Beneficiary Summary File Data Dictionary - CCW Version 07/2006 NAME TYPE LENGTH ---------------------------------------- ------ 1. Encrypted 723 Beneficiary CHAR 15 ID A unique CCW beneficiary identifier field (BENE_ID) that is specific to the Chronic Condition Warehouse. This field is encrypted prior to delivery to researchers. The BENE_ID field is used to cross- reference data for each beneficiary across all claim and assessment data files. SHORT NAME: BENE_ID LONG NAME: BENE_ID SOURCE: CCW 2. STATE CODE CHAR 2 THIS FIELD SPECIFIES THE STATE OF RESIDENCE OF THE BENEFICIARY AND IS BASED ON THE MAILING ADDRESS USED FOR CASH BENEFITS OR THE MAILING ADDRESS USED FOR OTHER PURPOSES (FOR EXAMPLE, PREMIUM BILLING). THIS INFORMATION IS MAINTAINED FROM CHANGE OF ADDRESS NOTICES SENT IN BY THE BENEFICIARIES, AND IS APPENDED TO THE RECORD AT TIME OF PROCESSING IN CENTRAL OFFICE. THE CODING SYSTEM IS THE SSA SYSTEM, NOT THE FEDERAL INFORMATION PROCESSING STANDARD (FIPS). sHORT NAME: STATE_CD LONG NAME: STATE_CODE LIMITATIONS: IN SOME CASES, THE CODE MAY NOT BE THE ACTUAL STATE OF RESIDENCE. (FOR EXAMPLE, IF THE BENEFICIARY HAS A REPRESENTATIVE PAYEE). CCW FIELD SOURCE AND DERIVATION: RIC-O; Field Name: BENE_MLG_CNTCT_STATE_CD Use the most recent residence change date where: (1) the change date is equal or prior to 12/31 of the reference year OR (2) the change date is equal or prior to the the beneficiary's date of death (if the beneficiary died in the reference year) If there is no residence record, the state_cd will be left blank. CMS DENOMINATOR DIFFERENCE: The SSA state code at the time of Denominator processing, which normally begins at the end of March of the year following the Denominator reference year. In the Denominator File processing, if there were no Residence records (RIC-O) found for a beneficiary on the EDB, then the beneficiary's SSA state code is set to 99. It is important to note that if the SSA state code is 99 and the SSA county code is '000' for a beneficiary, then the value 99 represents a valid location: American Samoa. 3. COUNTY CODE CHAR 3 THIS CODE SPECIFIES THE SSA CODE FOR THE COUNTY OF RESIDENCE OF THE BENEFICIARY. EACH STATE HAS A SERIES OF CODES BEGINNING WITH '000' FOR EACH COUNTY WITHIN THAT STATE. CERTAIN CITIES WITHIN THAT STATE HAVE THEIR OWN CODE. COUNTY CODES MUST BE COMBINED WITH STATE CODES IN ORDER TO LOCATE THE SPECIFIC COUNTY. THE CODING SYSTEM IS THE SSA SYSTEM, NOT THE FEDERAL INFORMATION PROCESSING SYSTEM (FIPS). SHORT NAME: CNTY_CD LONG NAME: BENE_COUNTY_CD EDIT-RULES: NUMERIC LIMITATIONS: SOME CODES MAY BE INVALID, UNKNOWN, OR '999'. (DIFFERENT FROM FIPS) CCW FIELD SOURCE AND DERIVATION: RIC-O; Field Name: BENE_MLG_CNTCT_CNTY_CD The residence change date is determined as described under state_cd. If the state_cd='05' and the cnty_cd='407', the cnty_cd = '470'. If there is no residence record, the cnty_cd='999' If the state_cd='99' and the cnty_cd is not equal to '000', the cnty_cd='999' CMS DENOMINATOR DIFFERENCE: The SSA county code of residence of a beneficiary is obtained in the same manner as the beneficiary's state code described above. If the state_cd='05' and the cnty_cd = '210', the cnty_cd = '200'. If there were no Residence records (RIC-O) found for a beneficiary on the EDB, or if the county code for the residence is unknown, then the beneficiary's SSA county code is set to '999'. 4. ZIP CODE OF RESIDENCE CHAR 9 THIS FIELD SPECIFIES THE ZIP CODE AND IS BASED UPON THE MAILING ADDRESS USED FOR CASH BENEFITS TO THE BENEFICIARY OR FOR OTHER PURPOSES (E.G., PREMIUM BILLING). 9 DIGITS SHORT NAME: BENE_ZIP LONG NAME: BENE_ZIP_CD EDIT-RULES: 9-DIGIT ZIP 5-DIGIT ZIP - ZERO BACK FILLED 3-DIGIT ZIP - ALL NINES NO ZIP - ALL ZEROS COMMENT: CODES IDENTIFY POSTAL SERVICE AREAS WITHIN THE U.S.A. BUT DO NOT NECESSARILY ADHERE TO BOUNDARIES OF CITIES, COUNTIES, STATES, OR OTHER JURISDICTIONS. THE CODE IS APPENDED TO THE RECORD AT TIME OF PROCESSING IN CENTRAL OFFICE. THE FIRST THREE POSITIONS OF THE ZIP CODE REPRESENT A PARTICULAR SECTIONAL POSTAL CENTER OR A METROPOLITAN CITY. THE FOLLOWING TWO DIGITS REPRESENT THE ASSOCIATED POST POST OFFICE SERVED BY THE POSTAL CENTER OR THE DELIVERY AREA SERVED BY THE POSTAL STATION. LIMITATIONS: ZIP CODE MAY NOT CORRESPOND WITH STATE OF RESIDENCE. CCW FIELD SOURCE AND DERIVATION: RIC-O; Field Name: BENE_MLG_CNTCT_ZIP_CD The residence change date is determined as described under state_cd. If bene_zip is missing, bene_zip='999999999', If the last 4-digits of bene_zip are missing (and the first 5 are populated), the last 4-digits are set to '0000' CMS DENOMINATOR DIFFERENCE: Primary = RIC-O; Field Name: BENE_MLG_CNTCT_ZIP_CD Secondary = RIC-A; Field Name: BENE_MLG_CNTCT_ZIP_CD The zip code of residence of a beneficiary is obtained in the same manner as the beneficiary's state and county codes described above. If a left-justified three-position zip code for the beneficiary on the EDB (indicating a foreign consular code) is encountered in the Denominator processing, the zip codes for the Denominator records are set to '999999999'. If there were no Residence records (RIC-O) found for a beneficiary on the EDB, then the beneficiary's zip code is taken from their Active Beneficiary Identification Data (RIC-A) record from the EDB. 5. DATE OF BIRTH DATE 8 THIS DATE SPECIFIES THE BENEFICIARY'S DATE OF BIRTH. 8 DIGITS SHORT NAME: BENE_DOB LONG NAME: BENE_BIRTH_DT EDIT-RULES: YYYYMMDD CCW FIELD SOURCE AND DERIVATION: RIC-A; Field Name: BENE_BIRTH_DT If a beneficiary’s date of birth on the UEDB is spaces or zeros, then the beneficiary’s date of birth on the Beneficiary Summary is recorded as missing. Otherwise, the value of the birth date in the input is stored into this field. CMS DENOMINATOR DIFFERENCE: If a beneficiary’s date of birth on the UEDB is spaces or zeros, then the beneficiary’s date of birth on the Denominator is recorded as all zeroes. Otherwise, the value of the birth date in the input is stored into this field. 6. SEX CHAR 1 THIS FIELD INDICATES THE SEX OF THE BENEFICIARY. SHORT NAME: SEX LONG NAME: BENE_SEX_IDENT_CD CODES: 0 = UNKNOWN 1 = MALE 2 = FEMALE CCW FIELD SOURCE AND DERIVATION: RIC-A; Field Name: BENE_SEX_IDENT_CD No derivation performed. CMS DENOMINATOR DIFFERENCE: If neither '1' or '2' was found in the beneficiary input data and the beneficiary's age is less than 65, the sex code is assigned '1', otherwise, if the beneficiary's age is greater than 64, the sex code is assigned a '2'. 7. BENEFICIARY RACE CODE CHAR 1 THE RACE OF A BENEFICIARY. SHORT NAME: RACE LONG NAME: BENE_RACE_CD CODES: 0 = UNKNOWN 1 = WHITE 2 = BLACK 3 = OTHER 4 = ASIAN 5 = HISPANIC 6 = NORTH AMERICAN NATIVE SQL-INFO: CHAR(1) NOT NULL CCW FIELD SOURCE AND DERIVATION: RIC-A; Field Name: BENE_RACE_CD No derivation performed. If BENE_RACE is missing, then BENE_RACE='0' 8. AGE NUM 3 BENEFICIARY'S AGE AT END OF THE REFERENCE YEAR. IN THE EVENT THAT THE BENEFICIARY EXPIRED DURING THE REFERENCE YEAR, THE AGE AT DATE OF DEATH IS USED. THIS DATE IS VERIFIED USING BOTH THE DATE OF DEATH AND VALID DATE OF DEATH INDICATOR SWITCH FROM THE CMS 100% DENOMINATOR FILE. 3 DIGITS CODES: AGE > 115, CODED AS 115 CCW FIELD SOURCE AND DERIVATION: Primary = Beneficiary Summary File Processing Calculation, Including Beneficiary Year of Birth as given on the UEDB and the Reference Year of the Beneficiary Summary File being created. If Age>115, Age=115 (maximum age allowed) If Age<0, Age=missing (erroneous date of birth) If the beneficiary died during the reference year, the beneficiary's birth date is substracted from the beneficiary's death date to calculate age, if the beneficiary is alive, the beneficiary's date of birth is substracted from 12/31 of the reference year to calculate the beneficiary's age CMS DENOMINATOR DIFFERENCE: Secondary Processing: 1) RIC-J; Field Name: BENE_ENTLMT_RSN_CD 2) RIC-A; Field Name: BENE_MDCR_STUS_CD If Age >= 98, Age=98 (maximum age allowed). The date of birth given by the input file is used to determine this field value. If the input file does not provide a valid date of birth for a beneficiary, then the following rules are used to set the beneficiary's age: (1) If there is no recorded entitlement history and no recorded Medicare status history information found in the EDB for the beneficiary, then the value in this field is set to 65. (2) If there is entitlement reason history found but no Medicare status code history found in the EDB, and if the latest entitlement reason history indicates that the beneficiary's reason for entitlement is not 'aged', then the value in this field is set to 62. (3) If there is Medicare status code history found for the beneficiary but no entitlement reason history for the beneficiary has been found from the EDB, and if the latest Medicare status code history indicates that the beneficiary's Medicare status was not 'aged' or 'aged with ESRD', then the value of thisfield is set to 62. (4) If none of 1, 2, or 3 above applies to the beneficiary, then the value in this field is set to 65. 9. ORIGINAL REASON FOR CHAR 1 ENTITLEMENT CODE THIS FIELD INDICATES THE REASON FOR THE BENEFICIARY'S ORIGINAL ENTITLEMENT TO MEDICARE BENEFITS. SHORT NAME: OREC LONG NAME: BENE_ENTLMT_RSN_ORIG CODES: 0 = OLD AGE AND SURVIVORS INSURANCE (OASI) 1 = DISABILITY INSURANCE BENEFITS (DIB) 2 = ESRD 3 = BOTH DIB AND ESRD CCW FIELD SOURCE AND DERIVATION: RIC-J; Field Name: BENE_ENTLMT_RSN_CD Uses the first (oldest) entitlement reason code for a beneficiary. (1) If a least 2 records of entitlement history are found on the UEDB, then the earliest dated record is used to set this field, while the latest dated record of entitlement (prior to the end of the reference year or date of death if beneficiary died during the reference year) is used to set Current Entitlement Reason Code (CREC). (2) If only 1 record of entitlement for the beneficiary is found on the UEDB, then that one record is used to set both the OREC and CREC. (3) If no record of entitlement history was found on the UEDB, then: (i) If Beneficiary's Age >= 65, then this field and CREC are set to '0' (ii) If Beneficiary's Age < 65 and NO recorded ESRD history on the UEDB has been found, then this field and CREC are set to '1' (iii) If Beneficiary's Age < 65 and the beneficiary was found to have ESRD during the reference year, then both this field and CREC are set to '3'. 10. CURRENT REASON FOR CHAR 1 ENTITLEMENT CODE THIS FIELD INDICATES THE REASON FOR THE BENEFICIARY'S CURRENT ENTITLEMENT TO MEDICARE BENEFITS. SHORT NAME: CREC LONG NAME: BENE_ENTLMT_RSN_CURR CODES: 0 = OLD AGE AND SURVIVOR'S INSURANCE (OASI) 1 = DISABILITY INSURANCE BENEFITS (DIB) 2 = ESRD 3 = DIB AND ESRD CCW FIELD SOURCE AND DERIVATION: RIC-J; Field Name: BENE_ENTLMT_RSN_CD Uses the most current entitlement reason code for a beneficiary (during or prior to the reference year). (1) If a least two records of entitlement history are found on the UEDB, then the earliest dated record is used to set OREC, while the latest dated record of entitlement (prior to the end of the reference year or date of death if beneficiary died during the reference year) is used to set this field. (2) If only one record of entitlement for the beneficiary is found on the UEDB, then that one record is used to set both the OREC and CREC. (3) If no record of entitlement history was found on the UEDB, then: (i) If Beneficiary's Age >= 65, then this field and OREC are set to '0' (ii) If Beneficiary's Age < 65 and NO recorded ESRD history on the UEDB has been found, then this field and OREC are set to '1' (iii) If Beneficiary's Age < 65 and the beneficiary was found to have ESRD during the reference year, then both this field and OREC are set to '3'. 11. END STAGE RENAL DISEASE CHAR 1 INDICATOR (ESRD) THIS FIELD SPECIFIES THAT A BENEFICIARY IS AFFLICTED WITH END STAGE RENAL DISEASE (ESRD). SHORT NAME: ESRD_IND LONG NAME: BENE_ESRD_IND CODES: EFFECTIVE 1992 Y = THE BENEFICIARY HAS ESRD 0 = THE BENEFICIARY DOES NOT HAVE ESRD CCW FIELD SOURCE AND DERIVATION: RIC-S; Field Name: BENE_ESRD_CVRG_STRT_DT and BENE_ESRD_CVRG_TRMNTN_DT This field is set to 'Y' if ESRD history during any part of the reference year was found for the beneficiary on the UEDB. If no such history of the ESRD was found, then the field is set to '0'. 12. MEDICARE STATUS CODE CHAR 2 THIS FIELD SPECIFIES THE REASON FOR THE BENEFICIARY'S ENTITLEMENT. SHORT NAME: MS_CD LONG NAME: BENE_MDCR_STUS_CD CODES: 10 = AGED WITHOUT ESRD 11 = AGED WITH ESRD 20 = DISABLED WITHOUT ESRD 21 = DISABLED WITH ESRD 31 = ESRD ONLY CCW FIELD SOURCE AND DERIVATION: RIC-X; Field Name: BENE_MDCR_STUS_CD This field is determined either by the most recently recorded Medicare Status Code (MSC) history found for the beneficiary on the UEDB prior to the end of the reference year or date of death if the beneficiary died during the reference year, or it is derived from the Beneficiary Age and ESRD Indicator. The following ordered rules determine the value for this field: (1) If there was recorded MSC history, then the MSC of the most recently recorded history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) gives the value for this field (2) If no recorded MSC history was found from the UEDB, then: (a) If Beneficiary's Age >= 65, then MSC = '10' (b) If Beneficiary's Age < 65, then MSC = '20' (c) If ESRD Indicator = 'Y', then the 2nd digit becomes a '1' (e.g., '10' becomes '11', '20' becomes '21') (3) If Beneficiary's Age >= 65 and the 1st digit of this field is a '2' or '3', then the 1st digit is changed to '1' (e.g., '20' becomes '10') (4) If Beneficiary's Age < 65 and the 1st digit of this field is a '1', then the 1st digit is changed to '2' (e.g., '10' becomes '20', '11' becomes '21') 13. PART A TERMINATION CODE CHAR 1 THIS CODE SPECIFIES THE REASON PART A ENTITLEMENT WAS TERMINATED. SHORT NAME: A_TRM_CD LONG NAME: BENE_PTA_TRMNTN_CD CODES: EFFECTIVE 1992 0 = NOT TERMINATED 1 = DEAD 2 = NON-PAYMENT OF PREMIUM 3 = VOLUNTARY WITHDRAWAL 9 = OTHER TERMINATION CCW FIELD SOURCE AND DERIVATION: Denominator Field #24 (Beneficiary Validated Day of Death Indicator) RIC-C; Field Name: BENE_PTA_ENTLMT_STUS_CD The Medicare Part A Entitlement Termination Reason Code value for this field is determined either by the most recent Medicare Part A history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) found for the beneficiary on the UEDB, or it is derived from Beneficiary Validated Day of Death Indicator. The following ordered rules determine the value for this field: (1) The default value for this field is ‘0.’ If this field is not modified by any of the following rules, then the value of this field will remain ‘0’, (2) If Beneficiary Validated Day of Death Indicator is set to ‘V’ (beneficiary has a validated day of death), then this field is set to ‘1’, (3) If Beneficiary Validated Day of Death Indicator has no value (i.e., the field is blank, because the beneficiary does not have a validated day of death), then the following rules are applied to this field: (a) If there is no recorded history of Medicare Part A found for the beneficiary on the UEDB, this field keeps the value ‘0’ assigned in step (1), (b) If recorded Medicare Part A history for the beneficiary is found on the UEDB, then the following rules are applied to this field: (i) If the Medicare Part A entitlement status in the most recent Medicare Part A history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) is ‘T’ (Terminated for Non- Payment of Premiums), then this field is set to ‘2’, (ii) If the Medicare Part A entitlement status in the most recent Medicare Part A history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) is ‘W’ (Voluntary Withdrawal from Premium Coverage), then this field is set to ‘3’, (iii) If the Medicare Part A entitlement status in the most recent Medicare Part A history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) is ‘C’ (No Longer Entitled Due to Disability Cessation), ‘F’ (Terminated Due to Invalid Enrollment or Enrollment Voided), ‘S’ (Terminated, No Longer Entitled Under ESRD Provision), or ‘X’ (Free Part A Terminated or Refused Hospital Insurance), then this field is set to ‘9.’ 14. PART B TERMINATION CHAR 1 THIS CODE SPECIFIES THE REASON PART B ENTITLEMENT WAS TERMINATED. SHORT NAME: B_TRM_CD LONG NAME: BENE_PTB_TRMNTN_CD CODES: EFFECTIVE 1992 0 = NOT TERMINATED 1 = DEAD 2 = NON-PAYMENT OF PREMIUM 3 = VOLUNTARY WITHDRAWAL 9 = OTHER TERMINATION CCW FIELD SOURCE AND DERIVATION: Denominator Field #24 (Beneficiary Validated Day of Death Indicator) RIC-D; Field Name: BENE_PTB_ENTLMT_STUS_CD The Medicare Part B Entitlement Termination Reason Code value for this field is determined either by the most recent record Medicare Part B history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) found for the beneficiary on the UEDB, or it is derived from Beneficiary Validated Day of Death Indicator. The following ordered rules determine the value for this field: (1) The default value for this field is ‘0.’ If this field is not modified by any of the following rules, then the value of this field will remain ‘0.’ (2) If Beneficiary Validated Day of Death Indicator) is set to ‘V’ (beneficiary has a validated day of death), then this field is set to ‘1.’ (3) If Beneficiary Validated Day of Death Indicator has no value (i.e., the field is blank, because the beneficiary does not have a validated day of death), then the following rules are applied to this field: (a) If there is no recorded history of Medicare Part B found for the beneficiary on the UEDB, this field keeps the value ‘0’ assigned in step (1). (b) If recorded Medicare Part B history for the beneficiary is found on the UEDB, then the following rules are applied to this field: (i) If the Medicare Part B entitlement status in the most recent Medicare Part B (prior to the end of the reference year or date of death if the beneficiary died during the reference year) history is ‘T’ (Terminated for Non- Payment of Premiums), then this field is set to ‘2’. (ii) If the Medicare Part B entitlement status in the most recent Medicare Part B history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) is ‘W’ (Voluntary Withdrawal from Premium Coverage), then this field is set to ‘3.’ (iii) If the Medicare Part B entitlement status in the most recent Medicare Part B history (prior to the end of the reference year or date of death if the beneficiary died during the reference year) is ‘C’ (No Longer Entitled Due to Disability Cessation), ‘F’ (Terminated Due to Invalid Enrollment or Enrollment Voided), ‘S’ (Terminated, No Longer Entitled Under ESRD Provision), or ‘X’ (Code Definition N/A), then this field is set to ‘9’. 15. MEDICARE ENTITLEMENT/BUY-IN CHAR 1 INDICATOR OCCURS: 12 TIMES SHORT NAME: BUYIN01 (THROUGH BUYIN12) LONG NAME: BENE_MDCR_ENTLMT_BUYIN_IND_01 (THROUGH BENE_MDCR_ENTLMT_BUYIN_IND_12) CODES: 0 = NOT ENTITLED 1 = PART A ONLY 2 = PART B ONLY 3 = PART A AND PART B A = PART A, STATE BUY-IN B = PART B, STATE BUY-IN C = PARTS A AND B, STATE BUY-IN CCW FIELD SOURCE AND DERIVATION: RIC-C; Field Name: BENE_PTA_ENTLMT_STRT_DT and BENE_PTA_ENTLMT_TRMNTN_DT RIC-D; Field Name: BENE_PTB_ENTLMT_STRT_DT and BENE_PTB_ENTLMT_TRMNTN_DT RIC-2; Field Name: BENE_TP_PTB_STRT_DT and BENE_TP_PTB_STOP_DT and (BENE_TP_PTB_PRM_PYR_CD in ('010', '020', '030', '040', '050', '060', '070', '080', '090', '100', '110', '120', '130', '140', '150', '160', '170', '180', '190', '200', '210', '220', '22A', '230', '240', '250', '260', '270', '280', '290', '300', '310', '320', '330', '340', '350', '360', '370', '380', '390', '400', '410', '420', '430','440','450', '460','470','480','490','500', '510','520','530','640','650') Each byte of this field represents a month of the Beneficiary Summary reference year. For example, the 1st byte represents Beneficiary Summary reference year month January, the 2nd byte represents Beneficiary Summary reference year month February, and so on until the 12th byte, which represents Beneficiary Summary reference year month December. Each monthly indicator takes the value of one of the code set listed in the Beneficiary Summary File data dictionary. If the beneficiary did not have recorded Beneficiary 3rd Party Part B coverage during a given month of the Beneficiary Summary reference year, then that month is coded ‘0.’ In the processing and determination of the values in this field, only state buy-in for Medicare Part B is considered. The state buy-in information for Medicare Part A is not considered due to the assumed low number of beneficiaries that have state buy-in for Medicare Part A. It is assumed, therefore, that if a beneficiary is documented as having state buy-in for Medicare Part B then the state is also buying in for that beneficiary’s Medicare Part A as well if the beneficiary does not have the necessary credits or work experience for free Medicare Part A (as the majority of the beneficiary population has free Medicare Part A). CMS DENOMINATOR DIFFERENCE: RIC-C; Field Name: BENE_PTA_ENTLMT_STRT_DT and BENE_PTA_ENTLMT_TRMNTN_DT RIC-D, Field Name: BENE_PTB_ENTLMT_STRT_DT and BENE_PTB_ENTLMT_TRMNTN_DT Third Party Master File, RIC-M; Field Name: TP_ACCRET_EFF_DT, TP_DELETE_EFF_DT, and TP_AGENCY_CD 16. HMO INDICATOR CHAR 1 CODE INDICATING BENEFICIARY HAS MEMBERSHIP IN HEALTH MAINTENANCE ORGANIZATION. OCCURS: 12 TIMES SHORT NAME: HMOIND01 (THROUGH HMOIND12) LONG NAME: BENE_HMO_IND_01 (THROUGH BENE_HMO_IND_12) CODES: EFFECTIVE 1992 0 = NOT A MEMBER OF HMO 1 = NON LOCK-IN, HCFA TO PROCESS PROVIDER CLAIMS 2 = NON LOCK-IN, GHO TO PROCESS IN-PLAN PART A AND IN-AREA PART B CLAIMS A = LOCK-IN, HCFA TO PROCESS PROVIDER CLAIMS B = LOCK-IN, GHO TO PROCESS IN-PLAN PART A AND IN-AREA PART B CLAIMS C = LOCK-IN, GHO TO PROCESS ALL PROVIDER CLAIMS CCW FIELD SOURCE AND DERIVATION: RIC-H; Field Name: BENE_GHO_ENRLMT_STRT_DT, BENE_GHO_DISENRLMT_DT, and BENE_GHO_LKIN_PMT_OPTN_CD Each byte of this field represents a month of the Beneficiary Summary reference year. For example, the first byte represents Beneficiary Summary reference year month January, the second byte represents Beneficiary Summary reference year month February, and so on until the twelfth byte, which represents Beneficiary Summary reference year month December. Each monthly indicator takes the value of one of the code set listed in the Beneficiary Summary File data dictionary. If the beneficiary did not have recorded coverage during a given month of the Beneficiary Summary reference year, then that month is coded ‘0.’ 17. HI COVERAGE CHAR 2 TOTAL NUMBER OF MONTHS OF PART A COVERAGE SHORT NAME: A_MO_CNT LONG NAME: BENE_HI_CVRAGE_TOT_MONS 2 DIGITS CCW FIELD SOURCE AND DERIVATION: RIC-C; Field Name: BENE_PTA_ENTLMT_STRT_DT and BENE_PTA_ENTLMT_TRMNTN_DT The value in this field will be within the valid range of values ‘00’ through ‘12,’ inclusive. The value of this field is derived in the Beneficiary Summary File processing through examination of the valid Medicare Part A coverage period(s) found for the beneficiary that has/have at least one month overlapping the time-span of the Beneficiary Summary File reference year. Only those months occurring during the Beneficiary Summary reference year are counted. 18. SMI COVERAGE CHAR 2 TOTAL NUMBER OF MONTHS OF PART B COVERAGE SHORT NAME: B_M0_CNT LONG NAME: BENE_SMI_CVRAGE_TOT_MONS 2 DIGITS CCW FIELD SOURCE AND DERIVATION: RIC-D; Field Name: BENE_PTB_ENTLMT_STRT_DT and BENE_PTB_ENTLMT_TRMNTN_DT The value in this field will be within the valid range of values ‘00’ through ‘12,’ inclusive. The value of this field is derived in the Beneficiary Summary File processing through examination of the valid Medicare Part B coverage period(s) found for the beneficiary that has/have at least one month overlapping the time-span of the Beneficiary Summary File reference year. Only those months occurring during the Beneficiary Summary reference year are counted. 19. HMO COVERAGE CHAR 2 TOTAL NUMBER OF MONTHS OF HMO COVERAGE. SHORT NAME: HMO_MO LONG NAME: BENE_HMO_CVRAGE_TOT_MONS 2 DIGITS CCW FIELD SOURCE AND DERIVATION: RIC-H; Field Name: BENE_GHO_ENRLMT_STRT_DT and BENE_GHO_DISENRLMT_DT The value in this field will be within the valid range of values ‘00’ through ‘12,’ inclusive. The value of this field is derived in the Beneficiary Summary File processing through examination of the valid HMO coverage period(s) found for the beneficiary that has/have at least one month overlapping the time-span of the Beneficiary Summary File reference year. Only those months occurring during the Beneficiary Summary reference year are counted. 20. STATE BUY-IN COVERAGE CHAR 2 TOTAL NUMBER OF MONTHS OF STATE BUY-IN. SHORT NAME: BUYIN_MO LONG NAME: BENE_STATE_BUYIN_TOT_MONS 2 DIGITS CCW FIELD SOURCE AND DERIVATION: RIC-2; Field Name: BENE_TP_PTB_STRT_DT and BENE_TP_PTB_STOP_DT and (BENE_TP_PTB_PRM_PYR_CD in ('010', '020', '030', '040', '050', '060', '070', '080', '090', '100', '110', '120', '130', '140', '150', '160', '170', '180', '190', '200', '210', '220', '22A', '230', '240', '250', '260', '270', '280', '290', '300', '310', '320', '330', '340', '350', '360', '370', '380', '390', '400', '410', '420', '430','440', '450','460','470','480','490','500','510','520','530','640','650') The value in this field will be within the valid range of values ‘00’ through ‘12,’ inclusive. The value of this field is derived in the Beneficiary Summary File processing through examination of the documented state buy-in coverage period(s) found for the beneficiary that has/have at least one month overlapping the time-span of the Beneficiary Summary File reference year. Only those months occurring during the Beneficiary Summary reference year are counted. CMS DENOMINATOR DIFFERENCE: Third Party Master File, RIC-M; Field Name: TP_ACCRET_EFF_DT and TP_DELETE_EFF_DT 21. VALID DATE OF DEATH SWITCH CHAR 2 SHORT NAME: V_DOD_SW LONG NAME: BENE_VALID_DEATH_DT_SW CODES: V = VALID DEATH DATE BLANK = DEFAULT CCW FIELD SOURCE AND DERIVATION: RIC-A, Field Name: VRFY_BENE_DEATH_DAY_SW This field will have either a value of ‘V’ or space (blank). By indicating that the beneficiary’s day of death has been verified, this field does not refer to the month or year but the specific day of the month. A non-verified day of death may occur within the accurate month and year of the beneficiary’s death, but the exact day of the month is not confirmed as being accurate. 22. DATE OF DEATH DATE 8 THIS FIELD INDICATES THE DATE OF DEATH OF THE BENEFICIARY. 8 DIGITS SHORT NAME: DEATH_DT LONG NAME: BENE_DEATH_DT EDIT-RULES: YYYYMMDD ZEROS = NOT APPLICABLE IF DAY OF DEATH IS UNKNOWN, CODED AS LAST DAY OF MONTH CCW FIELD SOURCE AND DERIVATION: RIC-A; Field Name: BENE_DEATH_DT If a beneficiary’s date of death on the UEDB is filled with spaces or zeros, then the beneficiary’s date of death on the Beneficiary Summary is recorded as missing. Otherwise, the value of the death date in the input is stored in this field. When the actual day of death is known, the death date is the last day of the death month. Please refer to the Beneficiary Validated Day of Death Indicator for further details on verified day of death. 23. BENEFICIARY ENROLLMENT NUM 2 REFERENCE YEAR ENROLLMENT YEAR THIS FIELD INDICATES THE REFERENCE YEAR OF ENROLLMENT OF THE BENEFICIARY. 2 DIGITS STANDARD ALIAS: BENE_ENRLMT_RFRNC_YR EDIT-RULES: YY 24. CMS 5% SAMPLE FLAG NUM 1 A flag indicating whether the beneficiary was included in the CMS 5% Denominator File for the reference year. This flag distinguishes between the beneficiaries that are part of the CMS annual 5% and those that are included as part of the ever-enrolled Chronic Condition Warehouse (previously or subsequently a part of the CMS annual 5%, but not for the reference year). The presence of this flag allows researchers to extrapolate data from the 5% sample. SHORT NAME: FIVEPCT LONG NAME: FIVEPCT CODES: 1 = Included in CMS 5% Denominator File 0 = Not included in CMS 5% Denominator File ************************************************************