OVERVIEW OF DATA USERS REFERENCE GUIDE FILES

The following summary table presents the key characteristics of each file discussed in the guide except the Reference/Resource Data files, PUFs and BEFs. Brief discussions of the Reference/Resource Data files, PUFs and BEFs can be found in their respective chapters. The table provides users with an overview of the files and their contents, and serves as a quick reference to a file that might meet specific data needs. The table is organized by data chapter, file group, and then file. For each file, the unit of analysis, data sample, years available, and file creation cycle are noted.

OVERVIEW TABLE OF FILES

CLAIMS AND UTILIZATION DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
NATIONAL CLAIMS HISTORY FILES
National Claims History (NCH) 100% Nearline File	Claim as submitted by CWF site; adjustments and/or interim billing may result in multiple claims for a service/stay	All claims for 100% of Medicare beneficiaries	Nearline: 1991-present	Monthly and annually
STANDARD ANALYTIC FILES
Inpatient 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All Inpatient claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Outpatient 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All Outpatient claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Home Health Agency (HHA) 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All HHA claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Hospice 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All Hospice claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Skilled Nursing Facility (SNF) 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All SNF claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Clinical Laboratory 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All clinical laboratory claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
Durable Medical Equipment (DME) 100% Standard Analytic File (SAF)	Final action claim; all adjustments resolved	All DME claims for 100% of Medicare beneficiaries	1991-present	Annual files produced quarterly
5% Sample Beneficiary Standard Analytic File (SAF)*	Final action claim; all adjustments resolved	All claims for 5% of Medicare beneficiaries	1991-present	Annual files produced quarterly
STAY RECORDS FILES
Medicare Provider Analysis and Review (MEDPAR) File	Hospital or SNF Stay	Inpatient/SNF claims for only 20% of Medicare beneficiaries from 1979-1983 and for 100% of beneficiaries from 1984-present	1984-present	Quarterly and annually
PART B MEDICARE FILES
Physician/Supplier Procedure Summary File*	Unique combinations of carrier, procedure code, first and second modifiers, type of service, place of service, specialty, and locality	100% of physician/ supplier procedures that occur in Part B Medicare claims	1991-present	Quarterly
Physician Sample File*	Claim line item	Random sample of physicians using all line items	1991-present	Annually
OTHER UTILIZATION FILES
Provider Summary File	Provider	All claims for 100% of Medicare beneficiaries	1987-present	Monthly
Physician Summary File	Physician	Charges, payments, and services by provider category	1991- present	Annually

*These files are successors to the BMAD files. Further information about the BMAD successor files can be found in the Migration of Data section for each BMAD file discussion in the Claims and Utilization Data chapter.

ENROLLMENT AND ELIGIBILITY DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
ENROLLMENT DATABASE FILES
Enrollment Database (EDB)	Enrollee	Everyone ever enrolled in Medicare	Beginning of Medicare program to present	Daily
5%+ Enrollment Database (EDB)	Enrollee	5% of population ever enrolled in Medicare and 100% of ESRD enrollees	Beginning of Medicare program to present	Monthly
OTHER ENROLLMENT FILES
Third Party Master (TPEARTH) File	Beneficiary	100% of Medicare beneficiaries for whom Part A and/or Part B premiums are paid by a Third Party	1978-present	Monthly
Group Health Plan (GHP) Master File	Beneficiary	100% of Medicare beneficiaries who have ever been enrolled in an MCO since 1983	1983-present	Daily Flat File-Monthly
Health Insurance Skeleton Eligibility Write-off (HISKEW) File	Beneficiary	100% of Medicare beneficiaries who have ever been enrolled	1989-present	Quarterly
Denominator File	Beneficiary	100% of entitled Medicare beneficiaries for specified year	1984-present	Annually
Name and Address File	Beneficiary	100% of Medicare beneficiaries	Current data	Ad hoc

COMBINED CLAIMS AND ENROLLMENT DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
Continuous Medicare History Sample (CMHS) File	Beneficiary	All claims for 5% of Medicare beneficiaries	1974-present	Annually

PROVIDER OF SERVICES DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
Provider of Services (POS) File	Provider	All Medicare and Medicaid institutional providers	1987-1989;	Annually;
Provider of Services (POS) File	Provider	All Medicare and Medicaid institutional providers	1991-present	Quarterly
Provider Specific File	Provider	PPS-eligible hospitals	1983-present	Quarterly
Medicare Physician Identification Eligibility Registry (MPIER) File	Physician	Medicare physician identification information	1993-present	Quarterly

PROVIDER COST REPORT DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
Hospital Minimum Datasets	Hospital	All Medicare-certified hospitals and hospital/health care facility complexes	1981-present	Quarterly
Exempt Hospital and Excluded Unit Datasets	Hospital	All PPS-exempt hospitals and PPS hospitals with excluded units	1985-present	Annually
Hospital Part B Datasets	Hospital	Four types of Part B services for all Medicare-certified hospitals: Ambulatory Surgical Centers, Outpatient Radiology, Other Outpatient Diagnostics, and "All Other"	1989-present	Quarterly
Hospital Capital Datasets	Hospital	All Medicare-certified hospitals	1985-present	Quarterly
Hospital Worksheet A Datasets	Hospital	All Medicare-certified hospitals	1992-present	Quarterly
Hospital Cost Report Systems Master File	Hospital	All Medicare-certified hospitals	1992-present	Quarterly
Skilled Nursing Facility (SNF) Datasets	SNF	All Medicare-certified Skilled Nursing Facilities	1989-present	Quarterly
End Stage Renal Disease (ESRD) Datasets	Renal facility	All Medicare-certified free-standing and hospital-based renal facilities	1989-present	Quarterly
Home Health Agency (HHA) Datasets	HHA	All Medicare-certified Home Health Agencies	1994-present	Quarterly

SPECIAL PROGRAMS DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
Renal Beneficiary and Utilization System (REBUS)/ Management and Medical Information System (PMMIS) Database for the End Stage Renal Desease (ESRD) Program	ESRD Beneficiary or Renal Provider	100% of Medicare beneficiaries with ESRD and 100% of Medicare-approved renal providers	1973-present	Beneficiary data: monthly and annually; Provider data: ad hoc
Medicare Current Beneficiary Survey (MCBS) Files	Beneficiary	Statistically representative sample of Medicare beneficiaries--approximately 13,000 aged and 2,500 Medicare beneficiaries with disabilities	1991-present	Annually

MEDICAID DATA
File Group or File Name	Unit of Analysis	Sample	Years	Frequency of File Creation
MEDICAID ELIGIBLES, CLAIMS, AND UTILIZATION FILES
Medicaid Valid Tapes File--Eligible File	Medicaid eligible individual	100% of Medicaid eligible individuals in MSIS participating States	1985-present	Quarterly
Medicaid Valid Tapes Files-- Claim Inpatient (Claim-IP) Claim Long-term (Claim-LT) Claim Other (Claim-OT) Claim-RX	Claim	All claims for 100% of Medicaid recipients in MSIS participating States	1985-present 1999-present	Quarterly
Medicaid Personal Summary Record File	Recipient	Summary of Medicaid eligibility claims for 100% of Medicaid eligibles in MSIS participating States	1985-1998	Quarterly
State Medicaid Research Files-- (SMRFs) Claim Inpatient (Claim-IP) Claim Long-term (Claim-LT) Claim Other (Claim-OT) Claim Drug (Claim-Rx) Person Summary Record File	Claim Recipient	All claims for 100% of Medicaid recipients in MSIS participating States Summary of Medicaid eligibility and claims for MSIS participating States by calendar year. DB2 Structure will replace summary and SMRF in 1999.	1992-1994 1992-1994	Annually Annually
Medicaid Tape Option CMS (previously HCFA) Form 2082 Totals File	State	All Medicaid recipients, services, and payments in all States	1987-present	Quarterly
MEDICAID DRUG REBATE FILES
Medicaid Drug Rebate Product Description File	11-Digit National Drug Code	All Medicaid covered drugs	1991-present	Quarterly
Medicaid Drug Rebate Utilization File	11-Digit National Drug Code and State	Medicaid drug utilization for all States	1991-present	Quarterly
Medicaid Budget and Expenditure System (MBES) File	State	Medicaid budget and expenditure data for participating states Children’s Budget and Expenditure Data	1989-present 1998-present	Quarterly Quarterly

Overview of CMS Data | Data Organization | File Discussion | Overview of Data | OIS

OVERVIEW OF DATA USERS REFERENCE GUIDE FILES

OVERVIEW TABLE OF FILES

CLAIMS AND UTILIZATION DATA

NATIONAL CLAIMS HISTORY FILES

STANDARD ANALYTIC FILES

STAY RECORDS FILES

PART B MEDICARE FILES

OTHER UTILIZATION FILES

ENROLLMENT AND ELIGIBILITY DATA

ENROLLMENT DATABASE FILES

OTHER ENROLLMENT FILES

COMBINED CLAIMS AND ENROLLMENT DATA

PROVIDER OF SERVICES DATA

PROVIDER COST REPORT DATA

SPECIAL PROGRAMS DATA

MEDICAID DATA

MEDICAID ELIGIBLES, CLAIMS, AND UTILIZATION FILES

MEDICAID DRUG REBATE FILES