Search Data Variables

The last updated date and time of resident data.

This field is used in determining if a record should be written to the resident history table.  It is a number showing which of the resident matching criteria was positive for a match, and is zero if it is a new resident.

This field is used in determining if a record should be written to the resident history table.  It is a number showing which of the resident matching criteria was positive for a match, and is zero if it is a new resident.

This value indicates which of the resident match criteria was assigned based on the patient information in the submitted record. The resident match procedure is used to determine if the patient information in an assessment record represents a new or existing patient.

Indicates whether the provider’s taxonomy value maps to the residential treatment facility provider category; ever in the calendar year.

Notes

NOTE1 and NOTE2

Indicates whether the provider’s taxonomy value maps to the respiratory, developmental, rehabilitative and restorative service provider category; ever in the calendar year.

Indicates whether the provider’s taxonomy value maps to the respite care facility provider category; ever in the calendar year.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

CODE INDICATING THE SCOPE OF MEDICAID BENEFITS TO WHICH AN ELIGIBLE IS ENTITLED FOR THE RESPECTIVE MONTH.

Describes the action the pharmacist took in response to a conflict or the result of a pharmacist’s professional service.

This is the value reported in the Result of Service Code field of the NCPDP claim form.

To obtain the Medicare payment amount for the services reported on the revenue center record, it is more accurate to use a different variable called the revenue center Medicare provider payment amount (REV_CNTR_PRVDR_PMT_AMT).

For Home Health, use the claim-level Medicare payment amount (variable that is the total of all revenue center records on the claim, which is called CLM_PMT_AMT), since each visit is not paid separately.

The amount Medicare paid for the services reported on the revenue center record.

This field is rarely populated for Part A claims due to per-diem or DRG payments; the claim payment amounts should be used instead.

For Hospital Outpatient services (also called Institutional Outpatient claims, which consist of claim type [variable called NCH_CLM_TYPE_CD]= 40), this variable can be summed across all revenue center lines for the claim to obtain the total Medicare claim payment amount.

The first code used to identify the detailed reason an adjustment was made (e.g. reason for denial or reducing payment).

The amount paid by the primary payer when the payer is primary to Medicare (Medicare is a secondary).

The second code used to identify the detailed reason an adjustment was made (e.g. reason for denial or reducing payment).
NOTE1: This field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.
NOTE2: Beginning with NCH weekly process date 7/7/00, this field will be populated with data. Claims processed prior to 7/7/00 will contain spaces in this field.

The amount paid by the secondary payer when two payers are primary to Medicare (Medicare is the tertiary payer).

The third code used to identify the detailed reason an adjustment was made (e.g. reason for denial or reducing payment).
NOTE1: This field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.
NOTE2: Beginning with NCH weekly process date 7/7/00, this field will be populated with data. Claims processed prior to 7/7/00 will contain spaces in this field.

The fourth code used to identify the detailed reason an adjustment was made (e.g. reason for denial or reducing payment).
NOTE1: This field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward.
NOTE2: Beginning with NCH weekly process date 7/7/00, this field will be populated with data. Claims processed prior to 7/7/00 will contain spaces in this field.

Claim adjustment group code used to categorize a payment adjustment for a claim or claim line. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

Claim adjustment reason code used to describe why a claim or claim line was paid differently than billed. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

This is not a comprehensive list of values; refer to website below for current values and descriptions:

This field is used to identify revenue center allogeneic stem cell acquisition/donor services

This field contains one of two potential pieces of data; the Ambulatory Payment Classification (APC) code or the Health Insurance Prospective Payment System (HIPPS) code, which corresponds with the revenue center line for the claim.

The APC codes are used as the basis for payment for outpatient prospective payment (OPPS) service (e.g., Part B institutional).

Some Part A claim types (e.g., home health and SNF) use resource groupings, which are similar to case-mix groups, as the basis for payment (e.g., HHRG, SNF RUGs).

For home health (HH) claims, when the revenue center code (variable called REV_CNTR) is 0023, the HHRG is located in this field and is a HIPPS code. This field is only meaningful for a HH claim when CMS determines the claim should be paid using a different HIPPS code than the one submitted by the provider. When this happens, the revised HIPPS code (the one actually used for payment purposes) appears in this field and the original HIPPS code submitted by the provider remains in the HCPCS_CD field. Otherwise, this variable will always be null or have a value of “00000” for HH revenue center records.

The resource utilization group for the particular revenue center is located in the data field called the APC or HIPPS code variable.

The APC is a four byte field.

The HIPPS code is a five byte field (such as 1AFKS).

This variable is the dollar amount the beneficiary is responsible for related to the deductible for blood products that appear on the revenue center record.

A deductible amount applies to the first 3 pints of blood (or equivalent units; applies only to whole blood or packed red cells - not platelets, fibrinogen, plasma, etc. which are considered biologicals). However, blood processing is not subject to a deductible. Calculation of the deductible amount considers both Part A and Part B claims combined. The blood deductible does not count toward meeting the inpatient hospital deductible or any other applicable deductible and coinsurance amounts for which the patient is responsible.

Revenue Center Capital Related Assets Adjustment (CRA) Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) Amount.

This line level field represents the ESRD PPS add-on payment for capital-related assets (CRA). For eligible CRAs that are home dialysis machines, ESRD facilities will be paid the CRA for TPNIES

This variable is the beneficiary’s liability under the annual Part B deductible for the revenue center record. The Part B deductible applies to both institutional (e.g., HOP) and non-institutional (e.g., Carrier and DME) services.

The total charge for the revenue center code for the billing period. Total charges include both covered and non-covered charges (as defined by UB-04 Billing Manual)

The provider-assigned revenue code for each cost center for which a separate charge is billed (type of accommodation or ancillary).

A cost center is a division or unit within a hospital (e.g. radiology, emergency room, pathology).

EXCEPTION: Revenue center code 0001 represents the total of all revenue centers included on the claim.

The provider-assigned revenue code for each cost center for which a separate charge is billed (type of accommodation or ancillary).

A cost center is a division or unit within a hospital (e.g., radiology, emergency room, pathology).

EXCEPTION: Revenue center code 0001 represents the total of all revenue centers included on the claim.

A code which identifies a specific accommodation, ancillary service or billing calculation (as defined by UB-04 Billing Manual).

This variable is the beneficiary’s liability for coinsurance for the revenue center record.

Beneficiaries only face coinsurance once they have satisfied Part B’s annual deductible, which applies to both institutional (e.g., HOP) and non-institutional (e.g., Carrier and DME) services.

For most Part B services, coinsurance equals 20 percent of the allowed amount.

The coinsurance amount is wage adjusted, based on the metropolitan statistical area (MSA) where the provider is located.

This is the date of service for the revenue center record.

However, it is populated only for home health claims, hospice claims, and Part B institutional (HOP) claims.

For home health claims, which are paid based on episodes that can last up to 60 days, this variable indicates the dates for the individual visits.

Code indicating whether the revenue center charges are subject to deductible and/or coinsurance.

This code represents a factor that specifies the amount of any Ambulatory payment classification (APC) discount. The discounting factor is applied to a line item with a service indicator (part of the REV_CNTR_PMT_MTHD_IND_CD) of 'T'. The flag is applicable when more than one significant procedure is performed.

**If there is no discounting the factor will be 1.0.**

This is the beginning date of service for the line item.

The Health Care Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The codes are divided into three levels, or groups as described below:
Level I: Codes and descriptors copyrighted by the American Medical Association's Current Procedural Terminology, Fourth Edition (CPT-4).  These are 5 position numeric codes representing physician and nonphysician services.
*Note: CPT-4 codes including both long and short descriptions shall be used in accordance with the CMS/AMA agreement.  Any other use violates the AMA copyright.
Level II: Includes codes and descriptors copyrighted by the American Dental Association's Current Dental Terminology, Fifth Edition (CDT-5).  These are 5 position alpha-numeric codes comprising the D series.  All other level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association).  These are 5 position alpha-numeric codes representing primarily items and nonphysician services that are not represented in the level I codes.
Level III: Codes and descriptors developed by Medicare carriers for use at the local (carrier) level. These are 5 position alpha-numeric codes in the W, X, Y or Z series representing physician and nonphysician services that are not represented in the level I or level II codes.
HCPCS - General Information (CMS Website)