Search Data Variables

The type of facility.

This field is stored in the CMS Integrated Data Repository (IDR) as the final action indicator; however, CMS has verified that for 2015 encounter records, this field should not be used to identify the final version of the record. Note that the term “final action” is used differently in encounter data, compared to fee-for-service (FFS) claims.

Claim Final Standard Payment Amount

This amount further adjusts the standard Medicare Payment amount (field called PPS_STD_VAL_PYMT_AMT) by applying additional standardization requirements (e.g. sequestration).

Claim Frequency Code (Encounter)

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care.

Claim Frequency Code (FFS)

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care.

Claim From Date (Encounter)

The first day on the billing statement covering services rendered to the beneficiary (a.k.a. 'Statement Covers From Date').

Claim From Date (FFS)

The first day on the billing statement covering services rendered to the beneficiary (a.k.a. 'Statement Covers From Date').

Claim Full Standard Payment Amount

Under the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the MS-LTC-DRG. This amount does not include any applicable outlier payment amount.

Claim Healthcare Common Procedure Coding System (HCPCS) Year Code

The terminal digit of the Healthcare Common Procedure Coding System (HCPCS) version used to code the claim.

Claim HHA Low Utilization Payment Adjustment (LUPA) Indicator Code

The code used to identify those Home Health PPS claims that have 4 visits or less in a 60-day episode.

If an HHA provides 4 visits or less, they will be reimbursed based on a national standardized per visit rate instead of Home Health resource groups (HHRGs).

Claim HHA Referral Code

Effective with Version 'I', the code used to identify the means by which the beneficiary was referred for Home Health services.

Claim HHA Total Visit Count

The count of the number of HHA visits as derived by CMS.

Claim Hospice Start Date

On an institutional claim, the date the beneficiary was admitted to the hospice care.

Claim Hospital Acquired Condition (HAC) Program Reduction Indicator Switch

This field is a switch that identifies hospitals subject to a Hospital Acquired Conditions (HAC) reduction of what they would otherwise be paid under the inpatient prospective payment system (IPPS).

Claim Hospital Readmission Reduction (HRR) Adjustment Payment Amount

This field represents the Hospital Readmission Reduction (HRR) Program Payment Amount. The amount is the reduction to the claim for a readmission.

Claim Hospital Readmission Reduction (HRR) Participant Indicator Code

This field is the code used to identify whether the hospital is participating in the Hospital Readmissions Reduction (HRR) program.

Claim HRR Adjustment Percent

Under the Hospital Readmissions Reduction (HRR) Program, the amount used to identify the readmission adjustment factor that will be applied.

Claim ID

This is the unique identification number for the claim.

Each Part A or institutional Part B claim has at least one revenue center record.

Each non-institutional Part B claim has at least one claim line.

All revenue center records or claim lines on a given claim have the same CLM_ID. It is used to link the revenue lines together and/or to the base claim.

Claim Inpatient Admission Type Code (Encounter)

The code indicating the type and priority of an inpatient admission associated with the service on an intermediary submitted claim.

Claim Inpatient Admission Type Code (FFS)

The code indicating the type and priority of an inpatient admission associated with the service on an intermediary submitted claim.

Claim Inpatient Initial MS DRG Code

Claim Inpatient Initial MS Diagnosis Related Group (DRG) Code

Claim Inpatient Low Volume Payment Amount

This is the amount field used to identify a payment adjustment given to hospitals to account for the higher costs per discharge for low income hospitals under the Inpatient Prospective Payment System (IPPS).

Claim Line Adjustment Code

Code indicating type of adjustment record claim/encounter represents at claim detail level.

Claim Line Adjustment Reason Code

Claim adjustment reason codes communicate why a service line was paid differently than it was billed.

Claim Line Beginning Date of Service

For services received during a single encounter with a provider, the date the service was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service began. For capitation premium payments, the date on which the period of coverage related to this payment began.

Claim Line Count - Calculated

The total number of lines on the claim within the TAF

Claim Line Count - Original

The total number of lines on the claim as recorded by the state when TMSIS data submitted

Claim Line Ending Date of Service

For services received during a single encounter with a provider, the date the service was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended.

Claim Line Number

This variable identifies an individual line number on a claim.

Each revenue center record or claim line has a sequential line number to distinguish distinct services that are submitted on the same claim.

All revenue center records or claim lines on a given claim have the same CLM_ID.

Claim Line Number (Encounter)

This variable identifies an individual line number on an encounter record claim.

Each revenue center record or claim line has a sequential line number to distinguish distinct services that are submitted on the same encounter record.

All revenue center records or claim lines on a given claim have the same encounter join key (variable called ENC_JOIN_KEY).

Claim Line Status Code

The claim line status codes identify the status of a specific detail claim line rather than the entire claim.

Claim MCO Paid Switch

A switch indicating whether or not a Managed Care Organization (MCO) has paid the provider for an institutional claim.

Claim Medical Record Number (Encounter)

The number assigned by the provider to the beneficiary's medical record to assist in record retrieval. The medical record number has special significance for chart review encounters. When the chart review’s purpose is to delete a diagnosis code from the claim, the medical record number should be ‘8’.

Claim Medical Record Number (FFS)

The number assigned by the provider to the beneficiary's medical record to assist in record retrieval.

Claim Medicare Non Utilization Days Count

On an institutional claim, the number of days of care that are not chargeable to Medicare facility utilization.

Claim Medicare Non-Payment Reason Code

The reason that no Medicare payment is made for services on an institutional claim.

Claim Medicare Utilization Day Count

On an institutional claim, the number of covered days of care that are chargeable to Medicare facility utilization that includes full days, coinsurance days, and lifetime reserve days.

It excludes any days classified as non-covered, leave of absence days, and the day of discharge or death.

Claim Model 4 Readmission Indicator Code

This field identifies the method of payment of a claim billed within 30 days of a Model 4 Bundled Payments for Care Improvement (BPCI) admission.

Claim Model Reimbursement Amount

This field contains the "Net Reimbursement Amount" of what Medicare would have paid for Global Budget Services from a hospital participating in the particular model. If the claim only includes global services, the reimbursement amount (CLM_PMT_AMT) will reflect $0 (zero). If the claim includes global services and non-global services, the reimbursement amount will reflect the amount Medicare actually paid for the non-global services.

Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code