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Durable Medical Equipment RIF¶

Source

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

Overview¶

The Durable Medical Equipment (DME) file contains final action, fee-for-service claims submitted by Durable Medical Equipment suppliers. This file includes:

diagnosis, (ICD-9 diagnosis),
services provided (CMS Common Procedure Coding System (HCPCS) codes),
dates of service,
reimbursement amounts,
DME provider number, 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¶

Durable Medical Equipment 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	`ASGMNTCD`	Carrier Claim Provider Assignment Indicator Switch		*
15	`PROV_PMT`	NCH Claim Provider Payment Amount*
16	`BENE_PMT`	NCH Claim Beneficiary Payment Amount*
17	`SBMTCHRG`	NCH Carrier Claim Submitted Charge Amount*
18	`ALOWCHRG`	NCH Carrier Claim Allowed Charge Amount*
19	`DEDAPPLY`	Carrier Claim Cash Deductible Applied Amount*
20	`HCPCS_YR`	Carrier Claim HCPCS Year Code
21	`PRNCPAL_DGNS_CD`	Claim Principal Diagnosis Code
22	`PRNCPAL_DGNS_VRSN_CD`	Primary Claim Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)		*
23	`ICD_DGNS_CD1`	Claim Diagnosis Code I
24	`ICD_DGNS_VRSN_CD1`	Claim Diagnosis Code I Diagnosis Version Code (ICD-9 or ICD-10)		*
25	`ICD_DGNS_CD2`	Claim Diagnosis Code II
26	`ICD_DGNS_VRSN_CD2`	Claim Diagnosis Code II Diagnosis Version Code (ICD-9 or ICD-10)		*
27	`ICD_DGNS_CD3`	Claim Diagnosis Code III
28	`ICD_DGNS_VRSN_CD3`	Claim Diagnosis Code III Diagnosis Version Code (ICD-9 or ICD-10)		*
29	`ICD_DGNS_CD4`	Claim Diagnosis Code IV
30	`ICD_DGNS_VRSN_CD4`	Claim Diagnosis Code IV Diagnosis Version Code (ICD-9 or ICD-10)		*
31	`ICD_DGNS_CD5`	Claim Diagnosis Code V
32	`ICD_DGNS_VRSN_CD5`	Claim Diagnosis Code V Diagnosis Version Code (ICD-9 or ICD-10)		*
33	`ICD_DGNS_CD6`	Claim Diagnosis Code VI
34	`ICD_DGNS_VRSN_CD6`	Claim Diagnosis Code VI Diagnosis Version Code (ICD-9 or ICD-10)		*
35	`ICD_DGNS_CD7`	Claim Diagnosis Code VII
36	`ICD_DGNS_VRSN_CD7`	Claim Diagnosis Code VII Diagnosis Version Code (ICD-9 or ICD-10)		*
37	`ICD_DGNS_CD8`	Claim Diagnosis Code VIII
38	`ICD_DGNS_VRSN_CD8`	Claim Diagnosis Code VIII Diagnosis Version Code (ICD-9 or ICD-10)		*
39	`ICD_DGNS_CD9`	Claim Diagnosis Code IX
40	`ICD_DGNS_VRSN_CD9`	Claim Diagnosis Code IX Diagnosis Version Code (ICD-9 or ICD-10)		*
41	`ICD_DGNS_CD10`	Claim Diagnosis Code X
42	`ICD_DGNS_VRSN_CD10`	Claim Diagnosis Code X Diagnosis Version Code (ICD-9 or ICD-10)		*
43	`ICD_DGNS_CD11`	Claim Diagnosis Code XI
44	`ICD_DGNS_VRSN_CD11`	Claim Diagnosis Code XI Diagnosis Version Code (ICD-9 or ICD-10)		*
45	`ICD_DGNS_CD12`	Claim Diagnosis Code XII
46	`ICD_DGNS_VRSN_CD12`	Claim Diagnosis Code XII Diagnosis Version Code (ICD-9 or ICD-10)		*
47	`RFR_UPIN`	DMERC Claim Ordering Physician UPIN Number
48	`RFR_NPI`	DMERC Claim Ordering Physician NPI Number
49	`CCLTRNUM`	Clinical Trial Number
50	`DOB_DT`	Date of Birth from Claim (Date)
51	`GNDR_CD`	Gender Code from Claim		*
52	`RACE_CD`	Race Code from Claim		*
53	`CNTY_CD`	County Code from Claim (SSA)
54	`STATE_CD`	State Code from Claim (SSA)		*
55	`ZIP_CD`	Zip Code of Residence from Claim
56	`CLM_BENE_PD_AMT`	Carrier Claim Beneficiary Paid Amount		*

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	`TAX_NUM`	Line Provider Tax Number
7	`HCFASPCL`	Line HCFA Provider Specialty Code		*
8	`PRTCPTG`	Line Provider Participating Indicator Code		*
9	`SRVC_CNT`	Line Service Count
10	`TYPSRVCB`	Line HCFA Type Service Code		*
11	`PLCSRVC`	Line Place Of Service Code		*
12	`EXPNSDT1`	Line First Expense Date
13	`EXPNSDT2`	Line Last Expense Date
14	`HCPCS_CD`	Health Care Common Procedure Coding System
15	`MDFR_CD1`	Line HCPCS Initial Modifier Code
16	`MDFR_CD2`	Line HCPCS Second Modifier Code
17	`BETOS`	Line NCH BETOS Code		*
18	`LINEPMT`	Line NCH Payment Amount
19	`LBENPMT`	Line Beneficiary Payment Amount
20	`LPRVPMT`	Line Provider Payment Amount
21	`LDEDAMT`	Line Beneficiary Part B Deductible Amount
22	`LPRPAYCD`	Line Beneficiary Primary Payer Code		*
23	`LPRPDAMT`	Line Beneficiary Primary Payer Paid Amount
24	`COINAMT`	Line Coinsurance Amount
25	`PRPYALOW`	Line Primary Payer Allowed Charge Amount
26	`LSBMTCHG`	Line Submitted Charge Amount
27	`LALOWCHG`	Line Allowed Charge Amount
28	`PRCNGIND`	Line Processing Indicator Code		*
29	`PMTINDSW`	Line Payment 80%/100% Code
30	`DED_SW`	Line Service Deductible Indicator Switch		*
31	`LINE_ICD_DGNS_CD`	Line Diagnosis Code
32	`LINE_ICD_DGNS_VRSN_CD`	Line Diagnosis Code Diagnosis Version Code (ICD-9 or ICD-10)		*
33	`DME_PURC`	Line DME Purchase Price Amount		*
34	`SUPLRNUM`	DMERC Line Supplier Provider Number
35	`SUP_NPI`	DMERC Line Item Supplier NPI Number
36	`PRCNG_ST`	DMERC Line Pricing State Code		*
37	`PRVSTATE`	DMERC Line Provider State Code		*
38	`SUP_TYPE`	DMERC Line Supplier Type Code		*
39	`MDFR_CD3`	DMERC Line HCPCS Third Modifier Code
40	`MDFR_CD4`	DMERC Line HCPCS Fourth Modifier Code
41	`SCRNSVGS`	DMERC Line Screen Savings Amount		*
42	`DME_UNIT`	DMERC Line Miles/Time/Units/Services Count
43	`UNIT_IND`	DMERC Line Miles/Time/Units/Services Indicator Code		*
44	`HCTHGBRS`	Hematocrit/Hemoglobin Test Results
45	`HCTHGBTP`	Hematocrit/Hemoglobin Test Type Code		*
46	`LNNDCCD`	Line National Drug Code
47	`LINE_OTHR_APLD_IND_CD1`	Line Other Applied Indicator 1^st Code		*
48	`LINE_OTHR_APLD_IND_CD2`	Line Other Applied Indicator 2^nd Code		*
49	`LINE_OTHR_APLD_IND_CD3`	Line Other Applied Indicator 3^rd Code		*
50	`LINE_OTHR_APLD_IND_CD4`	Line Other Applied Indicator 4^th Code		*
51	`LINE_OTHR_APLD_IND_CD5`	Line Other Applied Indicator 5^th Code		*
52	`LINE_OTHR_APLD_IND_CD6`	Line Other Applied Indicator 6^th Code		*
53	`LINE_OTHR_APLD_IND_CD7`	Line Other Applied Indicator 7^th Code		*
54	`LINE_OTHR_APLD_AMT1`	Line Other Applied Amount for 1^st Code		*
55	`LINE_OTHR_APLD_AMT2`	Line Other Applied Amount for 2^nd Code		*
56	`LINE_OTHR_APLD_AMT3`	Line Other Applied Amount for 3^rd Code		*
57	`LINE_OTHR_APLD_AMT4`	Line Other Applied Amount for 4^th Code		*
58	`LINE_OTHR_APLD_AMT5`	Line Other Applied Amount for 5^th Code		*
59	`LINE_OTHR_APLD_AMT6`	Line Other Applied Amount for 6^th Code		*
60	`LINE_OTHR_APLD_AMT7`	Line Other Applied Amount for 7^th Code		*

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