|
1 |
BENE_ID |
CCW Beneficiary ID |
| 2 |
MSIS_ID |
Encrypted State Assigned Beneficiary Unique Identifier |
| 3 |
STATE_CD |
Submitting State Alpha Abbreviation |
| 4 |
MME_TYPE_CD |
Medicare — Medicaid Eligibility Type Code: Annual Dual Eligibility Status |
| 5 |
SAMPLE_GRP |
Sample Group Indicator — 1% |
| 6 |
BIRTH_DT |
Date of Birth |
| 7 |
AGE |
Age (in years) |
| 8 |
ALIVE_MOS |
Months Alive |
| 9 |
BENE_DEATH_DT |
Beneficiary Date of Death |
| 10 |
SEX_CD |
Sex (Biological) - Latest in Year |
| 11 |
MDCR_RTI_RACE |
Medicare — Research Triangle Institute (RTI) Race Code |
| 12 |
MDCD_RACE_ETHNCTY_CD |
Medicaid — Race and Ethnicity Constructed Code — Latest in Year |
| 13 |
MDCR_STATE_CD |
Medicare — State Code — FIPS |
| 14 |
MDCR_COUNTY_CD |
Medicare — County FIPS Code — Latest in Year |
| 15 |
MDCR_PTA_MOS |
Medicare Part A Enrolled Months |
| 16 |
MDCR_PTB_MOS |
Medicare Part B Enrolled Months |
| 17 |
MDCR_PTAPTB_MOS |
Medicare Part A and Part B Enrolled Months |
| 18 |
MDCR_PTD_MOS |
Medicare — Part D Months |
| 19 |
FD_MOS |
Medicare — Full Dual Months |
| 20 |
PD_MOS |
Partial Dual Months |
| 21 |
MDCR_ONLY_MOS |
Medicare Only Months |
| 22 |
MDCD_ELGBLTY_GRP_CD_LTST |
Medicaid — Eligibility Group Code — Latest in Year |
| 23 |
MDCD_ABD_MOS |
Medicaid Enrollment — Aged, Blind, Disabled Months |
| 24 |
MDCD_ONLY_MOS |
Medicaid Aged, Blind, Disabled Only Months |
| 25 |
MDCD_CHIP_NON_ABD_MOS |
MDCD or CHIP Enrollment — Non-ABD Months |
| 26 |
MDCD_RSTRCTD_BNFTS_CD_LTST |
Medicaid — Scope of Medicaid or CHIP Benefits — Latest in Year |
| 27 |
MDCR_COVSTART |
Medicare — Coverage Start Date |
| 28 |
MDCR_OREC |
Medicare — Original Reason for Entitlement Code (OREC) |
| 29 |
MDCR_CREC |
Medicare — Current Reason for Entitlement Code (CREC) |
| 30 |
MDCR_MS_CD |
Medicare Status Code — Latest in Year |
| 31 |
MDCR_DIB_AWD_CD |
Medicare — SSA Disability Insurance Benefit Award Code |
| 32 |
MDCR_DIB_JSTFCTN_CD |
Medicare — Disability Insurance Benefit Entitlement to Medicare Justification Code |
| 33 |
MDCR_DIB_PRMRY_IMPRMNT_CD |
Medicare — SSA Disability Insurance Benefit Dx Primary Impairment Code |
| 34 |
MDCR_DIB_SCNDRY_IMPRMNT_CD |
Medicare — SSA Disability Insurance Benefit Dx Secondary Impairment Code |
| 35 |
MDCR_FFS_MEDICAL_MOS |
Medicare — Fee-for-Service Medical Coverage Months |
| 36 |
MDCR_HMO_MOS |
Medicare — HMO Coverage Months |
| 37 |
MDCR_MC_PACE_MOS |
Medicare — Program of All-Inclusive Care for the Elderly (PACE) Months |
| 38 |
MDCR_MC_MMP_MOS |
Medicare-Medicaid Plan (MMP) Coverage Months |
| 39 |
MDCR_MC_OTHER_MOS |
Medicare — Other Managed Care Months |
| 40 |
MDCR_MC_UNKNOWN_MOS |
Medicare — Unknown Plan Type Manage Care Months |
| 41 |
MDCR_C_SNP_MOS |
Medicare-Medicaid Chronic Conditions Special Needs Plan (C-SNP) Months |
| 42 |
MDCR_D_SNP_MOS |
Medicare-Medicaid Dual Eligible Special Needs Plan (D-SNP) Months |
| 43 |
MDCR_I_SNP_MOS |
Medicare-Medicaid Institutional Special Needs Plan (I-SNP) Months |
| 44 |
MDCD_FFS_MEDICAL_MOS |
Medicaid — Fee-for-Service Medical Coverage Months |
| 45 |
MDCD_MC_MEDICAL_MOS |
Medicaid — Managed Care Medicaid Coverage Months |
| 46 |
MDCD_OTHR_MC_MOS |
Medicaid — Other (non-Comprehensive) Managed Care Medicaid Coverage Months |
| 47 |
MDCD_CMC_COV_MOS |
Medicaid — Comprehensive Managed Care Months |
| 48 |
MDCD_PCCM_COV_MOS |
Medicaid — Primary Care Case Management (PCCM) Months |
| 49 |
MDCD_HIO_COV_MOS |
Medicaid — Health Insuring Organization (HIO) Months |
| 50 |
MDCD_PHP_COV_MOS |
Medicaid — Prepaid Inpatient or Ambulatory Health Plan (PIHP/PAHP) Months |
| 51 |
MDCD_LTC_COV_MOS |
Medicaid — Long-Term Care Prepaid Inpatient Health Plan (PIHP) Months |
| 52 |
MDCD_BEHAVIORAL_COV_MOS |
Medicaid Managed Care Mental Health or Substance Abuse Coverage Months |
| 53 |
MDCD_DENTAL_COV_MOS |
Medicaid — Managed Care Dental Coverage Months |
| 54 |
MDCD_TRANSPORTATION_COV_MOS |
Medicaid — Managed Care Transportation Months |
| 55 |
MDCD_DISEASE_MGMT_COV_MOS |
Medicaid — Managed Care Disease Management Plan Coverage Months |
| 56 |
MDCD_PACE_COV_MOS |
Medicaid — Program of All-Inclusive Care for the Elderly (PACE) Months |
| 57 |
MDCD_PHARMACY_COV_MOS |
Medicaid — Managed Care Pharmacy Months |
| 58 |
MDCD_HLTH_MDCL_HOME_COV_MOS |
Medicaid — Health or Medical Home Months |
| 59 |
MDCD_INTEGRATED_DUAL_COV_MOS |
Medicaid — Integrated care for Dual Eligible Months |
| 60 |
MDCD_WVR_1115_TYPE_CD |
Medicaid — 1115 Waiver Type Code — Latest in Year |
| 61 |
MDCD_WVR_1915C_TYPE_CD |
Medicaid — 1915(c) Waiver Type Code — Latest in Year |
| 62 |
MDCD_WVR_1915B_MOS |
Medicaid — 1915(b) Waiver Months |
| 63 |
MDCD_WVR_1915C_TYPE_CD |
Medicaid — 1915(c) Waiver Type Code — Latest in Year |
| 64 |
MDCD_WVR_1915BC_MOS |
Medicaid — 1915(b)(c) Waiver Months |
| 65 |
MDCR_LTCH_MOS |
Medicare — Long-Term Care Hospital Months (from Claims) |
| 66 |
MDCR_SNF_MOS |
Medicare — Skilled Nursing Facility Months (from Claims) |
| 67 |
MDCR_NF_MOS |
Medicare — Nursing Facility months (from MDS) |
| 68 |
MDCD_HOSPITAL_LTSS_MOS |
Medicaid — Hospital LTSS Months |
| 69 |
MDCD_IPF_LTSS_MOS |
Medicaid — IP Psych Facility for Individuals under age 21 — LTSS Months |
| 70 |
MDCD_NF_LTSS_MOS |
Medicaid — Nursing Facility LTSS Months |
| 71 |
MDCD_ICF_IID_LTSS_MOS |
Medicaid — Intermediate Care Facility for individuals with intellectual disabilities — LTSS Months |
| 72 |
MDCD_OTHER_LTSS_MOS |
Medicaid — Other Type of Facility LTSS Months |
| 73 |
MDCD_CARE_LEVEL_MOS |
Medicaid — Total LTSS Months (All Levels of Care) |
| 74 |
MDCD_SKILLED_CARE_MOS |
Medicaid — Skilled Level of Care for LTSS Months |
| 75 |
MDCD_INTERMEDIATE_CARE_MOS |
Medicaid — Intermediate level of Care for LTSS Months |
| 76 |
MDCD_CUSTODIAL_CARE_MOS |
Medicaid — Custodial Level of Care for LTSS Months |
| 77 |
MDCD_LTSS_LEVEL_MOS |
Medicaid — LTSS Provider 1 Level of Care Code Months |
| 78 |
MDCR_DUAL_STUS_CD_01 |
Medicare — Medicaid Dual Eligibility Code — January |
| 79 |
MDCR_BUYIN_01 |
Medicare — Entitlement/Buy-In Indicator — January |
| 80 |
MDCR_FFS_MEDICAL_01 |
Medicare — Fee-for-Service Medical Coverage Indicator — January |
| 81 |
MDCR_DUAL_STUS_CD_02 |
Medicare — Medicaid Dual Eligibility Code — February |
| 82 |
MDCR_BUYIN_02 |
Medicare — Entitlement/Buy-In Indicator — February |
| 83 |
MDCR_FFS_MEDICAL_02 |
Medicare — Fee-for-Service Medical Coverage Indicator — February |
| 84 |
MDCR_DUAL_STUS_CD_03 |
Medicare — Medicaid Dual Eligibility Code — March |
| 85 |
MDCR_BUYIN_03 |
Medicare — Entitlement/Buy-In Indicator — March |
| 86 |
MDCR_FFS_MEDICAL_03 |
Medicare — Fee-for-Service Medical Coverage Indicator — March |
| 87 |
MDCR_DUAL_STUS_CD_04 |
Medicare — Medicaid Dual Eligibility Code — April |
| 88 |
MDCR_BUYIN_04 |
Medicare — Entitlement/Buy-In Indicator — April |
| 89 |
MDCR_FFS_MEDICAL_04 |
Medicare — Fee-for-Service Medical Coverage Indicator — April |
| 90 |
MDCR_DUAL_STUS_CD_05 |
Medicare — Medicaid Dual Eligibility Code — May |
| 91 |
MDCR_BUYIN_05 |
Medicare — Entitlement/Buy-In Indicator — May |
| 92 |
MDCR_FFS_MEDICAL_05 |
Medicare — Fee-for-Service Medical Coverage Indicator — May |
| 93 |
MDCR_DUAL_STUS_CD_06 |
Medicare — Medicaid Dual Eligibility Code — June |
| 94 |
MDCR_BUYIN_06 |
Medicare — Entitlement/Buy-In Indicator — June |
| 95 |
MDCR_FFS_MEDICAL_06 |
Medicare — Fee-for-Service Medical Coverage Indicator — June |
| 96 |
MDCR_DUAL_STUS_CD_07 |
Medicare — Medicaid Dual Eligibility Code — July |
| 97 |
MDCR_BUYIN_07 |
Medicare — Entitlement/Buy-In Indicator — July |
| 98 |
MDCR_FFS_MEDICAL_07 |
Medicare — Fee-for-Service Medical Coverage Indicator — July |
| 99 |
MDCR_DUAL_STUS_CD_08 |
Medicare — Medicaid Dual Eligibility Code — August |
| 100 |
MDCR_BUYIN_08 |
Medicare — Entitlement/Buy-In Indicator — August |
| 101 |
MDCR_FFS_MEDICAL_08 |
Medicare — Fee-for-Service Medical Coverage Indicator — August |
| 102 |
MDCR_DUAL_STUS_CD_09 |
Medicare — Medicaid Dual Eligibility Code — September |
| 103 |
MDCR_BUYIN_09 |
Medicare — Entitlement/Buy-In Indicator — September |
| 104 |
MDCR_FFS_MEDICAL_09 |
Medicare — Fee-for-Service Medical Coverage Indicator — September |
| 105 |
MDCR_DUAL_STUS_CD_10 |
Medicare — Medicaid Dual Eligibility Code — October |
| 106 |
MDCR_BUYIN_10 |
Medicare — Entitlement/Buy-In Indicator — October |
| 107 |
MDCR_FFS_MEDICAL_10 |
Medicare — Fee-for-Service Medical Coverage Indicator — October |
| 108 |
MDCR_DUAL_STUS_CD_11 |
Medicare — Medicaid Dual Eligibility Code — November |
| 109 |
MDCR_BUYIN_11 |
Medicare — Entitlement/Buy-In Indicator — November |
| 110 |
MDCR_FFS_MEDICAL_11 |
Medicare — Fee-for-Service Medical Coverage Indicator — November |
| 111 |
MDCR_DUAL_STUS_CD_12 |
Medicare — Medicaid Dual Eligibility Code — December |
| 112 |
MDCR_BUYIN_12 |
Medicare — Entitlement/Buy-In Indicator — December |
| 113 |
MDCR_FFS_MEDICAL_12 |
Medicare — Fee-for-Service Medical Coverage Indicator — December |
| 114 |
MDCD_STATE_CD_01 |
Medicaid — State Alpha Abbreviation — January |
| 115 |
MDCD_STATE_CD_02 |
Medicaid — State Alpha Abbreviation — February |
| 116 |
MDCD_STATE_CD_03 |
Medicaid — State Alpha Abbreviation — March |
| 117 |
MDCD_STATE_CD_04 |
Medicaid — State Alpha Abbreviation — April |
| 118 |
MDCD_STATE_CD_05 |
Medicaid — State Alpha Abbreviation — May |
| 119 |
MDCD_STATE_CD_06 |
Medicaid — State Alpha Abbreviation — June |
| 120 |
MDCD_STATE_CD_07 |
Medicaid — State Alpha Abbreviation — July |
| 121 |
MDCD_STATE_CD_08 |
Medicaid — State Alpha Abbreviation — August |
| 122 |
MDCD_STATE_CD_09 |
Medicaid — State Alpha Abbreviation — September |
| 123 |
MDCD_STATE_CD_10 |
Medicaid — State Alpha Abbreviation — October |
| 124 |
MDCD_STATE_CD_11 |
Medicaid — State Alpha Abbreviation — November |
| 125 |
MDCD_STATE_CD_12 |
Medicaid — State Alpha Abbreviation — December |
| 126 |
MDCD_FFS_MEDICAL_01 |
Medicaid — Fee-for-Service Medical Coverage Indicator — January |
| 127 |
MDCD_ELGBLTY_GRP_CD_01 |
Medicaid — Eligibility Group Code — January |
| 128 |
MDCD_ABD_01 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — January |
| 129 |
MDCD_FFS_MEDICAL_02 |
Medicaid — Fee-for-Service Medical Coverage Indicator — February |
| 130 |
MDCD_ELGBLTY_GRP_CD_02 |
Medicaid — Eligibility Group Code — February |
| 131 |
MDCD_ABD_02 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — February |
| 132 |
MDCD_FFS_MEDICAL_03 |
Medicaid — Fee-for-Service Medical Coverage Indicator — March |
| 133 |
MDCD_ELGBLTY_GRP_CD_03 |
Medicaid — Eligibility Group Code — March |
| 134 |
MDCD_ABD_03 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — March |
| 135 |
MDCD_FFS_MEDICAL_04 |
Medicaid — Fee-for-Service Medical Coverage Indicator — April |
| 136 |
MDCD_ELGBLTY_GRP_CD_04 |
Medicaid — Eligibility Group Code — April |
| 137 |
MDCD_ABD_04 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — April |
| 138 |
MDCD_FFS_MEDICAL_05 |
Medicaid — Fee-for-Service Medical Coverage Indicator — May |
| 139 |
MDCD_ELGBLTY_GRP_CD_05 |
Medicaid — Eligibility Group Code — May |
| 140 |
MDCD_ABD_05 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — May |
| 141 |
MDCD_FFS_MEDICAL_06 |
Medicaid — Fee-for-Service Medical Coverage Indicator — June |
| 142 |
MDCD_ELGBLTY_GRP_CD_06 |
Medicaid — Eligibility Group Code — June |
| 143 |
MDCD_ABD_06 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — June |
| 144 |
MDCD_FFS_MEDICAL_07 |
Medicaid — Fee-for-Service Medical Coverage Indicator — July |
| 145 |
MDCD_ELGBLTY_GRP_CD_07 |
Medicaid — Eligibility Group Code — July |
| 146 |
MDCD_ABD_07 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — July |
| 147 |
MDCD_FFS_MEDICAL_08 |
Medicaid — Fee-for-Service Medical Coverage Indicator — August |
| 148 |
MDCD_ELGBLTY_GRP_CD_08 |
Medicaid — Eligibility Group Code — August |
| 149 |
MDCD_ABD_08 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — August |
| 150 |
MDCD_FFS_MEDICAL_10 |
Medicaid — Fee-for-Service Medical Coverage Indicator — September |
| 151 |
MDCD_ELGBLTY_GRP_CD_09 |
Medicaid — Eligibility Group Code — September |
| 152 |
MDCD_ABD_09 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — September |
| 153 |
MDCD_FFS_MEDICAL_10 |
Medicaid — Fee-for-Service Medical Coverage Indicator — October |
| 154 |
MDCD_ELGBLTY_GRP_CD_10 |
Medicaid — Eligibility Group Code — October |
| 155 |
MDCD_ABD_10 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — October |
| 156 |
MDCD_FFS_MEDICAL_11 |
Medicaid — Fee-for-Service Medical Coverage Indicator — November |
| 157 |
MDCD_ELGBLTY_GRP_CD_11 |
Medicaid — Eligibility Group Code — November |
| 158 |
MDCD_ABD_11 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — November |
| 159 |
MDCD_FFS_MEDICAL_12 |
Medicaid — Fee-for-Service Medical Coverage Indicator — December |
| 160 |
MDCD_ELGBLTY_GRP_CD_12 |
Medicaid — Eligibility Group Code — December |
| 161 |
MDCD_ABD_12 |
Medicaid Enrollment — Aged, Blind, Disabled Indicator — December |
| 162 |
MME_TYPE_CD_01 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — January |
| 163 |
MME_TYPE_CD_02 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — February |
| 164 |
MME_TYPE_CD_03 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — March |
| 165 |
MME_TYPE_CD_04 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — April |
| 166 |
MME_TYPE_CD_05 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — May |
| 167 |
MME_TYPE_CD_06 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — June |
| 168 |
MME_TYPE_CD_07 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — July |
| 169 |
MME_TYPE_CD_08 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — August |
| 170 |
MME_TYPE_CD_09 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — September |
| 171 |
MME_TYPE_CD_10 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — October |
| 172 |
MME_TYPE_CD_11 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — November |
| 173 |
MME_TYPE_CD_12 |
Medicare-Medicaid Eligibility Type Code: Dual Eligibility Status — December |
| 174 |
RFRNC_YR |
Reference Year (MMLEADS) |