Eligibility API - NPI Lookup - amsMipsEligibleClinician

[Shane Jarrell]

I'm not currently seeing the property amsMipsEligibleClinician supplied for most NPIs. Parsing the organizations is extremely difficult since the TIN is shadowed. Why is it shadowed, it's public info, no? I'm also using the secure endpoint as well. Another reason it should be available I would think. Based off the schema for npi-secure-v3 or npi-secure this should be populated.

Is this a bug or is there any work to populate this property in the very near future?

https://qpp.cms.gov/api/eligibility/secure/npis/XXXXXXXXXX?runNum=2&year=2019

[Craig Powell]

Shane,

Regarding the property amsMipsEligibleClinician...

Please reference this documentation on how and where to see that property

https://qpp.cms.gov/api/eligibility/docs/secure/#/V3/get_api_eligibility_secure_npis__npi_

Note that there are conditions where the amsMipsEligibleClinician property will not be present.  An example would be if the NPI is not participating in an APM

Two examples from the public version of the NPI Endpoint

• Clinician is not a member of an APM and has no amsMipsEligibleClinician property:         https://qpp.cms.gov/api/eligibility/npi/1366590101
  
• Clinician is a member of an APM and the amsMipsEligibileClinician property is present:   https://qpp.cms.gov/api/eligibility/npi/1003077538

TINs are shadowed because they are classified as Personally Identifiable Information (PII).  As such, they will only display for tokens or authentication that has explicit or implicit permission to see them.

Regards

Craig

QPP Team 

[Shane Jarrell]

Craig--You're referencing the Swagger API documentation which doesn't explain these cases and says nothing about this property being based on APM participation. Please provide the actual documentation which you are referencing for the cases please. It's my understanding that a eligible clinician doesn't have to participate in an APM to be MIPS eligible. Why then is this property based on that? The opt-in endpoint doesn't differentiate between MIPS ineligible versus eligible therein lies the need for this property and inform customers of their options.

[Craig Powell]

Shane,

You are correct that an eligible clinician doesn't have to participate in an APM to be MIPS eligible.  However, amsMipsEligibleClinician is a property provided by AMS (QPP's source for APM related information) and reflects a clinicians eligibility in relation to APM membership.    

I believe the property you're looking for is mipsEligible, which is based upon a clinicians Claims data (and several other factors) and is not related to APM membership.  

At this time, the Swagger API documentation is the best source of information for these types of questions.  You're correct that it does not document certain scenarios (like the fact NPIs that are not part of an APM will not show the amsMipsEligibleClinician property).  We are grateful for any input you may have to enhance documentation and training materials around the Eligibility API.  Each recommendation gives us opportunity to improve down the road.  

Please keep forwarding questions as needed 

Craig

QPP Team

[Shane Jarrell]

Thanks, Craig. Your response is much appreciated. I was wondering what the hell ams stood for, that might be one thing is to detail that little nugget. It's all a little vague to me. mipsEligible would be great to use but sadly the group name doesn't match up to what we always have in the application and we can't match the TIN till they authorize us. So, that could be a toss up. AGain, thank you though and I'll try and detail more out for documentation in my posts.