Updated research request forms and data security approval requirement effective 4/24/23
Data File Search
What does this file include? (variable highlights)
Admission, discharge dates
Diagnosis (ICD diagnosis)
Procedure (ICD procedure code)
FFS reimbursement amount
Hospital provider number
Program:
Medicare
This file includes (variable highlights)
Diagnosis (ICD diagnosis),
Procedure (ICD procedure code)
Admission, discharge dates or end date of covered benefits
Charge amounts, total and assigned to specific departments
FFS reimbursement amount
Hospital 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 codes
Dates of service
Medicare FFS reimbursement amount
Outpatient facility provider number
Program:
Medicare
What does this file include? (variable highlights)
Diagnosis (ICD diagnosis)
Procedure (CPT code)
Dates of service
Charges
Allowed amounts
Reimbursement amount
Provider NPI number
Program:
Medicare
What does this file include? (variable highlights)
Diagnosis codes (ICD diagnosis)
Procedure codes (ICD procedure)
Admission/discharge dates
FFS Reimbursement amount
SNF 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 service
Charge
Reimbursement amounts
Supplier provider number
Supplier NPI
Program:
Medicare
What does this file include? (variable highlights)
Type of visit (eg: skilled care, home health aide, physical therapy)
Quantity of services
Diagnosis (ICD diagnosis),
Dates of service
Reimbursement amount
Home 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 service
Submitted charges
Reimbursement amounts
Hospice provider number
Program:
Medicare
This file includes (variable highlights):
Admission, discharge dates
Diagnosis (ICD diagnosis) codes
Procedure (ICD procedure) codes
Diagnostic related group (DRG) codes
Patient discharge status code
Organization NPI
Part C/Medicare Advantage benefit package and contract number
Revenue center codes, dates, unit counts
No payment variables are available
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service…
Program:
Medicare
This file includes (variable highlights):
Diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Part C Benefit Package and Contract number
Organization NPI number
No payment information
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…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
Diagnosis (ICD diagnosis)
HCPCS code
Date of service (line date)
NPI for line rendering physician
No payment information
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:
Diagnosis codes (ICD diagnosis)
Procedure codes (ICD procedure)
Resouce Utilization Group codes (RUGs)
Admission/discharge dates
Organization NPI number only
No payment variables
Part C/Medicare Advantage benefit package and contract number
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…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
Diagnosis (ICD diagnosis)
HCPCS code
Organization NPI
NPI for line supplier
Date 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 services provided…
Program:
Medicare
This file includes (variable highlights):
Part C Benefit Package and Contract number
Diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Organization NPI
NPI for line rendering physician
Patient discharge status code
No payment variables
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…
Program:
Medicare
What does this file include? (variable highlights)
Service date
Product Service ID (NDC code)
Quantity dispensed
Days supply
Cost
Payment
Linkage variables:
Plan Contract ID, Plan Benefit Package ID for linkage to Plan Characteristics file
Product ID (NDC code) used by the CCW to link to the Drug Characteristics data
Beneficiary Id for linkage to MTM and Plan Election characteristics files, CMS utilization, enrollment and assessment data for Medicare and Medicaid
Formulary drug identifier for…
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 Part D…
Program:
Medicare
What does this file include? (variable highlights)
CCW Formulary Drug Identifier
Tier ID
Step Therapy Indicator
Quantity Limit
Prior authorization
Linking 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 restrictions
To examine plan differences in formularies
Special considerations
Linking variables provide information for each Part D Drug Event (PDE)…
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 approved by…
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)
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 linked…
Program:
Medicare
What does this file include? (variable highlights)
Whether beneficiary met target criteria
Long term care residence
Number of drug-therapy recommendations made
Number of drug-therapy problems resolved
Linking variable
CCW Beneficiary IDs
Why do researchers request this file?
Assess the effect of medication management on prescribing patterns and clinical outcome
Identify cost of illness impact of the Part D MTM program
Special considerations
All beneficiaries in the file were enrolled in MTM at some…
Program:
Medicare
What does this file include? (variable highlights)
Part D Plan enrollment and disenrollment dates
Enrollment type, eg: auto, facilitated, passive, point of sale
Months of LIS subsidy
Beneficiary self-selector indicator
Contract ID
Plan ID
Linking variables:
CCW Beneficiary ID: linkage to the PDE and all other CMS Medicare or Medicaid data files
Contract ID and Plan ID: linkage to the Part D Plan Characteristics file
Why do researchers request this file?
Conduct research that identifies LIS…
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 mature…
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.
ResDAC…
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 quality…
Program:
Medicaid