Reminder: DUA and VRDC access needs to be extended or renewed annually. Read more.
The amount of the capitated payment bill submitted by the managed care entity to the state.
The date that the managed care entity submitted the capitated payment bill to the state.
The charge amount (rounded to whole dollars) for the cardiac catheterization lab related to the beneficiary's stay.
The charge amount (rounded to whole dollars) for cardiology services and electrocardiogram(s) provided during the beneficiary's stay.
The code used to identify that the care improvement model is being used for bundling payments.
The code used to identify that the care improvement model is being used for bundling payments
The code used to identify that the care improvement model is being used for bundling payments.
The code used to identify that the care improvement model is being used for bundling payments.
The National Provider Identifier (NPI) number of the Home Health Agency (HHA) or Hospice rendering Medicare services during the period the physician is providing care plan oversight (CPO).
Care Planning Lock Date
Care Preferences Section Notes
The amount paid by the beneficiary for the non-institutional Part B (carrier, or DMERC) claim.
The CMS National Provider Identifier (NPI) number assigned to the billing provider
The amount of the cash deductible as submitted on the claim.
This variable is the beneficiary’s liability under the annual Part B deductible for all line items on the claim; it is the sum of all line-level deductible amounts. (variable called LINE_BENE_PTB_DDCTBL_AMT)
The Part B deductible applies to both institutional (e.g., HOP) and non-institutional (e.g., Carrier and DME) services.
Carrier-generated code describing whether the Part B claim is an original debit, full credit, or replacement debit.
The code on a non-institutional claim indicating to whom payment was made or if the claim was denied.
Effective with Version H, the amount of a payment made on behalf of a Medicare bene- ficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim.
NOTE: During the Version H conversion, this field was populated with data throughout history (back to service year 1991) by summing up the line item primary payer amounts.
Variable indicates whether or not the provider accepts assignment for the noninstitutional claim.
The unique physician identification number (UPIN) of the physician who referred the beneficiary to the physician who performed the Part B services.
The provider identification number (PIN) of the physician/supplier (assigned by the MAC) who referred the beneficiary to the physician who ordered these services.
This field identifies the Site of Service National Provider Identifier (NPI).
The base number of units assigned to the line item anesthesia procedure on the carrier claim (non-DMERC).
The profiling identification number (PIN) of the physician/supplier (assigned by the carrier) who performed the service for this line item on the carrier claim (non-DMERC).
Clinical lab charge amount on the Carrier line.
The code used to track health professional shortage area (HPSA) and physician scarcity bonus payments on carrier claims.
This field represents the National Provider Identifier (NPI) of the Medicare Diabetes Prevention Program (MDPP) Coach.
The count of the total units associated with services needing unit reporting such as transportation, miles, anesthesia time units, number of services, volume of oxygen or blood units.
This is a line item field on the carrier claim (non-DMERC) and is used for both allowed and denied services.
Code indicating the units associated with services needing unit reporting on the line item for the carrier claim (non-DMERC).
The National Provider Identifier (NPI) assigned to the performing provider.
The provider identification number (PIN) of the physician/supplier (assigned by the Medicare Administrative Contractor [MAC]) who performed the service for this line item.
The ZIP code of the physician/supplier who performed the Part B service for this line item on the carrier claim (non-DMERC).
The unique physician identification number (UPIN) of the physician who performed the service for this line item on the carrier claim (non-DMERC).
NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.
Source: NCH
Code denoting the carrier-specific locality used for pricing the service for this line item on the carrier claim (non-DMERC).
Code identifying the type of provider furnishing the service for this line item on the carrier claim.
Code identifying the type of provider furnishing the service for this line item on the carrier claim.
The code on the carrier (non-DMERC) line item that identifies the line items that have been paid a reduced fee schedule amount (65%, 75% or 85%) because a physician's assistant performed the service.
The pharmacy's internal invoice number on pharmaceutical claims.
The number used to identify the prescription order number for drugs and biologicals purchased through the competitive acquisition program (CAP).
The identification number assigned by CMS to a carrier authorized to process claims from a physician or supplier.
Effective July 2006, the Medicare Administrative Contractors (MACs) began replacing the existing carriers and started processing physician or supplier claim records for states assigned to its jurisdiction.
The national provider identifier (NPI) number of the physician who referred the beneficiary or the physician who ordered the Part B services or durable medical equipment (DME).
The unique physician identification number (UPIN) of the physician who referred the beneficiary or the physician who ordered the Part B services or durable medical equipment (DME).
NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.
The unique physician identification number (UPIN) of the physician who referred the beneficiary or the physician who ordered the Part B services or durable medical equipment (DME).
NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.
This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for a cataract as of the end of the calendar year.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for a cataract as of the end of the calendar year.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Cataracts.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Cataracts.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Cataracts.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for a cataract on July 1 of the specified reference period.
This variable indicates whether the PDE occurred within the catastrophic benefit phase of the Medicare Part D benefit, according to the source PDE.
When the value equals C (above attachment point), then the PDE is in the catastrophic phase. When the value equals A (attachment point), the PDE has caused the beneficiary to move into the catastrophic phase (i.e., this is the “triggering” PDE).
Cataract - Combined Medicare & Medicaid Claims