> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# MIPS (2026) - Promoting Interoperability Category

> This article describes the Promoting Interoperability Performance Category for MIPS 2026.

## Overview

### What is Promoting Interoperability (MIPS PI Category)?

In 2026, MIPS-Eligible Professionals (EPs), that do not have an existing exclusion for the PI category, must attest to their performance on objectives and measures, across 4 categories; Promoting Interoperability, is 1 of the 4 categories. Interoperability, or the use of technology to exchange and make use of information, makes communicating patient information less burdensome and improves outcomes. The Promoting Interoperability category historically was designed for inpatient facility reporting and is the newest iteration of what was previously known as Meaningful Use, and Advancing Care Information. It has since been targeted towards outpatient providers, and finally extended to any MIPS providers that trigger the requirements (not excluded for other reasons). The MIPS Promoting Interoperability performance category emphasizes the electronic exchange of health information using certified electronic health record technology (CEHRT) to improve:

* Patient access to their health information;
* The exchange of information between clinicians and pharmacies; and
* The systematic collection, analysis, and interpretation of healthcare data.

Promoting Interoperability accounts for 25% of an EP’s MIPS score unless you qualify for a [Hardship Exception](#hardship_exceptions) or have an existing automatic exclusion and reweighting of the category.

### Reporting Requirements

For Performance Year 2026, you must submit collected data for certain measures from each of the 4 objective measures (unless an exclusion is claimed) for the same 180 continuous days or more during 2026 (this is an increase from the previous 90 day minimum in CY2023). The 4 objectives and measures that Elation supports are:

1. [e-Prescribing](/articles/Promoting-Interoperability-MIPS-eRX)
2. [Health Information Exchange (HIE) - Support Electronic Referral Loops by Sending & Receiving Health Information](/articles/Promoting-Interoperability-MIPS-HIE-Sending-Receiving-Health-Information)
3. [Provider to Patient Exchange](/articles/Promoting-Interoperability-MIPS-Provider-to-Patient-Exchange)
4. [Public Health & Clinical Data Exchange- Immunization Registry Reporting and Electronic Case Reporting](/articles/Promoting-Interoperability-MIPS-Public-Health-and-Clinical-Data-Exchange)

In addition to submitting measures, you must enter Elation's CMS Identification code (2025C43YZH8S00G) during reporting and submit a **yes** to:

* The Actions to Limit or Restrict Compatibility or Interoperability of CEHRT (previously named the Prevention of Information Blocking) Attestation,
* The ONC Direct Review Attestation,
* [The security risk analysis](/articles/Promoting-Interoperability-Security-Risk-Analysis), and;
* [The SAFER Guides measure](/articles/Promoting-Interoperability-MIPS-SAFER-Guides-Assessment) (High Priority Practices Guide)

### Scoring

The scoring for the Promoting Interoperability objectives and measures are as follows.

* [e-Prescribing](/articles/Promoting-Interoperability-MIPS-eRX) (10 points)
* [Query of PDMP](/articles/Promoting-Interoperability-MIPS-Query-of-Prescription-Drug-Monitoring-Program) (10 points)
* [Health Information Exchange (HIE) - Support Electronic Referral Loops by Sending & Receiving Health Information](/articles/Promoting-Interoperability-MIPS-HIE-Sending-Receiving-Health-Information) (30 points total)
* [Health Information Exchange (HIE) - Bi-Directional Exchange](/articles/Promoting-Interoperability-MIPS-2026-Health-Information-Exchange-HIE-Bi-Directional-Exchange) (30 points)
* [Enabling Exchange Under TEFCA](/articles/Promoting-Interoperability-MIPS-2026-TEFCA) (30 points)
* [Provider to Patient Exchange](/articles/Promoting-Interoperability-MIPS-Provider-to-Patient-Exchange) (25 points)
* [Public Health & Clinical Data Exchange- Immunization Registry Reporting and Electronic Case Reporting](/articles/Promoting-Interoperability-MIPS-Public-Health-and-Clinical-Data-Exchange) (25 points total)

You must report all required measures (submit a **yes**/report at least 1 patient in the numerator, as applicable, or claim an exclusion) or you will earn a zero for the Promoting Interoperability performance category.

<Note>
  For the Public Health and Clinical Data Exchange objective, you will be awarded full points if a **yes** is submitted for 1 of the 2 required measures (Immunization Registry and Electronic Case Reporting) or one “yes” and one exclusion.

  **Electronic Case Reporting (eCR) Suppression**: Due to ongoing technical onboarding pauses, CMS has finalized a policy to suppress the Electronic Case Reporting measure for 2026. You must still report a response (Yes, No, or Exclusion), but you will receive full credit regardless of the performance as long as you provide an answer.
</Note>

If exclusions are claimed, the points for those measures will be reallocated to other measures.

#### Bonus Points

Certain optional measures will allow you to receive bonus points:

* You can earn 5 bonus points for submitting a yes response for one of the optional Public Health and Clinical Data Exchange measures (Public Health Registry Reporting, Clinical Data Registry Reporting, or Syndromic Surveillance Reporting).

### Hardship Exceptions

Hardship Exceptions allow for the Promoting Interoperability performance category to receive a weight of 0% when calculating your final score and the 25% will be redistributed to another performance category (or categories) unless you choose to submit data for Promoting Interoperability.

Some clinicians will be **automatically** reweighted based on:

* Their special status (for example, hospital-based clinicians),
* **If they are a part of a small practice (less than 15 providers).**

These clinicians will not need to submit a Promoting Interoperability hardship exception application.
If you’re reporting as a group or virtual group all MIPS eligible clinicians in the group or virtual group must qualify for reweighting for the group to be reweighted, unless the group or virtual group has a special status that qualifies them for automatic reweighting.

You may submit a MIPS Promoting Interoperability Performance Category Hardship Exception Application, citing one of the following reasons for review and approval:

* MIPS eligible clinician using decertified EHR technology
* Insufficient Internet connectivity
* Extreme and uncontrollable circumstances
* Lack of control over the availability of CEHRT

If your hardship exception is approved, the Promoting Interoperability performance category will be reweighted.

## Achieving Objectives in Elation

Follow the instructions below for the measures that Elation supports:

1. [e-Prescribing](/articles/Promoting-Interoperability-MIPS-eRX)
2. [Health Information Exchange (HIE) - Support Electronic Referral Loops by Sending & Receiving Health Information](/articles/Promoting-Interoperability-MIPS-HIE-Sending-Receiving-Health-Information)
3. [Health Information Exchange (HIE) - Bi-Directional Exchange](/articles/Promoting-Interoperability-MIPS-2026-Health-Information-Exchange-HIE-Bi-Directional-Exchange)
4. [Provider to Patient Exchange](/articles/Promoting-Interoperability-MIPS-Provider-to-Patient-Exchange)
5. [Public Health & Clinical Data Exchange- Immunization Registry Reporting and Electronic Case Reporting](/articles/Promoting-Interoperability-MIPS-Public-Health-and-Clinical-Data-Exchange)
6. [Query of Prescription Drug Monitoring Program (PDMP)](/articles/Promoting-Interoperability-MIPS-Query-of-Prescription-Drug-Monitoring-Program)

## Additional Resources

* [QPP Promoting Interoperability Performance Category Overview](https://qpp.cms.gov/reporting-requirements/ways-to-report/traditional-mips/promoting-interoperability?py=2026)
* [2026 Promoting Interoperability Performance Category Quick Start Guide: Traditional MIPS](https://qpp-cm-prod-content.s3.amazonaws.com/uploads/3599/2026-Promoting-Interoperability-Quick-Start-Guide.pdf)

\*This article is provided for instructional purposes only. Elation Health does not support or guarantee anything other than relay useful information from various organizations. Elation Health also does not provide support for third-party technologies. We recommend consulting[CMS guidelines](https://qpp.cms.gov/resources/resource-library)for the most up to date information.

Copyright U.S Centers for Medicare & Medicaid Services. All rights reserved.

## Related Articles

* [MIPS (2026) Overview](/articles/MIPS-2026-Overview)
* [Promoting Interoperability (MIPS) - e-Prescribing](/articles/Promoting-Interoperability-MIPS-eRX)
* [Promoting Interoperability (MIPS) - Health Information Exchange (HIE) - Sending & Receiving Health Information](/articles/Promoting-Interoperability-MIPS-HIE-Sending-Receiving-Health-Information)
* [Promoting Interoperability (MIPS) - Provider to Patient Exchange](/articles/Promoting-Interoperability-MIPS-Provider-to-Patient-Exchange)
* [Promoting Interoperability (MIPS) - Public Health and Clinical Data Exchange](/articles/Promoting-Interoperability-MIPS-Public-Health-and-Clinical-Data-Exchange)
* [Promoting Interoperability (MIPS) - Security Risk Analysis](/articles/Promoting-Interoperability-Security-Risk-Analysis)
* [Promoting Interoperability (MIPS) - SAFER Guides Assessment](/articles/Promoting-Interoperability-MIPS-SAFER-Guides-Assessment)
* [Promoting Interoperability (MIPS) - Query of Prescription Drug Monitoring Program (PDMP)](/articles/Promoting-Interoperability-MIPS-Query-of-Prescription-Drug-Monitoring-Program)[](/articles/Quality-Category-MIPS-2024)