This variable is contained in the following files:
SAS Name
MDCD_TOTAL_USE_06
This variable is the total count of Medicaid inpatient (IP), long-term care (LT), pharmacy (RX) and other services (OT) (header) claims for the beneficiary for each month, after removing the managed care capitated payment claims from the OT file.
CCW filtered the OT claims header records to distinguish between capitated payments and payments for services. Capitated payment claims are header claims where the claim type code (T-MSIS variable called CLM_TYPE_CD) is equal to '2' (Medicaid or expansion claim) 'B' (S-CHIP claim) or 'V' (Other Services claim).
The Medicaid payment information corresponding to this variable is in the monthly MDCD_TOTAL_SPEND_01–12 variables variable; however, due to CMS payment redaction requirements the dollar totals will not reflect the (redacted) managed care expenditures. MMLEADS counts all claims in these monthly MDCD_ TOTAL_USE_01–12 variables. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.
Source: T-MSIS Claims file (derived)