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The Medicare Carrier (Encounter, Final File) includes Medicare Advantage plan paid records for professional providers, including physicians, physician assistants, clinical social workers, nurse practitioners.

Records for some organizational providers are also found in the Carrier (Encounter) file.  Examples include independent clinical laboratories, ambulance providers, freestanding ambulatory surgical centers and freestanding radiology centers.

Researchers rarely use this file alone.

This file includes (variable highlights):

  • Part C Benefit Package and Contract number
  • diagnosis (ICD diagnosis)
  • HCPCS code
  • Date of service (line date)
  • NPI for line rendering physician
  • No payment information
  • Encounter records submitted to CMS by September, 2018, for dates of service in CY 2015.

Special considerations:

  • Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include records for these additional items and services provided under the plan.

Program
Medicare
Category
Privacy Level
Research Identifiable Files