CCW Data File Descriptions
Institutional Base Claim Files: The Institutional Claim Files are claims that are submitted on a CMS-1450 or UB-92 from hospitals, HHAs, Hospices, or other institutional providers. The base claim files generally contain variables that are found at the claim level. The file contains one record for each claim. Click here for data documentation.
Institutional Revenue Center Files: The revenue center files contain all variables found in the revenue center trailer of the institutional standard analytical files. These files include variables such as revenue center code, revenue center dates, and revenue center total charge amounts. There is an institutional revenue center file for each of the file types (Inpatient, Outpatient, SNF, Home Health Agency, and Hospice.) Institutional Condition/Occurrence/Span/Value Code Files: The institutional code files will contain information for ALL file types in one file. For example, the Institutional Condition Code file, will contain all the condition codes submitted for Inpatient, Skilled nursing facility, Home Health Agency, Hospice, and Outpatient claims. These code files generally give more information about the filing and processing of the claim. For more information, see the variable values for each code type (Condition, Occurrence, Span, Value).
Inpatient files: The Inpatient files contain final action claims data submitted by inpatient hospital providers for reimbursement of facility costs. Some of the information contained in this file includes diagnosis, (ICD-9 diagnosis), procedure (ICD-9 procedure code), Diagnosis Related Group (DRG), dates of service, reimbursement amount, hospital provider, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Skilled Nursing Facility files: The Skilled Nursing Facility (SNF) files contains final action claims data submitted by SNF providers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis and ICD-9 procedure code), dates of service, reimbursement amount, SNF provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Outpatient files: The Outpatient files contain final action claims data submitted by institutional outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, community mental health centers, and ambulatory surgical centers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis, ICD-9 procedure code, CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, outpatient provider number, revenue center codes and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Home Health Agency files: The Home Health Agency (HHA) files contain final action claims data submitted by HHA providers. Some of the information contained in this file includes the number of visits, type of visit (skilled-nursing care, home health aides, physical therapy, speech therapy, occupational therapy, and medical social services), diagnosis (ICD-9 diagnosis), the dates of visits, reimbursement amount, HHA provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Hospice files: The Hospice files contain final action claims data submitted by Hospice providers. Some of the information contained in this file includes the level of hospice care received (e.g., routine home care, inpatient respite care), terminal diagnosis (ICD-9 diagnosis), the dates of service, reimbursement amount, Hospice provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Non-Institutional Claim Files: The Non-Institutional Claim Files are claims that are submitted on a CMS-1500 form for professional services and supplies. The claim level files represent the variables found at the claim level, such as total claim payment amount, provider/supplier state, or beneficiary state. Click here for data documentation.
Non-Institutional Line Files: The Non-Institutional Claim Files are claims that are submitted on a CMS-1500 form for professional services and supplies. The non-institutional line files represent the information that can occur multiple times on a claim, such as HCPCS or diagnosis codes.
Carrier files: The Carrier files (old file name Physician/Supplier Part B) contain final action claims data submitted by non-institutional providers. Examples of non-institutional providers include physicians, physician assistants, clinical social workers, nurse practitioners, independent clinical laboratories, ambulance providers, and stand-alone ambulatory surgical centers. Some of the information contained in this file includes diagnosis and procedure (ICD-9 diagnosis, CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, non-institutional provider numbers (e.g., UPIN, PIN), and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Durable Medical Equipment: The Durable Medical Equipment (DME) contains final action claims data submitted by Durable Medical Equipment suppliers. Some of the information contained in this file includes diagnosis, (ICD-9 diagnosis), services provided (CMS Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, DME provider number, and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Minimum Data Set: The Long Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid.
The MDS contains items that measure physical, psychological and psycho-social functioning. The items in the MDS give a multidimensional view of the patient's functional capacities, and can be used to present a nursing home's profile. The MDS now plays a key role in the Medicare and Medicaid reimbursement system and in monitoring the quality of care provided to nursing facility residents. Click here for data documentation.
Outcome and Assessment Information Set: The Home Health Outcome and Assessment Information Set (OASIS) contains data items that were developed for measuring patient outcomes for the purpose of performance improvement in home health care. Medicare certified home care agencies are required to conduct patient-specific comprehensive assessments at specified time points. The data are collected at start of care, 60-day follow-ups, and discharge (and surrounding an inpatient facility stay).
OASIS data items address socio-demographic, environmental, support system, health status, functional status, and health service utilization characteristics of the patient. Click here for data documentation.
Inpatient Rehabilitation Facility Patient Assessment Instrument: The Medicare Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) contains data items that were developed primarily for IRF PPS. However, the data collected will also be used for quality of care purposes. The IRF-PAI will be collected on all Medicare Part A fee-for-service patients who receive services under Part A from an IRF at admission and upon discharge. IRF-PAI data items address the physical, cognitive, functional, and psychosocial status of patients. Click here data documentation.
Swing Bed Minimum Data Set: Data from the Swing bed-MDS will be used to establish the RUG-III groups required for reimbursement under the SNF PPS. Swing bed hospitals are required to complete the SB-MDS for all patients in a Medicare Part A stay who are receiving SNF-level services. The SB-MDS must be completed at set intervals during the swing bed stay. Swing Bed MDS data items address the physical, cognitive, functional, and psychosocial status of patients. Click here for data documentation.
CCW Beneficiary Summary File: This file contains variables that are similar to the Denominator file. The source for the Beneficiary Data File is the Unloaded EDB. This file will be specific to beneficiaries included in requested cohort (and control group, if applicable). The Beneficiary Summary File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. The information in the Beneficiary Summary File is 'frozen' in March of the following calendar year. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/Both), reasons for entitlement, state buy-in indicators, and monthly managed care indicators (yes/no). The Beneficiary Summary File is used to determine beneficiary demographic characteristics, entitlement, and beneficiary participation in Medicare Managed Care Organizations. Click here for data documentation.
CCW Chronic Conditions Summary File: This file contains a flag to indicate if a beneficiary has had any one of the 21 predefined chronic conditions by year. See the data documentation for more information.
CCW 100% Denominator File: The Denominator File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. The information in the Denominator File is 'frozen' in March of the following calendar year. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/Both), reasons for entitlement, state buy-in indicators, and monthly managed care indicators (yes/no). The Denominator File is used to determine beneficiary demographic characteristics, entitlement, and beneficiary participation in Medicare Managed Care Organizations. Click here for data documentation.
CCW 5% Denominator File: The Denominator File contains demographic and enrollment information about each beneficiary enrolled in Medicare during a calendar year. The information in the Denominator File is 'frozen' in March of the following calendar year. Some of the information contained in this file includes the beneficiary unique identifier, state and county codes, zipcode, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/Both), reasons for entitlement, state buy-in indicators, and monthly managed care indicators (yes/no). The Denominator File is used to determine beneficiary demographic characteristics, entitlement, and beneficiary participation in Medicare Managed Care Organizations. Click here for data documentation.
Research Identifiable File (CCW BENE_ID to HIC crosswalk): This file allows a researcher to link the submitted HIC finder file with the CCW Files or link a previous 5% file from CMS with CCW Files.
MCBS to Bene_id crosswalk: This file will allow the researcher to link the MCBS data with the CCW data.
Last Modified October 16, 2008