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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 1^st ANSI Code		*
9	`REVANSI2`	Revenue Center 2^nd ANSI Code
10	`REVANSI3`	Revenue Center 3^rd ANSI Code
11	`REVANSI4`	Revenue Center 4^th 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 1^st Medicare Secondary Payer Paid Amount		*
30	`REV_MSP2`	Revenue Center 2^nd 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