Background:

This document describes the development and content of the TAF Annual Managed Care Plan (APL) file. The APL provides TAF users with detailed information about each managed care entity authorized to enroll Medicaid or CHIP beneficiaries, including the plan’s business characteristics (such as profit status), its contract with the state (such as type of reimbursement arrangement and operating authority), and the location and type of beneficiaries the plan is allowed to enroll.

Year of Data:
Source:
CMS
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PDF
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Updated 2017-2018 Medicaid and CHIP Data Now Available

CMS is pleased to announce that updated Medicaid T-MSIS Analytic Files (TAFs) for service years 2017 and 2018 are now available. The TAF research files contain data on Medicaid and Children's Health Insurance Program (CHIP) beneficiary demographics, program enrollment, service use, and payments. In September 2020, CMS made TAF enrollment and claims files* for service years 2017 and 2018 available to researchers.

New Enrollee-level EDGE Data Now Available for Research

CMS is pleased to announce the availability of the Enrollee-Level External Data Gathering Environment (EDGE) Limited Data Set (LDS) for the 2019 benefit year to requesters who seek the data for research purposes. The EDGE LDS contains certain masked enrollment and claims data for on- and off-Exchange enrollees in risk adjustment covered plans in the individual and small group (including merged) markets, in states where HHS operated the risk adjustment program for the 2019 benefi

Next Generation ACO Model Provider RIF

The Next Generation ACO (NGACO) Model Provider file contains information about the participating providers in the NGACO Model. The file includes one record per year of participation for participating organizations. A related file, the Next Generation ACO Model Beneficiary file, contains identifying information about the beneficiaries assigned to a provider who is participating in the NGACO Model.

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 Generation ACO Model can be directed to NextGenerationACOModel@cms.hhs.gov

Next Generation ACO Model Beneficiary RIF

The Next Generation ACO (NGACO) Model Beneficiary file contains information about the Medicare beneficiaries enrolled in the NGACO Model. The file includes one record per year of enrollment for assigned beneficiaries. A related file, the Next Generation ACO Model Provider file, contains information about the participating providers in the NGACO Model.

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 Bene ID
  • 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

Understanding Economic Variables using Medicare Data Files

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to using Medicare Fee-for-Service (FFS) Data for Research.

Medicare billing and payment systems directly impact what is observable in claims data and how to interpret the fields. This presentation will provide background for researchers interested in charges and payments including:

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