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 (in which the Provider participates)
Entity ID (with which the Provider is associated)
National Provider Identifier (NPI)
Tax Identification Number (TIN)
CMS Certification Number (CCN)
Provider Start Date
Provider End Date
Provider Participation Type Code
The Entity ID is the only key field needed to link a Provider to their Entity.
The NPI, TIN, and/or CCN can be used to link to claims and other relevant CCW data.
A Provider may have an…
Program:
Medicare
The Healthcare Effectiveness Data and Information Set (HEDIS) Patient-Level Detail (PLD) files are a set of standardized healthcare quality measures designed to provide information for reliable comparison of health plan performance. The HEDIS PLD data are submitted annually by Medicare Advantage (MA) Organizations, Cost Plans, and Demonstration Plans and contribute to the assignment of CMS Star Ratings for MA plans.
HEDIS data are released as a set of two files per year:
File 1: HEDIS Measures File (does…
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 ID
Assigned in Preliminary/Prospective Assignment Period
Assigned in Quarter 1
Assigned in Quarter 2
Assigned in Quarter 3
Assigned in Quarter 4
Assigned in Final Reconciliation
Part D Eligible Months
HICN (populated in PY2013-PY2019/2019-A)
Date of birth
Date of death
Gender
Race
Medicare Beneficiary Identifier (MBI)
Special considerations
This file can be linked to any other CMS file that includes the Bene ID.
These files differ from the…
Program:
Medicare
What does this file include? (variable highlights)
ACO ID
ACO Name
Start Date
Tax Identification Number (TIN) of ACO Participant
TIN Legal Business Name
National Provider Identifier (NPI) for practitioner
Name of Provider Associated with the NPI
CMS Certification Number (CCN; formerly OSCAR number)
CCN Facility Type
CCN Facility Type Description
Provider Specialty Code
ACO Location (county primarily served)
Year of ACO Source Record
Special considerations
Shared Savings Program RIFs do not…
Program:
Medicare
What does this file include? (variable highlights)
ESCO Name
Period of Performance
Tax Identification Number of the practice/facility associated with the Individual NPI
Parent Participant NPI Number
Organization Name
Provider Type description
CMS Certification Number (CCN)
Special considerations
This file can be linked to any other CMS file that include the TIN, CCN, or NPI.
PY1 is for a 15 month period beginning in October, all other PYs are for a calendar year beginning in January.
All technical…
Program:
Medicare
What does this file include? (variable highlights)
ACO identifier
Performance year
Organization Name
CMS organization identifiers including Tax Identification Number, CMS Certification Number (CCN)
Provider type description
Special considerations
This file can be linked to any other CMS file that contains the ORG_TIN, ORG_NPI or ORG_CCN
Providers can be linked to their assigned beneficiaries by linking the ACO_ID in the provider file to the ACO_NUM in the beneficiary file
Questions regarding the Next…
Program:
Medicare
What does this file include? (variable highlights)
Beneficiary identifiers
Practice identifier for the practice to which the beneficiary was attributed
Number and percent of primary care services provided to the beneficiary that were billed by the practice
HCC percentile risk score
Special considerations
Data documentation is specific to each performance year.
This RIF can be linked to any other CMS file that includes the Bene ID.
Two additional VM program RIFs are available:
VM Practice-Level RIF…
Program:
Medicare
What does this file include? (variable highlights)
Practice Identifier
Eligible professional NPI
Eligible professional subject to the VM
Provider specialty
No practice-level Quality and Resource Use Report (QRUR) or VM information (must link to VM Practice-Level RIF)
Special considerations
Data documentation is specific to each performance year.
Two additional VM program RIFs are available:
VM Practice-Level RIF
VM Beneficiary-Level RIF
Program:
Medicare
What does this file include? (variable highlights)
Practice Identifier
Quality and Resource Use Report (QRUR) information
VM information
Benchmark information
Special considerations
Data documentation is specific to each performance year.
This RIF includes thousands of records with hundreds of variables.
Can be linked to provider NPI in the VM NPI-Practice-Level RIF
Two additional VM program RIFs are available:
VM NPI-Practice-Level RIF
VM Beneficiary-Level File RIF
Program:
Medicare
What does this file include? (variable highlights)
Provider file
Pioneer ACO ID
Tax identification number
Provider specialty code
Beneficiary file
Bene ID
Pioneer ACO ID
Aggregated expenditures and claim counts
Settlement file
Pioneer ACO ID
Beneficiary counts
Performance year expenditures and savings
Special considerations
Each file needs to be specified separately on a data request.
Only the Pioneer ACO Beneficiary file can be linked to other CMS data via the Bene ID.
Program:
Medicare