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Data File Search
What does this file include? (variable highlights)
Diagnosis codes
Present on Admission indicator
Admission date
Charges and payments
Provider identifier
Patient discharge status or destination
Counts of covered days
Special considerations
Encounter data reporting may vary by state, year and eligibility group.
Stays may be made up of multiple records.
Long term care services provided to community-dwelling beneficiaries are found in the TAF OT file.
CMS continues to work with states to address data…
Program:
Medicaid
What does this file include? (variable highlights)
National Drug Code (NDC)
Days supply covered by the prescription
Charges and Medicaid payments (FFS only)
National Provider Identifier (NPI) for the billing provider
Special considerations
Encounter data reporting may vary by state, year and eligibility group.
Information on the drug name, dosage and format is not recorded in the TAF RX file. An external source of NDC data will be required if that information is needed.
CMS continues to work…
Program:
Medicaid
What does this file include (variable highlights)
Managed Care Plan type
Waivers such as 1115
Eligible population indicators such as CHIP coverage
Special considerations
This file does not contain individual service records but contains information about plans that can be linked to individual enrollment information and may help put utilization into context.
CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated…
Program:
Medicaid
What does this file include (variable highlights)
Provider taxonomy indicators such as eye or vision, behavioral health, speech language or hearing services
Residential treatment facility indicator
Substance Use Disorder Service provider indicator
Special considerations
This file does not contain individual service records but contains information about providers that can be linked to individual service records.
CMS continues to work with states to address data quality issues. In addition to…
Program:
Medicaid
What does this file include? (variable highlights)
Bene_ID (links to all other CMS Research Identifiable Files (RIF))
State, county, zipcode
Date of birth, gender, race
Eligibility category
Dual Medicare-Medicaid eligibility
Medicaid managed care enrollment
Summary utilization, Medicaid payments
Program:
Medicaid
What does this file include? (variable highlights)
10 diagnosis code fields
7 procedure code fields
Discharge status
Charges and payments (FFS only)
Provider identifier
Special considerations
Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group.
Program:
Medicaid
What does this file include? (variable highlights)
As appropriate for the type of service on the record:
2 diagnosis codes
1 procedure code
Broadly defined Type of Service codes
Charges and payments (FFS only)
Provider identifier
Special considerations
Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group
Program:
Medicaid
What does this file include? (variable highlights)
5 diagnosis codes
Admission date
Charges and payments (FFS only)
Provider identifier
Patient discharge status or destination
Counts of covered days
Special considerations
Encounter record reporting may not be complete. Data reporting may vary by state, year and eligibility group.
Stays may be made up of multiple records.
Long term care services provided to community-dwelling beneficiaries are found the MAX OT file.
Program:
Medicaid
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? (variable highlights)
National Drug Code (NDC)
Days supply covered by the prescription
Charges and Medicaid payments (FFS only)
National Provider Identifier (NPI) for the billing provider
Special considerations
Encounter record reporting may not be complete. Data reporting may vary by…
Program:
Medicaid
What does this file include? (variable highlights)
Three flags for each chronic condition (based on end of calendar year):
Medicaid only (found in Medicaid claims)
Medicare only (found in Medicare claims)
Combined data (found in Medicare and Medicaid claims)
Special considerations
The algorithms used to assign the flags are available from the CCW website.
Algorithms that include multi-year look-back periods are applied without the purchase of additional years of data.
This is a…
Program:
Medicaid
What does this file include? (variable highlights)NDI date of deathICD-10 description and code for cause of deathUnderlying conditions for cause of deathCDC category code for cause of deathSpecial considerationsSome states are not included in the later years. See specific availability below.This is a segment of the MESF file. Another segment, the Conditions Segment can also be requested.Only beneficiaries with a date of death in the annual Medicaid enrollment file are included in the file. The date can…
Program:
Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
End-of-life care decisions
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
HIPPS code
Socio-demographic variables
Information on patient home environment and informal caregivers
Health status, including diagnosis codes
Functional status
Psychosocial status
Health service utilization
Emergent care
Hospital admission
Special considerations
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) suspended required completion for non-Medicare and non-Medicaid patients.
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Pre-hospitalization living situation
Co-morbid conditions
Communication status
Functional status
Program:
Medicare
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
End-of-life care decisions
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
Healthcare providers/populations addressed by specific, individual surveys include:
Hospital
Home Health
Home and Community Based Services
Fee-for-Service
Medicare Advantage & Part D Plan (PDP)
In-Center Hemodialysis
Nationwide Adult Medicaid
Hospice
Accountable Care Organizations
Outpatient and Ambulatory Surgery
Merit-based Incentive Payment System quality payment program
Measures of beneficiary experience focus on the patient experience or perception rather than patient satisfaction. Focus areas…
Program:
Medicare
What does this file include? (variable highlights)
HRS data include:
Demographic and background information, including household
Physical and mental health
Cognition
Functional limitations
Employment
Disability
Health insurance
Assets and Income
Wills, including advanced directives
Linked files include:
Medicare denominator/Beneficiary Summary File (BSF)
Medicare fee-for-service (FFS) claims
Inpatient, MedPAR, Outpatient, Durable Medical Equipment (DME), Carrier,…
Program:
Medicare
HOS variables contain the following information in a baseline survey and two-year follow-up survey:
Demographic information including primary language
Disability status
Physical and mental health status
HEDIS Effectiveness of Care measures
Health-related quality of life (HRQOL)
Special considerations
CMS will provide additional file specifications to researchers with approved data requests.
Information on the survey and data can be found on the Medicare Health Outcomes Survey website.…
Program:
Medicare
HEDIS data are released as a set of two files per year:
File 1: HEDIS Measures File (does not include Plan All-Cause Readmission measures)
File 2: Plan All-Cause Readmissions File
HEDIS data are released based on the measurement year of the plan data submission, which reflect health care delivered in that calendar year. Other HEDIS reports may distinguish between measurement year and submission year. Care should be taken to confirm that the correct years are being requested.
HEDIS record layouts vary…
Program:
Medicare
What does this file include? (variable highlights)
Colorectal cancer screening
Comprehensive diabetes care (multiple measures)
High risk medication usage
Each record represents the experience of a beneficiary in a specific plan for the calendar year (CY). Beneficiaries enrolled in more than one plan during the CY will have multiple records in this file.
Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.
Program:
Medicare
What does this file include? (variable highlights)
Readmission indicator
Chronic condition weight
Each record represents a hospitalization for a beneficiary in the calendar year (CY). Beneficiaries with multiple hospitalizations will have multiple records in this file.
Beneficiaries can be linked to other beneficiary data via the BENE_ID and to plan information via the HEDIS_CONTRACT_ID and HEDIS_PLAN_ID variables.
Program:
Medicare
What does this file include? (variable highlights)The MD-PPAS contain data on specialty, TIN practice assignment, place of service information, provider demographics, geographic location, and summary Medicare utilization measures for over 1.2 million providers.The MD-PPAS has been updated to version 2.4 from version 2.3 to reflect the following changes: The MD-PPAS data include a modified broad specialty variable that provides a more detailed breakdown of non-physician specialties.The data also…
Program:
Medicare
What does this file include? (variable highlights)ACO IDAssigned in Preliminary/Prospective Assignment PeriodAssigned in Quarter 1Assigned in Quarter 2Assigned in Quarter 3Assigned in Quarter 4Assigned in Final ReconciliationPart D Eligible MonthsHICN (populated in PY2013-PY2019/2019-A)Date of birthDate of deathGenderRaceMedicare Beneficiary Identifier (MBI)Special considerationsThis file can be linked to any other CMS file that includes the Bene ID.These files differ from the monthly Claim and Claim…
Program:
Medicare