RIC         1  1  $RICFMT                               C RIC CODE FOR ADMIN IDENTIFICATION RECORD

                              13,039                    A RIC A - HCFA RECORD SUMMARY
                                   0                    N RIC N - HCFA RECORD SUMMARY

FILEYR      2  2  $YRFMT                                C YY REFERENCE YEAR OF RECORD

                              13,039                   C2 1992 COST AND USE FILE

BASEID      4  8  $BSIDFMT                              C UNIQUE IDENTIFICATION NUMBER

                              13,039             LOW-HIGH BASEIDS

H_DOB      12  8  $DTE8FMT                              C DATE OF BIRTH

                              13,039                      DATE AS YYYYMMDD

H_DOD      20  6  $DTE6FMT                              C DATE OF DEATH

                              12,367                      MISSING
                                 672        000000-999999 DATE AS YYMMDD

H_DODSRC   26  2  $SRCFMT                               C SOURCE OF DEATH INFORMATION

                              12,367                      NO DATE OF DEATH
                                   0                   01 FROM MEDICARE BILL
                                   0                   03 CLERICAL ENTRY
                                   0                   05 BILL AND CLERICAL
                                 255                   10 PROVEN MBR
                                  46                   11 PROVEN MBR AND BILL
                                 315                   20 UNPROVEN MBR
                                  55                   21 UNPROVEN MBR AND BILL
                                   0                   23 UNPROVEN MBR AND CLERICAL
                                   1                   25 UNPROVEN MBR, BILL AND CLERICAL

H_SEX      28  1  $SEXFMT                               C SEX CODE

                               5,739                    1 MALE
                               7,300                    2 FEMALE

H_RACE     29  1  $RACEFMT                              C RACE CODE

                                 128                      UNKNOWN
                                   0                    0 UNKNOWN
                              11,060                    1 WHITE
                               1,477                    2 BLACK
                                 160                    3 OTHER
                                  48                    4 ASIAN
                                 156                    5 HISPANIC
                                  10                    6 N AMERICAN NATIVE

H_AGE      30  3  AGEFMT                                N AGE

                              13,039                0-999 AGE IN YEARS

D_STRAT    33  1  $AGEFMT                               C MCBS SAMPLE STRATUM

                               1,162                    1  0-44
                               1,246                    2 45-64
                               3,059                    3 65-69
                               1,872                    4 70-74
                               1,859                    5 75-79
                               1,872                    6 80-84
                               1,969                    7 85 +

H_ENT01    34  1  $ENTFMT                               C JAN MEDICARE ENTITLEMENT

                                 362                    A PART A MEDICARE ONLY
                                 119                    B PART B MEDICARE ONLY
                              11,258                    C PART A AND B MEDICARE
                               1,300                    N NO MEDICARE ENTITLEMENT

H_ENT02    35  1  $ENTFMT                               C FEB MEDICARE ENTITLEMENT

                                 358                    A PART A MEDICARE ONLY
                                 119                    B PART B MEDICARE ONLY
                              11,303                    C PART A AND B MEDICARE
                               1,259                    N NO MEDICARE ENTITLEMENT

H_ENT03    36  1  $ENTFMT                               C MAR MEDICARE ENTITLEMENT

                                 371                    A PART A MEDICARE ONLY
                                 121                    B PART B MEDICARE ONLY
                              11,359                    C PART A AND B MEDICARE
                               1,188                    N NO MEDICARE ENTITLEMENT

H_ENT04    37  1  $ENTFMT                               C APR MEDICARE ENTITLEMENT

                                 381                    A PART A MEDICARE ONLY
                                 122                    B PART B MEDICARE ONLY
                              11,414                    C PART A AND B MEDICARE
                               1,122                    N NO MEDICARE ENTITLEMENT

H_ENT05    38  1  $ENTFMT                               C MAY MEDICARE ENTITLEMENT

                                 390                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,482                    C PART A AND B MEDICARE
                               1,044                    N NO MEDICARE ENTITLEMENT

H_ENT06    39  1  $ENTFMT                               C JUN MEDICARE ENTITLEMENT

                                 399                    A PART A MEDICARE ONLY
                                 125                    B PART B MEDICARE ONLY
                              11,554                    C PART A AND B MEDICARE
                                 961                    N NO MEDICARE ENTITLEMENT

H_ENT07    40  1  $ENTFMT                               C JUL MEDICARE ENTITLEMENT

                                 372                    A PART A MEDICARE ONLY
                                 127                    B PART B MEDICARE ONLY
                              11,698                    C PART A AND B MEDICARE
                                 842                    N NO MEDICARE ENTITLEMENT

H_ENT08    41  1  $ENTFMT                               C AUG MEDICARE ENTITLEMENT

                                 378                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,756                    C PART A AND B MEDICARE
                                 782                    N NO MEDICARE ENTITLEMENT

H_ENT09    42  1  $ENTFMT                               C SEP MEDICARE ENTITLEMENT

                                 372                    A PART A MEDICARE ONLY
                                 123                    B PART B MEDICARE ONLY
                              11,794                    C PART A AND B MEDICARE
                                 750                    N NO MEDICARE ENTITLEMENT

H_ENT10    43  1  $ENTFMT                               C OCT MEDICARE ENTITLEMENT

                                 383                    A PART A MEDICARE ONLY
                                 124                    B PART B MEDICARE ONLY
                              11,824                    C PART A AND B MEDICARE
                                 708                    N NO MEDICARE ENTITLEMENT

H_ENT11    44  1  $ENTFMT                               C NOV MEDICARE ENTITLEMENT

                                 388                    A PART A MEDICARE ONLY
                                 124                    B PART B MEDICARE ONLY
                              11,854                    C PART A AND B MEDICARE
                                 673                    N NO MEDICARE ENTITLEMENT

H_ENT12    45  1  $ENTFMT                               C DEC MEDICARE ENTITLEMENT

                                 399                    A PART A MEDICARE ONLY
                                 121                    B PART B MEDICARE ONLY
                              11,888                    C PART A AND B MEDICARE
                                 631                    N NO MEDICARE ENTITLEMENT

H_DOE      46  6  $DTE6FMT                              C ENTITLEMENT START DATE

                                   2                      MISSING
                              13,037        000000-999999 DATE AS YYMMDD

H_DOT      52  6  $DTE6FMT                              C ENTITLEMENT END DATE

                              12,999                      MISSING
                                  40        000000-999999 DATE AS YYMMDD

H_MEDSTA   58  2  $MSCFMT                               C MEDICARE STATUS CODE AS OF DEC 31

                                   1                      UNKNOWN
                              10,611                   10 AGED, NO ESRD
                                  25                   11 AGED, ESRD
                               2,324                   20 DISABLED, NO ESRD
                                  25                   21 DISABLED, ESRD
                                  53                   31 ESRD ONLY

H_LAF      60  2  $LAFFMT                               C STATUS OF SSA BENEFIT CHECK (LAF) DEC 31

                                  32                      UNKNOWN
                                   0                   AD CUR PAY-ADJ FOR DUAL ENTITLEMENT
                                   0                   AF TRANSFER TO ANOTHER PC OR DIO
                                   0                   A9 CUR PAY-MISCELLANEOUS ADJUSTMENT
                              11,892                    C CURRENT PAYMENT STATUS
                                   1                   DW DEFERRED-WORKERS COMP
                                  35                   D2 DEF-RETIREMENT TEST
                                   3                   D3 DEF-D2 FOR PRIMARY
                                   4                   D6 DEF-RECOVER OVERPAYMENT
                                   2                   D9 DEF-MISCELLANEOUS REASON
                                   2                    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                   RN CUR PAY-PART B REINSTATED
                                   0                    S SUSP-DEFERRED RETIREMENT
                                   3                   SD SUSP-OTHER
                                   0                   SF SUSP-FAILS TO MEET RESIDENCE REQUIRMNT
                                  17                   SH SUSP-GOVERNMENT PENSION
                                   3                   SP SUSP-PUBLIC ASSISTANCE
                                   5                   S0 SUSP-CONTINUING DISABILITY INVESTIG
                                  47                   S2 SUSP-FAILS RETIREMENT TEST
                                   3                   S3 SUSP-PRIMARY ACCOUNT S2
                                   3                   S6 SUSP-CHECK RETURNED FOR ADDRESS
                                  15                   S7 SUSP-VOCATIONAL REHAB REFUSAL
                                   1                   S8 SUSP-PAYEE NOT DETERMINED
                                   2                   S9 SUSP-MISCELLANEOUS REASON
                                   1                   TR TERM-CLAIM WITHDRAWN
                                   0                   T0 TERM-BENEFITS PAID BY ANOTHER AGENCY
                                 631                   T1 TERM-DEATH OF BENEFICIARY
                                   0                   T2 TERM-DEATH OF PRIMARY
                                   1                   T3 TERM-DIVORCE, MARRIAGE, REMARRIAGE
                                   2                   T5 TERM-ENTITLED ON ANOTHER ACCT
                                   5                   T8 TERM-RECOVERY FROM DISABILITY
                                   1                   T9 TERM-MISCELLANEOUS
                                 304                    U ACTIVE UNINSURED STATUS (NO SSA CHECK)
                                   0                   XR TERMINATED -
                                  15                   X1 TERM-DEATH OF INSURED
                                   0                   X5 TERM-ENTITLED TO ANOTHER BENEFIT
                                   8                   X7 TERM OF UNINSURED
                                   0                   X9 TERM MISCELLANEOUS
                                   1                   ZZ ERRONEOUS ENTITLEMENT

H_RESST    62  2  $STFMT                                C SSA STATE CODE OF RESIDENCE AS OF DEC 31

                                  25                      UNKNOWN
                                 407                   01 AL
                                   0                   02 AK
                                 112                   03 AZ
                                 109                   04 AR
                               1,156                   05 CA
                                 234                   06 CO
                                 106                   07 CT
                                   0                   08 DE
                                  63                   09 DC
                                 677                   10 FL
                                 641                   11 GA
                                   0                   12 HI
                                  77                   13 ID
                                 451                   14 IL
                                 335                   15 IN
                                 260                   16 IA
                                 172                   17 KS
                                 177                   18 KY
                                 132                   19 LA
                                 136                   20 ME
                                 169                   21 MD
                                 164                   22 MA
                                 398                   23 MI
                                 157                   24 MN
                                 106                   25 MS
                                 185                   26 MO
                                   0                   27 MT
                                   2                   28 NE
                                 136                   29 NV
                                   1                   30 NH
                                 661                   31 NJ
                                 121                   32 NM
                                 936                   33 NY
                                   8                   34 NC
                                  60                   35 ND
                                 544                   36 OH
                                 233                   37 OK
                                   4                   38 OR
                                 693                   39 PA
                                 195                   40 PR
                                   1                   41 RI
                                 497                   42 SC
                                   1                   43 SD
                                  72                   44 TN
                                 847                   45 TX
                                   3                   46 UT
                                   1                   47 VT
                                   0                   48 VI
                                 491                   49 VA
                                 453                   50 WA
                                 135                   51 WV
                                 441                   52 WI
                                  54                   53 WY
                                   0                54-99 UNKNOWN

H_RESCTY   64  3  $CTYFMT                               C SSA COUNTY CODE OF RES. AS OF DEC 31

                                  25                      UNKNOWN
                              13,014              000-999 COUNTY CODE

H_ZIP      67  5  $ZIPFMT                               C POSTAL ZIPCODE OF RESIDENCE AS OF DEC 31

                                  25                      UNKNOWN
                              13,014          00000-99999 ZIP CODE

H_CENSUS   72  2  $CENFMT                               C CENSUS REGION OF RESIDENCE AS OF DEC 31

                                  25                      UNKNOWN
                                   0                   ** UNKNOWN
                                 409                   01 NEW ENGLAND
                               2,290                   02 MIDDLE ATLANTIC
                               2,169                   03 EAST NORTH CENTRAL
                                 837                   04 WEST NORTH CENTRAL
                               2,681                   05 SOUTH ATLANTIC
                                 762                   06 EAST SOUTH CENTRAL
                               1,321                   07 WEST SOUTH CENTRAL
                                 737                   08 MOUNTAIN
                               1,613                   09 PACIFIC
                                 195                   10 PUERTO RICO

H_METRO    74  1  $METFMT                               C METRO STATUS

                               3,495                    N NON-METRO AREA
                                  25                    U UNKNOWN
                               9,519                    Y METRO AREA

H_HSBEG1   75  6  $DTE6FMT                              C BEGINNING DATE OF LATEST HOSPICE PERIOD

                              12,818                      MISSING
                                 221        000000-999999 DATE AS YYMMDD

H_HSEND1   81  6  $DTE6FMT                              C ENDING DATE OF LATEST HOSPIC PERIOD

                              12,818                      MISSING
                                 221        000000-999999 DATE AS YYMMDD

H_HSBEG2   87  6  $DTE6FMT                              C BEGINNING DATE OF 2ND HOSPICE PERIOD

                              12,993                      MISSING
                                  46        000000-999999 DATE AS YYMMDD

H_HSEND2   93  6  $DTE6FMT                              C ENDING DATE OF 2ND HOSPICE PERIOD

                              12,993                      MISSING
                                  46        000000-999999 DATE AS YYMMDD

H_HSBEG3   99  6  $DTE6FMT                              C BEGINNING DATE OF 3RD HOSPICE PERIOD

                              13,017                      MISSING
                                  22        000000-999999 DATE AS YYMMDD

H_HSEND3  105  6  $DTE6FMT                              C ENDING DATE OF 3RD HOSPICE PERIOD

                              13,017                      MISSING
                                  22        000000-999999 DATE AS YYMMDD

H_HSBEG4  111  6  $DTE6FMT                              C BEGINNING DATE OF 4TH HOSPICE PERIOD

                              13,018                      MISSING
                                  21        000000-999999 DATE AS YYMMDD

H_HSEND4  117  6  $DTE6FMT                              C ENDING DATE OF 4TH HOSPICE PERIOD

                              13,018                      MISSING
                                  21        000000-999999 DATE AS YYMMDD

H_ESRBEG  123  6  $DTE6FMT                              C BEGINNING DATE OF ESRD PERIOD

                              13,039                      MISSING
                                   0        000000-999999 DATE AS YYMMDD

H_ESREND  129  6  $DTE6FMT                              C ENDING DATE OF ESRD PERIOD

                              13,039                      MISSING
                                   0        000000-999999 DATE AS YYMMDD

H_GHPSW   135  1  $GHPSW                                C 1= SOME GROUP HEALTH PARTICIPATION IN 93

                              12,321                    0 NO ENROLLMENT
                                 718                    1 SOME ENROLLMENT

H_PLTP01  136  2  $PLNFMT                               C GHP PLAN TYPE JAN

                              12,393                      NO ENROLLMENT FOR MONTH
                                 207                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 398                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN01  138  5  $GHPFMT                               C GHP CONTRACT NUMBER JAN

                                 646          H0000-H9999 PLAN IDENTIFIER
                              12,393                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY01  143  4                                        N MEDICARE PERCAP PAYMENT JAN

H_PLTP02  147  2  $PLNFMT                               C GHP PLAN TYPE FEB

                              12,387                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 403                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN02  149  5  $GHPFMT                               C GHP CONTRACT NUMBER FEB

                                 652          H0000-H9999 PLAN IDENTIFIER
                              12,387                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY02  154  4                                        N MEDICARE PERCAP PAYMENT FEB

H_PLTP03  158  2  $PLNFMT                               C GHP PLAN TYPE MAR

                              12,390                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 400                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN03  160  5  $GHPFMT                               C GHP CONTRACT NUMBER MAR

                                 649          H0000-H9999 PLAN IDENTIFIER
                              12,390                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY03  165  4                                        N MEDICARE PERCAP PAYMENT MAR

H_PLTP04  169  2  $PLNFMT                               C GHP PLAN TYPE APR

                              12,386                      NO ENROLLMENT FOR MONTH
                                 206                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 406                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN04  171  5  $GHPFMT                               C GHP CONTRACT NUMBER APR

                                 653          H0000-H9999 PLAN IDENTIFIER
                              12,386                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY04  176  4                                        N MEDICARE PERCAP PAYMENT APR

H_PLTP05  180  2  $PLNFMT                               C GHP PLAN TYPE MAY

                              12,381                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  26                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 409                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN05  182  5  $GHPFMT                               C GHP CONTRACT NUMBER MAY

                                 658          H0000-H9999 PLAN IDENTIFIER
                              12,381                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY05  187  4                                        N MEDICARE PERCAP PAYMENT MAY

H_PLTP06  191  2  $PLNFMT                               C GHP PLAN TYPE JUN

                              12,380                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 410                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN06  193  5  $GHPFMT                               C GHP CONTRACT NUMBER JUN

                                 659          H0000-H9999 PLAN IDENTIFIER
                              12,380                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY06  198  4                                        N MEDICARE PERCAP PAYMENT JUN

H_PLTP07  202  2  $PLNFMT                               C GHP PLAN TYPE JUL

                              12,373                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 417                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN07  204  5  $GHPFMT                               C GHP CONTRACT NUMBER JUL

                                 666          H0000-H9999 PLAN IDENTIFIER
                              12,373                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY07  209  4                                        N MEDICARE PERCAP PAYMENT JUL

H_PLTP08  213  2  $PLNFMT                               C GHP PLAN TYPE AUG

                              12,369                      NO ENROLLMENT FOR MONTH
                                 208                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 422                   06 RISK HMO
                                  11                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN08  215  5  $GHPFMT                               C GHP CONTRACT NUMBER AUG

                                 670          H0000-H9999 PLAN IDENTIFIER
                              12,369                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY08  220  4                                        N MEDICARE PERCAP PAYMENT AUG

H_PLTP09  224  2  $PLNFMT                               C GHP PLAN TYPE SEP

                              12,369                      NO ENROLLMENT FOR MONTH
                                 206                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 425                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN09  226  5  $GHPFMT                               C GHP CONTRACT NUMBER SEP

                                 670          H0000-H9999 PLAN IDENTIFIER
                              12,369                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY09  231  4                                        N MEDICARE PERCAP PAYMENT SEP

H_PLTP10  235  2  $PLNFMT                               C GHP PLAN TYPE OCT

                              12,366                      NO ENROLLMENT FOR MONTH
                                 207                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 427                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN10  237  5  $GHPFMT                               C GHP CONTRACT NUMBER OCT

                                 673          H0000-H9999 PLAN IDENTIFIER
                              12,366                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY10  242  4                                        N MEDICARE PERCAP PAYMENT OCT

H_PLTP11  246  2  $PLNFMT                               C GHP PLAN TYPE NOV

                              12,369                      NO ENROLLMENT FOR MONTH
                                 209                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 422                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN11  248  5  $GHPFMT                               C GHP CONTRACT NUMBER NOV

                                 670          H0000-H9999 PLAN IDENTIFIER
                              12,369                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY11  253  4                                        N MEDICARE PERCAP PAYMENT NOV

H_PLTP12  257  2  $PLNFMT                               C GHP PLAN TYPE DEC

                              12,371                      NO ENROLLMENT FOR MONTH
                                 211                   01 HCPP
                                  25                   02 COST HMO
                                   4                   05 OLD RISK HMO
                                 418                   06 RISK HMO
                                  10                   12 DEMO RISK HMO
                                   0                   17 PACE DEMO PLAN
                                   0                   18 HCPP

H_PLAN12  259  5  $GHPFMT                               C GHP CONTRACT NUMBER DEC

                                 668          H0000-H9999 PLAN IDENTIFIER
                              12,371                    N UNKNOWN, OR NO PLAN
                                   0                90091 PLAN IDENTIFIER

H_PLPY12  264  4                                        N MEDICARE PERCAP PAYMENT DEC

H_MCSW    268  1  $SWFMT                                C Y=SOME MEDICAID ELIGIBILITY FOR CY

                              10,810                    N NO PARTICIPATION
                               2,229                    Y SOME PARTICIPATION

H_MCDE01  269  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JAN

                                   0                    A STATE PART A BUY-IN
                               1,856                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,121                    N NO BUY-IN THIS MONTH

H_MCDE02  270  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR FEB

                                   0                    A STATE PART A BUY-IN
                               1,862                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,115                    N NO BUY-IN THIS MONTH

H_MCDE03  271  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR MAR

                                   0                    A STATE PART A BUY-IN
                               1,866                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,111                    N NO BUY-IN THIS MONTH

H_MCDE04  272  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR APR

                                   0                    A STATE PART A BUY-IN
                               1,880                    B STATE PART B BUY-IN
                                  62                    C STATE PART A AND B BUY-IN
                              11,097                    N NO BUY-IN THIS MONTH

H_MCDE05  273  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR MAY

                                   0                    A STATE PART A BUY-IN
                               1,892                    B STATE PART B BUY-IN
                                  61                    C STATE PART A AND B BUY-IN
                              11,086                    N NO BUY-IN THIS MONTH

H_MCDE06  274  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JUN

                                   0                    A STATE PART A BUY-IN
                               1,910                    B STATE PART B BUY-IN
                                  64                    C STATE PART A AND B BUY-IN
                              11,065                    N NO BUY-IN THIS MONTH

H_MCDE07  275  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR JUL

                                   0                    A STATE PART A BUY-IN
                               1,931                    B STATE PART B BUY-IN
                                  65                    C STATE PART A AND B BUY-IN
                              11,043                    N NO BUY-IN THIS MONTH

H_MCDE08  276  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR AUG

                                   0                    A STATE PART A BUY-IN
                               1,950                    B STATE PART B BUY-IN
                                  66                    C STATE PART A AND B BUY-IN
                              11,023                    N NO BUY-IN THIS MONTH

H_MCDE09  277  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR SEP

                                   0                    A STATE PART A BUY-IN
                               1,966                    B STATE PART B BUY-IN
                                  67                    C STATE PART A AND B BUY-IN
                              11,006                    N NO BUY-IN THIS MONTH

H_MCDE10  278  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR OCT

                                   0                    A STATE PART A BUY-IN
                               1,954                    B STATE PART B BUY-IN
                                  67                    C STATE PART A AND B BUY-IN
                              11,018                    N NO BUY-IN THIS MONTH

H_MCDE11  279  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR NOV

                                   0                    A STATE PART A BUY-IN
                               1,950                    B STATE PART B BUY-IN
                                  69                    C STATE PART A AND B BUY-IN
                              11,020                    N NO BUY-IN THIS MONTH

H_MCDE12  280  1  $MCDCFMT                              C MEDICAID ELIGIBILITY FOR DEC

                                   0                    A STATE PART A BUY-IN
                               1,916                    B STATE PART B BUY-IN
                                  69                    C STATE PART A AND B BUY-IN
                              11,054                    N NO BUY-IN THIS MONTH

H_MACY01  281  3  $MACYFMT                              C BUY-IN AGENCY FOR JAN

                              11,121                    N UNKNOWN, OR NO BUY-IN
                               1,918              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY02  284  3  $MACYFMT                              C BUY-IN AGENCY FOR FEB

                              11,115                    N UNKNOWN, OR NO BUY-IN
                               1,924              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY03  287  3  $MACYFMT                              C BUY-IN AGENCY FOR MAR

                              11,111                    N UNKNOWN, OR NO BUY-IN
                               1,928              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY04  290  3  $MACYFMT                              C BUY-IN AGENCY FOR APR

                              11,097                    N UNKNOWN, OR NO BUY-IN
                               1,942              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY05  293  3  $MACYFMT                              C BUY-IN AGENCY FOR MAY

                              11,086                    N UNKNOWN, OR NO BUY-IN
                               1,953              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY06  296  3  $MACYFMT                              C BUY-IN AGENCY FOR JUN

                              11,065                    N UNKNOWN, OR NO BUY-IN
                               1,974              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY07  299  3  $MACYFMT                              C BUY-IN AGENCY FOR JUL

                              11,043                    N UNKNOWN, OR NO BUY-IN
                               1,996              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY08  302  3  $MACYFMT                              C BUY-IN AGENCY FOR AUG

                              11,023                    N UNKNOWN, OR NO BUY-IN
                               2,016              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY09  305  3  $MACYFMT                              C BUY-IN AGENCY FOR SEP

                              11,006                    N UNKNOWN, OR NO BUY-IN
                               2,033              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY10  308  3  $MACYFMT                              C BUY-IN AGENCY FOR OCT

                              11,018                    N UNKNOWN, OR NO BUY-IN
                               2,021              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY11  311  3  $MACYFMT                              C BUY-IN AGENCY FOR NOV

                              11,020                    N UNKNOWN, OR NO BUY-IN
                               2,019              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_MACY12  314  3  $MACYFMT                              C BUY-IN AGENCY FOR DEC

                              11,054                    N UNKNOWN, OR NO BUY-IN
                               1,985              S00-S99 STATE AGENCY CODE
                                   0              000-999 STATE AGENCY CODE

H_HOSSW   317  1  $UTLFMT                               C 1 = ONE OR MORE HOSPICE BILLS IN CY

                              12,964                    0 NO UTILIZATION THIS TYPE
                                  75                    1 SOME UTILIZATION THIS TYPE

H_INPSW   318  1  $UTLFMT                               C 1 = ONE OR MORE INP DISCHARGES IN CY

                              10,560                    0 NO UTILIZATION THIS TYPE
                               2,479                    1 SOME UTILIZATION THIS TYPE

H_SNFSW   319  1  $UTLFMT                               C 1 = ONE OR MORE SNF ADMISSIONS IN CY

                              12,783                    0 NO UTILIZATION THIS TYPE
                                 256                    1 SOME UTILIZATION THIS TYPE

H_HHASW   320  1  $UTLFMT                               C 1 = ONE OR MORE HHA VISITS IN CY

                              12,096                    0 NO UTILIZATION THIS TYPE
                                 943                    1 SOME UTILIZATION THIS TYPE

H_OUTSW   321  1  $UTLFMT                               C 1 = ONE OR MORE OUTPT VISITS IN CY

                               6,601                    0 NO UTILIZATION THIS TYPE
                               6,438                    1 SOME UTILIZATION THIS TYPE

H_PBSW    322  1  $UTLFMT                               C 1 = ONE OR MORE PART B CLAIMS IN CY

                               2,236                    0 NO UTILIZATION THIS TYPE
                              10,803                    1 SOME UTILIZATION THIS TYPE

H_PTARMB  323  6                                        N $$$$$$$ TOTAL PART A REIMB CY

H_PTBRMB  329  6                                        N $$$$$$$ TOTAL PART B REIMB CY

H_LATDCH  335  6  $DTE6FMT                              C DISCHARGE DATE OF LATEST INP STAY

                              10,643                      MISSING
                               2,396        000000-999999 DATE AS YYMMDD

H_LATDRG  341  3  $DRGFMT                               C DRG CODE FOR LATEST INP STAY

                              10,643                      UNKNOWN, OR NO DISCHARGE
                               2,396              000-999 DRG

H_DISDES  344  2  $DSTFMT                               C DISCHARGE DESTINATION FOR LAST STAY

                              10,643                      NO DISCHARGE
                               1,504                   01 DISCHARGE TO HOME
                                  23                   02 TRANSFER-TO HOSP
                                 258                   03 TRANSFER-TO SNF
                                  76                   04 TRANSFER-TO ICF
                                  60                   05 TRANSFER-OTHER
                                 202                   06 TRANSFER TO HHA
                                   8                   07 LAMA
                                   1                   08 HOME IV DRUG
                                   0                   09 ADMIT/READMIT
                                   0                10-19 TRANSFER-ST CODES
                                 264                   20 EXPIRED
                                   0                21-29 EXPIRED-ST CODES
                                   0                   30 STILL PATIENT
                                   0                31-39 STILL PATIENT, ST
                                   0                   40 EXPIRED AT HOME
                                   0                   41 DIED IN FACILITY
                                   0                   42 DIED, PLACE UNK
                                   0                43-99 NOT USED

H_LATLOS  346  3                                        C NOT USED

H_INPSTY  349  2                                        N NO. OF INPAT STAYS FOR CY

H_INPDAY  351  3                                        N NO. OF INPAT COVRD DAYS FOR CY

H_INPCHG  354  6                                        N $$$$$$$ INPAT CHARGES FOR CY

H_INPCCH  360  6                                        N $$$$$$$ INPAT COVRD CHGS FOR CY

H_INPRMB  366  6                                        N $$$$$$$ INPAT REIMB FOR CY

H_INPDED  372  4                                        C NOT USED

H_INPCDY  376  2                                        N INPAT COVRD DAYS USED IN CY

H_INPCAM  378  5                                        N $$$$$$ TOTAL INP COINS AMT CY

H_PSYDAY  383  3                                        C NOT USED

H_LRDAY   386  3                                        C NOT USED

H_BLDED   389  2                                        C NOT USED

H_SNFSTY  391  2                                        N TOTAL SNF STAYS IN CY

H_SNFDAY  393  3                                        N TOTAL SNF COVERED DAYS IN CY

H_SNFCHG  396  6                                        N $$$$$$$ TOTAL SNF CHRGS IN CY

H_SNFCCH  402  6                                        N $$$$$$$ TOTAL SNF COV CHRGS CY

H_SNFRMB  408  6                                        N $$$$$$$ TOTAL SNF REIMB IN CY

H_SNFCDY  414  3                                        N TOTAL SNF COINS DAYS IN CY

H_SNFCAM  417  6                                        N $$$$$$ TOTAL SNF COINS AMT CY

H_HHAVST  423  3                                        N TOTAL HHA VISITS IN CY

H_HHACCH  426  6                                        N $$$$$$$ TOTAL HHA COV CHGS CY

H_HHACHO  432  6                                        N $$$$$$ TOT HHA OTHER COV CHGS CY

H_HHARMB  438  6                                        N $$$$$$ TOT HHA REIMB IN CY

H_HSDAYS  444  3                                        N TOTAL COVRD HOSPICE DAYS CY

H_HSTCHG  447  6                                        N $$$$$$$ TOT HOSPICE CHGS CY

H_HSREIM  453  6                                        N $$$$$$$ TOT HOSPICE REIMB CY

H_OUTBIL  459  3                                        N TOTAL OUTPT BILLS IN CY

H_OUTCHG  462  6                                        N $$$$$$$ TOTAL OUTPT COV CHG CY

H_OUTRMB  468  6                                        N $$$$$$$ TOTAL OUTPT REIMB CY

H_PMTCLM  474  4                                        N TOTAL PHYSICIAN/SUPPLIER CLAIMS IN CY

H_PMTLIN  478  4                                        N TOTAL PHYSICIAN/SUPPLIER LINE ITEMS CY

H_PMTSCH  482  6                                        N $$$$$$$ TOT SUBMITTED CHGS CY

H_PMTACH  488  6                                        N $$$$$$$ TOT ALLOWED CHGS CY

H_PMTRMB  494  6                                        N $$$$$$$ TOT PHYS REIMB CY

H_PMTVST  500  3                                        N TOTAL OFFICE VISITS IN CY

H_PMTCHO  503  6                                        N TOTAL OFFICE VISIT CHARGES IN CY

H_PTBDED  509  4                                        C NOT USED

