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MAX Provider Characteristics

Description

There is currently considerable interest at CMS in examining health reform proposals, program integrity, and access-to-care issues among certain types of Medicaid providers. However, it has not been possible to easily conduct provider-based research activities because the provider identification numbers collected in MSIS data are largely unedited, undocumented, and state-specific. Starting in February 2009, states were required to include National Provider Identifiers (NPIs) on their MSIS claims. The main limitation of NPIs on claims for Medicaid services is that certain classes of nonmedical providers are not required to obtain an NPI. For example, adult day health care, case management, personal care, nonemergency transportation, and many other services are excluded from the NPI requirement. Because these so-called "wrap-around" (e.g., nonmedical) services can represent a significant part of the Medicaid package of services, and are of particular interest to policymakers, this "hole" in the assignment of the NPI can be problematic for provider-related research. Nonetheless, the availability of the NPI on MSIS claims makes the development of a uniform provider characteristics file more feasible.

MAXPC 2009 data are available for all 51 Medicaid jurisdictions.  MAXPC 2010 data are available for 45 states (all states and the District of Columbia except Idaho, Kansas, Maine, New Jersey, North Dakota, and Utah).  MAXPC 2011 data are available for 35 states (all states and the District of Columbia except Arizona, California, Colorado, Florida, Idaho, Kansas, Maine, Massachusetts, Nebraska, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Rhode Island, and Utah). These data files contain useful provider information from the National Plan and Provider Enumeration System (NPPES) and state-specific provider files (when available). They can be easily linked to the provider identification numbers (provider IDs) in MAX 2010.  The data and accompanying documentation are available through the links in the “Data Files” section below.

General Information

In the “Data Files” section below, we provide zip files containing the MAXPC data files.

In the “Downloads” section below, we provide zip files containing the MAXPC production reports, which include:

1. SAS Load Statements - For users of the Statistical Analysis System (SAS), we provide the SAS load statements that can be used for each MAXPC file.
2. Data Dictionaries – We include the data dictionary, which describes the file layout and content.
3. State-Specific Validation Tables – These tables provide a large number of statistics on each state’s MAXPC file and are used to monitor changes over time.
4. Cross-State Validation Tables – These tables examine the same measures as the state-specific validation tables but focus on a single year of data, with each state side-by-side.  These are useful for detecting if one state is similar to other states.
5. Anomaly Tables – We review the validation tables looking for outliers and unexpected changes.  We record salient anomalies in the anomaly tables.  We recommend that you read the anomalies to determine if the data should be included in your analysis.
6. Validation Specifications (for the Validation Tables) – The validation tables (described above) contain many measures that researchers could find useful for their analysis.  In the validation specification document, we defined how each measure in the validation table was created. We recommend that you use this document to better understand the subpopulation and the data element(s) used in the construction of each measure.

Note:  MAXPC 2009 was the first year for this data.  Consequently, in 2009, we provided only the cross-state version of the validation tables.

Reports and Issue Briefs

  • The MAX Provider Characteristics File Implementation Report describes the design, implementation, and results of the MAXPC prototype, which was based on three states using provider data from 2006 and 2009. Based on the findings of this report, CMS decided to produce MAXPC beginning with 2009 data.  See the “Downloads” section below.
  • “Medicaid Analytic Extract Provider Characteristics (MAXPC) Evaluation Report, 2010.” In this report, we describe the motivation for creating the MAXPC file. We also describe its design and content, and examine the quality and completeness of each of the six types of provider IDs (inpatient billing provider, long-term care billing provider, other services billing and servicing providers, and prescription drug billing and prescribing providers). Our analysis focuses on the 45 states that had the requisite MSIS files available for calendar year 2010 services (Idaho, Kansas, Maine, New Jersey, North Dakota, and Utah are excluded). The quality and completeness varies substantially by state and by type of provider ID. The report is available through the links in the “Downloads” section.
  • “Medicaid Analytic Extract Provider Characteristics (MAXPC) Evaluation Report, 2009”. This report describes the design, content, and motivation for creating the MAXPC file. The report also examines the quality and completeness of each of the six types of provider IDs in each of the 51 states. The quality and completeness vary substantially by state and by type of provider ID. The report also identifies recommendations for CMS to help improve the quality of the provider IDs. The report is available through the links in the “Downloads” section.
  • “Physician Service Use and Participation in Medicaid, 2009.” This issue brief presents an analysis of physician use and participation using the 2009 MAXPC data, Area Resource File (extracted from the American Medical Association master file), and National Plan and Provider Enumeration System data. The analysis focuses on four major topic areas: (1) the number of physicians serving Medicaid enrollees and average physician caseload, (2) the distribution of Medicaid physician caseload by physician, (3) enrollees served by in-state and out-of-state physicians, and (4) physician participation rates in Medicaid. It is available through the links in the “Downloads” section.

Data Files