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CODE INDICATING THE TYPE OF THE FIRST OF UP TO FOUR MANAGED CARE PLAN TYPES IN WHICH THE ELIGIBLE WAS ENROLLED FOR THE RESPECTIVE MONTH.
DOLLAR VALUE PLACED ON THE SERVICE BY THE PROVIDER.
(DISPLAY SIGNED NUMERIC) (SAS USERS: ZONED DECIMAL - ZD8)
DATE THE DRUG, DEVICE OR SUPPLY WAS PRESCRIBED BY THE PHSYCIAN OR OTHER PRACTITIONER.
The date the drug, device, or supply was prescribed by the physician or other practitioner. This should not be confused with the prescription fill date (RX_FILL_DT), which represents the date the prescription was actually filled by the provider.
This variable contains the prescriber identification number as reported by the Part D sponsor on the PDE record submitted to CMS.
Historically, this could be an NPI, DEA identification number, or UPIN. Since NPIs are now required by CMS (after April 2013), they appear most frequently (2009 forward). The type of prescriber identifier used is documented in the PRSCRBR_ID_QLFYR_CD variable.
Starting with 2014 data, the PRSCRBR_ID can be used to link to the NPI variable in the Prescriber Characteristics File.
This variable contains information regarding the type of prescriber identification number that was submitted on the original PDE data, as reported by the Part D sponsor on the PDE record submitted to CMS.
Historically, this identifier could be an NPI, DEA identification number, UPIN, or state license number. After April 2013, it is an NPI.
The national provider identifier (NPI) number assigned to uniquely identify the physician or practitioner who prescribed the beneficiary's medication.
NPIs replaced Drug Enforcement Agency (DEA) numbers as the standard prescriber identifiers in May 2013. This field also enables linkage between the Part D Event File, NPI is contained in a PDE field called the PRSCRBR_ID, and the CCW Prescriber Characteristics File
The state where the prescriber practices, using the standard two-character postal state code.
The CCW Prescriber Characteristics File allows for up to 5 practice location states associated with the prescriber during the year.
The number of associated states may vary from year to year.
The 2nd state where the prescriber practices, using the standard two-character postal state code.
The CCW Prescriber Characteristics File allows for up to 5 practice location states associated with the prescriber during the year.
The number of associated states may vary from year to year.
The 3rd state where the prescriber practices, using the standard two-character postal state code.
The CCW Prescriber Characteristics File allows for up to 5 practice location states associated with the prescriber during the year.
The number of associated states may vary from year to year.
The 4th state where the prescriber practices, using the standard two-character postal state code.
The CCW Prescriber Characteristics File allows for up to 5 practice location states associated with the prescriber during the year.
The number of associated states may vary from year to year.
THE UNIQUE IDENTIFICATION NUMBER ASSIGNED TO A PROVIDER, BY THE STATE, WHICH IDENTIFIES THE PHYSICIAN OR OTHER PROVIDER PRESCRIBING THE DRUG, DEVICE OR SUPPLY.
A unique identification number assigned by the state to the provider who prescribed the drug, device, or supply. This must be the individual’s ID number, not a group identification number.
The National Provider ID (NPI) of the provider who prescribed a medication to a patient.
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 2 (FAMILY PLANNING).
(SAS USERS: ZONED DECIMAL - ZD8)
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 4 (FEDERALLY QUALIFIED HEALTH CENTERS)
(SAS USERS: ZONED DECIMAL - ZD8)
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 6 (HOME AND COMMUNITY-BASED CARE FOR DISABLED ELDERLY AND INDIVIDUALS AGE 65 AND OLDER)
(SAS USERS: ZONED DECIMAL - ZD8)
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 7 (HOME AND COMMUNITY-BASED CARE WAIVER SERVICES)
(SAS USERS: ZONED DECIMAL - ZD8)
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 5 (INDIAN HEALTH SERVICES)
(SAS USERS: ZONED DECIMAL - ZD8)
MEDICAID PAYMENT AMOUNT FOR ALL PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 3 (RURAL HEALTH CLINIC)
(SAS USERS: ZONED DECIMAL - ZD8)
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 2 (FAMILY PLANNING).
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 4 (FEDERALLY QUALIFIED HEALTH CENTERS).
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 6 (HOME AND COMMUNITY-BASED CARE FOR DISABLED ELDERLY AND INDIVIDUALS AGE 65 AND OLDER).
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 7 (HOME AND COMMUNITY-BASED CARE WAIVER SERVICES).
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 5 (INDIAN HEALTH SERVICES).
NUMBER OF PRESCRIPTION DRUG RECORDS CONTAINING MSIS PROGRAM TYPE = 3 (RURAL HEALTH CLINIC).
DATE THE PRESCRIPTION WAS FILLED BY THE PHARMACY OR OTHER PROVIDER.
Date the drug, device, or supply was dispensed by the provider.
This variable indicates whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Pressure Ulcers and Chronic Ulcers.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Pressure Ulcers and Chronic Ulcers.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Pressure Ulcers and Chronic Ulcers.
This variable indicates whether a beneficiary met the condition criteria for pressure ulcers and chronic ulcers as of the end of the calendar year.
This variable shows the date when the beneficiary first met the criteria for the pressure ulcers and chronic ulcers indicator. The variable will be blank for beneficiaries that have never had the condition.
This variable is the CCW-assigned pharmacy identification number that is used to uniquely identify pharmacy entities. This variable is only populated if the pharmacy ownership changed in the reference year and the new owner did not keep the same pharmacy identifiers as the previous owner. This variable allows linkage of records in this file that are for the same physical location.
Previous Record Date
This variable indicates if the PDE was processed by the Part D plan using pricing rules that differ from the plan's negotiated price. Most PDEs have missing values, indicating that they were obtained from in-network pharmacies.
An indicator of whether the participating provider was considered a primary care specialist for purposes of applying exclusivity rules.
Effective with Version 'J', the code used to indicate if the diagnosis is ICD-9 or ICD-10.
NOTE: With 5010, the diagnosis and procedure codes have been expanded to accommodate ICD-10, even though ICD-10 is not scheduled for implementation until 10/2013.
A code indicating the language the beneficiary speaks other than English at home; most recent in the calendar and the two prior years.
The diagnosis code on the claim. There are up to 12 diagnosis codes on the IP header claim, up to five (5) for LT, and up to two (2) for OT. The lower the number, the more important the diagnosis in the patient treatment/billing (i.e., DGNS_CD_1 is considered the primary diagnosis).
The amount of payment (rounded to whole dollars) made on behalf of the beneficiary by a primary payer other than Medicare, which has been applied to the covered Medicare charges for the stay.
The code indicating the type of payer who has primary responsibility for the payment of the Medicare beneficiary's claims related to the stay (if not Medicare).
If patient/resident has an indwelling or external CATHETER placed in current setting (G3b=1), what is the PRIMARY reason the catheter was put in place?
The questions on the primary reason and other explanations are asked on day1, day 3, day 5, day7. The “_other” variables are reasons to explain in the “5 = other (specify)” category below.
Explanation of reason for catheter when "Other" is selected
If patient/resident has an indwelling or external CATHETER placed in current setting (G3b=1), what is the PRIMARY reason the catheter was put in place?
Explanation of reason for catheter when "Other" is selected
If patient/resident has an indwelling or external CATHETER placed in current setting (G3b=1), what is the PRIMARY reason the catheter was put in place?
Explanation of reason for catheter when "Other" is selected
If patient/resident has an indwelling or external CATHETER placed in current setting (G3b=1), what is the PRIMARY reason the catheter was put in place?