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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.

Definitions of 'Cost' in Medicare Utilization Files

Date Recorded
Tuesday, August 13, 2013

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.

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