Quality & Stars

TRC: Transitions of Care (HEDIS measure)

~8 min readBy Pelica Health teamPublished August 28, 2026Updated August 28, 2026Reviewed by Catherine Zhao

Short answer

TRC is the HEDIS Transitions of Care measure, written by NCQA and scored by CMS as Part C Star measure C20 at a weight of 1. For members 18 and older discharged from an inpatient stay it reports four rates: notification of inpatient admission, receipt of discharge information, patient engagement after discharge, and medication reconciliation post-discharge. CMS averages the four. In the 2026 Star Ratings the national average was 63% and 4 stars started at 69%. TRC is a quality measure, not a billing code. The billing code is TCM.

What TRC is

TRC is the HEDIS Transitions of Care measure. NCQA writes the specification, health plans report it, and CMS picks it up as Part C Star Ratings measure C20. It asks a narrow question about a discharge: did the people responsible for this patient's care outside the hospital find out in time, and did they do something about it.

The denominator is discharges, not members. A member with three qualifying inpatient stays contributes three times. The eligible population is members 18 and older, and discharges are counted from January 1 through December 1 of the measurement year so the 30-day windows close inside the year.

TRC reports four rates rather than one. CMS averages them. That averaging is the whole reason a plan can do excellent work on the clinical side and still land at 3 stars.

63%

National average for the TRC composite in the 2026 Star Ratings. Average star: 3.1.

69%

Where 4 stars started in the 2026 Star Ratings. 5 stars started at 79%.

4 → 1

Four indicator rates, averaged into one Star measure at a weight of 1.

TRC, TCM, and the ADT feed are three different things

These get used interchangeably in meetings and they should not be. They sit at different layers of the same 30 days.

Term	What it is	Who owns the rules	What “done” means
TRC	A HEDIS quality measure with four indicators	NCQA writes it, CMS scores it as C20	Documentation exists inside each indicator's window
TCM	A Medicare service billed with CPT 99495 or 99496	CMS, through the Physician Fee Schedule	Contact within 2 business days, visit within 7 or 14 days, med rec on or before the visit
ADT	The real-time admit, discharge and transfer message feed	Nobody scores it; it is plumbing	The message lands in your system while the windows are still open

The same phone call can satisfy a TCM element and a TRC indicator. It can also satisfy one and miss the other, because the clocks are different. TCM counts 2 business days for the contact; TRC counts 2 calendar days for notification. A Friday discharge is where that difference shows up.

For the operational side of turning a discharge feed into work that finishes inside the windows, see turning ADT feeds into action in under five days. For the billing rules, see the TCM CPT codes.

The four TRC indicators

Each indicator is scored separately against its own window, and each one needs documentation. Nothing is inferred.

Indicator	Window	What has to be documented
Notification of inpatient admission	Day of admission through 2 calendar days after (3 days)	Receipt of a notification that the member was admitted, dated inside the window
Receipt of discharge information	Day of discharge through 2 calendar days after (3 days)	Receipt of the discharge information, dated inside the window
Patient engagement after inpatient discharge	Within 30 days after discharge	An office visit, home visit or telehealth encounter with the member
Medication reconciliation post-discharge	Date of discharge through 30 days after (31 days)	A prescribing practitioner, clinical pharmacist or registered nurse reconciling the discharge medications against the current list

Two of these windows are three days wide. That is the part teams underestimate. Half the measure is decided in the first 72 hours, before most discharge summaries have been read by anyone.

How CMS scores TRC

In the 2026 Star Ratings, C20 is a process measure weighted at 1, scored by clustering, included in the improvement measure and included in the Categorical Adjustment Index. The metric CMS uses is stated plainly in the technical notes: the average of the four TRC rates. The 2026 ratings were built on calendar year 2024 data.

Stars	2026 TRC score
1 star	Less than 44%
2 stars	44% to less than 56%
3 stars	56% to less than 69%
4 stars	69% to less than 79%
5 stars	79% or higher

Small contracts are handled separately. Contracts under 500 enrollees as of the July 2024 enrollment report are excluded from the measure. Contracts between 500 and 999 are included only when measure score reliability reaches 0.7. Cut points move every year, so treat the table above as last year's bar, not next year's target. The mechanics behind that movement are covered in cut points and Tukey outlier deletion.

The standalone medication reconciliation measure disappears after 2026

Until now, the medication reconciliation work counted twice. C17 Medication Reconciliation Post-Discharge used the same specification as the TRC med rec indicator, word for word: discharges from January 1 through December 1 for members 18 and older, reconciled from the date of discharge through 30 days after. It was scored on its own, and it was also one quarter of C20.

CMS removed C17 beginning with the 2027 Star Ratings, alongside Care for Older Adults Pain Assessment and MTM Program Completion Rate for CMR. Transitions of Care survives the cut and stays a weight-1 process measure in the 2027 set.

The practical effect is not relief. Removing measures concentrates the program's total weight on the ones that remain, and it removes a measure most plans scored well on. C17's national average was 77% against an average star of 3.8, better than TRC on both counts.

Medication reconciliation is not where most plans lose TRC

The common belief is that med rec is the indicator that fails. The 2026 Star Ratings data says otherwise. C17, which uses the identical med rec specification, averaged 77% nationally. The four-indicator TRC composite averaged 63%. Arithmetic puts the other three indicators around 58% on average.

The drag sits in the two notification indicators, and CMS's own numbers show why they behave as a pair. In the standard error calculation for C20, the correlation between notification of inpatient admission and receipt of discharge information is 0.77, the highest of any pair of TRC components. They rise and fall together because they depend on the same thing: whether admission and discharge events reach your system while a 3-day window is still open.

These are also the two indicators NCQA calls hybrid-only. There is no administrative shortcut. A claim proves the stay happened; it does not prove you were told about it on day two.

Where TRC reporting is going

NCQA is building a new Transitions of Care measure on ECDS reporting. In NCQA's words, the plan is to “introduce an ECDS version of the measure into HEDIS, which will be available for optional reporting before the hybrid version is retired in Measurement Year (MY) 2029.” The earliest implementation of the ECDS version is MY2028.

NCQA has been explicit that the first two indicators are the hard part of that translation, because some components cannot currently be represented in the digital standards. Until the switch, TRC stays hybrid and the notification indicators still ride on medical record review. What changes for a plan that starts now is the interoperability work, and that work pays off before the measure changes. See the ECDS transition guide for what to build first.

Common mistakes teams make with TRC

Running TRC as a chart chase in Q4. Two of the four windows close 72 hours after the event. A retrospective abstraction can find documentation that exists; it cannot create documentation for a window that closed in March.
Treating a fax in a shared inbox as receipt of discharge information. The indicator needs a dated record showing receipt inside the window. An unopened fax queue is not that.
Assuming a readmission resets the clock. When a discharge is followed by a readmission or direct transfer to an inpatient setting within 31 days, the measure uses the admit date of the first admission and the discharge date of the last one. It is one event, not two.
Working only the med rec indicator because it used to have its own Star measure. After the 2027 Star Ratings it does not, and it was never the weak rate.
Forgetting the required exclusions. Members in hospice or using hospice services during the measurement year, members who died during the measurement year, and discharges where the last discharge falls after December 1 all come out.
Modeling next year against this year's cut points. C20 moved with the field, and the guardrail caps annual movement at 5 percentage points, not at zero.

How Pelica handles TRC

Every TRC failure we have seen traces back to the same thing: the team learned about the admission or the discharge after the window had already closed.

Pelica ingests ADT feeds live and writes each admission and discharge onto the member's record the moment the message arrives, with all four indicator clocks already running and visible. The Care Management copilot works the resulting queue: it documents the notification, chases the discharge summary, books the engagement visit, and routes the med rec to a pharmacist or nurse before day 30. Customers close 70%+ of transitions-of-care gaps within 30 days.

Related terms

TCM is the billable Medicare service that covers the same 30 days, and CPT 99495 and 99496 are how it is claimed. ADT is the feed that makes the 3-day indicators possible at all. Plan All-Cause Readmissions is the weight-3 outcome measure on the other side of a failed transition, and a readmission inside 31 days also changes how a TRC discharge is counted.

Sources

Frequently asked questions

Common questions about the HEDIS Transitions of Care measure, its four indicators, and how CMS scores it.

What does TRC stand for in HEDIS?

TRC stands for Transitions of Care. It is the NCQA HEDIS measure that looks at what happened around an inpatient discharge for members 18 and older, and it reports four separate rates: notification of inpatient admission, receipt of discharge information, patient engagement after inpatient discharge, and medication reconciliation post-discharge.

What are the four TRC indicators and their time windows?

Notification of inpatient admission is documented on the day of admission or within the following 2 calendar days. Receipt of discharge information is documented on the day of discharge or within the following 2 calendar days. Patient engagement after inpatient discharge must happen within 30 days after discharge. Medication reconciliation post-discharge must be done on the date of discharge through 30 days after discharge, which is 31 total days.

Is TRC the same thing as TCM?

No. TRC is a HEDIS quality measure that NCQA writes and health plans report. TCM is Transitional Care Management, a Medicare service a practice bills with CPT 99495 or 99496. They cover the same 30 days after a discharge and the same clinical work often satisfies both, but they have different rules, different owners, and different definitions of done. A TCM claim can be paid while a TRC indicator still fails, and the reverse happens too.

Is Transitions of Care a Medicare Star Ratings measure?

Yes. CMS scores it as Part C measure C20, a process measure with a weight of 1. The metric is the average of the four TRC rates. In the 2026 Star Ratings the national average was 63% with an average star of 3.1, and the 2026 cut points were: below 44% for 1 star, 44% to under 56% for 2 stars, 56% to under 69% for 3 stars, 69% to under 79% for 4 stars, and 79% or higher for 5 stars.

Why was Medication Reconciliation Post-Discharge removed from the Star Ratings?

It measured the same thing twice. C17 Medication Reconciliation Post-Discharge used the identical specification to the medication reconciliation indicator already inside the TRC composite. CMS removed it beginning with the 2027 Star Ratings, along with Care for Older Adults Pain Assessment and MTM Program Completion Rate for CMR. Transitions of Care stays in the 2027 measure set at a weight of 1, so the med rec work still counts, just once.

Which TRC indicator drags scores down the most?

Not medication reconciliation, despite the folklore. In the 2026 Star Ratings the standalone medication reconciliation measure, which uses the same specification as the TRC indicator, had a national average of 77% while the four-indicator TRC composite averaged 63%. The gap sits in the other indicators, led by the two notification rates. Those two are hybrid-only, so a plan gets credit only when a dated document proves the admission or discharge information arrived inside a 3-day window.

Is TRC moving to ECDS reporting?

NCQA is building a new Transitions of Care measure that uses ECDS reporting. NCQA's stated plan is to introduce the ECDS version for optional reporting first, with the earliest implementation in measurement year 2028, and to retire the hybrid version in measurement year 2029. Until then TRC stays hybrid, and the two notification indicators still require medical record review.

Half of TRC is decided in the first 72 hours after the event.

Pelica reads the ADT feed live, opens all four TRC clocks on the member's record the moment the message lands, and works the notification, the engagement visit and the med rec until each one closes. Customers close 70%+ of transitions-of-care gaps within 30 days.

Book a Demo → See the Care Management copilot