File Version: K, CCW Data Documentation May, 2019

Carrier (Fee-for-Service)

SAS NameVariable Name
1BENE_IDEncrypted CCW Beneficiary ID
2CLM_IDClaim ID
3NCH_NEAR_LINE_REC_IDENT_CDNCH Near Line Record Identification Code (RIC)
4NCH_CLM_TYPE_CDNCH Claim Type Code
5CLM_FROM_DTClaim From Date (FFS)
6CLM_THRU_DTClaim Through Date (FFS)
7NCH_WKLY_PROC_DTNCH Weekly Claim Processing Date
8CARR_CLM_ENTRY_CDCarrier Claim Entry Code
9CLM_DISP_CDClaim Disposition Code
10CARR_NUMCarrier or MAC Number
11CARR_CLM_PMT_DNL_CDCarrier Claim Payment Denial Code
12CLM_PMT_AMTClaim (Medicare) Payment Amount
450NCH_PRMRY_PYR_CLM_PD_AMTNCH Primary Payer (if not Medicare) Claim Paid Amount
14RFRG_PHYSN_NPICarrier/DMERC Claim Referring Physician UPIN Number
15RFRG_NPIClaim Referring Physician NPI Number
16CARR_CLM_PRVDR_ASGNMT_IND_SWCarrier Claim Provider Assignment Indicator Switch
17NCH_CLM_PRVDR_PMT_AMTNCH Claim Provider Payment Amount
18NCH_CLM_BENE_PMT_AMTNCH Claim Payment Amount to Beneficiary
501PRVDR_VLDTN_TYPE_CDProvider Validation Type Code
451CLM_BENE_PD_AMTCarrier Claim Beneficiary Paid Amount
19NCH_CARR_CLM_SBMTD_CHRG_AMTNCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
60CLM_BENE_ID_TYPE_CDClaim Beneficiary Identifier Type Code
20NCH_CARR_CLM_ALOWD_AMTNCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
21CARR_CLM_CASH_DDCTBL_APLD_AMTCarrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
22CARR_CLM_HCPCS_YR_CDClaim Healthcare Common Procedure Coding System (HCPCS) Year Code
23CARR_CLM_RFRNG_PIN_NUMCarrier Claim Referring Provider ID Number (PIN)
452CPO_PRVDR_NUMCare Plan Oversight (CPO) Provider Number
453CPO_ORG_NPI_NUMCPO Organization NPI Number
454CARR_CLM_BLG_NPI_NUMCarrier Claim Billing NPI Number
24PRNCPAL_DGNS_CDClaim Principal Diagnosis Code (FFS)
25PRNCPAL_DGNS_VRSN_CDClaim Principal Diagnosis Version Code (FFS)
26ICD_DGNS_CD1Claim Diagnosis Code I (FFS)
27ICD_DGNS_VRSN_CD1Claim Diagnosis Code I Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
28ICD_DGNS_CD2Claim Diagnosis Code II (FFS)
29ICD_DGNS_VRSN_CD2Claim Diagnosis Code II Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
30ICD_DGNS_CD3Claim Diagnosis Code III (FFS)
31ICD_DGNS_VRSN_CD3Claim Diagnosis Code III Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
32ICD_DGNS_CD4Claim Diagnosis Code IV (FFS)
33ICD_DGNS_VRSN_CD4Claim Diagnosis Code IV Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
34ICD_DGNS_CD5Claim Diagnosis Code V (FFS)
35ICD_DGNS_VRSN_CD5Claim Diagnosis Code V Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
36ICD_DGNS_CD6Claim Diagnosis Code VI (FFS)
37ICD_DGNS_VRSN_CD6Claim Diagnosis Code VI Diagnosis Version Code (ICD-9/ICD-10) (FFS)
38ICD_DGNS_CD7Claim Diagnosis Code VII (FFS)
39ICD_DGNS_VRSN_CD7Claim Diagnosis Code VII Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
40ICD_DGNS_CD8Claim Diagnosis Code VIII (FFS)
41ICD_DGNS_VRSN_CD8Claim Diagnosis Code VIII Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
42ICD_DGNS_CD9Claim Diagnosis Code IX (FFS)
43ICD_DGNS_VRSN_CD9Claim Diagnosis Code IX Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
44ICD_DGNS_CD10Claim Diagnosis Code X (FFS)
45ICD_DGNS_VRSN_CD10Claim Diagnosis Code X Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
46ICD_DGNS_CD11Claim Diagnosis Code XI (FFS)
47ICD_DGNS_VRSN_CD11Claim Diagnosis Code XI Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
48ICD_DGNS_CD12Claim Diagnosis Code XII (FFS)
49ICD_DGNS_VRSN_CD12Claim Diagnosis Code XII Diagnosis Version Code (ICD-9 or ICD-10) (FFS)
50CLM_CLNCL_TRIL_NUMClinical Trial Number
51DOB_DTDate of Birth from Claim
52GNDR_CDGender Code from Claim
53BENE_RACE_CDBeneficiary Race Code (Encounter)
54BENE_CNTY_CDCounty Code from Claim (SSA)
55BENE_STATE_CDBeneficiary Residence (SSA) State Code (FFS)
56BENE_MLG_CNTCT_ZIP_CDZip Code of Residence from Claim
58ACO_ID_NUMClaim Accountable Care Organization (ACO) Identification Number
59Carrier Claim Site of Service NPI Number
500CLM_RSDL_PYMT_IND_CDClaim Residual Payment Indicator Code

LINE FILE

SAS NameVariable Name
1BENE_IDEncrypted CCW Beneficiary ID
2CLM_IDClaim ID
3CLM_LINE_NUMClaim Line Number
4NCH_CLM_TYPE_CDNCH Claim Type Code
5CLM_THRU_DTClaim Through Date (FFS)
6CARR_PRFRNG_PIN_NUMCarrier Line Performing Provider ID Number (PIN)
7PRF_PHYSN_UPINCarrier Line Performing UPIN Number
8PRF_PHYSN_NPICarrier Line Performing NPI Number
9ORG_NPI_NUMOrganization (or group) NPI Number
10CARR_LINE_PRVDR_TYPE_CDCarrier Line Provider Type Code
11TAX_NUMLine Provider Tax Number
12PRVDR_STATE_CDNCH Provider SSA State Code
13PRVDR_ZIPCarrier Line Performing Provider ZIP Code
14PRVDR_SPCLTYLine CMS Provider Specialty Code
15PRTCPTNG_IND_CDLine Provider Participating Indicator Code
16CARR_LINE_RDCD_PMT_PHYS_ASTN_CCarrier Line Reduced Payment Physician Assistant Code
17LINE_SRVC_CNTLine Service Count (FFS)
18LINE_CMS_TYPE_SRVC_CDLine CMS Type Service Code
19LINE_PLACE_OF_SRVC_CDLine Place Of Service Code (FFS)
20CARR_LINE_PRCNG_LCLTY_CDCarrier Line Pricing Locality Code
21LINE_1ST_EXPNS_DTLine First Expense Date (FFS)
22LINE_LAST_EXPNS_DTLine Last Expense Date (FFS)
23HCPCS_CDHealthcare Common Procedure Coding System (HCPCS) Code (FFS)
24HCPCS_1st_mdfr_cdHCPCS Initial Modifier Code (FFS)
25HCPCS_2ND_MDFR_CDHCPCS Second Modifier Code (FFS)
26BETOS_CDLine Berenson-Eggers Type of Service (BETOS) Code
27LINE_NCH_PMT_AMTLine NCH Medicare Payment Amount
28LINE_BENE_PMT_AMTLine Payment Amount to Beneficiary
29LINE_PRVDR_PMT_AMTLine Provider Payment Amount
30LINE_BENE_PTB_DDCTBL_AMTLine Beneficiary Part B Deductible Amount
31LINE_BENE_PRMRY_PYR_CDLine Primary Payer Code (if not Medicare)
32LINE_BENE_PRMRY_PYR_PD_AMTLine Primary Payer (if not Medicare) Paid Amount
33LINE_COINSRNC_AMTLine Beneficiary Coinsurance Amount
34LINE_SBMTD_CHRG_AMTLine Submitted Charge Amount
35LINE_ALOWD_CHRG_AMTLine Allowed Charge Amount
36LINE_PRCSG_IND_CDLine Processing Indicator Code
37LINE_PMT_80_100_CDLine Payment 80% / 100% Code
38LINE_SERVICE_DEDUCTIBLELine Service Deductible Indicator Switch
39CARR_LINE_MTUS_CNTCarrier Line Miles/Time/Units/Services (MTUS) Count
40CARR_LINE_MTUS_CDCarrier Line Miles/Time/Units/Services (MTUS) Indicator Code
41LINE_ICD_DGNS_CDLine Diagnosis Code
42LINE_ICD_DGNS_VRSN_CDLine Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)
43HPSA_SCRCTY_IND_CDCarrier Line Health Professional Shortage Area (HPSA)/Scarcity Indicator Code
44LINE_RX_NUMCarrier Line RX Number
45LINE_HCT_HGB_RSLT_NUMHematocrit/Hemoglobin Test Results
46LINE_HCT_HGB_TYPE_CDHematocrit/Hemoglobin Test Type Code
47LINE_NDC_CDLine National Drug Code (NDC) (FFS)
48CARR_LINE_CLIA_LAB_NUMClinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
49CARR_LINE_ASNTHSA_UNIT_CNTCarrier Line Anesthesia Unit Count
50CARR_LINE_CL_CHRG_AMTCarrier Line Clinical Lab Charge Amount
51PHYSN_ZIP_CDLine Place of Service (POS) Physician Zip Code
52LINE_OTHR_APLD_IND_CD1Line Other Applied Indicator 1st Code
53LINE_OTHER_APLD_IND_CD2Line Other Applied Indicator 2nd Code
54LINE_OTHR_APLD_IND_CD3Line Other Applied Indicator 3rd Code
55LINE_OTHR_APLD_IND_CD4Line Other Applied Indicator 4th Code
56LINE_OTHR_APLD_IND_CD5Line Other Applied Indicator 5th Code
57LINE_OTHR_APLD_IND_CD6Line Other Applied Indicator 6th Code
58LINE_OTHR_APLD_IND_CD7Line Other Applied Indicator 7th Code
59LINE_OTHR_APLD_AMT1Line Other Applied Amount for 1st Code
60LINE_OTHR_APLD_AMT2Line Other Applied Amount for 2nd Code
61LINE_OTHR_APLD_AMT3Line Other Applied Amount for 3rd Code
62LINE_OTHR_APLD_AMT4Line Other Applied Amount for 4th Code
63LINE_OTHR_APLD_AMT5Line Other Applied Amount for 5th Code
64LINE_OTHR_APLD_AMT6Line Other Applied Amount for 6th Code
65LINE_OTHR_APLD_AMT7Line Other Applied Amount for 7th Code
66THRPY_CAP_IND_CD1Therapy cap Indicator 1 Code
67THRPY_CAP_IND_CD2Therapy cap Indicator 2 Code
68THRPY_CAP_IND_CD3Therapy cap Indicator 3 Code
69THRPY_CAP_IND_CD4Therapy cap Indicator 4 Code
70THRPY_CAP_IND_CD5Therapy cap Indicator 5 Code
71CLM_NEXT_GNRTN_ACO_IND_CD1Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population-Based Payment (PBP)
72CLM_NEXT_GNRTN_ACO_IND_CD2Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth
73CLM_NEXT_GNRTN_ACO_IND_CD3Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits
74CLM_NEXT_GNRTN_ACO_IND_CD4Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3-day SNF waiver
75CLM_NEXT_GNRTN_ACO_IND_CD5Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation
456Carrier Line Medicare Diabetes Prevention Program (MDPP) NPI Number
502LINE_RSDL_PYMT_IND_CDLine Residual Payment Indicator Code
503LINE_RP_IND_CDLine Representative Payee (RP) Indicator Code
504LINE_PRVDR_VLDTN_TYPE_CDLine Provider Validation Type Code

Demonstrations/Innovations Code File

SAS NameVariable Name
1BENE_IDEncrypted CCW Beneficiary ID
2CLM_IDClaim ID
3NCH_CLM_TYPE_CDNCH Claim Type Code
4DEMO_ID_SQNC_NUMDemonstration sequence number
5DEMO_ID_NUMDemonstration number
6DEMO_INFO_TXTDemo information text
CSV