Search Data Variables

CODE INDICATING WHETHER OR NOT THE ELIGIBLE HAD AT LEAST ONE INPATIENT HOSPITAL STAY IN THE YEAR WITH A MATERNAL DELIVERY DIAGNOSIS CODE.

If beneficiaries who are eligible for Medicare and Medicaid (often called full benefit dual eligibles) enroll in Part D plans with premiums higher than the regional benchmark, they are responsible for paying the premium amount above the benchmark. The benchmark is a statutorily defined amount that is based on the average premium amounts for Part D plans for each region (varies by year).   This variable indicates whether the Part D sponsor has voluntarily waived the portion of the monthly adjusted basic beneficiary premium that is a de minimis amount above the low-income subsidy (LIS) premium benchmark for subsidy-eligible individuals.   LIS individuals who enroll in plans that waive the de minimis premium amount are charged a monthly beneficiary premium for basic prescription drug coverage rather than for the higher de minimis amount (i.e., full benefit dual eligible beneficiaries have a full premium subsidy and would essentially have $0 premium payment).

This is a text field that contains information related to the demonstration.

For example, a claim involving a CHOICES demo id '05' would contain the MCO plan contract number in the first five positions of this text field.

The number assigned to identify a CMS demonstration project.

This field is also used to denote special processing (a.k.a. Special Processing Number, SPN).

The number of demonstration identification trailers present on the claim.

This variable identifies whether the organization’s contract is for a demonstration.

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

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

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for depression 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 Depression.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Depression.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Depression.

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for depression on July 1 of the specified reference period.

This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for depression, bipolar, or other depressive mood disorders as of the end of the calendar year.

Depression - Combined Medicare & Medicaid Claims

Depression - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

Depression - Medicaid Only Claims

Depression - Medicaid Only Claims, First Ever Occurrence Date

Depression - Medicare Only Claims

Depression - Medicare Only Claims, First Ever Occurrence Date

Depression - Combined Medicare & Medicaid Claims

Depression - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

Depression - Medicaid Only Claims

Depression - Medicaid Only Claims, First Ever Occurrence Date

Depression - Medicare Only Claims

Depression - Medicare Only Claims, First Ever Occurrence Date

The Medicare Severity diagnostic related group (MS-DRG) to which a hospital claim belongs for prospective payment purposes that is derived by the Encounter Data Processing System (EDPS).

Description of the associated state-specific DRG code.

The code indicating the destination of the beneficiary upon discharge from a facility; also denotes death or skilled nursing facility (SNF)/still patient situations.

This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for diabetes as of the end of the calendar year.

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for diabetes 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  Diabetes.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Diabetes.

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Diabetes.

This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for diabetes on July 1 of the specified reference period.

The code for whether the patient had a diagnosis ofDiabetic Neuropathy.

Diabetes - Combined Medicare & Medicaid Claims

Diabetes - Combined Medicare & Medicaid Claims, First Ever Occurrence Date

Diabetes - Medicaid Only Claims

Diabetes - Medicaid Only Claims, First Ever Occurrence Date

Diabetes - Medicare Only Claims

Diabetes - Medicare Only Claims, First Ever Occurrence Date

The code used to identify the present on admission (POA) indicator code associated with the diagnosis codes (DGNSCD1–DGNSCD25).

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Diagnosis and Procedure Basis for opioid use disorder. 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Diagnosis and Procedure Basis for  opioid use disorder. 

This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Diagnosis and Procedure Basis for opioid use disorder. 

This variable shows the date when the beneficiary first met the criteria for the opioid use disorder (OUD) indicator. The variable will be blank for beneficiaries that have never had the condition.

This variable indicates whether a beneficiary met the Diagnosis and Procedure Basis for Opioid Use Disorder (OUD) as of the end of the calendar year.

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).