Medicare Data File Descriptions
Inpatient SAF: The Inpatient SAF contains 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 SAF: The Skilled Nursing Facility (SNF) SAF 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 SAF: The Outpatient SAF contains 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, and community mental health 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 SAF: The Home Health Agency (HHA) SAF contains 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.
Carrier SAF: The Carrier SAF (old file name Physician/Supplier Part B) contains 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 free-standing 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, NPI), and beneficiary demographic information. Each observation in this file is at the claim level. Click here for data documentation.
Hospice SAF: The Hospice SAF contains 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.
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.
MedPAR File: The MedPAR File contains inpatient hospital and skilled nursing facility (SNF) final action stay records. Each MedPAR record represents a stay in an inpatient hospital or SNF. An inpatient "stay" record summarizes all services rendered to a beneficiary from the time of admission to a facility through discharge. Each MedPAR record may represent one claim or multiple claims, depending on the length of a beneficiary's stay and the amount of inpatient services used throughout the stay. The record unit of MedPAR file is the hospital or SNF stay. Annual MedPAR files are available for fiscal years and calendar years 1991 forward. Click here for data documentation.
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.
Vital Status File: The Vital Status File contains demographic information about each beneficiary ever entitled to Medicare. 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, and age. Often the Vital Status File is used to obtain recent death information for a cohort of Medicare beneficiaries. Click here for data documentation.
Name and Address File: The Name and Address File contains Name and mailing contact address. Often the Name and Address File is requested to contact Medicare beneficiaries for participation in a study. Click here for data documentation.
Beneficiary Annual Summary File (BASF) File: The Beneficiary Annual Summary File is a beneficiary level file that contains enrollment, eligibility, vital statistics, and summarized information about the service utilization by file type. In addition, the file contains two different condition categories, the Condition Categories or CCs and the Chronic Conditions Data Warehouse flags called CCW Flags.
Part D Denominator File: The Part D denominator file contains demographic and enrollment information about each beneficiary enrolled in Medicare during the calendar year. In addition to the variables included in the historical Denominator record layout, the Part D denominator includes a derived race/ethnicity code, an indicator for Other Credible Drug Coverage, and monthly indicators for MA-PD/PDP enrollment, Low Income Subsidy (LIS) enrollment, Retiree Drug Subsidy, and State Reported Dual Eligibility Status.
Part D Drug Event (PDE) File: The PDE data contain prescription drug costs and payment data that enable CMS to make payments to the plans and otherwise administer the Part D benefit. When a beneficiary fills a prescription under Medicare Part D, a prescription drug plan sponsor must submit a summary record to CMS. The PDE data are not the same as individual drug claim transactions but are summary extracts using CMS-defined standard fields.
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.
Last Modified June 23, 2009