Medicare Advantage Beneficiary and Plan Information
This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.
Medicare is a health insurance program, administered by the United States government, for people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other special criteria like the End Stage Renal Disease program (ESRD).
This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.
This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.
This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.
The eleven model alignment files contain the point-in-time eligibility and alignment status of model beneficiaries, and a list of eligible-but-not-enrolled patients for participating practice reporting. These alignment validation files, also known as Enrollment, Validation, Alignment, and Adjudication (EVAA) files, were generated semi-annually throughout the duration of the model, each October and April. There were a total of 10 EVAA analytical cycles, between October 2017 and April 2022. The model alignment file names indicate the cycle number (01-10) and the year and month of the cycle. In addition, there is a final model alignment file that represents the alignment status of model beneficiaries at the end of the model.
What does this file include? (variable highlights)
A record represents the eligibility and alignment status of a beneficiary.
The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.
The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.
The Provider List file contains the list of all NPIs enrolled in the model, including the activation and deactivation dates.
What does this file include? (variable highlights)
A record represents a provider (NPI) who is enrolled in the registry.
The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.
The Practice List file contains the list of all practices enrolled in the model, including an indicator if the practice is active and the number of files submitted for the practice.
What does this file include? (variable highlights)
A record represents a single physician practice (billing TIN).
The practice TIN can be linked to other Medicare data that contains TINs.
The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.
The Visit file contains all data extracted to create a beneficiary visit, and includes both uploaded data and manually entered data from the model data collection registry. All generated risk scores and baseline groups are contained in this file. The file is generated at the visit level, with one row for each visit for each beneficiary.
What does this file include? (variable highlights)
A record represents a patient at the time of a particular visit, and includes information such as visit date, baseline risk score, visit risk score, and baseline group.
The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.
The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.
The Beneficiary Demographic file contains all beneficiary demographic information entered via manual entry and upload to the model data collection registry. Additionally, partial beneficiary data that was created through the semi-annual beneficiary alignment validation process is also included and could be considered a data input method. The file is at the beneficiary level, with one record for each beneficiary. It’s possible for the same beneficiary to appear in the file twice, if two or more organizations tried to enroll the same beneficiary.
What does this file include? (variable highlights)
A record represents a single beneficiary. Some beneficiaries may have more than one record if more than one organization tried to enroll them in the trial.
The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.
The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.
The Final Clinical file is a model-curated version of the information in the Raw Clinical data. Million Hearts® business rules are applied to the raw data and select information is extracted and translated into custom codes.
Note that clinical data excludes all “Incomplete” visits.
What is a clinical data element? Data fields that can be collected, utilized, or stored in various application systems.
What does this file include? (variable highlights)
A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.
The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.
The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.
The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.
The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.
The Raw Clinical file contains all visit and clinical data that was uploaded to the model’s data collection registry. This data is preserved as it was uploaded, therefore it may contain data that is not relevant for the Million Hearts® registry as the measures are defined. The file is at the clinical data element level and contains one row per clinical data element per beneficiary, using industry standard codes.
Note that this file excludes all manually entered data in the Million Hearts® registry.
What does this file include? (variable highlights)
A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.
The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.
The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.
The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.
The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.