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Outpatient RIF

Source

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

Overview

The Outpatient file contains final action, fee-for-service claims data submitted by institutional outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, and community mental health centers.

This file includes:

  • diagnosis (ICD-9 diagnosis)
  • Healthcare Common Procedure Coding System (HCPCS) codes,
  • dates of service,
  • reimbursement amount,
  • outpatient provider number,
  • revenue center codes, 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

Outpatient 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 FI_CLM_PROC_DT FI Claim Process Date
9 QUERY_CD Claim Query Code *
10 PROVIDER Provider Number *
11 FAC_TYPE Claim Facility Type Code *
12 TYPESRVC Claim Service Classification Type Code *
13 FREQ_CD Claim Frequency Code *
14 FI_NUM FI Number *
15 NOPAY_CD Claim Medicare Non Payment Reason Code *
16 PMT_AMT Claim Payment Amount *
17 PRPAYAMT NCH Primary Payer Claim Paid Amount*
18 PRPAY_CD NCH Primary Payer Code *
19 PRSTATE NCH Provider State Code *
20 ORGNPINM Organization NPI Number
21 SRVC_LOC_NPI_NUM Claim Service Location NPI Number
22 AT_UPIN Claim Attending Physician UPIN Number
23 AT_NPI Claim Attending Physician NPI Number
24 AT_PHYSN_SPCLTY_CD Claim Attending Physician Specialty Code *
25 OP_UPIN Claim Operating Physician UPIN Number
26 OP_NPI Claim Operating Physician NPI Number
27 OP_PHYSN_SPCLTY_CD Claim Operating Physician Specialty Code *
28 OT_UPIN Claim Other Physician UPIN Number
29 OT_NPI Claim Other Physician NPI Number
30 OT_PHYSN_SPCLTY_CD Claim Other Physician Specialty Code *
31 RNDRNG_PHYSN_NPI Claim Rendering Physician NPI Number
32 RNDRNG_PHYSN_SPCLTY_CD Claim Rendering Physician Specialty Code *
33 RFR_PHYSN_NPI Claim Referring Physician NPI Number
34 RFR_PHYSN_SPCLTY_CD Claim Referring Physician Specialty Code *
35 MCOPDSW Claim MCO Paid Switch * *
36 STUS_CD Patient Discharge Status Code *
37 TOT_CHRG Claim Total Charge Amount * *
38 BLDDEDAM NCH Beneficiary Blood Deductible Liability Amount *
39 PCCHGAMT NCH Professional Component Charge Amount *
40 PRNCPAL_DGNS_CD Claim Principal Diagnosis Code
41 ICD_DGNS_CD1 Claim Diagnosis Code I
42 ICD_DGNS_CD2 Claim Diagnosis Code II
43 ICD_DGNS_CD3 Claim Diagnosis Code III
44 ICD_DGNS_CD4 Claim Diagnosis Code IV
45 ICD_DGNS_CD5 Claim Diagnosis Code V
46 ICD_DGNS_CD6 Claim Diagnosis Code VI
47 ICD_DGNS_CD7 Claim Diagnosis Code VII
48 ICD_DGNS_CD8 Claim Diagnosis Code VIII
49 ICD_DGNS_CD9 Claim Diagnosis Code IX
50 ICD_DGNS_CD10 Claim Diagnosis Code X
51 ICD_DGNS_CD11 Claim Diagnosis Code XI
52 ICD_DGNS_CD12 Claim Diagnosis Code XII
53 ICD_DGNS_CD13 Claim Diagnosis Code XIII
54 ICD_DGNS_CD14 Claim Diagnosis Code XIV
55 ICD_DGNS_CD15 Claim Diagnosis Code XV
56 ICD_DGNS_CD16 Claim Diagnosis Code XVI
57 ICD_DGNS_CD17 Claim Diagnosis Code XVII
58 ICD_DGNS_CD18 Claim Diagnosis Code XVIII
59 ICD_DGNS_CD19 Claim Diagnosis Code XIX
60 ICD_DGNS_CD20 Claim Diagnosis Code XX
61 ICD_DGNS_CD21 Claim Diagnosis Code XXI
62 ICD_DGNS_CD22 Claim Diagnosis Code XXII
63 ICD_DGNS_CD23 Claim Diagnosis Code XXIII
64 ICD_DGNS_CD24 Claim Diagnosis Code XXIV
65 ICD_DGNS_CD25 Claim Diagnosis Code XXV
66 FST_DGNS_E_CD First Claim Diagnosis E Code
67 ICD_DGNS_E_CD1 Claim Diagnosis E Code I
68 ICD_DGNS_E_CD2 Claim Diagnosis E Code II
69 ICD_DGNS_E_CD3 Claim Diagnosis E Code III
70 ICD_DGNS_E_CD4 Claim Diagnosis E Code IV
71 ICD_DGNS_E_CD5 Claim Diagnosis E Code V
72 ICD_DGNS_E_CD6 Claim Diagnosis E Code VI
73 ICD_DGNS_E_CD7 Claim Diagnosis E Code VII
74 ICD_DGNS_E_CD8 Claim Diagnosis E Code VIII
75 ICD_DGNS_E_CD9 Claim Diagnosis E Code IX
76 ICD_DGNS_E_CD10 Claim Diagnosis E Code X
77 ICD_DGNS_E_CD11 Claim Diagnosis E Code XI
78 ICD_DGNS_E_CD12 Claim Diagnosis E Code XII
79 ICD_PRCDR_CD1 Claim Procedure Code I
80 PRCDR_DT1 Claim Procedure Code I Date
81 ICD_PRCDR_CD2 Claim Procedure Code II
82 PRCDR_DT2 Claim Procedure Code II Date
83 ICD_PRCDR_CD3 Claim Procedure Code III
84 PRCDR_DT3 Claim Procedure Code III Date
85 ICD_PRCDR_CD4 Claim Procedure Code IV
86 PRCDR_DT4 Claim Procedure Code IV Date
87 ICD_PRCDR_CD5 Claim Procedure Code V
88 PRCDR_DT5 Claim Procedure Code V Date
89 ICD_PRCDR_CD6 Claim Procedure Code VI
90 PRCDR_DT6 Claim Procedure Code VI Date
91 ICD_PRCDR_CD7 Claim Procedure Code VII
92 PRCDR_DT7 Claim Procedure Code VII Date
93 ICD_PRCDR_CD8 Claim Procedure Code VIII
94 PRCDR_DT8 Claim Procedure Code VIII Date
95 ICD_PRCDR_CD9 Claim Procedure Code IX
96 PRCDR_DT9 Claim Procedure Code IX Date
97 ICD_PRCDR_CD10 Claim Procedure Code X
98 PRCDR_DT10 Claim Procedure Code X Date
99 ICD_PRCDR_CD11 Claim Procedure Code XI
100 PRCDR_DT11 Claim Procedure Code XI Date
101 ICD_PRCDR_CD12 Claim Procedure Code XII
102 PRCDR_DT12 Claim Procedure Code XII Date
103 ICD_PRCDR_CD13 Claim Procedure Code XIII
104 PRCDR_DT13 Claim Procedure Code XIII Date
105 ICD_PRCDR_CD14 Claim Procedure Code XIV
106 PRCDR_DT14 Claim Procedure Code XIV Date
107 ICD_PRCDR_CD15 Claim Procedure Code XV
108 PRCDR_DT15 Claim Procedure Code XV Date
109 ICD_PRCDR_CD16 Claim Procedure Code XVI
110 PRCDR_DT16 Claim Procedure Code XVI Date
111 ICD_PRCDR_CD17 Claim Procedure Code XVII
112 PRCDR_DT17 Claim Procedure Code XVII Date
113 ICD_PRCDR_CD18 Claim Procedure Code XVIII
114 PRCDR_DT18 Claim Procedure Code XVIII Date
115 ICD_PRCDR_CD19 Claim Procedure Code XIX
116 PRCDR_DT19 Claim Procedure Code XIX Date
117 ICD_PRCDR_CD20 Claim Procedure Code XX
118 PRCDR_DT20 Claim Procedure Code XX Date
119 ICD_PRCDR_CD21 Claim Procedure Code XXI
120 PRCDR_DT21 Claim Procedure Code XXI Date
121 ICD_PRCDR_CD22 Claim Procedure Code XXII
122 PRCDR_DT22 Claim Procedure Code XXII Date
123 ICD_PRCDR_CD23 Claim Procedure Code XXIII
124 PRCDR_DT23 Claim Procedure Code XXIII Date
125 ICD_PRCDR_CD24 Claim Procedure Code XXIV
126 PRCDR_DT24 Claim Procedure Code XXIV Date
127 ICD_PRCDR_CD25 Claim Procedure Code XXV
128 PRCDR_DT25 Claim Procedure Code XXV Date
129 RSN_VISIT_CD1 Reason for Visit Diagnosis Code I
130 RSN_VISIT_CD2 Reason for Visit Diagnosis Code II
131 RSN_VISIT_CD3 Reason for Visit Diagnosis Code III
132 PTB_DED NCH Beneficiary Part B Deductible Amount
133 PTB_COIN NCH Beneficiary Part B Coinsurance Amount
134 PRVDRPMT Claim Outpatient Provider Payment Amount
135 BENEPMT Claim Outpatient Beneficiary Payment Amount *
136 DOB_DT Date of Birth from Claim (Date)
137 GNDR_CD Gender Code from Claim *
138 RACE_CD Race Code from Claim *
139 CNTY_CD County Code from Claim (SSA)
140 STATE_CD State Code from Claim (SSA) *
141 ZIP_CD Zip Code of Residence from Claim
142 CLM_MDCL_REC Claim Medical Record Number
143 ACTIONCD FI or MAC Claim Action Code *
144 BLDFRNSH NCH Blood Pints Furnished Quantity
145 CLM_TRTMT_AUTHRZTN_NUM Claim Treatment Authorization Number *
146 CLM_PRCR_RTRN_CD Claim Pricer Return Code *
147 CLM_SRVC_FAC_ZIP_CD Claim service facility ZIP code (where service was provided) *
148 CLM_OP_TRANS_TYPE_CD Claim Outpatient transaction type *
149 CLM_OP_ESRD_MTHD_CD Claim Outpatient End Stage Renal Disease (ESRD) Method of Reimbursement Code *
150 CLM_NEXT_GNRTN_ACO_IND_1_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP) *
151 CLM_NEXT_GNRTN_ACO_IND_2_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth *
152 CLM_NEXT_GNRTN_ACO_IND_3_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits *
153 CLM_NEXT_GNRTN_ACO_IND_4_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver *
154 CLM_NEXT_GNRTN_ACO_IND_5_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation *
155 ACO_ID_NUM Claim Accountable Care Organization (ACO) Identification Number

Revenue Center File

Index SAS Name Variable Name Limitation Code Table
1 BENE_ID Encrypted CCW Beneficiary ID
2 CLM_ID Claim ID *
3 THRU_DT Claim Through Date
4 CLM_LN Claim Line Number
5 CLM_TYPE NCH Claim Type Code *
6 REV_CNTR Revenue Center Code *
7 REV_DT Revenue Center Date
8 REVANSI1 Revenue Center 1st ANSI Code *
9 REVANSI2 Revenue Center 2nd ANSI Code
10 REVANSI3 Revenue Center 3rd ANSI Code
11 REVANSI4 Revenue Center 4th ANSI Code
12 APCHIPPS Revenue Center APC/HIPPS *
13 HCPCS_CD Revenue Center HCFA Common Procedure Coding System
14 MDFR_CD1 Revenue Center HCPCS Initial Modifier Code
15 MDFR_CD2 Revenue Center HCPCS Second Modifier Code
16 MDFR_CD3 HCPCS Third Modifier Code
17 MDFR_CD4 HCPCS Fourth Modifier Code
18 PMTMTHD Revenue Center Payment Method Indicator Code *
19 DSCNTIND Revenue Center Discount Indicator Code *
20 PACKGIND Revenue Center Packaging Indicator Code *
21 OTAF_1 Revenue Center Obligation to Accept As Full (OTAF) Payment Code
22 IDENDC Revenue Center IDE
23 REV_UNIT Revenue Center Unit Count
24 REV_RATE Revenue Center Rate Amount
25 REVBLOOD Revenue Center Blood Deductible Amount
26 REVDCTBL Revenue Center Cash Deductible Amount
27 WAGEADJ Revenue Center Coinsurance/Wage Adjusted Coinsurance Amount *
28 RDCDCOIN Revenue Center Reduced Coinsurance Amount *
29 REV_MSP1 Revenue Center 1st Medicare Secondary Payer Paid Amount *
30 REV_MSP2 Revenue Center 2nd Medicare Secondary Payer Paid Amount *
31 RPRVDPMT Revenue Center Provider Payment Amount
32 RBENEPMT Revenue Center Beneficiary Payment Amount
33 PTNTRESP Revenue Center Patient Responsibility Payment *
34 REVPMT Revenue Center Payment Amount
35 REV_CHRG Revenue Center Total Charge Amount * *
36 REV_NCVR Revenue Center Non-Covered Charge Amount *
37 REVSTIND Revenue Center Status Indicator Code *
38 REV_CNTR_NDC_QTY Revenue Center NDC Quantity
39 REV_CNTR_NDC_QTY_QLFR_CD Revenue Center NDC Quantity Qualifier Code *
40 RNDRNG_PHYSN_UPIN Revenue Center Rendering Physician UPIN
41 RNDRNG_PHYSN_NPI Revenue Center Rendering Physician NPI
42 RNDRNG_PHYSN_SPCLTY_CD Rendering Physician Specialty Code *
43 REVDEDCD Revenue Center Deductible Coinsurance Code *
44 REV_CNTR_PRCNG_IND_CD Revenue Center Pricing Indicator Code *
45 THRPY_CAP_IND_CD1 Revenue Center Therapy Cap Indicator 1 Code *
46 THRPY_CAP_IND_CD2 Revenue Center Therapy Cap Indicator 2 Code *
47 RC_PTNT_ADD_ON_PYMT_AMT Revenue Center Patient/Initial Visit Add-On Payment Amount (for initial wellness visit) *

Condition 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 RLTCNDSQ Claim Related Condition Code Sequence
5 RLT_COND Claim Related Condition Code *

Occurence 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 RLTOCRSQ Claim Related Occurrence Code Sequence
5 OCRNC_CD Claim Related Occurrence Code *
6 OCRNCDT Claim Related Occurrence Date

Span 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 RLTSPNSQ Claim Related Span Code Sequence
5 SPAN_CD Claim Occurrence Span Code *
6 SPANFROM Claim Occurrence Span From Date
7 SPANTHRU Claim Occurrence Span Through Date

Value 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 RLTVALSQ Claim Related Value Code Sequence
5 VAL_CD Claim Value Code *
6 VAL_AMT Claim Value Amount *

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