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Medicaid Analytic eXtract (MAX) General Information

The Impact of T-MSIS Developments on MAX

The structure of MAX data through 2013 will be unaffected by the change in data collection to T-MSIS.  MAX 2014 Data Dictionary revisions will reflect the new T-MSIS Eligibility Group data field that was added to the MSIS Data Dictionary, Release 5 (April 2014).  Regarding MAX data availability, MSIS data are no longer available for a number of states and the fiscal quarters needed for complete MAX production. We are continuing to produce MAX data for as many states as possible.  However, the limited availability of MSIS data is delaying our ability to produce MAX data for all states.  When T-MSIS data become available, it will be possible for us to produce MAX data for all states.  MAX 2014 production is being scheduled for states for which sufficient MSIS data are available.  Please see the Frequently Asked Question (FAQ) on this issue for the availability of MAX 2011 to MAX 2014 data by state.

What’s New in April 2017!

  • MAX 2013 data are now available for the following 28 states:  Arkansas, Arizona, California, Connecticut, Georgia, Hawaii, Idaho, Indiana, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia and Wyoming.  Summary data and supporting documentation (SAS load statements, data dictionaries, record counts, anomaly tables, managed care crosswalks, and waiver crosswalks) are available through the links in the “Downloads” section below and the validation tables are available through the MAX Validation Reports/Tables page.

What’s New in January 2017!  

  • MAX 2014 data are now available for the following eleven states: Georgia, Iowa, Mississippi, Missouri, New Jersey, Pennsylvania, South Dakota, Tennessee, Vermont, West Virginia and Wyoming. Summary data and supporting documentation (SAS load statements, data dictionaries, record counts, anomaly tables, managed care crosswalks, and waiver crosswalks) are available through the links in the “Downloads” section below and the validation tables are available through the MAX Validation Reports/Tables page.
     
  • An updated introduction to MAX data is available under ‘Downloads’ at ‘Introduction to Medicaid Analytic eXtract (MAX) Data.

What’s New in July 2016!

  • MAX 2013 data are now available for the following 20 states:  Arkansas, Arizona, Connecticut, Georgia, Hawaii, Indiana, Iowa, Michigan, Mississippi, Missouri, New Jersey, New York, Oklahoma, Pennsylvania, South Dakota, Tennessee, Vermont, Washington, West Virginia and Wyoming.  Summary data and supporting documentation (SAS load statements, data dictionaries, record counts, anomaly tables, managed care crosswalks, and waiver crosswalks) are available through the links in the “Downloads” section below and the validation tables are available through the MAX Validation Reports/Tables page.

What’s New in June 2016!

  • MAX 2012 data are now available for all states and the District of Columbia, except for Colorado, Idaho, Kansas and Rhode Island.  Summary data and supporting documentation (SAS load statements, data dictionaries, record counts, anomaly tables, managed care crosswalks, and waiver crosswalks) are available through the links in the “Downloads” section below and the validation tables are available through the MAX Validation Reports/Tables page.

What’s New in April 2016!

  •  “MAX 2011 data are now available for all states and the District of Columbia, except for Colorado.  Summary data and supporting documentation (SAS load statements, data dictionaries, record counts, anomaly tables, managed care crosswalks, and waiver crosswalks) are available through the links in the “Downloads” section below and the validation tables are available through the MAX Validation Reports/Tables page.

Description

Each state’s Medicaid agency collects enrollment and claims data for persons enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).  These data are collected in the state’s Medicaid Management Information System (MMIS).  Each state’s MMIS is tailored to the needs of that state’s Medicaid program.  In partnership with the states, the federal government seeks to manage the Medicaid program and monitor the progress of the health care delivery system nationally.  Because the Medicaid program varies by state, the data in the MMIS are converted into a national standard and submitted to CMS via the Medicaid and CHIP Statistical Information System (MSIS).

The MSIS data (enrollment and claims data) are reported to CMS on a quarterly basis.  The enrollment data identify Medicaid and CHIP enrollees in each month of that quarter and whose enrollment in a prior period should be revised (due to a correction or retroactive enrollment).  The fee-for-service (FFS) claims data identify who received what service from which provider at what cost.  The FFS claims data are submitted based on the quarter in which the claim was adjudicated, not when the service was performed.  The managed care encounter records (also known as encounter claims) identify who received what service under which managed care organization and from which provider.  The encounter records are submitted based on the quarter in which the encounter was processed, not when the service was performed.  The MSIS data are challenging to use for research because the data represent a mixture of time periods.  Consequently, CMS developed the Medicaid Analytic Extract (MAX) files, a more research-friendly set of Medicaid administrative files.  

The enrollment information in MAX identifies monthly enrollment after the retroactive/correction records have been applied and after certain state-specific data elements are transformed into a consistent, national format.  The claims in MAX identify the services rendered and the cost of those services after the adjustments have been applied.  The enrollment pertains to people enrolled in the given calendar year (CY), and claims pertain to the services rendered in that same time period, thereby making a consistent—and more meaningful—time period for analyses of enrollment, service utilization, and expenditures.

A Powerpoint presentation entitled "Introduction to Medicaid Analytic eXtract (MAX) Data" is available in the “Downloads Section.” Researchers might find this presentation helpful because it:

  • Describes the source data,
  • Provides an overview of MAX data,
  • Describes the types of MAX data,
  • Lists a number of the MAX data enhancements,
  • Explains the linkages to other data sources,
  • Describes related MAX data products, and
  • Identifies Medicaid data limitations.

General Information

In the “Downloads” section, we provide a number of zip files, which contain the following supporting documents about MAX:

1. SAS Load Statements - For users of the Statistical Analysis System (SAS), we provide the SAS load statements that can be used for each MAX file.

2. Data Dictionaries – We include the data dictionaries for the Inpatient Hospital (IP), Long-Term Care (LT), Other Services (OT), Prescription Drug (RX), and Person Summary (PS) MAX files. From 1999-2004, the data dictionaries did not change.  Beginning in 2005, however, the record lengths, variable locations, and data element descriptions changed from year to year.  We listed the changes at the beginning of each data dictionary.

Due to issues with the availability of the Social Security Administration (SSA) Death Master File (DMF), the Centers for Medicare and Medicaid Services (CMS) removed the SSA Date of Death from external Medicaid Analytic eXtract (MAX) files (1999-forward) in April 2014. Date of death is still reported in the MAX Personal Summary (PS) file using the Medicaid Statistical Information System (MSIS) Date of Death and Medicare Enrollment Database (EDB) Date of Death. Researchers interested in receiving death record information from state vital statistics offices should contact the National Center for Health Statistics (NCHS) to learn about the National Death Index.

3. Variable Crosswalk – Over time, data elements have been added or removed from the MAX files.  We recommend that you review the variable crosswalk to get a better understanding of when the changes occurred.

4. Record Counts – We include a table showing the number of records in each MAX file.  We recommend that you use this table to confirm that you received the correct number of records in your files.

5. Data Anomalies Reports and Tables – We review the validation tables (described below) looking for outliers and unexpected changes.  We record salient anomalies about the eligibility and the claims data in the data anomalies reports and tables.  We recommend that you read the anomalies to determine if the data should be included in your analysis.

6. Waiver Crosswalk – Beginning in MAX 2005, we created the waiver crosswalk, which describes each state’s Section 1915(b) managed care/freedom of choice waiver, Section 1915(c) Home and Community-Based Services (HCBS) waiver, Section 1915(b)(c) managed care HCBS waiver, Section 1115 demonstration waiver, and Health Insurance Flexibility and Accountability (HIFA) waiver.  For each waiver, we identify the waiver type, waiver identification number in MAX, waiver name from both CMS’s and the state’s perspective, original CMS approval date, most recent CMS renewal date, expiration date, and whether reporting of the waiver is still ongoing in MAX data.  This crosswalk is invaluable to researchers wanting to understand the various waiver authorities active in the state and whom the authorities serve.  

7. Managed Care Crosswalk – Beginning in MAX 2009, we created the managed care crosswalk, which identifies each state’s managed care plan identification number, plan name, plan type (comprehensive care or prepaid health plan), and whether the plan reported enrollment, capitation payments, and managed care encounter records (claim-like records for managed care services).  This crosswalk is invaluable to researchers wanting to understand more about managed care plans and the completeness of their data.  

8. HCBS Taxonomy – As states have sought to make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use by, and spending for, those Medicaid beneficiaries who need long-term services and supports (LTSS).  Because state Medicaid programs differ in the types of services they offer, and in how they report these services in their data, analyzing HCBS at the national level has been challenging.  To enable CMS to monitor the wide range of Section 1915(c) HCBS waiver services and to help researchers approach the study and analysis of waivers in a uniform manner, Truven Health Analytics, formerly known as Thomson Reuters, led the development of an HCBS waiver services taxonomy.   The first version of the taxonomy was constructed from literature reviews, expert interviews, and an analysis of service definition information provided by 176 HCBS waivers and nine demonstration grants for community alternatives to Psychiatric Residential Treatment Facilities.  This draft taxonomy was tested by a working group of state associations and staff from 10 states and one Area Agency on Aging.  Mathematica then conducted a pilot test in which the taxonomy was applied to 2008 MSIS HCBS waiver claims.  Through these tests, Mathematica and Truven worked jointly to refine the taxonomy into its current version.  The taxonomy includes 18 categories and over 60 services.

9. HCBS Taxonomy Crosswalk – Beginning in MAX 2010, we created the HCBS taxonomy crosswalk, which maps Section 1915 (c) waiver services (program type = 6, 7) in the MAX OT file into the HCBS taxonomy.  The crosswalk uses national Healthcare Common Procedure Coding System (HCPCS) procedure codes, Current Procedural Terminology (CPT) procedure codes, state-specific procedure codes, procedure code modifiers, place-of-service codes, and type-of-service codes to map the services into the new OT data element called HCBS Taxonomy Code for Waivers.  The first two characters of the data element correspond to the 18 taxonomy categories and the full five characters uniquely identify each taxonomy service.  

10. Validation Specifications (for the Validation Reports) – The validation tables (described below) 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.

MAX Validation Reports - These reports are prepared for each of the 50 states and the District of Columbia. The reports provide a lot of statistics on the data contained in the MAX files, including enrollment, utilization and Medicaid payments. Due to the volume of these reports, they are not included in the “Downloads” section; instead they are available through the MAX Validation Reports/Tables page.  

Publications

Baugh, D. and S. Verghese. Migration Patterns for Medicaid Enrollees 2005–2007.  Medicare & Medicaid Research Review, Vol. 3, No. 4, 2013, pp. E1–E14.  The study used 2005-2007 Medicaid enrollment records that were unduplicated and linked across states and over the study period to report descriptive statistics on enrollee migration across states.  Among all enrollees, 3.7 percent moved to another state at least once and most moved only once.  Overall, 72.2 percent of moves did not result in an enrollment gap, whereas 8.2 percent of moves resulted in gaps of fewer than three months, and 11.4 percent of moves resulted in gaps of more than six months.  These initial findings provide a context for further examining the consequences of enrollee moves on their health and on program expenditures.  The consequences of enrollment gaps will become increasingly important as the Medicaid population grows under the provisions of the Affordable Care Act.

Bouchery, E.  Utilization of Dental Services Among Medicaid Enrolled Children.  Medicare & Medicaid Research Review, Vol. 3, No. 3, 2013, pp. E1–E14.  This study uses multivariate logistic regression on the Medicaid Analytic Extract (MAX) 5 percent sample file, known as Mini-MAX, to assess the association between enrollee and county characteristics and dental preventive and treatment service utilization.  There was substantial variation in service use by age.  Relative to a 9-year-old, a 2-year-old was 28 percentage points less likely, and a 15-year-old was 15 percentage points less likely to receive preventive dental services.  Children enrolled in Medicaid for only a part of a year were significantly less likely to receive a preventive or a treatment dental service relative to children covered by Medicaid for the full year. For preventive care, children enrolled for nine months were 15 percentage points less likely to have a service.  Those enrolled for six months were 30 points less likely, those enrolled for three months were 41 points less likely.  Children eligible for Medicaid based on disability were 9 and 6 percentage points less likely to receive a preventive or treatment dental service, respectively, than their counterparts who were eligible based on income alone.  The study identifies some subgroups of children who are particularly underserved and for whom states may need to devote more attention.

Byrd, V. and A. Dodd.  Assessing the Usability of MAX 2008 Encounter Data for Comprehensive Managed Care.  Medicare & Medicaid Research Review, Vol. 3, No. 1, 2013, pp. E1–E18.  As growing numbers of Medicaid enrollees receive benefits through comprehensive managed care, researchers and policy makers seeking to understand the service use of these enrollees must rely on encounter data.  The objective of this study was to assess the availability, completeness and quality of physician, clinic and outpatient service (OT), inpatient (IP) and prescription drug (RX) encounter claims to judge the usability of the 2008 MAX encounter data.  For each basis of eligibility (BOE) group in each state that had at least 10 percent participation in comprehensive managed care and submitted at least 200 encounter claims, the completeness and quality of the OT, IP and RX encounter data were evaluated using comparison metrics created from the full-benefit non-dual fee-for-service (FFS) population across all states with substantial FFS participation.  Data that met both the completeness and quality criteria were considered usable.  The completeness and quality of the encounter data were high.  The encounter data were considered usable for at least one BOE category for 22 of 25 states that submitted OT encounter data, 20 of 24 states that submitted IP data and 13 of 15 states that submitted RX data.  Most states that have comprehensive managed care plans are reporting OT, IP and RX data.  Of those data, the majority are complete and are of comparable quality to FFS data for adults, children, the disabled and aged populations.  

Libersky, J., A. Dodd and S. Verghese.  National and State Trends in Enrollment and Spending for Dual Eligibles Under Age 65 in Medicaid Managed Care.  Disability and Health Journal, Vol. 6, No. 2, April 2013, pp. 87-94.  To reduce costs and improve care, states are increasingly enrolling individuals with disabilities in Medicaid managed care. Many states allow or require adults who are dually eligible for Medicaid and Medicare to enroll in these plans.  This study (1) quantifies changes in enrollment by managed care arrangement for duals under age 65, between 2005 and 2008 and (2) compares enrollment and spending between dual eligibles and Medicaid-only beneficiaries.  The authors used Medicaid Analytic eXtract data to compare the Medicaid enrollment and spending for all-year, full-benefit dual eligibles ages 21–64 with that of Medicaid-only Supplemental Security Income (SSI) and disabled beneficiaries. The study population was classified into 9 types of managed care to quantify enrollment and calculate expenditures by year.  Nationwide, the proportion of adult duals in managed care increased from 2005 to 2008, with the expansion of prepaid health plans (PHPs) (31.0%–46.6%), particularly behavioral health PHPs, driving the increase. In 2008, Medicaid-only disabled adults were three times as likely as dual adults to enroll in comprehensive managed care (CMC) (35.1% versus 11.7%). Average Medicaid expenditures per enrollee differed markedly by managed care arrangement and state.  From 2005 to 2008, there was little expansion of CMC among adult duals, while the use of PHPs to cover carved out services increased greatly. New federal initiatives aim to reduce barriers to enrolling duals into comprehensive, integrated managed care. With expanded enrollment, it will be important to monitor enrollment and evaluate whether integration improves care.

Nysenbaum, J., E. Bouchery and R. Malsberger.  Availability and Usability of Behavioral Health Organization Encounter Data in MAX 2009.  Medicare & Medicaid Research Review, Vol. 4, No. 2, 2014, pp. E1–E12.  This article compares metrics of reporting completeness and quality for Behavioral Health Organizations (BHOs) to similar metrics for six states that primarily cover mental health and substance abuse services on a fee-for-service (FFS) basis.  For inpatient hospital data, out of 15 states reporting enrollment in BHO plans in 2009, 10 reported complete capitation data. Inpatient hospital encounter data were available in four states (Arizona, Colorado, Florida and Iowa), compared well to FFS ranges, and appeared usable for research.  Outpatient service data were available for five states, but the analysis suggests that the data are only sufficiently complete for analysis in Arizona and Iowa.  In conclusion, the initial assessment of availability, completeness, and quality of BHO encounter data in MAX 2009 suggests that only limited data are available and usable.

Peebles, V. and A. Bohl.  The HCBS Taxonomy:  A New Language for Classifying Home- and Community-Based Services.  Medicare and Medicaid Research Review. Vol. 4, No. 3, 2014, pp. E1-E17.  As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending.  Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging.  This article describes the HCBS taxonomy and findings on HCBS waiver expenditures and users.  The authors analyzed FFS claims from 28 approved states in the 2010 MAX files.  They summed expenditures and counted the unique number of users across each HCBS taxonomy service and category.  The taxonomy was developed jointly by Truven Health (at that time Thomson Reuters) and Mathematica Policy Research, with stakeholder input, and reviewed using procedure codes.  Today, the taxonomy is organized by 18 categories and over 60 specific services.  For calendar year 2010, 28 states spent almost $23.6 billion on HCBS, with 80 percent of expenditures categorized as round-the-clock, home-based and day services.  Other services, such as case management, or equipment, modifications, and technology were widely used, but are not particularly costly and do not account for a large portion of expenditures in every state.  By providing a common language, the taxonomy provides detailed information on services and makes it easier to assess and identify state-level variation for HCBS.

Availability

Because MAX production requires seven quarters of MSIS data (four quarters for the calendar year plus three additional quarters for the adjustment records), there can be a considerable delay between the end of a calendar year and the availability of the corresponding MAX files.  We produce the files as quickly as possible and release them on a scheduled basis.  New releases are announced at the top of this webpage.

Since the MAX data contain protected health information (PHI) and personally identifiable information (PII), they are protected under the Privacy Act. The data are available for approved research activities only through a Data Use Agreement (DUA) or Interagency Agreement (IA) with CMS.  Note that only approved academic research projects and certain government agencies are entitled to a DUA or IA to obtain MAX data. The DUA form is below in the “Downloads Section”.  For help in preparing data requests (including DUAs), technical assistance with the data, or to report data problems, please contact the Research Data Assistance Center (ResDAC) via the link in the "Related Links" section.

MAX Data Prior to 1999

Before 1999, states had the option to submit either MSIS data or aggregate summary statistics, using the HCFA-2082 reporting format.  CMS began producing State Medicaid Research File (SMRF) data from MSIS in the late 1980s for a small group of participating states.  The number of states for which SMRF were produced increased greatly in 1992 and continued to increase through 1998 as participation in MSIS grew.  The Balanced Budget Act (BBA) of 1997 mandated that all states report MSIS data beginning in 1999.  Along with the BBA mandate, data collection in MSIS expanded and SMRF was given a new name – MAX.  SMRF data are not available for requests.

MAX Data for 1999–2004

The file layouts for MAX 1999–2004 are exactly the same.  

After production was completed for MAX 2004, we reprocessed the following files:

  • In Tennessee’s MAX data, we determined there was a substantial shortfall of records in the IP file. It was possible to correct this shortfall by reprocessing the Tennessee IP file. It was also necessary to reprocess the PS file because some data elements in the PS file are summary statistics about inpatient hospital utilization and expenditures. The IP file was reprocessed on November 5, 2008 and the PS file was reprocessed on November 7, 2008.
  • In Arizona’s MAX data, we identified a problem with the Medicaid identification numbers (MSIS ID) provided to CMS. The data for all MAX files (IP, LT, OT, RX, and PS) were reprocessed on February 26, 2009.

Users that received these files prior to the indicated dates may want to request copies of the reprocessed files.

MAX Data for 2005

We were unable to process the following state with the requisite seven quarters of MSIS data:

  • Maine was unable to accurately report its IP, LT, and OT claims because it did not have a fully functional MMIS.  Consequently, the state’s MAX 2005 files only include the PS and RX files.  Summary statistics that would normally appear in the PS file for IP, LT, and OT services were not populated.

We made the following revisions to the PS file:

  • Added a variable that gauges the validity of the Social Security numbers (SSNs)
  • Added the SSN obtained from the Medicare enrollment database (EDB)
  • Added new race and ethnicity variables
  • Added monthly dual Medicare and Medicaid enrollment
  • Added monthly waiver enrollment information (waiver identification number and waiver type) for up to three waivers per month
  • Added annual enrollment in Section 1915(c) waivers using a national, uniform classification
  • Added expenditure variables for each of the 21 Community-Based Long-Term Care categories
  • Removed the quarterly and annual dual Medicare and Medicaid enrollment flags that used an old (pre-1999) definition

We made the following revisions to the claims files:

  • Added new race and ethnicity variables
  • Added an indicator variable for whether the claim linked to an enrollment record and the person was enrolled in Medicaid or CHIP for at least one month
  • Added National Provider Identifier (but it was set to missing for all records; the data became available beginning in 2009)
  • Added Provider Taxonomy (but it was set to missing for all records; the data became available beginning in 2009)
  • Increased the length of the diagnosis and procedure codes
  • Removed the annual dual Medicare and Medicaid enrollment flags that used an old (pre-1999) definition

In the OT file, we also:

  • Added a new Community-Based Long-Term Care Flag

In the RX file, we also:

  • Removed the claims-based Medicare Crossover Flag

Please see the MAX 2005 data dictionaries for more information about these and other minor revisions.

MAX Data for 2006

We were unable to process the following state with the requisite seven quarters of MSIS data:

  • Maine was unable to accurately report its IP, LT, and OT claims because it did not have a fully functional MMIS.  Consequently, the state’s MAX 2006 files only include the PS and RX files.  Summary statistics that would normally appear in the PS file for IP, LT, and OT services were not populated.

We made the following revisions to the PS file:

  • Added more values to the monthly and quarterly Medicare Dual Codes
  • Added more values to the monthly Restricted Benefits Flag
  • Added a new value to the monthly and annual Waiver Type
  • Added new values to the Recipient Indicator

We made the following revisions to the RX file:

  • Removed the Medicare Coinsurance Payment Amount
  • Removed the Medicare Deductible Payment Amount

Please see the MAX 2006 data dictionaries for more information about these and other minor revisions.

MAX Data for 2007

We were unable to process the following state with the requisite seven quarters of MSIS data:

  • Maine was unable to accurately report its IP, LT, and OT claims because it did not have a fully functional MMIS.  Consequently, the state’s MAX 2007 files only include the PS and RX files.  Summary statistics that would normally appear in the PS file for IP, LT, and OT services were not populated.

We made the following revisions to the PS file:

  • Deleted the quarterly Medicare Dual Code

We made the following revisions to the RX file:

  • Removed the Hierarchical Ingredient Code List
  • Removed the American Hospital Formulary System Class Code
  • Replaced the Specific Therapeutic Class Code with the Hierarchical Specific Therapeutic Class Code (a new variable)
  • Replaced the Smart Key with these four variables:
        o Clinical Formulation Identification Number
        o Ingredient List Identifier
        o Hierarchical Specific Therapeutic Class Code Sequence Number
        o Filler

 Please see the MAX 2007 data dictionaries for more information about these and other minor revisions.

MAX Data for 2008

We were unable to process the following states with the requisite seven quarters of MSIS data:

  • Maine was unable to accurately report its IP, LT, and OT claims because it did not have a fully functional MMIS.  Consequently, the state’s MAX 2008 files only include the PS and RX files.  Summary statistics that would normally appear in the PS file for IP, LT, and OT services were not populated.
  • Massachusetts was unable to accurately report its claims because it did not have a fully functional MMIS. The MAX 2008 files only contain claims adjudicated through Q2 FY 2009.  Consequently, some claims representing services provided in CY 2008 will be missing and some claims may not be fully adjusted.
  • Utah was unable to report all of its claims by the prescribed deadline. The MAX 2008 files only contain claims adjudicated through Q1 FY 2009. Consequently, some claims representing services provided in CY 2008 will be missing and some claims may not be fully adjusted.
  • Wisconsin was unable to report all of its claims by the prescribed deadline. The MAX 2008 files only contain claims adjudicated through Q3 FY 2009. Consequently, some claims representing services provided in CY 2008 will be missing and some claims may not be fully adjusted.

We made the following revision to the PS file:

  • Added a new value to the monthly Restricted Benefits Flag

Please see the MAX 2008 data dictionaries for more information about these and other minor revisions.

After production was completed for MAX 2008, we reprocessed the following file:

• In North Carolina’s PS file, a researcher noticed two undocumented values in the monthly dual codes (EL_MDCR_DUAL_MO_x, where x = 1–12).  The undocumented values were "5 " (5 space) and "   " (space space).  We researched the issue and determined that the correct values should be "50" and "00", respectively.  The annual dual code (EL_MDCR_DUAL_ANN), the validation tables, and the claims files (which use the annual dual code) are unaffected by the error.  We regret the inconvenience this may have on the user community, but the good news is that you can easily fix the error yourself, by recoding "5 " (5 space) to "50" (5 zero) and recoding "  " (space space) to "00" (zero zero).  We fixed the error in the PS file on August 27, 2013.  

Users that received the file prior to the indicated date will need to fix it themselves or request a copy of the corrected file.

MAX Data for 2009

We were unable to process the following states with the requisite seven quarters of MSIS data:

  • Idaho was unable to accurately report its claims following the implementation of a new MMIS.  As a result, the state’s MAX 2009 files only contain IP, LT, and RX claims reported to MSIS through Q2 FY 2010 and OT claims reported to MSIS through Q1 FY 2010.  Consequently, some claims representing services provided in CY 2009 will be missing and some claims may not be fully adjusted.
  • Maine was unable to accurately report its IP, LT, and OT claims because it did not have a fully functional MMIS.  Consequently, the state’s MAX 2008 files only include the PS and RX files.  Summary statistics that would normally appear in the PS file for IP, LT, and OT services were not populated.

We made the following revisions to the PS file:

  • Added new values to the monthly and annual Medicare Dual Codes

We made the following revisions to the claims file:

  • Added new values to the annual Medicare Dual Code
  • Began populating National Provider Identifier
  • Began populating Provider Taxonomy

In the IP and LT file, we also:

  • Added new values to Patient Status Code

In the OT file, we also:

  • Added new values to Place of Service

Please see the MAX 2009 data dictionaries for more information about these and other minor revisions.

MAX Data for 2010 and 2011 

‘Errors were found in the labels for selected line items in the MAX Validation Tables for 2010 and 2011.  However, the data cells were correct and consistent with prior years.  The errors in these labels have been corrected in the tables now posted on the MAX Validation Reports/Tables page.  The errors in previous tables for 2010 and 2011 are as follows:  

(1)  The label “# of Stays with > $1 Million Paid” appeared in Row #22 in all of the worksheets.  This label, from the ‘IP All Stays’ worksheet, was copied to all of these worksheets in error. The correct labels vary across the list of worksheets.

(2) Row # 18 in ‘LT All Claim’ tab said “% FFS Claims - Average Medicaid Paid, Adjusted Claims (Include $0)”.  It should be “FFS Claims - Average Medicaid Paid, Adjusted Claims (Include $0)”.

(3) Rows # 33 through #43 in ‘PS Enrolled $’ tab was missing “Average Medicaid Paid per…” text at the start of the label. Without the appropriate label, it was unclear if these rows were counting enrollees or the Average amount paid.’

MAX Data for 2010

We made the following revisions to the PS file:

• Added expenditure variables for each of the 18 HCBS taxonomy categories

We made the following revisions to the OT file:

• Added HCBS taxonomy code

Please see the MAX 2010 data dictionaries for more information about these and other minor revisions.

MAX Data for 2011

We made the following revisions to the PS file:

• Expanded the PREMIUM PAYMENT GROUP (data element numbers 104-106) to include an occurrence for TOS = 23, Capitated Payments to Private Health Insurance (PHI).  The group now occurs four times, for TOS 20, 21, 22 and 23.  

• Added one new variable for Encounter Record Count for HCBS (Data Element 107).

• Replaced the HGT_FLAG (Data Element 5) with FILLER because the high group test is no longer applicable (SSNs are now randomized).

• Description for RBF= W updated (Data Element 55).

• The total record length is now 3058.

We made the following revisions to the OT file:

• Added TOS value = 23 to MSIS Type of Service (Data Element 21) and MAX Type of Service (Data Element 23).

Please see the MAX 2011 data dictionaries for more information about these and other minor revisions.

Related Links