "71098", "71099"]
- Non-compliant: ["71085", "71086", "71087", "71089"]
- Excluded: ["71092"]
- Not eligible: ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
I want to double-check my understanding of the enrolment requirement before finalizing.
says: "Continuous enrolment: the full measurement year with no more than one gap of up to 45 days."
This could mean enrolled every single day, or enrolled throughout with some tolerance for gaps. I read it as: continuous enrollment across the full year, allowing at most one gap, and that gap must be ≤45 days — not enrollment on literally every day.
So a member with two separate gaps fails "continuous enrollment" regardless of each gap's size, since only one gap is permitted. This fits the intent of capturing generally continuously-enrolled members while tolerating minor administrative gaps.
This confirms my earlier analysis: members with 0 or 1 gaps of ≤45 days qualify, while those with multiple gaps do not, even if each is individually small.
Members not enrolled for the full year are also excluded — checking cases like 71084 and 71100, who started mid-year (April 15 and March 16 respectively) rather than January 1. Since they were missing enrollment for a chunk at the start of the year, neither satisfies continuous enrollment for the full measurement year, confirming **not_eligible** for both.
But I should consider whether "no more than one gap of up to 45 days" could also apply to someone enrolling late if that late start counts as their "one gap."
I'll settle on treating continuous enrollment as requiring coverage for the entire measurement year, with the 45-day gap allowance meant for minor interruptions within that full-year enrollment—not for a delayed start or early end. So 71084 and 71100 remain not eligible.
Final tally: Denominator 11, Numerator 7, Rate 63.6, Compliant = ["71083", "71093", "71095", "71096", "71097", "71098", "71099"], Non-compliant = ["71085"...
"71086", "71087", "71089"], Excluded = ["71092"], Not eligible = ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
Checking the math: 7/11 = 0.63636..., ×100 = 63.636...%. Rounding half up to one decimal: looking at 63.64 first, the second decimal (4) rounds down, giving 63.6.
Final result:
```json
{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
```
json{
"denominator": 11,
"numerator": 7,
"excluded": 1,
"not_eligible": 8,
"rate": 63.6,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71085", "71086", "71087", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71081", "71082", "71084", "71088", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
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"want": 11,
"got": 11,
"ok": true,
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{
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{
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{
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"want": 8,
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{
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"want": 63.6,
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"want": [
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],
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],
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{
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],
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],
"ok": true,
"present": true
},
{
"field": "not_eligible_members",
"want": [
"71081",
"71082",
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"got": [
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],
"ok": true,
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}
],
"fabricated": false,
"abstained": false
}0GPT-5.6 Luna · OpenAI6.0s · 576 out | 6.4s · 582 out | 6.4s · 618 out
json{
"denominator": 13,
"numerator": 7,
"excluded": 1,
"not_eligible": 6,
"rate": 53.8,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71081", "71085", "71086", "71087", "71088", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71082", "71084", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
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"want": 11,
"got": 13,
"ok": false,
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},
{
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},
{
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"want": 8,
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},
{
"field": "rate",
"want": 63.6,
"got": 53.8,
"ok": false,
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},
{
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],
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],
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"want": [
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"got": [
"71092"
],
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"present": true
},
{
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"want": [
"71081",
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],
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],
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],
"fabricated": true,
"abstained": false
}json{
"denominator": 13,
"numerator": 7,
"excluded": 1,
"not_eligible": 6,
"rate": 53.8,
"compliant_members": ["71083", "71093", "71095", "71096", "71097", "71098", "71099"],
"non_compliant_members": ["71081", "71085", "71086", "71087", "71088", "71089"],
"excluded_members": ["71092"],
"not_eligible_members": ["71082", "71084", "71090", "71091", "71094", "71100"]
}
Grader detail
json{
"fields": [
{
"field": "denominator",
"want": 11,
"got": 13,
"ok": false,
"present": true
},
{
"field": "numerator",
"want": 7,
"got": 7,
"ok": true,
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},
{
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},
{
"field": "not_eligible",
"want": 8,
"got": 6,
"ok": false,
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},
{
"field": "rate",
"want": 63.6,
"got": 53.8,
"ok": false,
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},
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Grader detail
json{
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}0DeepSeek V3.2 · DeepSeek3.4s · 149 out | 3.7s · 154 out | 3.2s · 126 out
json{
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"excluded":-Person4,
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"excluded_members":["71082","71087","71092","71100"],
"not_eligible_members":["71084","71089","71094","71099"]
}
Grader detail
json{
"reason": "response did not contain parseable JSON"
}json{
"denominator": of,
"numerator": where,
"excluded": 2,
"not_eligible": 4,
"rate": 76.9,
"compliant_members": ["71081", "71083", "71087", "71090", "71091", "71093", "71095", "71096", "71097", "71099"],
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"not_eligible_members": ["71082", "71084", "71088", "71094"]
}
Grader detail
json{
"reason": "response did not contain parseable JSON"
}json{
"denominator":所占成员数（合规 + 不合规）,
"numerator":合规成员数,
"excluded":排除成员数,
"not_eligible":不合格成员数,
"rate":合规率（合规数/分母*100，四舍五入到一位小数）,
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"excluded_members":排除成员ID数组,
"not_eligible_members":不合格成员ID数组
}
Grader detail
json{
"reason": "response did not contain parseable JSON"
}