RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               4,563             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,554            C000-C999 Event created from claim
                               3,009            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                               1,554                      Missing
                                   0                   DU Dental
                                  38                   ER Emergency Room
                               2,865                   IP Inpatient
                                  43                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                  63                   OP Outpatient
                                   0                   PM Prescribed medicine
                                   0                   SD Separately billing physician
                                   0                   SL Separately billing lab

CLAIMID    20  7                                        N Claim this survey event matched to

EVBEGYY    27  2  $EVENTYY                              C Event begin year

                                   3                   -8 Don't know
                               4,560                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                  10                   -8 Don't know
                                   0                   95 Still in progress
                               4,553                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                  95                   -8 Don't know
                               4,468                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   8                   -8 Don't know
                               4,555                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                  15                   -8 Don't know
                                   0                   95 Still in progress
                               4,548                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                   1                   -7 Refused
                                  85                   -8 Don't know
                               4,477                      Day of month

SOURCE     39  1  $SOURCE                               C Source of event: survey, claim, or both?

                                 559                    1 Survey only
                               1,554                    2 Claims only
                               2,450                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                   0                    B Both community & facility
                               3,688                    C Community
                                 165                    D Deemed community
                                 490                    F Facility
                                  49                    G Deemed facility
                                 171                    S SNF

AMTTOT     41  9                                        N Total payment

IMPATOT    50  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                               3,385                    0 Not imputed
                               1,178                    1 Imputed

AMTCOV     51  9                                        N Medicare program liability, incl. copays

AMTNCOV    60  9                                        N Total payment not covered by Medicare

AMTCARE    69  9                                        N Amount paid by Medicare

IMPSCARE   78  1  IMPFLAG                               N AMTCARE payment source imputed?

                               4,560                    0 Not imputed
                                   3                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               4,463                    0 Not imputed
                                 100                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                               4,228                    0 Not imputed
                                 335                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                               3,876                    0 Not imputed
                                 687                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                               4,412                    0 Not imputed
                                 151                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                               4,268                    0 Not imputed
                                 295                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               4,485                    0 Not imputed
                                  78                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               4,439                    0 Not imputed
                                 124                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                               4,552                    0 Not imputed
                                  11                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                               4,518                    0 Not imputed
                                  45                    1 Imputed

AMTPRVE   124  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                               4,206                    0 Not imputed
                                 357                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                               4,090                    0 Not imputed
                                 473                    1 Imputed

AMTPRVI   135  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                               4,274                    0 Not imputed
                                 289                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                               4,168                    0 Not imputed
                                 395                    1 Imputed

AMTPRVU   146  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                               4,486                    0 Not imputed
                                  77                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                               4,486                    0 Not imputed
                                  77                    1 Imputed

AMTOOP    157  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                               3,951                    0 Not imputed
                                 612                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               3,765                    0 Not imputed
                                 798                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                               4,323                    0 Not imputed
                                 240                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                               4,286                    0 Not imputed
                                 277                    1 Imputed

AMTOTH    179  9                                        N Amount paid by other payor(s)

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                               4,558                    0 Not imputed
                                   5                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               4,545                    0 Not imputed
                                  18                    1 Imputed

ODIAGCNT  190  2                                        N Number of diagnosis codes on claim

ODIAG1    192  5                                        C Primary ICD-9 diagnosis code from claim

ODIAG2    197  5                                        C Second ICD-9 diagnosis code from claim

ODIAG3    202  5                                        C Third ICD-9 diagnosis code from claim

DRG       207  3                                        C Diagnosis related group from claim

PROCCNT   210  2                                        N Number of procedure codes on claim

PROC1     212  4                                        C First procedure code from claims

PROV      216  6                                        C Medicare provider number from claim

STATUS    222  2  $STATUS                               C Beneficiary status as of claim thru date

                                 561                      Missing
                               2,003                   01 Discharged to home/self care
                                 113                   02 Discharged to other short-term hospital
                                 754                   03 Discharged to skilled nursing facility
                                  74                   04 Discharged to intermediate care facility
                                  23                   05 Disch to another type of institution
                                 576                   06 Discharged to home care of organized HMO
                                  20                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                 160                   20 Expired (did not recover Christian Sci)
                                   5                   30 Still patient
                                   0                   40 Expired at home (hospice claims only)
                                   0                   41 Expired in hospital, SNF, ICF or hospice
                                   0                   42 Expired in unknown place (hospice only)
                                  37                   50 Hospice - home (eff. 10/96)
                                  34                   51 Hospice - medical facility (eff. 10/96)
                                  41                   61 Disch w/i facility to swing-bed SNF (99)
                                   0                   71 Disch to other facility for O/P svcs(99)
                                   0                   72 Disch to this facility for O/P svcs (99)
                                 162                      Other destination

UTLZNDAY  224  3                                        N Number of covered days of care

COINDAY   227  2                                        N Total number of coinsurance days

LRDAYS    229  2                                        N Number of lifetime reserve days used

HMO       231  1  $HMO                                  C Event provided by an HMO?

                               3,854                    0 Event not provided by HMO
                                 709                    1 Event provided by HMO

