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Data File Search
The AHCAH dataset contains two files, a Hospital file and a Patient file, which are both provided for a research request (i.e., cannot be requested separately). The Patient file contains a record for each AHCAH admission for the patient, and includes other beneficiary-specific data such as the beneficiary’s program eligibility status (Medicare, Medicaid, Dual) and the state Medicaid identifier, if applicable. The file also contains the facility submission date for the data represented in the file record. The…
Program:
Medicare, Medicaid
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
ResDAC provides resources on Medicaid TAF data quality.…
Program:
Medicaid
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
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)
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
Source data
Medicare: FFS, PDE and MA
Medicaid: MAX data
What does this file include? (variable highlights)
Eligibility, enrollment variables
Aggregated cost and use
Medicare: FFS, PDE includes FFS and MA
Medicaid: FFS, managed care encounter where available
Prescription Drug service utilization reported for classes of drugs
Chronic Condition flags - 27 CCW Chronic Conditions plus an additional 25 other condition flags
All four files are released for approved MMLEADS data requests…
Program:
Medicare, Medicaid
What is different about MMLEADS 3.0?
MMLEADS now consists of two files—a beneficiary summary file and single cost (i.e., payments) and use (i.e., claim counts) file that combines Medicare and Medicaid information. CCW Chronic Condition and other condition flags are no longer provided.
Source data
Medicare: FFS, PDE and MA
Medicaid: T-MSIS data
What does this file include? (variable highlights)
Eligibility, enrollment variables
Aggregated claim counts and payment amounts
Medicare: FFS, PDE includes…
Program:
Medicare, Medicaid