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Beneficiary monthly alignment status.
Beneficiary monthly assignment status.
Beneficiary monthly alignment status.
Beneficiary monthly alignment status.
This variable indicates whether the plan reassignment occurred in January of the reference year.
This variable is populated only if the beneficiary was newly reassigned for their January plan, regardless if they opted out of the re-assignment. This flag resets yearly.
A flag to indicate that there is record in the Disability and Needs supplemental file for this person with monthly values of: HCBS chronic conditions, care level status for LongTerm Services and Supports (LTSS) program, disabilities (concentrating, walking, dressing/bathing, and errands), pregnancy, enrollment in Social Security Disability Insurance (SSDI), receipt of Supplemental Security Income (SSI), SSI State supplement status, SSI status, Birth to Conception status, receipt of Temporary Assistance for Needy Families (TANF) benefits, had some form of third party liability (TPL) insurance coverage and/or had some other form of third party liability (TPL) funding besides insurance coverage.
This variable is the date the beneficiary disenrolled in the Part D Plan, if applicable
This variable is the date the Part D plan sponsor received the election form from the beneficiary.
This variable is the date that Part D coverage began for the beneficiary.
This variable contain the enrollment type code, which is used to identify the source/mechanism of the Part D enrollment.
The race of the beneficiary.
Race code of the beneficiary
Race code from claim
A flag to indicate that there is record in the Eligibility Dates supplemental file for this person.
A flag to indicate that there is record in the Health Home (HLTH_HOME) State Plan Option (SPO) supplemental file for this person that includes Health Home or Community First, 1915i, 1915J, 1915a, 1932a or 1937 SPO participation.
A flag to indicate that there is record in the Managed Care (MC) Enrollment supplemental file for this person that includes Managed Care enrollment data.
A flag to indicate that there is a record in the Money Follows the Person (MFP) supplemental file for this person that includes MFP data.
A flag to indicate that there is record in the Waiver supplemental file for this person.
The social security administration (SSA) standard 2-digit state code of a beneficiary's residence.
The social security administration (SSA) standard 2-digit state code of a beneficiary's residence.
A data element to identify how the beneficiary self-directed the service, i.e. Hiring Authority (the beneficiary has decision-making authority to recruit, hire, train and supervise the individuals who furnish his/her services), Budget Authority (The beneficiary has decision-making authority over how the Medicaid funds in a budget are spent), or both Hiring and Budget Authority.
Beneficiary sex.
Source: CCW Master Beneficiary Summary File (MBSF)
The date the beneficiary began its association with a specific APM Entity.
Values: CCYYMMDD
The count of the total number of coinsurance days involved with the beneficiary's stay in a facility.
During each benefit period (calendar year) the beneficiary is responsible for coinsurance for particular days of inpatient care (no coinsurance from day 1 through day 60, then for days 61 through 90 there is 25% coinsurance), SNF care (no coinsurance until day 21, then is 1/8 of inpatient hospital deductible amount through 100th day of SNF).
Different rules apply for lifetime reserve days, etc.
The ZIP code of the mailing address where the beneficiary may be contacted. It is the zip 5 and 4-digit extension as submitted on the encounter record.
The count of the number of hospice period trailers present for the beneficiary's record.
Medicare covers hospice benefit periods which may consist of 2 initial 90 day periods followed by an unlimited number of 60 day periods.
Hospice benefits are generally in lieu of standard Part A hospital benefits for treating the terminal condition.
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the blood deductible for the stay.
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the inpatient deductible for the stay.
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for part A coinsurance for the stay.
Indicates the benefit phase in which the claim was expected to occur based on a data of service ordering of the beneficiary's claims, the beneficiary's accumulated gross drug and out-of-pocket costs, and the plan's deductible, initial coverage limit (ICL) and out-of-pocket threshold (OOPT) amount. Phases may include Deductible, Pre-ICL, ICL (Coverage Gap) or Catastrophic. Events that occur between two different phases are called straddle PDEs.
This is a CCW-derived field that indicates the benefit phase in which the prescription likely occurred. This is done by ordering the beneficiary's claims by their dates of service and then comparing the cost of those PDEs to the benefit structure for the beneficiary’s plan.
The benefit phase is described using a two-digit code. The first digit indicates the benefit phase immediately before the prescription was filled, and the second digit indicates the benefit phase immediately after the prescription was filled. The two digits are necessary because the benefit phases depend on specific dollar amounts and often do not split exactly between prescription fills; that is, a particular PDE may “straddle” more than one benefit phase. For example, “DD” indicates that the beneficiary was in the deductible phase of the benefit both before and after filling the prescription, but “PI” indicates that this PDE occurred partly in the pre-ICL phase and partly in the coverage gap.
Source: PDE (derived)
The benefit category corresponding to the service reported on the claim or encounter record.
This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for benign prostatic hyperplasia as of the end of the calendar year.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for benign prostatic hyperplasia as of the end of the calendar year.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Benign Prostatic Hyperplasia
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Benign Prostatic Hypertrophy
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Benign Prostatic Hypertrophy
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for benign prostatic hyperplasia on July 1 of the specified reference period.
Patient ID
Case ID. Same patient may have several assessments (i.e. rows)
The MEDPAR Beneficiary Identification Code (BIC) reported on the first claim record included in the stay.
A data element corresponding with UB-04 form locator FL4 that classifies the claim as to the type of facility (2nd digit), type of care (3rd digit) and the billing record's sequence in the episode of care (4th digit). (Note that the 1st digit is always zero.)
This variable is the billing provider city name, as submitted on the encounter.
This variable is the billing provider’s 2-character United States Postal Service (USPS) state code abbreviation, as submitted on the encounter.
STATE ASSIGNED UNIQUE IDENTIFICATION NUMBER FOR THE BILLING PROVIDER.
A unique identification number assigned by the state to a provider. This should represent the entity billing for the service.
The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care.
The taxonomy code for the provider billing for the service.
This code describes the area of specialty for the billing provider.
The taxonomy code for the provider billing for the service.