Bene Summary File - CCW Version (January 2010) If associated CCW data is read into a SAS version 6.x environment, the "SHORT NAMES" will be displayed in the output file. If associated CCW data is read into a SAS version 8.x environment, the "LONG NAMES" will be displayed in the output file. 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 NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS. FOR RRB BENEFICIARIES, THE STATE IS CODED IN SSA BASED ON MAILING ADDRESS. LIMITATIONS: IN SOME CASES, THE CODE MAY NOT BE THE ACTUAL STATE OF RESIDENCE. (FOR EXAMPLE, IF THE BENEFICIARY HAS A REPRESENTATIVE PAYEE). NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: 'GEOGRAPHIC CODE MANUAL FOR STATE AND COUNTY OF RESIDENCE' PRODUCED BY THE SSA. LIMITATIONS: SOME CODES MAY BE INVALID, UNKNOWN, OR '999'. (DIFFERENT FROM FIPS) NAME TYPE LENGTH ------------------------------------- ------ 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). 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. SOURCE: EDB LIMITATIONS: ZIP CODE MAY NOT CORRESPOND WITH STATE OF RESIDENCE. NAME TYPE LENGTH ------------------------------------- ------ 5. Date of Birth DATE 8 THIS DATE SPECIFIES THE BENEFICIARY'S DATE OF BIRTH. SHORT NAME: BENE_DOB LONG NAME: BENE_BIRTH_DT EDIT-RULES: YYYYMMDD SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS NAME TYPE LENGTH ------------------------------------- ------ 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 NAME TYPE LENGTH ------------------------------------- ------ 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 NAME TYPE LENGTH ------------------------------------- ------ 8. Age NUM 3 BENEFICIARY'S AGE AT END OF REFERENCE YEAR. SHORT NAME: AGE LONG NAME: BENE_AGE_AT_END_REF_YR CODES: MAXIMUM AGE IS 115 NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: ENROLLMENT DATA BASE NAME TYPE LENGTH ------------------------------------- ------ 11. ESRD Indicator CHAR 1 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 NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: THIS FIELD IS CODED FROM AGE, ORIGINAL REASON FOR ENTITLEMENT, CURRENT REASON FOR ENTITLEMENT AND ESRD INDICATOR CONTAINED IN THE ENROLLMENT DATA BASE AT THE CENTRAL OFFICE AT THE DATE OF PROCESSING. NAME TYPE LENGTH ------------------------------------- ------ 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 SOURCE: ENROLLMENT DATA BASE NAME TYPE LENGTH ------------------------------------- ------ 14. Part B Termination Code 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 SOURCE: ENROLLMENT DATA BASE NAME TYPE LENGTH ------------------------------------- ------ 15. Medicare Entitlement/ CHAR 1 Buy-In Indicator Indicates for each month of the denominator reference year, the entitlement of the beneficiary to Medicare Part A, Medicare Part B, or Medicare Parts A and B both, as well as whether or not the beneficiary's state of residence was liable and paid for the beneficiary's Medicare Part B monthly premiums 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 NAME TYPE LENGTH ------------------------------------- ------ 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 4 = Fee-for-service participant in case or disease management demonstration project (effective 2005 forward) 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’. NAME TYPE LENGTH ------------------------------------- ------ 17. HI Coverage Count CHAR 2 TOTAL NUMBER OF MONTHS OF PART A COVERAGE SHORT NAME: A_MO_CNT LONG NAME: BENE_HI_CVRAGE_TOT_MONS NAME TYPE LENGTH ------------------------------------- ------ 18. SMI Coverage Count CHAR 2 TOTAL NUMBER OF MONTHS OF PART B COVERAGE SHORT NAME: B_MO_CNT LONG NAME: BENE_SMI_CVRAGE_TOT_MONS NAME TYPE LENGTH ------------------------------------- ------ 19. Managed Care and Non-FFS CHAR 2 Demo Coverage Count TOTAL NUMBER OF MONTHS OF HMO COVERAGE. SHORT NAME: HMO_MO LONG NAME: BENE_HMO_CVRAGE_TOT_MONS NAME TYPE LENGTH ------------------------------------- ------ 20. State Buy-In Coverage CHAR 2 Count TOTAL NUMBER OF MONTHS OF STATE BUY-IN. SHORT NAME: BUYIN_MO LONG NAME: BENE_STATE_BUYIN_TOT_MONS NAME TYPE LENGTH ------------------------------------- ------ 21. Valid Date of Death Switch CHAR 2 Indicates that a beneficiary's day of death has been verified (by SSA or the RRB) as the exact day of the beneficiary becoming deceased. SHORT NAME: V_DOD_SW LONG NAME: BENE_VALID_DEATH_DT_SW CODES: V = VALID DEATH DATE BLANK = DEFAULT NAME TYPE LENGTH ------------------------------------- ------ 22. Date of Death DATE 8 THIS FIELD INDICATES THE DATE OF DEATH OF THE BENEFICIARY. SHORT NAME: DEATH_DT LONG NAME: BENE_DEATH_DT EDIT-RULES: YYYYMMDD NAME TYPE LENGTH ------------------------------------- ------ 23. Beneficiary Enrollment NUM 4 Reference Year THIS FIELD INDICATES THE REFERENCE YEAR OF ENROLLMENT OF THE BENEFICIARY. SHORT NAME: RFRNC_YR LONG NAME: BENE_ENROLLMT_REF_YR EDIT-RULES: YYYY NAME TYPE LENGTH ------------------------------------- ------ 24. CMS 5% Sample Flag CHAR 1 A flag indicating whether the beneficiary was included in the CMS 5% Denominator File for the reference year. SHORT NAME: FIVEPCT LONG NAME: FIVE_PERCENT_FLAG CODES: Y = Included in CMS 5% Denominator File Null = Not included in CMS 5% Denominator File NAME TYPE LENGTH ------------------------------------- ------ 25. Enhanced (CCW) 5% CHAR 1 Sample Flag A flag indicating whether the beneficiary was included in the enhanced CCW 5% sample (i.e., once in, always in). 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. SHORT NAME: EFIVEPCT LONG NAME: ENHANCED_FIVE_PERCENT_FLAG CODES: Y = Included in enhanced 5% sample Null = Not included in enhanced 5% sample NAME TYPE LENGTH ------------------------------------- ------ 26. Unequated Beneficiary CHAR 2 Identification Code This code specifies the type of beneficiary for cash payment programs and identifies the type of relationship between the individual and primary beneficiary when the individual is qualified under another’s account. SHORT NAME: CRNT_BIC LONG NAME: CRNT_BIC_CD ********************************************************************* PART D VARIABLES (ONLY INCLUDED WITH PART D BENEFICIARY SUMMARY FILE) ********************************************************************* NAME TYPE LENGTH -------------------------------------- ------ ------ On/Off Creditable Coverage Switch CHAR 1 Indicates for the Denominator reference year, the presence or absence of creditable coverage status. X = Enrolled in Medicare A and/or B, but no MIIR record for the year 0 = No instances of any creditable coverage status switch being "ON" at any point during the year 1 = For at least 1 month during the year, 1 out of 5 creditable coverage switches was "ON". Therefore, the beneficiary was enrolled in at least 1 of 5 creditable coverage categories (i.e., FEHB, Tricare, VA, SPAP, or working aged). SHORT NAME: CRDCOVSW LONG NAME: CRDTBL_CVRG_SW NAME TYPE LENGTH ----------------------------------- ------ Cost Share Group CHAR 2 Code indicating beneficiary liability of cost-sharing. OCCURS: 12 TIMES SHORT NAME: CSTSHR01 - CSTSHR12 LONG NAME: CST_SHR_GRP_CD_01 - CST_SHR_GRP_CD_12 00 = Not Medicare enrolled for the month XX = Enrolled in Medicare A and/or B, but no MIIR record for the month Enrolled in Medicare A and/or B and enrolled in Part D and: 01 = Bene is deemed with 100% premium-subsidy and no copayment 02 = Bene is deemed with 100% premium-subsidy and low copayment 03 = Bene is deemed with 100% premium-subsidy and high copayment 04 = Bene with LIS, 100% premium-subsidy and high copayment 05 = Bene with LIS, 100% premium-subsidy and 15% copayment 06 = Bene with LIS, 75% premium-subsidy and 15% copayment 07 = Bene with LIS, 50% premium-subsidy and 15% copayment 08 = Bene with LIS, 25% premium-subsidy and 15% copayment 09 = No premium subsidy nor cost sharing Enrolled in Medicare A and/or B, but not Part D enrolled and: 10 = Not enrolled in Part D, but employer is entitled for RDS subsidy 11 = Bene with creditable coverage but no RDS 12 = Not Part D enrolled. No RDS and no creditable coverage 13 = None of the above conditions have been met NAME TYPE LENGTH ----------------------------------- ------ Retiree Drug Subsidy Char 1 Indicators Indicates for each month of the Denominator reference year, whether the employer should be subsidized for the beneficiary. Occurs: 12 times Short name: RDSIND01 - RDSIND12 Long name: RDS_IND_01 - RDS_IND_12 0 = Not Medicare enrolled for the month X = Enrolled in Medicare A and/or B, but no MIIR record for the month Y = Employer subsidized for the retired beneficiary N = No employer subsidization for the retired beneficiary NAME TYPE LENGTH ----------------------------------- ------ State Reported Dual CHAR 2 Eligible Status Code Indicates for each month of the Denominator reference year, the dual eligibility status, if any, for the beneficiary. OCCURS: 12 TIMES SHORT NAME: DUAL_01 - DUAL_12 LONG NAME: DUAL_STUS_CD_01 - DUAL_STUS_CD_12 CODES: 00 = Not Medicare enrolled for the month XX = Enrolled in Medicare A and/or B, but no MIIR record for the month NA = Non-Medicaid 01 = QMB only 02 = QMB and Medicaid coverage including RX 03 = SLMB only 04 = SLMB and Medicaid coverage including RX 05 = QDWI 06 = Qualifying Individuals 08 = Other Dual Eligibles (Non-QMB, SLMB, QWDI, or QI) w/Medicaid coverage including RX 09 = Other Dual Eligibles but without Medicaid coverage 99 = Unknown NAME TYPE LENGTH ----------------------------------- ------ Part D Plan Coverage Num 2 Months Contains the total number of months of Part D plan coverage for the beneficiary. The value in this field will be within the valid range of values '00' through '12', inclusive, dependent on the number of occurrences when the Plan indicators = H, R, S, or E. SHORT NAME: PLNCOVMO LONG NAME: PLAN_CVRG_MOS_NUM NAME TYPE LENGTH ----------------------------------- ------ Retiree Drug Subsidy Num 2 Months Contains the total number of months the employer is entitled to a retiree drug subsidy for the beneficiary. The value in this field will be within the valid range of values of '00' through '12' inclusive, dependent on the number of occurrences where the Retiree Drug Subsidy indicators = Y. Short name: RDSCOVMO Long name: RDS_CVRG_MOS_NUM NAME TYPE LENGTH ----------------------------------- ------ Medicaid Dual Eligible Num 2 Months Contains the total number of months of dual eligibility for the beneficiary. The value in this field will be within the valid range of values '00' through '12', inclusive, dependent on the number of occurrences when the Medicaid Dual Eligible Indicators not equal to '^^'. SHORT NAME: DUAL_MO LONG NAME: DUAL_ELGBL_MOS_NUM NAME TYPE LENGTH ----------------------------------- ------ Research Triangle CHAR 1 Institute Race Code Enhanced race/ethnicity designation based on first and last name algorithms. SHORT NAME: RTI_RACE LONG NAME: RTI_RACE_CD x = Enrolled in Medicare A and/or B, but no MIIR record found; unable to determine RTI Race Code 0 = Unknown 1 = Non-Hispanic White 2 = Black (or African American) 3 = Other 4 = Asian/Pacific Islander 5 = Hispanic 6 = American Indian/Alaska Native NAME TYPE LENGTH ------------------------------------- ------ Encrypted Plan Contract ID CHAR 5 Encrypted, unique number CMS assigns to each contract that a Part D plan has with CMS. This is the final contract to which the beneficiary was assigned at the time of payment reconciliation. The first character of the contract ID is a letter representing the type of plan. SHORT NAME: CNTRCT (CNTRCT01 - CNTRCT12) LONG NAME: PTD_CNTRCT_ID_ (PTD_CNTRCT_ID_01 - PTD_CNTRCT_ID_12) SOURCE: CCW CODES: H = Managed Care Organizations other than Regional PPO R = Regional PPO S = PDP E = Employer-Sponsored (starting January 2007) NAME TYPE LENGTH ------------------------------------- ------ Encrypted Plan Benefit Package ID CHAR 3 Encrypted, unique number CMS assigns to identify a specific plan benefit package within a contract (12 monthly occurrences). SHORT NAME: PBPID (PBPID01 - PBPID12) LONG NAME: PTD_PBP_ID_ (PTD_PBP_ID_01 - PTD_PBP_ID_12) SOURCE: CCW NAME TYPE LENGTH ------------------------------------- ------ Encrypted Segment ID CHAR 3 Encrypted segment number CMS assigns to identify a segment or subdivision of a Part D plan benefit package within a contract (12 monthly occurrences). SHORT NAME: SGMTID (SGMTID01 - SGMTID12) LONG NAME: PTD_SGMT_ID_ (PTD_SGMT_ID_01 - PTD_SGMT_ID_12) SOURCE: CCW