Search Data Variables

This data element indicates that the claim is for a beneficiary for whom other thirdparty resource development and collection activities are in progress, when the liability is not another health insurance plan for which the eligible is a beneficiary.

Notes 

Notes for other treatment 

This is the amount of any payment made by other third-party payers that reduces the beneficiary’s liability for the PDE and counts towards Part D’s true out-of-pocket (TrOOP) requirement. Two examples are payments by qualified state pharmacy assistance programs or charities. This variable does not include amounts covered by the Part D low-income subsidy.

This code is used when the Other TrOOP Amount (variable called OTHR_TROOP_AMOUNT) includes Inflation Reduction Act Subsidy Amount (IRASA) dollars for benefit year 2023.

Number of months the beneficiary was enrolled in any other type of waiver in the calendar year.

Indicates whether the patient was receiving dialysis at the time of admission.

Indicates whether the patient was receiving dialysis at the time of discharge.

Indicates whether the patient was receiving hemodialysis at the time of admission.

Indicates whether the patient was receiving hemodialysis at the time of discharge.

Indicates whether the patient was receiving IV antibiotics at the time of admission.

Indicates whether the patient was receiving IV antibiotics at the time of discharge.

Indicates whether the patient was receiving IV anticoagulation medications at the time of admission.

Indicates whether the patient was receiving IV anticoagulation medications at the time of discharge.

Indicates whether the patient was receiving other IV medications at the time of admission.

Indicates whether the patient was receiving other IV medications at the time of discharge.

Indicates whether the patient was receiving IV vasoactive medications at the time of admission.

Indicates whether the patient was receiving IV vasoactive medications at the time of discharge.

Indicates whether the patient had IV access at the time of admission.

Indicates whether the patient had IV access at the time of discharge.

Indicates whether the patient had central IV access at the time of admission.

Indicates whether the patient had central IV access at the time of discharge.

Indicates whether the patient had mid-line IV access at the time of admission.

Indicates whether the patient had mid-line IV access at the time of discharge.

Indicates whether the patient had peripheral IV access at the time of admission.

Indicates whether the patient had peripheral IV access at the time of discharge.

Indicates whether the patient was receiving IV medications at the time of admission.

Indicates whether the patient was receiving IV medications at the time of discharge.

Indicates that the patient had no IV access at the time of admission.

Indicates that the patient had no IV access at the time of discharge.

Indicates whether the patient was receiving peritoneal dialysis at the time of admission.

Indicates whether the patient was receiving peritoneal dialysis at the time of discharge.

Indicates whether the patient was receiving transfusions at the time of admission.

Indicates whether the patient was receiving transfusions at the time of discharge.

Overarching OUD Disorder (Any of the Three Sub-Indicators) First Ever Occurrence Date - Medicaid Only Claims

Diagnosis and Procedure Basis for OUD First Ever Occurrence Date - Medicaid Only Claims

Opioid-Related Hospitalization or ED First Ever Occurrence Date - Medicaid Only Claims

Opioid-Related Hospitalization or ED First Ever Occurrence Date - Medicare Only Claims

Use of Medication-Assisted Treatment (MAT) First Ever Occurrence Date - Medicaid Only Claims

Use of Medication-Assisted Treatment (MAT) First Ever Occurrence Date - Medicare Only Claims

This variable is the dollar amount of the Medicare-defined Part D annual Out-of-Pocket (OOP) Cost Threshold. This field is blank for Fixed Capitated Reinsurance Demonstration Projects.

This variable is the dollar amount of the Medicare-defined Part D annual Out-of-Pocket (OOP) Cost Threshold.

This field is blank for Fixed Capitated Reinsurance Demonstration Projects

This field specifies the number of days paid as outliers under Prospective Payment System (PPS) and the days over the threshold for the DRG.

This code indicates the Type of Outlier Code or DRG Source.

The charge amount (rounded to whole dollars) for out-patient services provided during the beneficiary's stay.

The code indicating whether or not the beneficiary has received outpatient services, ambulatory surgical care, or both.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Overarching opioid use disorder (any positive result from the three indicators: DX or procedure, hospital or ED, or MAT). 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Overarching opioid use disorder (any positive result from the three indicators: DX or procedure, hospital or ED, or MAT). 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Overarching opioid use disorder (any positive result from the three indicators: DX or procedure, hospital or ED, or MAT).