RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               4,449             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,447            C000-C999 Event created from claim
                               3,002            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                               1,447                      Missing
                                   0                   DU Dental
                                  44                   ER Emergency Room
                               2,641                   IP Inpatient
                                  56                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                 261                   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

                                   2                   -8 Don't know
                               4,447                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                  27                   -8 Don't know
                                   0                   95 Still in progress
                               4,422                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                 215                   -8 Don't know
                               4,234                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   8                   -8 Don't know
                                   1                   -9 Not ascertained
                               4,440                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                  14                   -8 Don't know
                                   1                   -9 Not ascertained
                                   0                   95 Still in progress
                               4,434                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                 116                   -8 Don't know
                                   1                   -9 Not ascertained
                               4,332                      Day of month

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

                                 812                    1 Survey only
                               1,447                    2 Claims only
                               2,190                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                   5                    B Both community & facility
                               3,617                    C Community
                                 165                    D Deemed community
                                 507                    F Facility
                                  10                    G Deemed facility
                                 145                    S SNF

AMTTOT     41  9                                        N Total payment

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

                               3,242                    0 Not imputed
                               1,207                    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?

                               4,443                    0 Not imputed
                                   6                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               4,328                    0 Not imputed
                                 121                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                               4,179                    0 Not imputed
                                 270                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                               3,871                    0 Not imputed
                                 578                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                               4,163                    0 Not imputed
                                 286                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                               3,988                    0 Not imputed
                                 461                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               4,358                    0 Not imputed
                                  91                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               4,314                    0 Not imputed
                                 135                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                               4,445                    0 Not imputed
                                   4                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                               4,412                    0 Not imputed
                                  37                    1 Imputed

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

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                               4,111                    0 Not imputed
                                 338                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                               3,999                    0 Not imputed
                                 450                    1 Imputed

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

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                               4,152                    0 Not imputed
                                 297                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                               4,056                    0 Not imputed
                                 393                    1 Imputed

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

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                               4,379                    0 Not imputed
                                  70                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                               4,379                    0 Not imputed
                                  70                    1 Imputed

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

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                               3,801                    0 Not imputed
                                 648                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               3,641                    0 Not imputed
                                 808                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                               4,280                    0 Not imputed
                                 169                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                               4,261                    0 Not imputed
                                 188                    1 Imputed

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

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                               4,443                    0 Not imputed
                                   6                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               4,425                    0 Not imputed
                                  24                    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

                                 814                      Missing
                               1,773                   01 Discharged to home/self care
                                 102                   02 Discharged to other short-term hospital
                                 628                   03 Discharged to skilled nursing facility
                                  63                   04 Discharged to intermediate care facility
                                   6                   05 Disch to another type of institution
                                 603                   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
                                 141                   20 Expired (did not recover Christian Sci)
                                   1                   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)
                                  44                   50 Hospice - home (eff. 10/96)
                                  49                   51 Hospice - medical facility (eff. 10/96)
                                  46                   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)
                                 163                      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?

                               3,474                    0 Event not provided by HMO
                                 975                    1 Event provided by HMO

