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 (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
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
What does this file include? (variable highlights)
Initial and gap coverage limits
Plan premium amount
Plan service area description
Crosswalk of current plan ID to previous years
Demonstration type
Special needs plan type
Linkage variables to the PDE and to each of the Plan Characteristic File sub-files:
Plan Contract ID, Plan Benefit Package ID (use in combination to link to specific plan)
Why do researchers request this file?
Studies that compare medication usage and clinical outcomes by plan benefits…
Program:
Medicare
What does this file include? (variable highlights)
Eligibility dates
Managed care enrollment
Waiver enrollment
Money Follows the Person program enrollment
Health Home information, including State Plan Option participants, chronic Home Health condition
Long-Term Services and Supports eligiblity
Conception-to-Birth Option eligibility
Disability information
Government Assistance program participation
Third Party Liability coverage
Special considerations
For resources on Medicaid TAF data quality, click here.
A…
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)
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 segment of the MESF…
Program:
Medicaid
What does this file include? (variable highlights)
NDI date of death
ICD-10 description and code for cause of death
Underlying conditions for cause of death
CDC category code for cause of death
Special considerations
Some 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…
Program:
Medicaid
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)
Beneficiary ID (allows linkage to other files)
ESCO Name
Monthly assignment status information
Date of birth
Date of death
Special Considerations
This file can be linked to any other CMS file that includes the Bene ID.
PY1 is for a 15 month period beginning in October, all other PYs are for a calendar year beginning in January.
All technical questions related to the CEC program should be directed to ESRD-CMMI@cms.hhs.gov.
Program:
Medicare
What does this file include? (variable highlights)
Beneficiary ID (allows linkage to other files)
ACO Name
Monthly assignment status information
Date of Birth
Date of Death
Special considerations
This file can be linked to any other CMS file that includes the BeneID
Beneficiaries can be linked to their assigned providers by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
Questions regarding the Next Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov
Program:
Medicare