Non-institutional claims or utilization
The Medicaid RX Prescription Drug file includes fee-for-service (FFS) claim and managed care encounter records that contain a National Drug Code (NDC) for a filled prescription.
What does this file include?
What does this file include?
File Sizes for Medicare and Medicaid Research Identifiable Files
Medicare Limited Data Set (LDS) Quarterly Claims and Enrollment Data
Opening the Medicare Physician/Supplier Procedure Summary Master (PSPS) File
RIF Medicare Quarterly Data
Using CMS Data for Research on Disparities in Health and Health Care
This webcast describes CMS data resources, files, and measures that can be used in studying disparities in health care.
NOTE: As of 4/26/18, the Medicare Encounter data (Part C) are available beginning with calendar year 2015.
Definitions of 'Cost' in Medicare Utilization Files
For each of the CMS claim file types, the variables used in calculating costs for CMS covered services is reviewed. Calculations are defined by 1) what Medicare reimbursed; 2) the beneficiary's responsibility; 3) other primary payers, and then 4) total due to the provider. The presentations also includes issues to be considered when calculating costs.
