New Enrollee-level EDGE Data Now Available for Research

CMS is pleased to announce the availability of the Enrollee-Level External Data Gathering Environment (EDGE) Limited Data Set (LDS) for the 2019 benefit year to requesters who seek the data for research purposes. The EDGE LDS contains certain masked enrollment and claims data for on- and off-Exchange enrollees in risk adjustment covered plans in the individual and small group (including merged) markets, in states where HHS operated the risk adjustment program for the 2019 b

Next Generation ACO Model Provider RIF

The Next Generation ACO (NGACO) Model Provider file contains information about the participating providers in the NGACO Model. The file includes one record per year of participation for participating organizations. A related file, the Next Generation ACO Model Beneficiary file, contains identifying information about the beneficiaries assigned to a provider who is participating in the NGACO Model.

What does this file include? (variable highlights)

  • ACO identifier
  • Performance year
  • Organization Name
  • CMS organization identifiers including Tax Identification Number, CMS Certification Number (CCN)
  • Provider type description

Special considerations

  • This file can be linked to any other CMS file that contains the ORG_TIN, ORG_NPI or ORG_CCN
  • Providers can be linked to their assigned beneficiaries by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
  • Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov

Next Generation ACO Model Beneficiary RIF

The Next Generation ACO (NGACO) Model Beneficiary file contains information about the Medicare beneficiaries enrolled in the NGACO Model. The file includes one record per year of enrollment for assigned beneficiaries. A related file, the Next Generation ACO Model Provider file, contains information about the participating providers in the NGACO Model.

What does this file include? (variable highlights)

  • Beneficiary ID (allows linkage to other files)
  • ACO Name
  • Monthly assignment status information
  • Date of Birth
  • Date of Death

Special considerations

  • This file can be linked to any other CMS file that includes the Bene ID
  • Beneficiaries can be linked to their assigned providers by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
  • Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov

Understanding Economic Variables using Medicare Data Files

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to using Medicare Fee-for-Service (FFS) Data for Research.

Medicare billing and payment systems directly impact what is observable in claims data and how to interpret the fields. This presentation will provide background for researchers interested in charges and payments including:

Hospitalization Information in the Inpatient File and the MedPAR

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to using Medicare Fee-for-Service (FFS) Data for Research.

In this presentation, you will learn of the strengths and weaknesses of the hospitalization information which can be found in either the Medicare Provider Analysis and Review (MedPAR) file or inpatient claims files.

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