Medicare Identifiable Data File Descriptions
Inpatient claim file: The Inpatient claim file contains final action claims data submitted by inpatient hospital providers for reimbursement of facility costs. Some of the information contained in this file includes diagnosis, (ICD-9 diagnosis), procedure (ICD-9 procedure code), Diagnosis Related Group (DRG), dates of service, reimbursement amount, hospital provider, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Skilled Nursing Facility claim file: The Skilled Nursing Facility (SNF) claim file contains final action claims data submitted by SNF providers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis and ICD-9 procedure code), dates of service, reimbursement amount, SNF provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Outpatient claim file: The Outpatient claim file contains final action claims data submitted by institutional outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, and community mental health centers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis, ICD-9 procedure code, CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, outpatient provider number, revenue center codes and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Home Health Agency claim file: The Home Health Agency (HHA) claim file contains final action claims data submitted by HHA providers. Some of the information contained in this file includes the number of visits, type of visit (skilled-nursing care, home health aides, physical therapy, speech therapy, occupational therapy, and medical social services), diagnosis (ICD-9 diagnosis), the dates of visits, reimbursement amount, HHA provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Carrier claim file: The Carrier claim file (old file name Physician/Supplier Part B) contains final action claims data submitted by non-institutional providers. Examples of non-institutional providers include physicians, physician assistants, clinical social workers, nurse practitioners, independent clinical laboratories, ambulance providers, and free-standing ambulatory surgical centers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis, CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, non-institutional provider numbers (e.g., UPIN, PIN, NPI), and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Hospice claim file: The Hospice claim file contains final action claims data submitted by Hospice providers. Some of the information contained in this file includes the level of hospice care received (e.g., routine home care, inpatient respite care), terminal diagnosis (ICD-9 diagnosis), the dates of service, reimbursement amount, Hospice provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Durable Medical Equipment claim file: The Durable Medical Equipment (DME) claim file contains final action claims data submitted by Durable Medical Equipment suppliers. Some of the information contained in this file includes diagnosis, (ICD-9 diagnosis), services provided (CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, DME provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
MedPAR File: The MedPAR File contains inpatient hospital and skilled nursing facility (SNF) final action stay records. Each MedPAR record represents a stay in an inpatient hospital or SNF. An inpatient "stay" record summarizes all services rendered to a beneficiary from the time of admission to a facility through discharge. Each MedPAR record may represent one claim or multiple claims, depending on the length of a beneficiary's stay and the amount of inpatient services used throughout the stay. The record unit of MedPAR file is the hospital or SNF stay. Click here for data documentation.
Denominator File: The Denominator File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. The information in the Denominator File is 'frozen' in March of the following calendar year. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/Both), reasons for entitlement, state buy-in indicators, and monthly managed care indicators (yes/no). The Denominator File is used to determine beneficiary demographic characteristics, entitlement, and beneficiary participation in Medicare Managed Care Organizations. This file is not available after March of 2010. This file was incorporated into the Beneficiary Summary File. Click here for data documentation.
Beneficiary Summary File: The Beneficiary Summary File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/C/D), reasons for entitlement, state buy-in indicators, and monthly managed care indicators (yes/no). As of 2006, it also includes variables specific to enrollment in Part D. They include a derived race/ethnicity code, an indicator for Other Credible Drug Coverage, and monthly indicators for MA-PD/PDP enrollment, Low Income Subsidy (LIS) enrollment, Retiree Drug Subsidy, and State Reported Dual Eligibility Status. For more information, review the data documentation. This file has been incorporated into the Master Beneficiary Summary file under the Medicare enrollment segment.
Master Beneficiary Summary File: The Master Beneficiary Summary File includes several segments.
Medicare Enrollment segment: This segment includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/C/D), reasons for entitlement, and monthly managed care indicators (yes/no). As of 2006, it also includes variables specific to enrollment in Part D.
Chronic Conditions segment: This segment includes 27 chornic conditions data warehouse flags called CCW Flags. This includes 6 new chronic conditions in addition to the 21 chronic conditions previously defined. For more information about the CCW Flags, please see the CCW User Guide.
Cost & Utilization segment: This segment includes summarized information about the service utilization and Medicare payment amounts by file type.
National Death Index (NDI) segment: This segment includes the National Death Index cause of death information. This is available for all Medicare beneficiaries from 1999-2008 and for Medicaid recipients from 1999-2007.
Vital Status File: The Vital Status File contains demographic information about each beneficiary ever entitled to Medicare. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, and age. Often the Vital Status File is used to obtain recent death information for a cohort of Medicare beneficiaries. Click here for data documentation.
Vital Status file with Names and/or Addresses: The Vital Status File with Names contains Name and mailing contact address. Often this file is requested to contact Medicare beneficiaries for participation in a study. The Vital Status File with Addresses contains mailing contact address often used when geocoding beneficary residence. Click here for data documentation.
Beneficiary Annual Summary File (BASF) File: The Beneficiary Annual Summary File is a beneficiary level file that contains enrollment, eligibility, vital statistics, and summarized information about the service utilization by file type. In addition, the file contains two different condition categories, the Condition Categories or CCs and the Chronic Conditions Data Warehouse flags called CCW Flags. For more information about the CCW Flags, please see the CCW User Manual. For more information about the BASF, review the data documentation. The last year of this file is calendar year 2010. This file has been incorporated into the Master Beneficiary Summary file under the Chronic conditions and Cost & Utilization segment.
Part D Drug Event (PDE) File: The PDE data contain prescription drug costs and payment data that enable CMS to make payments to the plans and otherwise administer the Part D benefit. When a beneficiary fills a prescription under Medicare Part D, a prescription drug plan sponsor must submit a summary record to CMS. The PDE data are not the same as individual drug claim transactions but are summary extracts using CMS-defined standard fields. For more information, review the data documentation.
Last Modified March 6, 2012