RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              11,984             LOW-HIGH BASEID Count

H_DOB      12  8  $DTE8FMT                              C Date of birth

                              11,984                      Date as YYYYMMDD

H_DOD      20  8  $DTE8FMT                              C Date of death

                              11,324                      Missing
                                 660                      Date as YYYYMMDD

H_DODSRC   28  2  $SRCFMT                               C Source of date of death

                              11,324                      No date of death
                                   1                   01 From Medicare bill
                                   0                   03 Clerical entry
                                   0                   05 Bill and clerical entry
                                 393                   10 Proven Medicare Benefits record
                                  50                   11 Proven Medicare Benefits record & bills
                                 172                   20 Unproven Medicare Benefits record
                                  41                   21 Unproven Mcare Benefits record & bills
                                   3                   23 Unproven Mcare Benefits rec & clerical
                                   0                   25 Unproven Mcare Benefits rec, bill & cler

H_SEX      30  1  $SEXFMT                               C Sex code

                               5,321                    1 Male
                               6,663                    2 Female

H_RACE     31  1  $RACEFMT                              C Race code

                                  20                    0 Unknown
                              10,131                    1 White
                               1,203                    2 Black
                                 123                    3 Other
                                 157                    4 Asian
                                 286                    5 Hispanic
                                  64                    6 North American Native

H_AGE      32  3                                        N SP age based on CMS date of birth

D_STRAT    35  1  $AGEFMT                               C MCBS Sample age stratum

                               1,078                    1  0-44
                               1,062                    2 45-64
                               2,029                    3 65-69
                               2,008                    4 70-74
                               1,833                    5 75-79
                               1,927                    6 80-84
                               2,047                    7 85 +

H_ENT01    36  1  $ENTFMT                               C Medicare entitlement code for Jan

                                 470                    A Part A Medicare only
                                  65                    B Part B Medicare only
                              11,110                    C Parts A and B Medicare
                                 339                    N No Medicare entitlement

H_ENT02    37  1  $ENTFMT                               C Medicare entitlement code for Feb

                                 470                    A Part A Medicare only
                                  65                    B Part B Medicare only
                              11,064                    C Parts A and B Medicare
                                 385                    N No Medicare entitlement

H_ENT03    38  1  $ENTFMT                               C Medicare entitlement code for Mar

                                 469                    A Part A Medicare only
                                  66                    B Part B Medicare only
                              11,036                    C Parts A and B Medicare
                                 413                    N No Medicare entitlement

H_ENT04    39  1  $ENTFMT                               C Medicare entitlement code for Apr

                                 464                    A Part A Medicare only
                                  65                    B Part B Medicare only
                              11,013                    C Parts A and B Medicare
                                 442                    N No Medicare entitlement

H_ENT05    40  1  $ENTFMT                               C Medicare entitlement code for May

                                 460                    A Part A Medicare only
                                  67                    B Part B Medicare only
                              10,976                    C Parts A and B Medicare
                                 481                    N No Medicare entitlement

H_ENT06    41  1  $ENTFMT                               C Medicare entitlement code for Jun

                                 468                    A Part A Medicare only
                                  66                    B Part B Medicare only
                              10,940                    C Parts A and B Medicare
                                 510                    N No Medicare entitlement

H_ENT07    42  1  $ENTFMT                               C Medicare entitlement code for Jul

                                 442                    A Part A Medicare only
                                  62                    B Part B Medicare only
                              10,936                    C Parts A and B Medicare
                                 544                    N No Medicare entitlement

H_ENT08    43  1  $ENTFMT                               C Medicare entitlement code for Aug

                                 449                    A Part A Medicare only
                                  62                    B Part B Medicare only
                              10,921                    C Parts A and B Medicare
                                 552                    N No Medicare entitlement

H_ENT09    44  1  $ENTFMT                               C Medicare entitlement code for Sep

                                 456                    A Part A Medicare only
                                  61                    B Part B Medicare only
                              10,912                    C Parts A and B Medicare
                                 555                    N No Medicare entitlement

H_ENT10    45  1  $ENTFMT                               C Medicare entitlement code for Oct

                                 449                    A Part A Medicare only
                                  58                    B Part B Medicare only
                              10,889                    C Parts A and B Medicare
                                 588                    N No Medicare entitlement

H_ENT11    46  1  $ENTFMT                               C Medicare entitlement code for Nov

                                 451                    A Part A Medicare only
                                  58                    B Part B Medicare only
                              10,864                    C Parts A and B Medicare
                                 611                    N No Medicare entitlement

H_ENT12    47  1  $ENTFMT                               C Medicare entitlement code for Dec

                                 448                    A Part A Medicare only
                                  56                    B Part B Medicare only
                              10,854                    C Parts A and B Medicare
                                 626                    N No Medicare entitlement

H_DOE      48  8  $DTE8FMT                              C Medicare entitlement start date

                              11,984                      Date as YYYYMMDD

H_DOT      56  8  $DTE8FMT                              C Medicare entitlement end date

                              11,944                      Missing
                                  40                      Date as YYYYMMDD

H_MEDSTA   64  2  $MSCFMT                               C Medicare status code as of 12/31

                                  11                      Unknown
                               9,776                   10 Aged, no ESRD
                                  61                   11 Aged, ESRD
                               2,083                   20 Disabled, no ESRD
                                  39                   21 Disabled, ESRD
                                  14                   31 ESRD only

H_LAF      66  2  $LAFFMT                               C Status of SSA check (LAF) as of 12/31

                                  12                      Unknown
                                   0                   AD Cur pay-adj for dual entitlement
                                   0                   AF Transfer to another PC or dio
                                   0                   A9 Cur pay-miscellaneous adjustment
                              10,927                    C Current payment status
                                   0                   DW Deferred-Workers' Compensation
                                   1                   D2 DEF-retirement test
                                   0                   D3 DEF-D2 for primary
                                   5                   D6 DEF-recover overpayment
                                   2                   D9 DEF-miscellaneous reason
                                   0                    J Advanced filing-current pay
                                   0                   L2 Advanced filing-worked inside U S
                                   0                   L3 Advanced filing-insured worked in U S
                                   0                    N Not in pay status
                                   0                   PB Delayed-benefit due but not paid
                                   0                    R Cur pay-Part B reinstated
                                   0                   RN Cur pay-Part B reinstated
                                   0                    S SUSP-deferred retirement
                                   0                   SD SUSP-other
                                   0                   SF SUSP-fails to meet residence requirment
                                  50                   SH SUSP-government pension
                                   1                   SP SUSP-public assistance
                                   0                   SW SUSP-Workers' Compensation
                                   2                   S0 SUSP-continuing disability investig
                                   2                   S2 SUSP-fails retirement test
                                   0                   S3 SUSP-primary account S2
                                   3                   S6 SUSP-check returned for address
                                  21                   S7 SUSP-vocational rehab refusal
                                   3                   S8 SUSP-payee not determined
                                   9                   S9 SUSP-miscellaneous reason
                                   0                   TA TERM-prior to entitlement
                                   0                   TJ TERM-prior to entlmt, not stop debit
                                   0                   TR TERM-claim withdrawn
                                   0                   T0 TERM-benefits paid by another agency
                                 618                   T1 TERM-death of beneficiary
                                   0                   T2 TERM-death of primary
                                   2                   T3 TERM-divorce, marriage, remarriage
                                   0                   T4 TERM-dependent child attained age 18
                                   0                   T5 TERM-entitled on another account
                                   0                   T6 TERM-child no longer student, disabled
                                   3                   T8 TERM-recovery from disability
                                   0                   T9 TERM-miscellaneous
                                 289                    U Active uninsured status (no SSA check)
                                   0                   XF Transfer to another PC or DIO
                                   0                   XR Terminated -
                                  16                   X1 TERM-death of insured
                                   0                   X5 TERM-entitled to another benefit
                                  18                   X7 TERM of uninsured
                                   0                   X9 TERM miscellaneous
                                   0                   ZZ Erroneous entitlement

H_RESST    68  2  $STFMT                                C SSA State code of residence as of 12/31

                                 440                   01 Alabama
                                   0                   02 Alaska
                                 241                   03 Arizona
                                 115                   04 Arkansas
                                 820                   05 California
                                 116                   06 Colorado
                                 150                   07 Connecticut
                                   3                   08 Delaware
                                  10                   09 Washington, DC
                                 938                   10 Florida
                                 375                   11 Georgia
                                   0                   12 Hawaii
                                   0                   13 Idaho
                                 388                   14 Illinois
                                  43                   15 Indiana
                                 117                   16 Iowa
                                 110                   17 Kansas
                                 235                   18 Kentucky
                                 116                   19 Louisiana
                                   1                   20 Maine
                                 149                   21 Maryland
                                 215                   22 Massachusetts
                                 635                   23 Michigan
                                 160                   24 Minnesota
                                   1                   25 Mississippi
                                 323                   26 Missouri
                                   0                   27 Montana
                                 114                   28 Nebraska
                                 259                   29 Nevada
                                   1                   30 New Hampshire
                                 333                   31 New Jersey
                                 219                   32 New Mexico
                                 816                   33 New York
                                 575                   34 North Carolina
                                   0                   35 North Dakota
                                 607                   36 Ohio
                                 115                   37 Oklahoma
                                   3                   38 Oregon
                                 673                   39 Pennsylvania
                                 218                   40 Puerto Rico
                                   0                   41 Rhode Island
                                 110                   42 South Carolina
                                   0                   43 South Dakota
                                 311                   44 Tennessee
                                 722                   45 Texas
                                   2                   46 Utah
                                   0                   47 Vermont
                                   0                   48 Virgin Islands
                                 138                   49 Virginia
                                 467                   50 Washington
                                 168                   51 West Virginia
                                 319                   52 Wisconsin
                                 104                   53 Wyoming
                                   9                      Unknown

H_RESCTY   70  3  $CTYFMT                               C SSA county code of residence as of 12/31

                                   9                      Unknown
                              11,975                      County code

H_ZIP      73  5  $ZIPFMT                               C Postal zip code of residence as of 12/31

                                   9                      Unknown
                              11,975                      ZIP Code

H_CENSUS   78  2  $CENFMT                               C Census Region of residence as of 12/31

                                 367                   01 New England
                               1,822                   02 Middle Atlantic
                               1,992                   03 East North Central
                                 824                   04 West North Central
                               2,466                   05 South Atlantic
                                 987                   06 East South Central
                               1,068                   07 West South Central
                                 941                   08 Mountain
                               1,290                   09 Pacific
                                 218                   10 Puerto Rico
                                   9                      Unknown

H_METRO    80  1  $METFMT                               C Metro status

                               3,194                    N Non-metro area
                                   9                    U Unknown
                               8,781                    Y Metro area

H_HSBEG1   81  8  $DTE8FMT                              C Beginning date of latest hospice period

                              11,245                      Missing
                                 739                      Date as YYYYMMDD

H_HSEND1   89  8  $DTE8FMT                              C Ending date of latest hospice period

                              11,245                      Missing
                                 739                      Date as YYYYMMDD

H_HSBEG2   97  8  $DTE8FMT                              C Beginning date of 2nd hospice period

                              11,748                      Missing
                                 236                      Date as YYYYMMDD

H_HSEND2  105  8  $DTE8FMT                              C Ending date of 2nd hospice period

                              11,748                      Missing
                                 236                      Date as YYYYMMDD

H_HSBEG3  113  8  $DTE8FMT                              C Beginning date of 3rd hospice period

                              11,838                      Missing
                                 146                      Date as YYYYMMDD

H_HSEND3  121  8  $DTE8FMT                              C Ending date of 3rd hospice period

                              11,838                      Missing
                                 146                      Date as YYYYMMDD

H_HSBEG4  129  8  $DTE8FMT                              C Beginning date of 4th hospice period

                              11,881                      Missing
                                 103                      Date as YYYYMMDD

H_HSEND4  137  8  $DTE8FMT                              C Ending date of 4th hospice period

                              11,881                      Missing
                                 103                      Date as YYYYMMDD

H_ESRBEG  145  8  $DTE8FMT                              C Beginning date of ESRD period

                              11,814                      Missing
                                 170                      Date as YYYYMMDD

H_ESREND  153  8  $DTE8FMT                              C Ending date of ESRD period

                              11,890                      Missing
                                  94                      Date as YYYYMMDD

H_GHPSW   161  1  $GHPSW                                C Some group health participation in year

                               9,834                    0 No enrollment
                               2,150                    1 Some enrollment

H_PNUM    162  3                                        N Number of GHPs in bene area in 2006

H_MANUM   165  3                                        N Number of MA plans in bene area in 2006

H_PFSNUM  168  3                                        N Number of PFFS plans in bene area in 200

H_PLTP01  171  2  $PLNFMT                               C GHP plan type for Jan

                              10,223                      No enrollment for month
                                  26                   01 Health care prepayment plan
                                  58                   02 Cost HMO
                               1,677                   06 Risk HMO

H_PLPY01  173  5                                        N Medicare capitation payment for Jan

H_PLTP02  178  2  $PLNFMT                               C GHP plan type for Feb

                              10,223                      No enrollment for month
                                  26                   01 Health care prepayment plan
                                  58                   02 Cost HMO
                               1,677                   06 Risk HMO

H_PLPY02  180  5                                        N Medicare capitation payment for Feb

H_PLTP03  185  2  $PLNFMT                               C GHP plan type for Mar

                              10,223                      No enrollment for month
                                  26                   01 Health care prepayment plan
                                  58                   02 Cost HMO
                               1,677                   06 Risk HMO

H_PLPY03  187  5                                        N Medicare capitation payment for Mar

H_PLTP04  192  2  $PLNFMT                               C GHP plan type for Apr

                              10,168                      No enrollment for month
                                  26                   01 Health care prepayment plan
                                  59                   02 Cost HMO
                               1,731                   06 Risk HMO

H_PLPY04  194  5                                        N Medicare capitation payment for Apr

H_PLTP05  199  2  $PLNFMT                               C GHP plan type for May

                              10,135                      No enrollment for month
                                  26                   01 Health care prepayment plan
                                  61                   02 Cost HMO
                               1,762                   06 Risk HMO

H_PLPY05  201  5                                        N Medicare capitation payment for May

H_PLTP06  206  2  $PLNFMT                               C GHP plan type for Jun

                              10,093                      No enrollment for month
                                  25                   01 Health care prepayment plan
                                  60                   02 Cost HMO
                               1,806                   06 Risk HMO

H_PLPY06  208  5                                        N Medicare capitation payment for Jun

H_PLTP07  213  2  $PLNFMT                               C GHP plan type for Jul

                              10,062                      No enrollment for month
                                  25                   01 Health care prepayment plan
                                  59                   02 Cost HMO
                               1,838                   06 Risk HMO

H_PLPY07  215  5                                        N Medicare capitation payment for Jul

H_PLTP08  220  2  $PLNFMT                               C GHP plan type for Aug

                              10,024                      No enrollment for month
                                  24                   01 Health care prepayment plan
                                  55                   02 Cost HMO
                               1,881                   06 Risk HMO

H_PLPY08  222  5                                        N Medicare capitation payment for Aug

H_PLTP09  227  2  $PLNFMT                               C GHP plan type for Sep

                               9,992                      No enrollment for month
                                  24                   01 Health care prepayment plan
                                  60                   02 Cost HMO
                               1,908                   06 Risk HMO

H_PLPY09  229  5                                        N Medicare capitation payment for Sep

H_PLTP10  234  2  $PLNFMT                               C GHP plan type for Oct

                               9,990                      No enrollment for month
                                  24                   01 Health care prepayment plan
                                  59                   02 Cost HMO
                               1,911                   06 Risk HMO

H_PLPY10  236  5                                        N Medicare capitation payment for Oct

H_PLTP11  241  2  $PLNFMT                               C GHP plan type for Nov

                               9,994                      No enrollment for month
                                  24                   01 Health care prepayment plan
                                  59                   02 Cost HMO
                               1,907                   06 Risk HMO

H_PLPY11  243  5                                        N Medicare capitation payment for Nov

H_PLTP12  248  2  $PLNFMT                               C GHP plan type for Dec

                               9,985                      No enrollment for month
                                  24                   01 Health care prepayment plan
                                  59                   02 Cost HMO
                               1,916                   06 Risk HMO

H_PLPY12  250  5                                        N Medicare capitation payment for Dec

H_PDTP01  255  1  $DPLNFMT                              C Part D plan type for Jan

                                   6                      Unknown
                               7,218                    0 No Part D enrollment
                               1,516                    1 MA-PD plan
                               3,244                    2 PDP

H_PDPY01  256  5                                        N Part D capitation payment for Jan

H_PDLS01  261  1  $DLISFMT                              C LIS Indicator for Jan

                                 340                      Unknown
                               8,603                    1 No premium subsidy
                                  20                    2 25% premium subsidy
                                  30                    3 50% premium subsidy
                                  23                    4 75% premium subsidy
                               2,968                    5 100% premium subsidy

H_PDRS01  262  1  $DRDSFMT                              C RDS Indicator for Jan

                                 340                      Unknown
                               9,839                    N Employer not subsidized for the benefici
                               1,805                    Y Employer subsidized for the beneficiary

H_PDTP02  263  1  $DPLNFMT                              C Part D plan type for Feb

                                   6                      Unknown
                               6,878                    0 No Part D enrollment
                               1,547                    1 MA-PD plan
                               3,553                    2 PDP

H_PDPY02  264  5                                        N Part D capitation payment for Feb

H_PDLS02  269  1  $DLISFMT                              C LIS Indicator for Feb

                                 386                      Unknown
                               8,549                    1 No premium subsidy
                                  20                    2 25% premium subsidy
                                  31                    3 50% premium subsidy
                                  23                    4 75% premium subsidy
                               2,975                    5 100% premium subsidy

H_PDRS02  270  1  $DRDSFMT                              C RDS Indicator for Feb

                                 386                      Unknown
                               9,791                    N Employer not subsidized for the benefici
                               1,807                    Y Employer subsidized for the beneficiary

H_PDTP03  271  1  $DPLNFMT                              C Part D plan type for Mar

                                   6                      Unknown
                               6,657                    0 No Part D enrollment
                               1,583                    1 MA-PD plan
                               3,738                    2 PDP

H_PDPY03  272  5                                        N Part D capitation payment for Mar

H_PDLS03  277  1  $DLISFMT                              C LIS Indicator for Mar

                                 414                      Unknown
                               8,511                    1 No premium subsidy
                                  21                    2 25% premium subsidy
                                  31                    3 50% premium subsidy
                                  26                    4 75% premium subsidy
                               2,981                    5 100% premium subsidy

H_PDRS03  278  1  $DRDSFMT                              C RDS Indicator for Mar

                                 414                      Unknown
                               9,758                    N Employer not subsidized for the benefici
                               1,812                    Y Employer subsidized for the beneficiary

H_PDTP04  279  1  $DPLNFMT                              C Part D plan type for Apr

                                   6                      Unknown
                               6,428                    0 No Part D enrollment
                               1,625                    1 MA-PD plan
                               3,925                    2 PDP

H_PDPY04  280  5                                        N Part D capitation payment for Apr

H_PDLS04  285  1  $DLISFMT                              C LIS Indicator for Apr

                                 442                      Unknown
                               8,478                    1 No premium subsidy
                                  21                    2 25% premium subsidy
                                  31                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,984                    5 100% premium subsidy

H_PDRS04  286  1  $DRDSFMT                              C RDS Indicator for Apr

                                 442                      Unknown
                               9,728                    N Employer not subsidized for the benefici
                               1,814                    Y Employer subsidized for the beneficiary

H_PDTP05  287  1  $DPLNFMT                              C Part D plan type for May

                                   6                      Unknown
                               5,901                    0 No Part D enrollment
                               1,657                    1 MA-PD plan
                               4,420                    2 PDP

H_PDPY05  288  5                                        N Part D capitation payment for May

H_PDLS05  293  1  $DLISFMT                              C LIS Indicator for May

                                 481                      Unknown
                               8,427                    1 No premium subsidy
                                  21                    2 25% premium subsidy
                                  33                    3 50% premium subsidy
                                  27                    4 75% premium subsidy
                               2,995                    5 100% premium subsidy

H_PDRS05  294  1  $DRDSFMT                              C RDS Indicator for May

                                 481                      Unknown
                               9,687                    N Employer not subsidized for the benefici
                               1,816                    Y Employer subsidized for the beneficiary

H_PDTP06  295  1  $DPLNFMT                              C Part D plan type for Jun

                                   6                      Unknown
                               5,489                    0 No Part D enrollment
                               1,695                    1 MA-PD plan
                               4,794                    2 PDP

H_PDPY06  296  5                                        N Part D capitation payment for Jun

H_PDLS06  301  1  $DLISFMT                              C LIS Indicator for Jun

                                 509                      Unknown
                               8,398                    1 No premium subsidy
                                  21                    2 25% premium subsidy
                                  35                    3 50% premium subsidy
                                  27                    4 75% premium subsidy
                               2,994                    5 100% premium subsidy

H_PDRS06  302  1  $DRDSFMT                              C RDS Indicator for Jun

                                 509                      Unknown
                               9,654                    N Employer not subsidized for the benefici
                               1,821                    Y Employer subsidized for the beneficiary

H_PDTP07  303  1  $DPLNFMT                              C Part D plan type for Jul

                                   6                      Unknown
                               5,501                    0 No Part D enrollment
                               1,710                    1 MA-PD plan
                               4,767                    2 PDP

H_PDPY07  304  5                                        N Part D capitation payment for Jul

H_PDLS07  309  1  $DLISFMT                              C LIS Indicator for Jul

                                 545                      Unknown
                               8,361                    1 No premium subsidy
                                  20                    2 25% premium subsidy
                                  35                    3 50% premium subsidy
                                  27                    4 75% premium subsidy
                               2,996                    5 100% premium subsidy

H_PDRS07  310  1  $DRDSFMT                              C RDS Indicator for Jul

                                 545                      Unknown
                               9,613                    N Employer not subsidized for the benefici
                               1,826                    Y Employer subsidized for the beneficiary

H_PDTP08  311  1  $DPLNFMT                              C Part D plan type for Aug

                                   6                      Unknown
                               5,483                    0 No Part D enrollment
                               1,717                    1 MA-PD plan
                               4,778                    2 PDP

H_PDPY08  312  5                                        N Part D capitation payment for Aug

H_PDLS08  317  1  $DLISFMT                              C LIS Indicator for Aug

                                 555                      Unknown
                               8,354                    1 No premium subsidy
                                  19                    2 25% premium subsidy
                                  35                    3 50% premium subsidy
                                  27                    4 75% premium subsidy
                               2,994                    5 100% premium subsidy

H_PDRS08  318  1  $DRDSFMT                              C RDS Indicator for Aug

                                 555                      Unknown
                               9,601                    N Employer not subsidized for the benefici
                               1,828                    Y Employer subsidized for the beneficiary

H_PDTP09  319  1  $DPLNFMT                              C Part D plan type for Sep

                                   6                      Unknown
                               5,433                    0 No Part D enrollment
                               1,718                    1 MA-PD plan
                               4,827                    2 PDP

H_PDPY09  320  5                                        N Part D capitation payment for Sep

H_PDLS09  325  1  $DLISFMT                              C LIS Indicator for Sep

                                 561                      Unknown
                               8,347                    1 No premium subsidy
                                  19                    2 25% premium subsidy
                                  36                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,993                    5 100% premium subsidy

H_PDRS09  326  1  $DRDSFMT                              C RDS Indicator for Sep

                                 561                      Unknown
                               9,590                    N Employer not subsidized for the benefici
                               1,833                    Y Employer subsidized for the beneficiary

H_PDTP10  327  1  $DPLNFMT                              C Part D plan type for Oct

                                   6                      Unknown
                               5,453                    0 No Part D enrollment
                               1,715                    1 MA-PD plan
                               4,810                    2 PDP

H_PDPY10  328  5                                        N Part D capitation payment for Oct

H_PDLS10  333  1  $DLISFMT                              C LIS Indicator for Oct

                                 594                      Unknown
                               8,316                    1 No premium subsidy
                                  19                    2 25% premium subsidy
                                  38                    3 50% premium subsidy
                                  29                    4 75% premium subsidy
                               2,988                    5 100% premium subsidy

H_PDRS10  334  1  $DRDSFMT                              C RDS Indicator for Oct

                                 594                      Unknown
                               9,551                    N Employer not subsidized for the benefici
                               1,839                    Y Employer subsidized for the beneficiary

H_PDTP11  335  1  $DPLNFMT                              C Part D plan type for Nov

                                   6                      Unknown
                               5,463                    0 No Part D enrollment
                               1,722                    1 MA-PD plan
                               4,793                    2 PDP

H_PDPY11  336  5                                        N Part D capitation payment for Nov

H_PDLS11  341  1  $DLISFMT                              C LIS Indicator for Nov

                                 616                      Unknown
                               8,303                    1 No premium subsidy
                                  19                    2 25% premium subsidy
                                  38                    3 50% premium subsidy
                                  29                    4 75% premium subsidy
                               2,979                    5 100% premium subsidy

H_PDRS11  342  1  $DRDSFMT                              C RDS Indicator for Nov

                                 616                      Unknown
                               9,525                    N Employer not subsidized for the benefici
                               1,843                    Y Employer subsidized for the beneficiary

H_PDTP12  343  1  $DPLNFMT                              C Part D plan type for Dec

                                   6                      Unknown
                               5,483                    0 No Part D enrollment
                               1,724                    1 MA-PD plan
                               4,771                    2 PDP

H_PDPY12  344  5                                        N Part D capitation payment for Dec

H_PDLS12  349  1  $DLISFMT                              C LIS Indicator for Dec

                                 631                      Unknown
                               8,291                    1 No premium subsidy
                                  20                    2 25% premium subsidy
                                  39                    3 50% premium subsidy
                                  30                    4 75% premium subsidy
                               2,973                    5 100% premium subsidy

H_PDRS12  350  1  $DRDSFMT                              C RDS Indicator for Dec

                                 631                      Unknown
                               9,509                    N Employer not subsidized for the benefici
                               1,844                    Y Employer subsidized for the beneficiary

H_MCSW    351  1  $SWFMT                                C Some Medicaid eligibility for the year

                               9,444                    N No participation
                               2,540                    Y Some participation

H_MCDE01  352  1  $MCDCFMT                              C Medicaid eligibility for Jan

                                   0                    A State Part A buy-in
                                 936                    B State Part B buy-in
                                  30                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,654                    N No buy-in this month
                               1,024                    Q State Part B QMB buy-in
                                 256                    S State Part B SLMB buy-in

H_MCDE02  353  1  $MCDCFMT                              C Medicaid eligibility for Feb

                                   0                    A State Part A buy-in
                                 934                    B State Part B buy-in
                                  30                    C State Part A and B buy-in
                                  85                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,660                    N No buy-in this month
                               1,021                    Q State Part B QMB buy-in
                                 254                    S State Part B SLMB buy-in

H_MCDE03  354  1  $MCDCFMT                              C Medicaid eligibility for Mar

                                   0                    A State Part A buy-in
                                 936                    B State Part B buy-in
                                  30                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,652                    N No buy-in this month
                               1,020                    Q State Part B QMB buy-in
                                 262                    S State Part B SLMB buy-in

H_MCDE04  355  1  $MCDCFMT                              C Medicaid eligibility for Apr

                                   0                    A State Part A buy-in
                                 935                    B State Part B buy-in
                                  32                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,661                    N No buy-in this month
                               1,018                    Q State Part B QMB buy-in
                                 254                    S State Part B SLMB buy-in

H_MCDE05  356  1  $MCDCFMT                              C Medicaid eligibility for May

                                   0                    A State Part A buy-in
                                 935                    B State Part B buy-in
                                  31                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,665                    N No buy-in this month
                               1,013                    Q State Part B QMB buy-in
                                 256                    S State Part B SLMB buy-in

H_MCDE06  357  1  $MCDCFMT                              C Medicaid eligibility for Jun

                                   0                    A State Part A buy-in
                                 929                    B State Part B buy-in
                                  31                    C State Part A and B buy-in
                                  82                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,679                    N No buy-in this month
                               1,005                    Q State Part B QMB buy-in
                                 258                    S State Part B SLMB buy-in

H_MCDE07  358  1  $MCDCFMT                              C Medicaid eligibility for Jul

                                   0                    A State Part A buy-in
                                 917                    B State Part B buy-in
                                  32                    C State Part A and B buy-in
                                  83                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,689                    N No buy-in this month
                               1,004                    Q State Part B QMB buy-in
                                 259                    S State Part B SLMB buy-in

H_MCDE08  359  1  $MCDCFMT                              C Medicaid eligibility for Aug

                                   1                    A State Part A buy-in
                                 926                    B State Part B buy-in
                                  31                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,684                    N No buy-in this month
                                 997                    Q State Part B QMB buy-in
                                 261                    S State Part B SLMB buy-in

H_MCDE09  360  1  $MCDCFMT                              C Medicaid eligibility for Sep

                                   0                    A State Part A buy-in
                                 925                    B State Part B buy-in
                                  31                    C State Part A and B buy-in
                                  83                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,688                    N No buy-in this month
                                 994                    Q State Part B QMB buy-in
                                 263                    S State Part B SLMB buy-in

H_MCDE10  361  1  $MCDCFMT                              C Medicaid eligibility for Oct

                                   0                    A State Part A buy-in
                                 914                    B State Part B buy-in
                                  33                    C State Part A and B buy-in
                                  83                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,696                    N No buy-in this month
                                 991                    Q State Part B QMB buy-in
                                 267                    S State Part B SLMB buy-in

H_MCDE11  362  1  $MCDCFMT                              C Medicaid eligibility for Nov

                                   0                    A State Part A buy-in
                                 909                    B State Part B buy-in
                                  33                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,697                    N No buy-in this month
                                 996                    Q State Part B QMB buy-in
                                 265                    S State Part B SLMB buy-in

H_MCDE12  363  1  $MCDCFMT                              C Medicaid eligibility for Dec

                                   0                    A State Part A buy-in
                                 892                    B State Part B buy-in
                                  33                    C State Part A and B buy-in
                                  84                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               9,730                    N No buy-in this month
                                 985                    Q State Part B QMB buy-in
                                 260                    S State Part B SLMB buy-in

H_MACY01  364  3  $MACYFMT                              C Buy-in agency for Jan

                               9,654                    N Unknown, or no buy-in
                               2,330              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY02  367  3  $MACYFMT                              C Buy-in agency for Feb

                               9,660                    N Unknown, or no buy-in
                               2,324              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY03  370  3  $MACYFMT                              C Buy-in agency for Mar

                               9,652                    N Unknown, or no buy-in
                               2,332              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY04  373  3  $MACYFMT                              C Buy-in agency for Apr

                               9,661                    N Unknown, or no buy-in
                               2,323              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY05  376  3  $MACYFMT                              C Buy-in agency for May

                               9,665                    N Unknown, or no buy-in
                               2,319              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY06  379  3  $MACYFMT                              C Buy-in agency for Jun

                               9,679                    N Unknown, or no buy-in
                               2,305              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY07  382  3  $MACYFMT                              C Buy-in agency for Jul

                               9,689                    N Unknown, or no buy-in
                               2,295              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY08  385  3  $MACYFMT                              C Buy-in agency for Aug

                               9,684                    N Unknown, or no buy-in
                               2,300              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY09  388  3  $MACYFMT                              C Buy-in agency for Sep

                               9,688                    N Unknown, or no buy-in
                               2,296              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY10  391  3  $MACYFMT                              C Buy-in agency for Oct

                               9,696                    N Unknown, or no buy-in
                               2,288              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY11  394  3  $MACYFMT                              C Buy-in agency for Nov

                               9,697                    N Unknown, or no buy-in
                               2,287              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY12  397  3  $MACYFMT                              C Buy-in agency for Dec

                               9,730                    N Unknown, or no buy-in
                               2,254              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_HOSSW   400  1  $UTLFMT                               C One or more hospice bills in CY

                              11,673                    0 No utilization this type
                                 311                    1 Some utilization this type

H_INPSW   401  1  $UTLFMT                               C One or more inpatient discharges in CY

                               9,697                    0 No utilization this type
                               2,287                    1 Some utilization this type

H_SNFSW   402  1  $UTLFMT                               C One or more SNF admissions in CY

                              11,362                    0 No utilization this type
                                 622                    1 Some utilization this type

H_HHASW   403  1  $UTLFMT                               C 1 = one or more HHA visits in CY

                              11,013                    0 No utilization this type
                                 971                    1 Some utilization this type

H_OUTSW   404  1  $UTLFMT                               C One or more outpatient visits in CY

                               4,906                    0 No utilization this type
                               7,078                    1 Some utilization this type

H_PBSW    405  1  $UTLFMT                               C One or more Part B claims in CY

                               2,393                    0 No utilization this type
                               9,591                    1 Some utilization this type

H_PTARMB  406  7                                        N Total Part A reimbursement in CY ($)

H_PTBRMB  413  7                                        N Total Part B reimbursement in CY ($)

H_PTAPRM  420  8                                        N Total Pt. A premium SP paid in CY ($.CC)

H_PTBPRM  428  8                                        N Total Pt. B premium SP paid in CY ($.CC)

H_LATDCH  436  8  $DTE8FMT                              C Discharge date of latest inpatient stay

                               9,697                      Missing
                               2,287                      Date as YYYYMMDD

H_LATDRG  444  3  $DRGFMT                               C DRG code for latest inpatient stay

                               9,697                      Unknown, or no discharge
                               2,287                      DRG

H_DISDES  447  2  $STATUS                               C Discharge dest for latest inpatient stay

                               9,697                      Missing
                               1,197                   01 Discharged to home/self care
                                  12                   02 Discharged to other short-term hospital
                                 430                   03 Discharged to skilled nursing facility
                                  39                   04 Discharged to intermediate care facility
                                  10                   05 Disch to another type of institution
                                 306                   06 Discharged to home care of organized HMO
                                  16                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                 162                   20 Expired (did not recover Christian Sci)
                                   2                   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)
                                  34                   50 Hospice - home (eff. 10/96)
                                  34                   51 Hospice - medical facility (eff. 10/96)
                                  21                   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)
                                  24                      Other destination

H_INPSTY  449  2                                        N No. of inpatient stays for CY

H_INPDAY  451  3                                        N No. of inpatient covered days for CY

H_INPCHG  454  7                                        N Inpatient charges for CY ($)

H_INPCCH  461  7                                        N Inpatient covered charges for CY ($)

H_INPRMB  468  7                                        N Inpatient reimbursement for CY ($)

H_INPCDY  475  2                                        N Inpatient coinsurance days used in CY

H_INPCAM  477  5                                        N Total inpatient coinsurance amt CY ($)

H_SNFSTY  482  2                                        N Total SNF stays in CY

H_SNFDAY  484  3                                        N Total SNF covered days in CY

H_SNFCHG  487  7                                        N Total SNF charges in CY  ($)

H_SNFCCH  494  7                                        N Total SNF covered charges in CY ($)

H_SNFRMB  501  7                                        N Total SNF reimbursement in CY ($)

H_SNFCDY  508  3                                        N Total SNF coinsurance days in CY

H_SNFCAM  511  7                                        N Total SNF coinsurance amount in CY ($)

H_HHAVST  518  5                                        N Total HHA visits in CY

H_HHACCH  523  7                                        N Total HHA covered charges in CY ($)

H_HHACHO  530  7                                        N Total HHA other covered charges CY ($)

H_HHRMBA  537  7                                        N Total HHA reimbursement in CY ($), Pt. A

                  Note: Prior to 1998 this was included in H_HHARMB.

H_HHRMBB  544  7                                        N Total HHA reimbursement in CY ($), Pt. B

                  Note: Prior to 1998 this was included in H_HHARMB.

H_HSDAYS  551  3                                        N Total covered hospice days in CY

H_HSTCHG  554  7                                        N Total hospice charges CY ($)

H_HSREIM  561  7                                        N Total hospice reimbursement in CY ($)

H_OUTBIL  568  3                                        N Total outpatient bills in CY

H_OUTCHG  571  7                                        N Total outpatient covered charges CY ($)

H_OUTRMB  578  7                                        N Total outpatient reimbursement CY ($)

H_PHYCLM  585  4                                        N Total physician claims in CY

H_PHYLIN  589  4                                        N Total physician line items in CY

H_PHYSCH  593  7                                        N Total physician submitted charges ($)

H_PHYACH  600  7                                        N Total physician allowed charges ($)

H_PHYRMB  607  7                                        N Total physician reimbursement ($)

H_PMTVST  614  3                                        N Total office visits in CY

H_PMTCHO  617  7                                        N Total office visit charges in CY ($)

H_DMECLM  624  4                                        N Total DME supplier claims in CY

                  Note: Prior to 1998 this was included in H_PMTCLM.

H_DMELIN  628  4                                        N Total DME supplier line items in CY

                  Note: Prior to 1998 this was included in H_PMTLIN.

H_DMESCH  632  7                                        N Total DME supplier submitted charges ($)

                  Note: Prior to 1998 this was included in H_PMTSCH.

H_DMEACH  639  7                                        N Total DME supplier allowed charges ($)

                  Note: Prior to 1998 this was included in H_PMTACH.

H_DMERMB  646  7                                        N Total DME supplier reimbursement ($)

                  Note: Prior to 1998 this was included in H_PMTRMB.

