The Beneficiary file is one of a set of three files types (entity, provider, beneficiary) included for each model. A Beneficiary is someone who is entitled to health services under a federal health insurance plan. A Beneficiary is associated with an Entity and is not tied to a specific Provider, but rather to the set of providers in an entity group.
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, which indicates that the Beneficiary is “currently” participating in the model.