Search Data Variables

Tobacco Use Disorders - Medicaid Only Claims, First Ever Occurrence Date

Tobacco Use Disorders - Medicare Only Claims, First Ever Occurrence Date

A code to identify which tooth numbering system is being used.

The tooth number serviced based on the tooth numbering system identified in the Tooth Designation System/Nomenclature (TOOTH_DSGNTN_SYS) field.

The area of the oral cavity on which the service was performed.

A code to identify the tooth’s surface on which the service was performed.

The total amount paid by Medicaid or the managed care plan on this claim or adjustment at the header claim level.

The total amount paid by the patient for services where they are required to use their personal funds to cover part of their care before Medicaid funds can be utilized.

The total amount (rounded to whole dollars) of all charges (covered and non-covered) for all services provided to the beneficiary for the stay.

The total charge amount (rounded to whole dollars) for all accommodations (routine hospital room and board charges for general care, coronary care and/or intensive care units) related to a beneficiary's stay.

The total charge amount (rounded to whole dollars) for all ancillary departments (other than routine room and board, CCU, and ICU) related to a beneficiary's stay.

The total amount billed for this claim, at the header claim level, as submitted by the provider

The total amount paid by Medicaid/CHIP beneficiary for each office or emergency department visit or purchase of prescription drugs in addition to the amount paid by Medicaid/CHIP.

The portion of the total charges amount (rounded to whole dollars) that is covered by Medicare for the stay.

This variable is the total cost of the prescription drug event and is taken directly from the original PDE.  It is the sum of the following components:

• The ingredient cost (INGRDNT_CST_PD_AMT),
• The dispensing fee (DSPNSNG_FEE_PD_AMT),
• The sales tax, if any (TOT_AMT_ATTR_SLS_TAX_AMT), and
• The vaccine administration fee, if any (VCCN_ADMIN_FEE_AMT, included starting in 2010).

This is the price paid for the drug at the point of sale (i.e., the pharmacy counter), and it does not include any rebates or discounts that the drug manufacturer provides directly to the Part D plan sponsor. 

TOTAL NUMBER OF MEDICAID COVERED DAYS FOR THE RECIPIENT IN AN NURSING FACILITY FOR THE CALENDAR YEAR.

(SAS USERS: ZONED DECIMAL - ZD3)

The claim level maximum amount determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment.

TOTAL AMOUNT OF MONEY PAID BY MEDICAID FOR THE RECIPIENT DURING THE CALENDAR YEAR (FEE-FOR-SERVICE AND PREMIUM PAYMENTS), FOR ALL TYPES OF SERVICE AND ANY TYPE OF CLAIM.

(SAS USERS: ZONED DECIMAL - ZD8)

The amount paid by Medicaid/CHIP or the managed care plan, on this claim, toward the beneficiary’s Medicare coinsurance.

The amount paid by Medicaid/CHIP or the managed care plan, on this claim, toward the beneficiary’s Medicare deductible.

Amount of payment made from the Medicare trust fund for the services covered by the claim record.

For hospital services, this amount does not include the claim pass-through per diem payments made by Medicare.

To obtain the total amount paid by Medicare for the stay, the pass-through amount (which is the daily per diem amount; field called PASSTHRU) must be added to this field.

The amount paid by insurance other than Medicare or Medicaid on this claim.

MEDICAID PAYMENT AMOUNT FOR ALL RECORDS CONTAINING MSIS PROGRAM TYPE = 2 (FAMILY PLANNING)

(SAS USERS: ZONED DECIMAL - ZD8)

MEDICAID PAYMENT AMOUNT FOR ALL RECORDS CONTAINING MSIS PROGRAM TYPE = 4 (FEDERALLY QUALIFIED HEALTH CENTERS)

(SAS USERS: ZONED DECIMAL - ZD8)

MEDICAID PAYMENT AMOUNT FOR ALL 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 RECORDS CONTAINING MSIS PROGRAM TYPE = 7 (HOME AND COMMUNITY-BASED CARE WAIVER SERVICES)

(SAS USERS: ZONED DECIMAL - ZD8)

MEDICAID PAYMENT AMOUNT FOR ALL RECORDS CONTAINING MSIS PROGRAM TYPE = 5 (INDIAN HEALTH SERVICES)

(SAS USERS: ZONED DECIMAL - ZD8)

MEDICAID PAYMENT AMOUNT FOR ALL RECORDS CONTAINING MSIS PROGRAM TYPE = 3 (RURAL HEALTH CLINIC)

(SAS USERS: ZONED DECIMAL - ZD8)

The total amount (rounded to whole dollars) that is payable for capital for the prospective payment system (PPS) (e.g., reimbursement for depreciation, rent, certain interest, real estate taxes for hospital buildings/equipment that are subject to PPS).

RECIPIENT'S TOTAL NUMBER OF FEE-F0R-SERVICE CLAIMS, PREMIUM PAYMENT CLAIMS AND ENCOUNTER RECORDS FOR THE CALENDAR YEAR, FOR ALL TYPES OF SERVICE AND ANY TYPE OF CLAIM.

(SAS USERS: ZONED DECIMAL - ZD5)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =2 (FAMILY PLANNING)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =4 (FEDERALLY QUALIFIED HEALTH CENTERS)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =6 (HOME AND COMMUNITY-BASED CARE FOR DISABLED ELDERLY AND INDIVIDUALS AGE 65 AND OLDER)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =7 (HOME AND COMMUNITY-BASED CARE WAIVER SERVICES)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =5 (INDIAN HEALTH SERVICES)

TOTAL NUMBER OF RECORDS CONTAINING MSIS PROGRAM TYPE =3 (RURAL HEALTH CLINIC)

Indicates the patient's total severity score.

Third-Party Liability (TPL) refers to the legal obligation of third parties (i.e., certain individuals, entities, or programs), to pay all or part of the expenditures for medical assistance furnished under a state plan.

Number of months the beneficiary was enrolled in a Traditional Primary Care Case Management (PCCM) Managed Care Plan in the calendar year.

This field houses the amount for the Transitional Drug Add-On Payment Adjustment (TDAPA) for ESRD claims (72X) with injectable, intravenous, and oral calcimimetics when reported with an AX modifier. These services qualify for an add-on payment from the ESRD Pricer.

Number of months the beneficiary was enrolled in a Transportation Prepaid Ambulatory Health Plan (PAHP) Managed Care Plan in the calendar year.

Indicates whether the provider’s taxonomy value maps to the transportation services provider category; ever in the calendar year.

Indicates that lack of transportation has not kept the patient from medical or non-medical appointments, from getting medications, work, or from getting things that they need.

This column documents that lack of transportation has not kept the patient from attending medical appointments, meetings, work or from getting things needed for daily living at the time of admission.

This column documents that lack of transportation has not kept the patient from attending medical appointments, meetings, work or from getting things needed for daily living at the time of admission.

Indicates the patient declined to respond about lack of transportation.

This column documents that at the time of admission the patient declined to respond to the question regarding lack of transportation.

This column documents that at the time of discharge the patient declined to respond to the question regarding lack of transportation.

Indicates the patient was unable to respond about lack of transportation.

This column documents that at the time of admission the patient was unable to respond to the question regarding lack of transportation.