RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              58,950             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                              26,366            C000-C999 Event created from claim
                              32,584            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                              26,366                      Missing
                                   0                   DU Dental
                               2,277                   ER Emergency Room
                                 643                   IP Inpatient
                                   0                   IU Institutional utilization
                              10,577                   MP Medical provider
                                 281                   OM Other medical expense
                              18,027                   OP Outpatient
                                   0                   PM Prescribed medicine
                                 393                   SD Separately billing physician
                                 386                   SL Separately billing lab

CLAIMID    20  7                                        N Claim this survey event matched to

FROMDT     27  6                                        C From date on claim

THRUDT     33  6                                        C Thru date on claim

EVBEGYY    39  2  $EVENTYY                              C Event begin year

                                  27                   -8 Don't know
                                   7                   -9 Not ascertained
                              58,916                      Year

EVBEGMM    41  2  $EVENTMM                              C Event begin month

                                 280                   -8 Don't know
                                   7                   -9 Not ascertained
                                   0                   95 Still in progress
                              58,663                      Month

EVBEGDD    43  2  $EVENTDD                              C Event begin day

                                  14                   -7 Refused
                              15,968                   -8 Don't know
                                   7                   -9 Not ascertained
                              42,961                      Day of month

SOURCE     45  1  $SOURCE                               C Source of event: survey, claim, or both?

                              13,612                    1 Survey only
                              26,366                    2 Claims only
                              18,972                    3 Both survey & claims

SITCODE    46  1  $SITCODE                              C Community or facility setting?

                                  12                    B Both community & facility
                              51,608                    C Community
                               2,272                    D Deemed community
                               4,358                    F Facility
                                  98                    G Deemed facility
                                 602                    S SNF

AMTTOT     47  9                                        N Total payment

IMPATOT    56  1  IMPFLAG                               N AMTTOT imputed in part or in total?

                              40,341                    0 Not imputed
                              18,609                    1 Imputed

AMTCOV     57  9                                        N Medicare program liability, incl. copays

AMTNCOV    66  9                                        N Total payment not covered by Medicare

AMTCARE    75  9                                        N Amount paid by Medicare

IMPSCARE   84  1  IMPFLAG                               N AMTCARE payment source imputed?

                              58,759                    0 Not imputed
                                 191                    1 Imputed

IMPACARE   85  1  IMPFLAG                               N AMTCARE payment amount imputed?

                              56,139                    0 Not imputed
                               2,811                    1 Imputed

AMTCAID    86  9                                        N Amount paid by Medicaid

IMPSCAID   95  1  IMPFLAG                               N AMTCAID payment source imputed?

                              53,722                    0 Not imputed
                               5,228                    1 Imputed

IMPACAID   96  1  IMPFLAG                               N AMTCAID payment amount imputed?

                              48,925                    0 Not imputed
                              10,025                    1 Imputed

AMTHMOM    97  9                                        N Amount paid by Medicare HMO

IMPSHMOM  106  1  IMPFLAG                               N AMTHMOM payment source imputed?

                              56,080                    0 Not imputed
                               2,870                    1 Imputed

IMPAHMOM  107  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                              54,734                    0 Not imputed
                               4,216                    1 Imputed

AMTHMOP   108  9                                        N Amount paid by private HMO

IMPSHMOP  117  1  IMPFLAG                               N AMTHMOP payment source imputed?

                              57,543                    0 Not imputed
                               1,407                    1 Imputed

IMPAHMOP  118  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                              56,954                    0 Not imputed
                               1,996                    1 Imputed

AMTVA     119  9                                        N Amount paid by Veterans Administration

IMPSVA    128  1  IMPFLAG                               N AMTVA payment source imputed?

                              58,888                    0 Not imputed
                                  62                    1 Imputed

IMPAVA    129  1  IMPFLAG                               N AMTVA payment amount imputed?

                              58,321                    0 Not imputed
                                 629                    1 Imputed

AMTPRVE   130  9                                        N Amt paid by employer-sponsored priv ins

IMPSPRVE  139  1  IMPFLAG                               N AMTPRVE payment source imputed?

                              54,079                    0 Not imputed
                               4,871                    1 Imputed

IMPAPRVE  140  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                              51,875                    0 Not imputed
                               7,075                    1 Imputed

AMTPRVI   141  9                                        N Amt paid by individually-purch priv ins

IMPSPRVI  150  1  IMPFLAG                               N AMTPRVI payment source imputed?

                              55,422                    0 Not imputed
                               3,528                    1 Imputed

IMPAPRVI  151  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                              54,079                    0 Not imputed
                               4,871                    1 Imputed

AMTPRVU   152  9                                        N Amt paid by priv ins (unknown purchased)

IMPSPRVU  161  1  IMPFLAG                               N AMTPRVU payment source imputed?

                              58,511                    0 Not imputed
                                 439                    1 Imputed

IMPAPRVU  162  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                              58,511                    0 Not imputed
                                 439                    1 Imputed

AMTOOP    163  9                                        N Amount paid out-of-pocket (OOP)

IMPSOOP   172  1  IMPFLAG                               N AMTOOP payment source imputed?

                              51,723                    0 Not imputed
                               7,227                    1 Imputed

IMPAOOP   173  1  IMPFLAG                               N AMTOOP payment amount imputed?

                              49,988                    0 Not imputed
                               8,962                    1 Imputed

AMTDISC   174  9                                        N Amount of uncollected SP liability

IMPSDISC  183  1  IMPFLAG                               N AMTDISC payment source imputed?

                              57,196                    0 Not imputed
                               1,754                    1 Imputed

IMPADISC  184  1  IMPFLAG                               N AMTDISC payment amount imputed?

                              56,919                    0 Not imputed
                               2,031                    1 Imputed

AMTOTH    185  9                                        N Amount paid by other payor(s)

IMPSOTH   194  1  IMPFLAG                               N AMTOTH payment source imputed?

                              58,910                    0 Not imputed
                                  40                    1 Imputed

IMPAOTH   195  1  IMPFLAG                               N AMTOTH payment amount imputed?

                              58,629                    0 Not imputed
                                 321                    1 Imputed

ODIAGCNT  196  2                                        N Number of diagnosis codes on claim

ODIAG1    198  5                                        C Primary ICD-9 diagnosis code from claim

ODIAG2    203  5                                        C Second ICD-9 diagnosis code from claim

ODIAG3    208  5                                        C Third ICD-9 diagnosis code from claim

HMO       213  1  $HMO                                  C Event provided by an HMO?

                              47,031                    0 Event not provided by HMO
                              11,919                    1 Event provided by HMO

