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Data File Search
What does this file include? (variable highlights)Admission, discharge datesDiagnosis (ICD diagnosis)Procedure (ICD procedure code)FFS reimbursement amountHospital provider number
Program:
Medicare
This file includes (variable highlights)Diagnosis (ICD diagnosis),Procedure (ICD procedure code)Admission, discharge dates or end date of covered benefitsCharge amounts, total and assigned to specific departmentsFFS reimbursement amountHospital 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 codesDates of serviceMedicare FFS reimbursement amountOutpatient facility provider number
Program:
Medicare
What does this file include? (variable highlights)Diagnosis (ICD diagnosis)Procedure (CPT code)Dates of serviceChargesAllowed amountsReimbursement amountProvider NPI number
Program:
Medicare
What does this file include? (variable highlights)Diagnosis codes (ICD diagnosis)Procedure codes (ICD procedure)Admission/discharge datesFFS Reimbursement amountSNF 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 serviceChargeReimbursement amountsSupplier provider numberSupplier NPI
Program:
Medicare
What does this file include? (variable highlights)Type of visit (eg: skilled care, home health aide, physical therapy)Quantity of servicesDiagnosis (ICD diagnosis),Dates of serviceReimbursement amountHome 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 serviceSubmitted chargesReimbursement amountsHospice provider number
Program:
Medicare
This file includes (variable highlights):Admission, discharge datesDiagnosis (ICD diagnosis) codesProcedure (ICD procedure) codesDiagnostic related group (DRG) codesPatient discharge status codeOrganization NPIPart C/Medicare Advantage benefit package and contract numberRevenue center codes, dates, unit countsNo payment variables are availableSpecial considerations:Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare…
Program:
Medicare
This file includes (variable highlights):Diagnosis (ICD diagnosis) codesHCPCS codeRevenue center codes, dates, unit countsPart C Benefit Package and Contract numberOrganization NPI numberNo payment informationSpecial 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 data may include records for…
Program:
Medicare
This file includes (variable highlights):Part C Benefit Package and Contract numberDiagnosis (ICD diagnosis)HCPCS codeDate of service (line date)NPI for line rendering physicianNo payment informationSpecial 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 data may include records for some of these additional…
Program:
Medicare
This file includes:Diagnosis codes (ICD diagnosis)Procedure codes (ICD procedure)Resource Utilization Group codes (RUGs)Admission/discharge datesOrganization NPI number onlyNo payment variablesPart C/Medicare Advantage benefit package and contract numberSpecial 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). …
Program:
Medicare
This file includes (variable highlights):Part C Benefit Package and Contract numberDiagnosis (ICD diagnosis)HCPCS codeOrganization NPINPI for line supplierDate of service (line date)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 data may include records for some of these additional items and…
Program:
Medicare
This file includes (variable highlights):Part C Benefit Package and Contract numberDiagnosis (ICD diagnosis) codesHCPCS codeRevenue center codes, dates, unit countsOrganization NPINPI for line rendering physicianPatient discharge status codeNo payment variablesSpecial 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…
Program:
Medicare
What does this file include? (variable highlights)Service dateProduct Service ID (NDC code)Quantity dispensedDays supplyCostPaymentLinkage variables:Plan Contract ID, Plan Benefit Package ID for linkage to Plan Characteristics fileProduct ID (NDC code) used by the CCW to link to the Drug Characteristics dataBeneficiary Id for linkage to MTM and Plan Election characteristics files, CMS utilization, enrollment and assessment data for Medicare and MedicaidFormulary drug identifier for linkage to the Part D…
Program:
Medicare
What does this file include? (variable highlights)
Product ID (NDC) used to link Drug Characteristics to PDE file
Brand name
Generic name
Strength
Form of the drug
Why do researchers request this file?
Researchers who do not have access to a proprietary NDC database use this file to identify specific drugs, strengths and formulation
Studies assessing pharmaceutical treatment that compare strengths and/or formulations of prescription drugs
Studies evaluating drug utilization under the Medicare…
Program:
Medicare
What does this file include? (variable highlights)CCW Formulary Drug IdentifierTier IDStep Therapy IndicatorQuantity LimitPrior authorizationLinking variables to the PDE file record:Formulary Identification Number (in each sub-file)Why do researchers request this file?To examine differences in utilization based on formulary inclusion or restrictionsTo examine plan differences in formulariesSpecial considerationsLinking variables provide information for each Part D Drug Event (PDE) record.The Tier ID available…
Program:
Medicare
What does this file include? (variable highlights)
Pharmacy type
Pharmacy dispenser type code
Pharmacy primary taxonomy code
DME service
Walk-in service
Linking variable to the PDE file:
CCW Pharmacy ID
Why do researchers request this file?
Evaluate medication possession rates by pharmacy type
Assess the effect of pharmacy type on clinical outcomes
Special considerations
Beginning with the CY 2014 file, it is possible to request an unencrypted pharmacy identifier.
Researchers who request and are…
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…
Program:
Medicare
What does this file include? (variable highlights)
Primary Taxonomy Code
Practice location (state)
Academic or Professional Credential for the prescriber
Linkage variables to the PDE file:
CCW Prescriber Identifier
Why do researchers request this file?
Studies describing prescribing patterns based on prescriber specialty
Evaluation of clinical outcome based on prescriber characteristics
Special considerations
Prior to CY2014 data, the prescriber ID is the encrypted CCW Prescriber ID, which cannot be…
Program:
Medicare
What does this file include? (variable highlights)Whether beneficiary met target criteriaLong term care residenceNumber of drug-therapy recommendations madeNumber of drug-therapy problems resolvedLinking variableCCW Beneficiary IDsWhy do researchers request this file?Assess the effect of medication management on prescribing patterns and clinical outcomeIdentify cost of illness impact of the Part D MTM programSpecial considerationsAll beneficiaries in the file were enrolled in MTM at some point during the year…
Program:
Medicare
What does this file include? (variable highlights)Part D Plan enrollment and disenrollment datesEnrollment type, eg: auto, facilitated, passive, point of saleMonths of LIS subsidyBeneficiary self-selector indicatorContract IDPlan IDLinking variables:CCW Beneficiary ID: linkage to the PDE and all other CMS Medicare or Medicaid data filesContract ID and Plan ID: linkage to the Part D Plan Characteristics fileWhy do researchers request this file?Conduct research that identifies LIS beneficiaries and…
Program:
Medicare
What does this file include? (variable highlights)
Records included based on discharge date within the file calendar year
Active, non-voided, non-denied final action claims
Diagnosis codes
Present on Admission Indicator
Procedure codes
Procedure date
Discharge status
Charges and payments
Provider identifier
Special considerations
Available encounter data may vary by state, year and eligibility group.
CMS continues to work with states to address data quality issues. In addition to preliminary and fully…
Program:
Medicaid
What does this file include? (variable highlights)
As appropriate for the type of service on the record:
Diagnosis codes
Procedure code
Charges and payments
Provider identifiers
Special considerations
Encounter data reporting may vary by state, year and eligibility group.
CMS continues to work with states to address data quality issues. In addition to preliminary and fully mature files, CMS may provide updated releases of the files for a given year. CMS has fee information for TAF data pricing…
Program:
Medicaid
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