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File Version: CCW record layout accessed May, 2019; CMS MAX 2014 data dictionary Aug 18, 2016

Short SAS NameLong SAS NameVariable Name
1BENE_IDBENE_IDEncrypted 723 CCW Beneficiary ID
2 MSIS_IDEncrypted MSIS Identification Number
3 STATE_CDState
4 YR_NUMYear of MAX Record
5 EL_DOB Birth date
6EL_SEX_CDSex (MAX)
7 EL_RACE_ETHNCY_CDRace/ethnicity (from MSIS)
8RACE_CODE_1Race - White (from MSIS)
9 RACE_CODE_2Race - Black (from MSIS)
10 RACE_CODE_3Race - Am Indian/Alaskan (from MSIS)
11 RACE_CODE_4Race - Asian (from MSIS)
12 RACE_CODE_5Race - Hawaiian/Pac Islands (from MSIS)
13 ETHNICITY_CODEEthnicity - Hispanic (from MSIS)
14 EL_SS_ELGBLTY_CD_LTSTState specific eligibility - most recent
15 EL_SS_ELGBLTY_CD_MOState specific eligibility - mo of svc
16EL_MAX_ELGBLTY_CD_LTSTMAX eligibility - most recent
17EL_MAX_ELGBLTY_CD_MOMAX eligibility - mo of svc
18 EL_MDCR_ANN_XOVR_OLDCrossover code (Annual) old values
19 MSNG_ELG_DATA Missing eligibility data
20 EL_MDCR_XOVR_CLM_BSD_CDCrossover code (from claims only)
21EL_MDCR_ANN_XOVR_99Crossover code (Annual)
22 MSIS_TOS MSIS Type of Service (TOS)
23 MSIS_TOPMSIS Type of Program (TOP)
52HCBS_TXNMY_WVR_CDHome and community-based services (HCBS) toxonomy code for waviers
25 CLTC_FLAGCommunity-based LT care (CLTC) flag
24 MAX_TOSMAX Type of Service (TOS)
26 PRVDR_ID_NMBR Billing provider identification number
27 NPI National Provider Identifier (MAX)
28 TAXONOMY Provider Taxonomy
29 TYPE_CLM_CD Type of claim
30 ADJUST_CDAdjustment code
31 PHP_TYPEManaged care type of plan code
32 PHP_IDManaged care plan identification code
33 MDCD_PYMT_AMTMedicaid payment amount
34 TP_PYMT_AMTThird party payment amount
35 PYMT_DTPayment/adjudication date
36 CHRG_AMTCharge amount
37 PHP_VALPrepaid plan value
38 MDCR_COINSUR_PYMT_AMTMedicare coinsurance payment amount
39 MDCR_DED_PYMT_AMTMedicare deductible payment amount
40 SRVC_BGN_DTBeginning date of service
41 SRVC_END_DTEnding date of service
42 PRCDR_CD_SYSProcedure (service) coding system
43 PRCDR_CDProcedure (service) code
44 PRCDR_SRVC_MDFR_CDProcedure (service) code modifier
45 DIAG_CD_1Principle Diagnosis code
46 DIAG_CD_2 Diagnosis codes (2nd diagnosis)
47 QTY_SRVC_UNITSQuantity of service
48 SRVC_PRVDR_ID_NMBRServicing provider identification number
49 SRVC_PRVDR_SPEC_CDServicing provider specialty code
50 PLC_OF_SRVC_CDPlace of service
51 UB_92_REV_CDUB-92 revenue code
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