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Carrier RIF¶

Source

https://www.resdac.org/cms-data/files/carrier-encounter

Overview¶

The Carrier file (also known as the Physician/Supplier Part B claims file) contains final action fee-for-service claims submitted on a CMS-1500 claim form. Most of the claims are from non-institutional providers, such as physicians, physician assistants, clinical social workers, nurse practitioners. Claims for other providers, such as free-standing facilities are also found in the Carrier file. Examples include independent clinical laboratories, ambulance providers, and free-standing ambulatory surgical centers. This file includes:

diagnosis and procedure (ICD-9 diagnosis, CMS Common Procedure Coding System (HCPCS) codes),
dates of service,
reimbursement amounts,
provider numbers (e.g., UPIN, PIN, NPI), and
beneficiary demographic information

Availability: CY 1999 - 2015

The 12-month run-off final action claims for 2016 will be available in the beginning of 2018.

Data Documentation¶

Carrier RIF¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`RIC_CD`	NCH Near Line Record Identification Code		*
4	`CLM_TYPE`	NCH Claim Type Code		*
5	`FROM_DT`	Claim From Date
6	`THRU_DT`	Claim Through Date
7	`WKLY_DT`	NCH Weekly Claim Processing Date
8	`ENTRY_CD`	Carrier Claim Entry Code
9	`DISP_CD`	Claim Disposition Code		*
10	`CARR_NUM`	Carrier Number		*
11	`PMTDNLCD`	Carrier Claim Payment Denial Code		*
12	`PMT_AMT`	Claim Payment Amount	*
13	`PRPAYAMT`	Carrier Claim Primary Payer Paid Amount*
14	`RFR_UPIN`	Carrier Claim Referring Physician UPIN Number
15	`RFR_NPI`	Carrier Claim Referring Physician NPI Number
16	`ASGMNTCD`	Carrier Claim Provider Assignment Indicator Switch		*
17	`PROV_PMT`	NCH Claim Provider Payment Amount*
18	`BENE_PMT`	NCH Claim Beneficiary Payment Amount*
19	`SBMTCHRG`	NCH Carrier Claim Submitted Charge Amount*
20	`ALOWCHRG`	NCH Carrier Claim Allowed Charge Amount*
21	`DEDAPPLY`	Carrier Claim Cash Deductible Applied Amount*
22	`HCPCS_YR`	Carrier Claim HCPCS Year Code
23	`RFR_PRFL`	Carrier Claim Referring PIN Number
24	`PRNCPAL_DGNS_CD`	Claim Principal Diagnosis Code
25	`PRNCPAL_DGNS_VRSN_CD`	Primary Claim Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)		*
26	`ICD_DGNS_CD1`	Claim Diagnosis Code I
27	`ICD_DGNS_VRSN_CD1`	Claim Diagnosis Code I Diagnosis Version Code (ICD-9 or ICD-10)		*
28	`ICD_DGNS_CD2`	Claim Diagnosis Code II
29	`ICD_DGNS_VRSN_CD2`	Claim Diagnosis Code II Diagnosis Version Code (ICD-9 or ICD-10)		*
30	`ICD_DGNS_CD3`	Claim Diagnosis Code III
31	`ICD_DGNS_VRSN_CD3`	Claim Diagnosis Code III Diagnosis Version Code (ICD-9 or ICD-10)		*
32	`ICD_DGNS_CD4`	Claim Diagnosis Code IV
33	`ICD_DGNS_VRSN_CD4`	Claim Diagnosis Code IV Diagnosis Version Code (ICD-9 or ICD-10)		*
34	`ICD_DGNS_CD5`	Claim Diagnosis Code V
35	`ICD_DGNS_VRSN_CD5`	Claim Diagnosis Code V Diagnosis Version Code (ICD-9 or ICD-10)		*
36	`ICD_DGNS_CD6`	Claim Diagnosis Code VI
37	`ICD_DGNS_VRSN_CD6`	Claim Diagnosis Code VI Diagnosis Version Code (ICD-9 or ICD-10)		*
38	`ICD_DGNS_CD7`	Claim Diagnosis Code VII
39	`ICD_DGNS_VRSN_CD7`	Claim Diagnosis Code VII Diagnosis Version Code (ICD-9 or ICD-10)		*
40	`ICD_DGNS_CD8`	Claim Diagnosis Code VIII
41	`ICD_DGNS_VRSN_CD8`	Claim Diagnosis Code VIII Diagnosis Version Code (ICD-9 or ICD-10)		*
42	`ICD_DGNS_CD9`	Claim Diagnosis Code IX
43	`ICD_DGNS_VRSN_CD9`	Claim Diagnosis Code IX Diagnosis Version Code (ICD-9 or ICD-10)		*
44	`ICD_DGNS_CD10`	Claim Diagnosis Code X
45	`ICD_DGNS_VRSN_CD10`	Claim Diagnosis Code X Diagnosis Version Code (ICD-9 or ICD-10)		*
46	`ICD_DGNS_CD11`	Claim Diagnosis Code XI
47	`ICD_DGNS_VRSN_CD11`	Claim Diagnosis Code XI Diagnosis Version Code (ICD-9 or ICD-10)		*
48	`ICD_DGNS_CD12`	Claim Diagnosis Code XII
49	`ICD_DGNS_VRSN_CD12`	Claim Diagnosis Code XII Diagnosis Version Code (ICD-9 or ICD-10)		*
50	`CCLTRNUM`	Clinical Trial Number
51	`DOB_DT`	Date of Birth from Claim (Date)
52	`GNDR_CD`	Gender Code from Claim		*
53	`RACE_CD`	Race Code from Claim		*
54	`CNTY_CD`	County Code from Claim (SSA)
55	`STATE_CD`	State Code from Claim (SSA)		*
56	`ZIP_CD`	Zip Code of Residence from Claim
57	`CLM_BENE_PD_AMT`	Carrier Claim Beneficiary Paid Amount		*
58	`CPO_PRVDR_NUM`	Care Plan Oversight (CPO) Provider Number
59	`CPO_ORG_NPI_NUM`	CPO Organization NPI Number
60	`CARR_CLM_BLG_NPI_NUM`	Carrier Claim Billing NPI Number
61	`ACO_ID_NUM`	Claim Accountable Care Organization (ACO) Identification Number

LINE FILE¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_LN`	Claim Line Number
4	`CLM_TYPE`	NCH Claim Type Code		*
5	`THRU_DT`	Claim Through Date
6	`PRF_PRFL`	Carrier Line Performing PIN Number
7	`PRF_UPIN`	Carrier Line Performing UPIN Number	*
8	`PRFNPI`	Carrier Line Performing NPI Number
9	`PRGRPNPI`	Carrier Line Performing Group NPI Number
10	`PRV_TYPE`	Carrier Line Provider Type Code		*
11	`TAX_NUM`	Line Provider Tax Number
12	`PRVSTATE`	Line NCH Provider State Code		*
13	`PROVZIP`	Carrier Line Performing Provider ZIP Code
14	`HCFASPCL`	Line HCFA Provider Specialty Code		*
15	`PRTCPTG`	Line Provider Participating Indicator Code		*
16	`ASTNT_CD`	Carrier Line Reduced Payment Physician Assistant Code		*
17	`SRVC_CNT`	Line Service Count
18	`TYPSRVCB`	Line HCFA Type Service Code		*
19	`PLCSRVC`	Line Place Of Service Code		*
20	`LCLTY_CD`	Carrier Line Pricing Locality Code
21	`EXPNSDT1`	Line First Expense Date
22	`EXPNSDT2`	Line Last Expense Date
23	`HCPCS_CD`	Health Care Common Procedure Coding System
24	`MDFR_CD1`	Line HCPCS Initial Modifier Code
25	`MDFR_CD2`	Line HCPCS Second Modifier Code
26	`BETOS`	Line NCH BETOS Code		*
27	`LINEPMT`	Line NCH Payment Amount
28	`LBENPMT`	Line Beneficiary Payment Amount
29	`LPRVPMT`	Line Provider Payment Amount
30	`LDEDAMT`	Line Beneficiary Part B Deductible Amount
31	`LPRPAYCD`	Line Beneficiary Primary Payer Code		*
32	`LPRPDAMT`	Line Beneficiary Primary Payer Paid Amount
33	`COINAMT`	Line Coinsurance Amount
34	`LSBMTCHG`	Line Submitted Charge Amount
35	`LALOWCHG`	Line Allowed Charge Amount
36	`PRCNGIND`	Line Processing Indicator Code		*
37	`PMTINDSW`	Line Payment 80%/100% Code
38	`DED_SW`	Line Service Deductible Indicator Switch		*
39	`MTUS_CNT`	Carrier Line Miles/Time/Units/Services Count
40	`MTUS_IND`	Carrier Line Miles/Time/Units/Services Indicator Code		*
41	`LINE_ICD_DGNS_CD`	Line Diagnosis Code
42	`LINE_ICD_DGNS_VRSN_CD`	Line Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)		*
43	`HPSASCCD`	Carrier Line HPSA/Scarcity Indicator Code		*
44	`CARRXNUM`	Carrier Line RX Number	*
45	`HCTHGBRS`	Hematocrit/Hemoglobin Test Results
46	`HCTHGBTP`	Hematocrit/Hemoglobin Test Type Code		*
47	`LNNDCCD`	Line National Drug Code
48	`CARR_LINE_CLIA_LAB_NUM`	Clinical Laboratory Improvement Amendments monitored laboratory number
49	`CARR_LINE_ANSTHSA_UNIT_CNT`	Carrier Line Anesthesia Unit Count
50	`CARR_LINE_CL_CHRG_AMT`	Carrier Line Clinical Lab Charge Amount
51	`PHYSN_ZIP_CD`	Line Place of Service (POS) Physician Zip Code
52	`LINE_OTHR_APLD_IND_CD1`	Line Other Applied Indicator 1^st Code		*
53	`LINE_OTHR_APLD_IND_CD2`	Line Other Applied Indicator 2^nd Code		*
54	`LINE_OTHR_APLD_IND_CD3`	Line Other Applied Indicator 3^rd Code		*
55	`LINE_OTHR_APLD_IND_CD4`	Line Other Applied Indicator 4^th Code		*
56	`LINE_OTHR_APLD_IND_CD5`	Line Other Applied Indicator 5^th Code		*
57	`LINE_OTHR_APLD_IND_CD6`	Line Other Applied Indicator 6^th Code		*
58	`LINE_OTHR_APLD_IND_CD7`	Line Other Applied Indicator 7^th Code		*
59	`LINE_OTHR_APLD_AMT1`	Line Other Applied Amount for 1^st Code		*
60	`LINE_OTHR_APLD_AMT2`	Line Other Applied Amount for 2^nd Code		*
61	`LINE_OTHR_APLD_AMT3`	Line Other Applied Amount for 3^rd Code		*
62	`LINE_OTHR_APLD_AMT4`	Line Other Applied Amount for 4^th Code		*
63	`LINE_OTHR_APLD_AMT5`	Line Other Applied Amount for 5^th Code		*
64	`LINE_OTHR_APLD_AMT6`	Line Other Applied Amount for 6^th Code		*
65	`LINE_OTHR_APLD_AMT7`	Line Other Applied Amount for 7^th Code		*
66	`THRPY_CAP_IND_CD1`	Line Therapy cap Indicator 1 Code		*
67	`THRPY_CAP_IND_CD2`	Line Therapy cap Indicator 2 Code		*
68	`THRPY_CAP_IND_CD3`	Line Therapy cap Indicator 3 Code		*
69	`THRPY_CAP_IND_CD4`	Line Therapy cap Indicator 4 Code		*
70	`THRPY_CAP_IND_CD5`	Line Therapy cap Indicator 5 Code		*
71	`CLM_NEXT_GNRTN_ACO_IND_1_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP)		*
72	`CLM_NEXT_GNRTN_ACO_IND_2_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth		*
73	`CLM_NEXT_GNRTN_ACO_IND_3_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits		*
74	`CLM_NEXT_GNRTN_ACO_IND_4_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver		*
75	`CLM_NEXT_GNRTN_ACO_IND_5_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation		*

Demonstrations/Innovations Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`DEMO_ID_SQNC_NUM`	Demonstration sequence number
5	`DEMO_ID_NUM`	Demonstration number		*
6	`DEMO_INFO_TXT`	Demo information text