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Bladder appliance notes
Notes on patient's assistance needed to manage bowel appliance
This column contains information on whether the patient needs an interpreter to communicate with a doctor or health care staff.
The dollar amount of limited gap benefits offered by the Part D plan.
This variable is the dosage form code according to the First DataBank (FDB) reference files. The dosage form describes the physcial presentation of a drug, suchg as tablet, capsule, or liquid. It may also incorporate the delivery and release mechanism of the drug.
When this variable appears in the Formulary file, it is the FDB dosage form code for a drug product on the formulary.
This variable describes the dosage form of a clinical formulation, according to the First DataBank (FDB) reference files. The dosage form is the physical presentation of a drug, such as tablet, capsule, or liquid. It may also incorporate the delivery and release mechanisms of the drug.
When this variable appears in the Formulary file, it is the FDB dosage form code description for a drug product on the formulary.
An indicator identifying the grouping algorithm used to assign Diagnosis Related Group (DRG) values.
The code identifying if the stay has an unusually long length (day outlier) or high cost (cost outlier)
The additional payment on a claim that is associated with either a cost outlier or length of stay outlier.
The amount of additional payment (rounded to whole dollars) approved due to an outlier situation over the DRG allowance for the stay.
The amount (called the 'DRG price' for purposes of MEDPAR analysis) that would have been paid if no deductibles, coinsurance, primary payers, or outliers were involved (rounded to whole dollars).
The relative weight for the DRG on the claim. Each year CMS assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average.
Indicates the type of Part D benefit structure used by the plan benefit package (Defined Standard, Actuarially Equivalent, Basic Alternative, or Enhanced Alternative).
CLASSIFIES THE DRUG ACCORDING TO AVAILABILITY TO THE PATIENT.USER NOTE: THIS IS FIRST DATA BANK DATA NATIONAL DRUG DATA FILE (NDDF) ELEMENT "CL".
This field indicates whether or not the drug is covered by Medicare Part D.
The Part D benefit does not cover all FDA-approved drugs. However, plan sponsors can offer an "enhanced" benefit package that covers non-Part D drugs, such as over-the-counter medications.
This is a CCW-derived field that indicates whether the prescription was subject to a step therapy protocol, according to the benefit structure and formulary for the beneficiary's plan.
This variable is the strength or potency of the drug product as dispensed, according to the First DataBank (FDB) reference files.
When this variable appears in the Formulary file, it is the FDB drug strength for a drug product on the formulary.
Each digit indicates which types of drugs are offered through the limited gap benefit.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Drug Use Disorder.
This variable indicates whether a beneficiary met the condition criteria for drug use disorder as of the end of the calendar year.
This variable shows the date when the beneficiary first met the criteria for the drug use disorder indicator. The variable will be blank for beneficiaries that have never had the condition.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having Drug Use Disorder.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Drug Use Disorder.
A code indicating the conflict, intervention and outcome of a prescription presented for fulfillment.
Drug Use Disorders - Combined Medicare & Medicaid Claims
Drug Use Disorders - Combined Medicare & Medicaid Claims, First Ever Occurrence Date
Drug Use Disorders - Medicare Only Claims
Drug Use Disorders -Medicare Only Claims, First Ever Occurrence Date
Drug Use Disorders - Medicaid Only Claims
Drug Use Disorders - Medicaid Only Claims, First Ever Occurrence Date
This field specifies whether enrollee was dually enrolled in Medicare & Medicaid during the year, or enrolled only in Medicaid. CCW attempted to link each person in MAX PS to the Medicare enrollment data. Those with a match are classified as dually enrolled.
The charge amount (rounded to whole dollars) for durable medical equipment (DME) (purchase of new DME and rentals) related to the beneficiary's stay.
This variable is the total Medicare payments for part B durable medical equipment (DME) for a given year. The total Beneficiary payments are calculated as the sum of LINE_COINSRNC_AMT + LINE_BENE_PTB_DDCTBL_AMT for the relevant lines.
Claims for DME are a subset of the claims in the Part B Carrier and DME data files. These claims are defined as those with a line BETOS code (BETOS_CD) where the first three digits are 'D1A', 'D1B', 'D1C', 'D1D', 'D1E', or 'D1F'.
This variable is the count of events in the part B durable medical equipment (DME) for a given year. An event is defined as each line item that contains the relevant service.
Claims for DME are a subset of the claims in the Part B Carrier and DME data files. These claims are defined as those with a line BETOS code (BETOS_CD) where the first three digits are 'D1A', 'D1B', 'D1C', 'D1D', 'D1E', or 'D1F'.
This variable is the total Medicare payments for part B durable medical equipment (DME) for a given year. Claims for DME are a subset of the claims in the Part B Carrier and DME data files.
These claims are defined as those with a line BETOS code (BETOS_CD) where the first three digits are 'D1A', 'D1B', 'D1C', 'D1D', 'D1E', or 'D1F'. The total Medicare payments are calculated as the sum of LINE_NCH_PMT_AMT where the LINE_PRCSG_IND_CD was ('A','R', or 'S') - for all relevant lines.
This variable indicates the total amount paid for part B durable medical equipment (DME) by a primary payer other than Medicare for a given year. Claims for DME are a subset of the claims in the Part B Carrier and DME data files.
These claims are defined as those with a line BETOS code (BETOS_CD) where the first three digits are ('D1A','D1B','D1C','D1D','D1E', or 'D1F'). The total Primary Payer Payments are calculated as the sum of the LINE_BENE_PRMRY_PYR_PD_AMT.
Age (in years) at the end of the calendar year
Months alive during the reference year (null if alive all year)
Annual county for the individual.
Beneficiary died during year, indicator
SSA Disability Insurance Benefit Diagnosis Award Code
Disability Insurance Benefit Entitlement to Medicare Justification code - from Social Security Administration (SSA)
SSA Disability Insurance Benefit Diagnosis Primary Impairment Code
SSA Disability Insurance Benefit Secondary Impairment Code
Medicaid Coverage Start Date - First occurrence since 1999 of Medicaid coverage, regardless of state (source: Uniform eligibility code from MAX)
Medicaid Race/Ethnicity Code
Medicare Coverage Start Date - First occurrence of Medicare (A or B) coverage based on Medicare enrollment
Medicare Beneficiary Race Code (modified using RTI algorithm)
Annual State code for the individual.
Monthly State Code: January through December (state of residence)