Updated research request forms and data security approval required beginning 4/24/23
Data File Search
What does this file include? (variable highlights)
Model ID (in which the Entity participates)
Model Name (in which the Entity particpates)
Entity ID
Entity Name
Entity Type
Entity Start Date
Entity End Date
The Entity ID is unique to CMMI systems and cannot be used to link to claims data or other CCW data. The Entity ID is the key field for tying CMDS Provider and Beneficiary participation data to a specific Entity and is unique across all models.
An Entity may have an End Date of 12/31/9999, which…
Program:
Medicare
What does this file include? (variable highlights)
Model ID (in which the Provider participates)
Entity ID (with which the Provider is associated)
National Provider Identifier (NPI)
Tax Identification Number (TIN)
CMS Certification Number (CCN)
Provider Start Date
Provider End Date
Provider Participation Type Code
The Entity ID is the only key field needed to link a Provider to their Entity.
The NPI, TIN, and/or CCN can be used to link to claims and other relevant CCW data.
A Provider may have an…
Program:
Medicare
These data files may be used as ‘finder files’ in combination with other requested Chronic Conditions Warehouse (CCW) files to isolate results to include (or not include as desired) entities, providers and or beneficiaries participating in specific models.
Each model has a set of up to three (3) files, one per participant type:
Entity file
Provider file
Beneficiary file
Data for each model will be updated the first month of each calendar quarter.
The quarterly file updates are full replacement files and…
Program:
Medicare
What does this file include? (variable highlights)
Model ID (with which the Beneficiary is associated)
Entity ID (with which the Beneficiary is associated)
CCW Beneficiary ID
Beneficiary Start Date
Beneficiary End Date
Voluntary Alignment Indicator
The Entity ID is the only key field needed to link a Beneficiary to their Entity.
The Beneficiary file also contains the CCW Beneficiary ID that can be used to link to claims and other relevant CCW data.
A Beneficiary may have an End Date of 12/31/9999,…
Program:
Medicare
What does this file include? (variable highlights)
State, county annual SSA codes
State, county monthly FIPS codes
Zip code, State and County
Date of birth, date of death
Race
Reason for entitlement
Monthly enrollment for each part of the Medicare program, A/B/C/D
Dual eligible status
Part C plan and enrollment information
Part D plan and enrollment information
Part D low income cost sharing
Special considerations
Four additional segments are available for order with this file:
Chronic…
Program:
Medicare
What does this file include? (variable highlights)
Two flags for each chronic condition:
First occurrence date
End of year indicator
Special considerations
The algorithms used to assign the flags are available from the CCW website.
Algorithms requiring a multiple-year look back period are completed without requiring the researcher to order multiple years of data.
Algorithms search data from Medicare Fee-For-Service (FFS) claims.
This file is a segment that can be requested in addition to the Master…
Program:
Medicare
What does this file include? (variable highlights)
Three flags for each chronic condition:
First occurrence date
Mid year indicator
End of year indicator
Special considerations
The algorithms used to assign the flags are available from the CCW website.
Algorithms requiring a multiple-year look back period are completed without requiring the researcher to order multiple years of data.
Algorithms search data from Medicare Fee-For-Service (FFS) claims.
The 27 CCW algorithms are being replaced with 30…
Program:
Medicare
What does this file include? (variable highlights)
Two flags for each chronic condition:
First ever occurrence date
End of year indicator
This file is a segment that can be requested in addition to the Master Beneficiary Summary File (MBSF) base file.
Special considerations
This file uses information from Fee-For-Service (FFS) Medicare claims.
Program:
Medicare
What does this file include? (variable highlights)
Summary of utilization and total annual payments for services such as:
physician visits, dialysis, DME, IP recorded emergency room visits, Ambulatory Surgical Centers, anesthesia, imaging, Part B drugs from Fee-for-service (FFS) Medicare
Number of hospital stays, Medicare covered days and total annual inpatient payments for services covered by FFS Medicare
Summary of Part D payments, events and prescription fills
This file is a segment that can be…
Program:
Medicare
What does this file include? (variable highlights)
NDI date of death
ICD-10 code for cause of death
Underlying conditions for cause of death
CDC category code for cause of death
This file is a segment that can be requested in addition to the Master Beneficiary Summary File (MBSF) base file.
Program:
Medicare
What does this file include? (variable highlights)
Admission, discharge dates
diagnosis (ICD diagnosis)
procedure (ICD procedure code)
FFS reimbursement amount
hospital provider number
Program:
Medicare
This file includes (variable highlights)
diagnosis (ICD diagnosis),
procedure (ICD procedure code)
admission, discharge dates or end date of covered benefits
charge amounts, total and assigned to specific departments
FFS reimbursement amount
hospital provider identification number
some dummy records for Medicare managed care coverage of IP stays
Program:
Medicare
What does this file include? (variable highlights)
diagnosis (ICD diagnosis)
procedure (ICD procedure code)
Healthcare Common Procedure Coding System (HCPCS) codes, including CPT codes
dates of service
Medicare FFS reimbursement amount
Outpatient facility provider number
Program:
Medicare
What does this file include? (variable highlights)
diagnosis (ICD diagnosis)
procedure (CPT code)
dates of service
charges
allowed amounts
reimbursement amount
provider NPI number
Program:
Medicare
What does this file include? (variable highlights)
Diagnosis codes (ICD diagnosis)
Procedure codes (ICD procedure)
Admission/discharge dates
FFS Reimbursement amount
SNF provider number
Program:
Medicare
What does this file include? (variable highlights)
diagnosis, (ICD diagnosis code)
services provided (CMS Common Procedure Coding System (HCPCS) codes)
dates of service
charge
reimbursement amounts
supplier provider number
supplier NPI
Program:
Medicare
What does this file include? (variable highlights)
type of visit (eg: skilled care, home health aide, physical therapy)
quantity of services
diagnosis (ICD diagnosis),
dates of service
reimbursement amount
home health agency provider number
Program:
Medicare
What does this file include? (variable highlights)
the level of hospice care received (e.g., home health aide, skilled nursing care)
diagnosis (ICD diagnosis codes)
the dates of service
submitted charges
reimbursement amounts
hospice provider number
Program:
Medicare
This file includes (variable highlights):
Admission, discharge dates
diagnosis (ICD diagnosis) codes
procedure (ICD procedure) codes
diagnostic related group (DRG) codes
patient discharge status code
organization NPI
Part C/Medicare Advantage benefit package and contract number
Revenue center codes, dates, unit counts
No payment variables are available
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer…
Program:
Medicare
This file includes (variable highlights):
diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Part C Benefit Package and Contract number
Organization NPI number
No payment information
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis)
HCPCS code
Date of service (line date)
NPI for line rendering physician
No payment information
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness…
Program:
Medicare
This file includes:
Diagnosis codes (ICD diagnosis)
Procedure codes (ICD procedure)
Resouce Utilization Group codes (RUGs)
Admission/discharge dates
Organization NPI number only
No payment variables
Part C/Medicare Advantage benefit package and contract number
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis)
HCPCS code
Organization NPI
NPI for line supplier
Date of service (line date)
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Organization NPI
NPI for line rendering physician
Patient discharge status code
No payment variables
Encounter records submitted to CMS by September, 2022 for dates of service in CY 2020
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service…
Program:
Medicare
The PY14 Risk Score Files includes six segments: a base file, four files with outputs from Part C models and one for Part D model outputs. All files can be linked to other CCW files via the Bene_ID.
What does this file include? (variable highlights)
PY14 Base file:
Part C monthly risk payment scores
Part C monthly model segment codes
Part D model risk payment scores
Part D monthly model segment codes
Part C monthly institutional indicators
Part C community and institutional non-monthly model payment…
Program:
Medicare