Data Documentation

Base Claim File

Number	SAS Name	Variable Name
1	BENE_ID	Encrypted CCW Beneficiary Identifier
2	MSIS_ID	Encrypted State Assigned Beneficiary Unique Identifier
3	STATE_CD	Submitting State Alpha Abbreviation
4	SUBMTG_STATE_CD	Submitting State FIPS Code
5	CLM_ID	CCW Claim Identifier
6	CLM_NUM_ORIG	Original Claim Identifier
7	CLM_NUM_ADJ	Adjustment Claim Identifier
8	CLM_TYPE_CD	Claim Type Code (TAF)
9	BILL_TYPE_CD	Bill Type Code
10	CROSSOVER_CLM_IND	Code To Indicate if a Portion of Claim is Paid by Medicare
11	ADJUST_CD	Claim Adjustment Code
12	ADJUST_RSN_CD	Adjustment Reason Code
13	ADJDCTN_DT	Adjudication Date
14	MDCD_PD_DT	Medicaid Paid Date
15	SPLIT_CLM_IND	Split Claim Indicator
16	CLL_CNT	Claim Line Count - Original
17	CLL_CNT_CALC	Claim Line Count - Calculated
18	PRSN_CLM_IND	Indicator of a Claim for a Person
19	SRVC_TRKNG_TYPE_CD	Service Tracking Type Code
20	FED_SRVC_CTGRY_CD	Federally Assigned Service Category Code Added During TAF Production
21	BIRTH_DT	Date of Birth
22	PTNT_DSCHRG_STUS_CD	Patient Status at Ending Date of Service
23	PGM_TYPE_CD	Program Type Code
24	MC_PLAN_ID	Managed Care Plan Identification Number
25	WVR_TYPE_CD	Waiver Type Code
26	WVR_ID	Waiver Identification Number
27	OTHR_INSRNC_IND	Indicator Insured is Covered by Another Plan (Not Medicare or Medicaid)
28	SECT_1115A_DEMO_IND	1115(A) Demonstration Participation Indicator
29	SRVC_BGN_DT	Claim Beginning Date of Service
30	SRVC_END_DT	Claim Ending Date of Service
31	SRVC_END_DT_CD	Identifies the Date Field Used to Populate SRVC_END_DT
32	ADMSM_DT	Admission Date (TAF)
33	ADMSN_HR	Admission Hour
34	DSCHRG_DT	Discharge Date
35	DSCHRG_HR	Discharge Hour
36	ADMTG_DGNS_CD	Admitting Diagnosis Code
37	ADMTG_DGNS_VRSN_CD	Admitting Diagnosis Version Code (ICD-9 or ICD-10)
38	DGNS_CD_1	Primary or Principal Diagnosis Code
39	DGNS_VRSN_CD_1	Diagnosis Version Code 1 (ICD-9 or ICD-10)
40	DGNS_POA_IND_1	Diagnosis Present on Admission Indicator 1
41	DGNS_1_CCSR_CTGRY_CD	AHRQ Clinical Classifications Software Refined (CCSR) Diagnosis 1 Category Code
42	DGNS_CD_2	Diagnosis Code 2
43	DGNS_VRSN_CD_2	Diagnosis Version Code 2 (ICD-9 or ICD-10)
44	DGNS_POA_IND_2	Diagnosis Present on Admission Indicator 2
45	DGNS_CD_3	Diagnosis Code 3
46	DGNS_VRSN_CD_3	Diagnosis Version Code 3 (ICD-9 or ICD-10)
47	DGNS_POA_IND_3	Diagnosis Present on Admission Indicator 3
48	DGNS_CD_4	Diagnosis Code 4
49	DGNS_VRSN_CD_4	Diagnosis Version Code 4 (ICD-9 or ICD-10)
50	DGNS_POA_IND_4	Diagnosis Present on Admission Indicator 4
51	DGNS_CD_5	Diagnosis Code 5
52	DGNS_VRSN_CD_5	Diagnosis Version Code 5 (ICD-9 or ICD-10)
53	DGNS_POA_IND_5	Diagnosis Present on Admission Indicator 5
54	HAC_IND	Health Care Acquired Condition (HAC) Indicator
55	IP_MH_DGNS_IND	Mental Health Diagnosis Indicator
56	IP_SUD_DGNS_IND	Substance Use Disorder Diagnosis Indicator
57	ADMTG_PRVDR_ID	Admitting Provider Identification Number
58	ADMTG_PRVDR_NPI	Admitting Provider NPI
59	ADMTG_PRVDR_TXNMY_CD	Admitting Provider Taxonomy Code
60	ADMTG_PRVDR_TYPE_CD	Admitting Provider Type Code
61	ADMTG_PRVDR_SPCLTY_CD	Admitting Provider Specialty Code
62	BLG_PRVDR_ID	Billing Provider Identification Number (TAF)
63	BLG_PRVDR_NPI	Billing Provider NPI
64	BLG_PRVDR_TXNMY_CD	Billing Provider Taxonomy Code
65	BLG_PRVDR_NPPES_TXNMY_CD	Billing Provider NPPES Taxonomy Code
66	BLG_PRVDR_TYPE_CD	Billing Provider Type Code
67	BLG_PRVDR_SPCLTY_CD	Billing Provider Specialty Code
68	RFRG_PRVDR_ID	Referring Provider Identification Number
69	RFRG_PRVDR_NPI	Referring Provider NPI
70	RFRG_PRVDR_TYPE_CD	Referring Provider Type Code
71	RFRG_PRVDR_SPCLTY_CD	Referring Provider Specialty Code
72	PRVDR_LCTN_CD	Provider Location Code
73	BRDR_STATE_IND	Border State Indicator
74	IP_MH_TXNMY_IND	Mental Health Provider Taxonomy Indicator
75	IP_SUD_TXNMY_IND	Substance Use Disorder Provider Taxonomy Indicator
76	NCVRD_DAYS	Medicaid Non-covered Days Count
77	CVRD_DAYS_ICF_IID	Count of Medicaid Covered Days in ICF for Patients with Intellectual Disability
78	CVRD_DAYS_NF	Count of Medicaid Covered Days in a Nursing Facility
79	CVRD_DAYS_IP_PSYCH	Count of Medicaid Covered Days in an Inpatient Psychiatric Facility (IPF)
80	CVRD_DAYS_IP_PSYCH_OVER_65	Count of Medicaid Covered Days in an IPF (Beneficiary Over 65 Years)
81	CVRD_DAYS_IP_PSYCH_UNDER_21	Count of Medicaid Covered Days in an IPF (Beneficiary Under 21 Years)
82	LEAVE_DAYS	Count of Days During Medicaid Coverage Period Patient was not Residing in LTC
83	FIXD_PYMT_IND	Fixed Payment Indicator
84	SRVC_TRKNG_PYMT_AMT	Service Tracking Payment Amount
85	PYMT_LVL_IND	Payment Level Indicator - Header or Line
86	BILLED_AMT	Total Claim Billed Amount
87	NCVRD_CHRG_AMT	Non-covered Charges Amount
88	MDCD_ALOWD_AMT	Total Medicaid Allowed Amount
89	MDCD_PD_AMT	Total Amount Paid By Medicaid
90	DAILY_RATE	Daily Rate that a Policy will Pay for a Covered Service
91	MDCD_ACMDTN_PD_AMT	Medicaid Amount Paid for All Accommodation (Room and Board) Revenue Lines
92	MDCD_ANCLRY_PD_AMT	Medicaid Amount Paid for All Ancillary (Non-Room & Board) Revenue Lines
93	MDCR_PD_AMT	Medicare Paid Amount
94	MDCR_DDCTBL_PD_AMT	Total Medicare Deductible Amount
95	MDCR_COINSRNC_PD_AMT	Total Medicare Coinsurance Amount
96	MDCR_CMBND_DDCTBL_IND	Medicare Combined Deductible and Coinsurance Indicator
97	MDCR_REIMBRSMT_TYPE_CD	Medicare Reimbursement Type Code
98	BENE_LIABILITY_AMT	Total Beneficiary Long-Term Care Liability Amount
99	COINSRNC_AMT	Beneficiary Coinsurance Amount
100	COPAY_AMT	Beneficiary Copayment Amount
101	DDCTBL_AMT	Beneficiary Deductible Amount
102	COPAY_WVD_IND	Indicator Signifying Copay was Waived by Provider
103	TP_PD_AMT	Total Third Party Liability Paid Amount
104	TP_COINSRNC_PD_AMT	Third Party Coinsurance Paid Amount
105	TP_COPAY_PD_AMT	Third Party Copayment Paid Amount
106	OTHR_INSRNC_PD_AMT	Total Other Than Medicare or Medicaid -Insurance Paid Amount
107	OTHR_TP_CLCTN_CD	Other Third Party Collection Code
108	FUNDNG_CD	Code To Indicate Source of Non-Federal Funding
109	FUNDNG_SRC_NON_FED_SHR_CD	Funding Source Non-Federal Share Code
110	DA_RUN_ID	TAF Production Run Identifier (unique for each TAF run)
111	TMSIS_RUN_ID	TMSIS State Data Processing Run Identifier
112	LT_VRSN	Long-Term Version Representing the Iteration of the File
113	LT_FIL_DT	Long-Term File Date - Represents the Year and Month of the Reporting Period
114	CCW_LD_DT	CCW Load Date (Claims)

Occurrence Code File

Number	SAS Name	Variable Name
115	BENE_ID	Encrypted CCW Beneficiary Identifier
116	MSIS_ID	Encrypted State Assigned Beneficiary Unique Identifier
117	STATE_CD	Submitting State Alpha Abbreviation
118	SUBMTG_STATE_CD	Submitting State FIPS Code
119	CLM_ID	CCW Claim Identifier
120	OCRNC_CD_SEQ	Occurrence Code Sequence
121	OCRNC_CD	Occurrence Code
122	OCRNC_CD_START_DT	Occurrence Code Start Date
123	OCRNC_CD_END_DT	Occurrence Code End Date

LINE FILE

Number	SAS Name	Variable Name
1	BENE_ID	Encrypted CCW Beneficiary Identifier
2	MSIS_ID	Encrypted State Assigned Beneficiary Unique Identifier
3	STATE_CD	Submitting State Alpha Abbreviation
4	SUBMTG_STATE_CD	Submitting State FIPS Code
5	CLM_ID	CCW Claim Identifier
6	LINE_NUM	Sequential Claim Line Number
7	CLM_NUM_ORIG	Original Claim Identifier
8	LINE_NUM_ORIG	Original Claim Line Number (TAF)
9	CLM_NUM_ADJ	Adjustment Claim Identifier
10	LINE_NUM_ADJ	Adjustment Claim Line Number
11	ADJDCTN_DT	Adjudication Date
12	LINE_CLAIM_STUS_CD	Claim Line Status Code
13	LINE_ADJUST_CD	Claim Line Adjustment Code
14	LINE_SRVC_BGN_DT	Claim Line Beginning Date of Service
15	LINE_SRVC_END_DT	Claim Line Ending Date of Service
16	BNFT_TYPE_CD	Benefit Type Code
17	TOS_CD	Type of Service Code
18	XIX_SRVC_CTGRY_CD	CMS-64 Form Category of Service for the Paid Claim
19	XXI_SRVC_CTGRY_CD	CMS-21 Form Category of Service for the Paid Claim
20	CMS_64_FED_CTGRY_CD	CMS-64 Form Code for Federal Reimbursement
21	REV_CNTR_CD	Revenue Center Code (TAF)
22	ACTL_SRVC_QTY	Actual Service Quantity
23	ALOWD_SRVC_QTY	Maximum Allowed Service Quantity
24	BLG_UOM_CD	Service Billing Unit of Measure Code
25	NDC	National Drug Code
26	NDC_UOM_CD	NDC Unit of Measure Code
27	NDC_QTY	NDC Quantity Dispensed
28	IMNZTN_TYPE_CD	Immunization Type Code
29	PRVDR_FAC_TYPE_CD	Provider Facility Type Code
30	SRVC_PRVDR_ID	Servicing Provider Identification Number (TAF)
31	SRVC_PRVDR_NPI	Servicing Provider NPI
32	SRVC_PRVDR_TXNMY_CD	Servicing Provider Taxonomy Code
33	SRVC_PRVDR_TYPE_CD	Servicing Provider Type Code
34	SRVC_PRVDR_SPCLTY_CD	Servicing Provider Specialty Code (TAF)
35	REV_CNTR_CHRG_AMT	Revenue Center Charge Amount
36	LINE_MDCD_ALOWD_AMT	Line Medicaid Allowed Amount
37	LINE_MDCD_PD_AMT	Line Medicaid Paid Amount
38	LINE_MDCD_FFS_EQUIV_AMT	Line Medicaid Fee For Service Equivalent Amount
39	LINE_TP_PD_AMT	Line Third Party Liability Paid Amount
40	LINE_OTHR_INSRNC_PD_AMT	Line Other Than Medicare or Medicaid -Insurance Paid Amount
41	LT_ACCMDTN_HCPCS_RATE	Long-Term Care Accommodation Rate
42	DA_RUN_ID	TAF Production Run Identifier (unique for each TAF run)
43	TMSIS_RUN_ID	TMSIS State Data Processing Run Identifier