Medicare Limited Data Set (LDS) Quarterly Claims and Enrollment Data

Medicare Limited Data Set (LDS) Quarterly Claims and Enrollment Data

Current Version Date: 
09/01/2016

Background

LDS Standard Analytic Files (SAFs) are created from the identifiable data contained in the Chronic Conditions Warehouse (CCW) by using the Research Identifiable File (RIF) extract scripts and modifying them to accommodate LDS claims layouts (i.e., removal of the claim From Date, creating age categories for Date of Birth, etc.).

To create the annual LDS SAFs, the identifiable data are extracted for each claim type (e.g., Inpatient, Outpatient, Skilled Nursing Facility, Home Health, Hospice, Carrier, and Durable Medical Equipment) and manipulated to either encrypt or mask certain fields according to CMS specifications (e.g., change the actual date of birth to age range). The files are then converted into user-friendly Comma-Separated Values (CSV) files and SAS read-in programs are prepared for ease of use. The LDS files are created in 5% and 100% versions (with the exception of Carrier and DME, which are only available as 5% files).

LDS SAFs and RIF claims determine (e.g., Part A and B claims) completion or final action at different intervals. An LDS SAF uses fee-for-service (FFS) claims completion through June 30 of the following year, whereas a RIF claim uses a rolling 12 months through December 31 of the following year.

Quarterly LDS File Creation

Following the same concept/approach used for RIF Medicare quarterly data files, beginning with the 3rd quarter of 2015, LDS requestors may request data on a quarterly basis, in addition to the annual files.

LDS data available on a quarterly basis includes Medicare FFS claims (Inpatient, Outpatient, Home Health Agency, Hospice, Skilled Nursing Facility, Carrier, and Durable Medical Equipment) and the LDS Denominator. The LDS quarterly files will continue to be created in 5% and 100% versions (with the exception of Carrier and DME, which are only available as 5% files).

LDS quarterly files will be static and include all claims received through the end of the quarter based on the Claim Thru Date. 

Quarterly files have an approximately 4.5-month lag (3 months for claim maturity and 1.5 months for reconciliation, validation, and to produce the extracts). For example, the 2016 Q1 file will represent claims received through June 30th, 2016 (3 months claim maturity) for services provided between January 1 and March 30 (Q1). The 2016 Q1 LDS claim files would be available in mid-August 2016 at approximately a 93% claims maturity for the quarter.

Table 1 provides a timeline for the release of quarterly data beginning with year 2015. Each quarterly file is a standalone file.

Table 1. Quarterly Data Extract Schedule – Year 2016 and forward*

Quarter 1

Quarter 2

Quarter 3

Quarter 4

Jan –March available to extract mid-August

April-June available to extract  mid-November

July-Sept available to extract mid-Feb

Oct-Dec available to extract mid-May

*The earliest LDS quarterly file available is for quarter 3, 2015 data.

Quarterly Data Process and Pricing

All initial requests for quarterly data, as well as requests for subsequent quarters of data, will be submitted following the established LDS data request process, described on the CMS website.

Standard costs have been developed for each quarterly file. These are listed on the CMS Price List for Research Files.

Annual Data Process and Pricing

The enrollment and annual claims files will continue to be offered at the standard annual price. The annual files will continue to be made available in late September of the year following the claim year.

Summary

  • LDS quarterly data are only available for the FFS claims data and the LDS Denominator.
  • LDS quarterly files do not reflect the same run off period as the annual LDS claim files, resulting in different claims maturity percentages.
  • LDS quarterly and annual claim files reflect the final action claims at the time they are extracted.
  • Requestors will pay the established cost for each quarterly data file. 
  • The standard annual file with a 6 month run off will be priced at the regular annual price.
  • Updates to the four quarterly files will not be offered. The standard annual file will be available in late September.
Article Number: 
1
External Author(s): 
Centers for Medicare & Medicaid Services (CMS)
This work was performed under CMS Contract Number HHSM-500-2015-00558G
Related Data File Families: 
Related Data Request Processes: