OFFICE OF INFORMATION SERVICES (OIS) FACILITIES FOR ACCESSING ENROLLMENT AND UTILIZATION DATA

Several facilities for accessing a variety of enrollment and utilization files are available to CMS (previously HCFA) Data Center (HDC) users. The OIS Enrollment and Utilization Access Facilities Table at the end of this chapter provides an overview of these access facilities. For each facility, the table indicates when the facility should be used, search attributes, and files that can be accessed. Brief descriptions of the access facilities listed in the table are also provided.

Decision Support Access Facility (DSAF)

The first access facility listed in the OIS Access Facilities Table, DSAF, provides users with a single access path to a wide array of Medicare data. Through DSAF, users can extract Medicare enrollment, entitlement, and utilization databases and files. DSAF provides easy-to-use screens and online instructions. Data selections can be based on a finder list, specific data fields, or a percentage sample. DSAF is divided into logical groupings referred to as "legs." Each leg provides access to different groups of files. A Summary Figure of the files available in each leg under DSAF can be obtained by contacting the OIS, EDG, Division of Information Distribution (DID) at 410-786-0159. DSAF is available to authorized HDC users. A written request must be submitted to the OIS, EDG, Division of Data Liason and Distribution (DDLD).

Enrollment Database Workbench (EDBW)

The EDBW is a menu-driven retrieval system that allows the creation of customized user-views containing enrollment and entitlement information. The EDBW can be used for access to current, complete Medicare beneficiary-specific elements such as personal characteristics, entitlement dates, and types of coverage.

Beneficiary Enrollment Retrieval (BERT) System

The BERT System is an online query facility that provides access to Medicare beneficiary demographic and enrollment and entitlement data. BERT is used to view specific beneficiary Enrollment Database (EDB) records.

Part B Extract and Summary System (BESS)

BESS is a menu-driven query system that provides multiple-path access to non-beneficiary specific physician/supplier claims data that have been summarized at the procedure code level. Additionally, BESS provides online access to Part B carrier information (e.g., carrier numbers, addresses, localities) and all procedure and modifier codes (e.g., Current Procedural Terminology-4 [CPT-4] codes, CMS alpha-numeric codes, carrier local codes). CMS (previously HCFA) Customer Information System (HCIS) The HCIS is a multi-dimensional software application that provides an easy-to-use access path for non-programmers to manipulate Medicare data into information. This software application is commonly referred to as the General Purpose Front End (GPFE) to the system. One aspect of HCIS provides Graphical User Interface (GUI) forms (views) and reports on the different types of Medicare services. Currently, the GPFE provides access to the following types of provider data: Inpatient, Outpatient, Skilled Nursing Facility (SNF), Home Health Agency (HHA), Hospice, Physician Services, Non-Physician Practitioner, Ambulance Services, Enrollment, Durable Medical Equipment (DME), and Clinical Laboratory Data. HCIS uses as source data the National Claims History (NCH) database and the Standard Analytical Files (SAFs). Data is segmented by calendar year based on date of service. A second aspect of HCIS is the mainframe access path to views containing key claims level data on individual beneficiaries, providers and beneficiary/provider data combinations. Views currently provided include SNF, HHA, Hospice, Outpatient, Clinical Lab and DME. The views provide instant access to a ranking of beneficiaries by provider according to service utilization and claims reimbursement. The views supplement the functionality provided under the HCIS General Purpose Front End.

Menu-driven Access to the 100% Nearline Claims File (MANRLINE) System

MANRLINE is an online, menu-driven system for submitting retrieval requests for NCH 100% Nearline File data. MANRLINE allows users selections of groups of NCH claims records based on the values of one or more variables such as Health Insurance Claim (HIC) number, beneficiary state, beneficiary county, provider type, provider number, Unique Physician Identification Number (UPIN), diagnosis, Diagnosis Related Group (DRG), procedure code (ICD-9-CM and Healthcare Common Procedure Coding System (HCPCS)), pricing locality, revenue center, and claim years. MANRLINE requests are processed bi-monthly. Each MANRLINE cycle encompasses four years of sequential data; i.e., 1991-1994, 1992-1995 or 1993-1996.  

Office of Information Services (OIS) Enrollment and Utilization Access Facilities Table