229x Filetype XLS File size 0.08 MB Source: requests.resdac.org
Sheet 1: Contact_Request Info
Specification Worksheet 11/2020 |
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State Programs | ||||||||||||||||||||
ResDAC TA: | ||||||||||||||||||||
Requester (Name/Org): | ||||||||||||||||||||
STUDY / PROJECT INFORMATION | ||||||||||||||||||||
Date: | ||||||||||||||||||||
Project/Study Name: | ||||||||||||||||||||
DUA: | ||||||||||||||||||||
State(s): | ||||||||||||||||||||
Select Files (X) | Select Population (X) | |||||||||||||||||||
2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | Qtrly* 2020 | State Segment | 5% National Sample | |||||||
Enrollment Data | ||||||||||||||||||||
Master Beneficiary Summary File (A/B/C/D) | ||||||||||||||||||||
Master Beneficiary Summary File Chronic Conditions | ||||||||||||||||||||
Master Beneficiary Summary File Cost & Use | ||||||||||||||||||||
Master Beneficiary Summary File Other Conditions | ||||||||||||||||||||
Plan Characteristics | ||||||||||||||||||||
Fee for Service Claims | ||||||||||||||||||||
Inpatient | ||||||||||||||||||||
Outpatient | ||||||||||||||||||||
SNF | ||||||||||||||||||||
Hospice | ||||||||||||||||||||
Home Health | ||||||||||||||||||||
Carrier | ||||||||||||||||||||
DMERC | ||||||||||||||||||||
*Quarterly data is available on a six month lag. i.e. Q1 data is available in October of the same year. *2020 claims are not considered fully mature and will continue to be updated for 13 months. |
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Encounter Claims | ||||||||||||||||||||
Inpatient | ||||||||||||||||||||
Outpatient | ||||||||||||||||||||
SNF | ||||||||||||||||||||
Home Health | ||||||||||||||||||||
Carrier | ||||||||||||||||||||
DMERC | ||||||||||||||||||||
Part D Event | ||||||||||||||||||||
Part D Event*** | ||||||||||||||||||||
Drug Characteristics | ||||||||||||||||||||
Prescriber Characteristics | ||||||||||||||||||||
Pharmacy Characteristics | ||||||||||||||||||||
Plan Characteristics | ||||||||||||||||||||
Formulary Characteristics | ||||||||||||||||||||
***If requesting Part D Event data, please fill out the Part D Variables tab in this document | ||||||||||||||||||||
***Beginning with 2014 PDE data, the CCW Pharmacy ID has changed to the NCPDP ID, and States are now eligible to request the Prescriber Characteristics file | ||||||||||||||||||||
Assessments | ||||||||||||||||||||
MDS Assessment | ||||||||||||||||||||
OASIS Assessment | ||||||||||||||||||||
IRF-PAI Assessment | ||||||||||||||||||||
Swing Bed Assessment | ||||||||||||||||||||
Other Files | ||||||||||||||||||||
MMLEADS - Medicare Medicaid Linked Enrollee Analytic Data Source | ||||||||||||||||||||
MedPAR (ss/ls/snf) | ||||||||||||||||||||
Crosswalks (Available for State Segment Only) | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to HIC | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to SSN | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to NAME | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to MSIS_ID / STATE_CD | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to RES_ID | ||||||||||||||||||||
Identifier Crosswalk CCW BENE_ID to MBI | ||||||||||||||||||||
Additional Comments | ||||||||||||||||||||
RIF data files will be delivered in a fixed column format with SAS programs (for SAS users) and FTS files (for non-SAS users). | ||||||||||||||||||||
REQUESTER INFORMATION | ||||||||||||||||||||
(1) Project Contact (person who will be responsible for operational and acquisition questions about the data) | ||||||||||||||||||||
Name: | ||||||||||||||||||||
Organization: | ||||||||||||||||||||
Address: | ||||||||||||||||||||
City: | State: | Zip Code: | ||||||||||||||||||
Telephone: | Email: | |||||||||||||||||||
(2) User (person who signed DUA #16) | ||||||||||||||||||||
Name: | ||||||||||||||||||||
Organization: | ||||||||||||||||||||
Address: | ||||||||||||||||||||
City: | State: | Zip Code: | ||||||||||||||||||
Telephone: | Email: | |||||||||||||||||||
(3) Custodian (person who signed DUA #17) | ||||||||||||||||||||
Name: | ||||||||||||||||||||
Organization: | ||||||||||||||||||||
Address: | ||||||||||||||||||||
City: | State: | Zip Code: | ||||||||||||||||||
Telephone: | Email: | |||||||||||||||||||
DELIVERY OPTIONS - Shipment via Courier Service | ||||||||||||||||||||
Courier Service: | Courier Account Number: | |||||||||||||||||||
Special Instructions: | ||||||||||||||||||||
Ship Data To (X) : | → | Project Contact | User | Custodian | ||||||||||||||||
OPERATING SYSTEM | ||||||||||||||||||||
Windows 2000 or higher | X | |||||||||||||||||||
. |
PDE Variable Justification | ||||
Current Version: 3/2019 | ||||
This justification worksheet only needs to be completed if requesting Part D Event (PDE) data | ||||
'X' to request | PDE Variable | Reason for Requesting PDE Element (In a few sentences, provide detailed justification for each element.) |
Risk of not receiving element (high, medium, low) If risk is high or medium, please provide explanation. |
CCW / ResDAC Notes |
General Variables | ||||
X [Automatically included with PDE data] | Encrypted Part D Event ID | Unique key for each Part D event | Not applicable | Needed to link to the Drug characteristics file |
X [Automatically included with PDE data] | Encrypted CCW Beneficiary ID | Need for linking | Not applicable | Needed for linking to other files |
Phase 1 and Demographic Variables | ||||
Patient Date of Birth (DOB) | Not edited - Recommend using Beneficiary Summary file | |||
Patient Gender | Not edited - Recommend using Beneficiary Summary file | |||
RX Service Date | ||||
Quantity Dispensed | ||||
Product/Service Identifier | ||||
Days Supply | ||||
Patient Pay Amount | ||||
Gross Drug Cost (sum of Ingredient Cost Paid, Dispensing Fee Paid, Total Amount Attributed to Sales Tax) | ||||
Patient Residence Code | New variable for 2013 PDE extracts and forward. | |||
Submission Clarification Code | New variable for 2013 PDE extracts and forward. | |||
Drug Coverage Status Code | ||||
The Brand-Generic Code reported by submitting plan | New variable for 2012 PDE extracts and forward. | |||
Dispensing Variables | ||||
Compound Code | ||||
Dispense as Written/Product Selection Code | ||||
Dispensing Status Code | This field will be blank starting with January 2011 service dates. | |||
Fill Number | Limitations: Fill Number is not edited across pharmacies. For example, Fill Number resets to 0 if a new pharmacy fills the prescription or if a "new" prescription for the same drug is filled more than once. This variable is supplied by the pharmacy. | |||
Adjustment/Deletion Code | ||||
Non-Standard Format Code | ||||
RX Pricing Exception Code | ||||
RX / Service Reference Number | ||||
Pharmacy Service Type Code | New variable for 2013 PDE extracts and forward. | |||
Prescription Origin Code | A code indicating the origin of the prescription. | |||
Payment Variables | ||||
Gross Drug Cost Below Out of-Pocket Threshold (GDCB) | ||||
Gross Drug Cost Above Out-of-Pocket Threshold (GDCA) | ||||
Other True Out-of-Pocket (TrOOP) Amount | ||||
Low-Income Cost-Sharing Subsidy Amount (LICS) | ||||
Patient Liability Reduction due to Other Payer Amount (PLRO) | ||||
Covered D Plan Paid Amount (CPP) | ||||
Non-covered Plan Paid Amount (NPP) | ||||
Gap Discount Amount reported by the Submitting Plan | New variable for 2012 PDE extracts and forward. | |||
Paid Date | ||||
Catastrophic Coverage Code | Field is optional for PDEs w/ Jan 2011 Service Dates going forward. | |||
Benefit Phase | ||||
UM variables (2006-2009 only) | ||||
Drug Tier | Variable valid 2006-2009. Starting in 2010, it is included in the formulary file. | |||
Prior Authorization | Variable valid 2006-2009. Starting in 2010, it is included in the formulary file. | |||
Quantity Limits | Variable valid 2006-2009. Starting in 2010, it is included in the formulary file. | |||
Maximum Step Number | Variable valid 2006-2009. Starting in 2010, it is included in the formulary file. | |||
Identification / Characteristics Linkage Variables | ||||
X [Automatically included with PDE data] | CCW Pharmacy ID (2006-2013) / NCPDP ID (2014 →) |
Not applicable | Needed to link to CCW Pharmacy characteristics file. Pharmacy linking variable switched from CCW Pharmacy ID to NCPDP ID in 2014. |
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X [Automatically included with PDE data] | Prescriber ID (unencrypted) | Not applicable | Prescriber identification variable newly released for 2013 and available historically to 2006. Delivered with Prescriber ID Qualifier Code. | |
X [Automatically included with PDE data] | Prescriber ID Qualifier Code | Not applicable | Prescriber identification variable newly released for 2013 and available historically to 2006. Delivered with Prescriber ID. | |
X [Automatically included with PDE data] | Formulary ID | Not applicable | ID assigned to each newly created formulary. Needed to link to the Formulary file | |
X [Automatically included with PDE data] | CCW Formulary RX ID | Not applicable | A CCW identifier for a drug product found in a Part D prescription drug plan formulary. Needed to link to the Formulary file | |
X [Automatically included with PDE data] | Plan Contract of Record ID | Not applicable | Needed to link to the Plan characteristics file | |
X [Automatically included with PDE data] | Plan Benefit Package of Record ID | Not applicable | Needed to link to the Plan characteristics file |
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