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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 1st Code *
53 LINE_OTHR_APLD_IND_CD2 Line Other Applied Indicator 2nd Code *
54 LINE_OTHR_APLD_IND_CD3 Line Other Applied Indicator 3rd Code *
55 LINE_OTHR_APLD_IND_CD4 Line Other Applied Indicator 4th Code *
56 LINE_OTHR_APLD_IND_CD5 Line Other Applied Indicator 5th Code *
57 LINE_OTHR_APLD_IND_CD6 Line Other Applied Indicator 6th Code *
58 LINE_OTHR_APLD_IND_CD7 Line Other Applied Indicator 7th Code *
59 LINE_OTHR_APLD_AMT1 Line Other Applied Amount for 1st Code *
60 LINE_OTHR_APLD_AMT2 Line Other Applied Amount for 2nd Code *
61 LINE_OTHR_APLD_AMT3 Line Other Applied Amount for 3rd Code *
62 LINE_OTHR_APLD_AMT4 Line Other Applied Amount for 4th Code *
63 LINE_OTHR_APLD_AMT5 Line Other Applied Amount for 5th Code *
64 LINE_OTHR_APLD_AMT6 Line Other Applied Amount for 6th Code *
65 LINE_OTHR_APLD_AMT7 Line Other Applied Amount for 7th 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