RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               4,645             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,479            C000-C999 Event created from claim
                               3,166            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                               1,479                      Missing
                                   0                   DU Dental
                                  43                   ER Emergency Room
                               2,948                   IP Inpatient
                                  70                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                 105                   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

                                   1                   -8 Don't know
                               4,644                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                   7                   -8 Don't know
                                   0                   95 Still in progress
                               4,638                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                   1                   -7 Refused
                                 153                   -8 Don't know
                               4,491                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   2                   -8 Don't know
                               4,643                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                   8                   -8 Don't know
                                   0                   95 Still in progress
                               4,637                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                 119                   -8 Don't know
                               4,526                      Day of month

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

                                 731                    1 Survey only
                               1,479                    2 Claims only
                               2,435                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                   1                    B Both community & facility
                               3,599                    C Community
                                 205                    D Deemed community
                                 639                    F Facility
                                  31                    G Deemed facility
                                 170                    S SNF

AMTTOT     41  9                                        N Total payment

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

                               3,290                    0 Not imputed
                               1,355                    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?

                               4,639                    0 Not imputed
                                   6                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               4,536                    0 Not imputed
                                 109                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                               4,283                    0 Not imputed
                                 362                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                               3,921                    0 Not imputed
                                 724                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                               4,406                    0 Not imputed
                                 239                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                               4,231                    0 Not imputed
                                 414                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               4,554                    0 Not imputed
                                  91                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               4,504                    0 Not imputed
                                 141                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                               4,645                    0 Not imputed
                                   0                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                               4,620                    0 Not imputed
                                  25                    1 Imputed

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

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                               4,254                    0 Not imputed
                                 391                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                               4,138                    0 Not imputed
                                 507                    1 Imputed

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

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                               4,365                    0 Not imputed
                                 280                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                               4,249                    0 Not imputed
                                 396                    1 Imputed

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

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                               4,571                    0 Not imputed
                                  74                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                               4,571                    0 Not imputed
                                  74                    1 Imputed

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

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                               4,061                    0 Not imputed
                                 584                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               3,905                    0 Not imputed
                                 740                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                               4,445                    0 Not imputed
                                 200                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                               4,411                    0 Not imputed
                                 234                    1 Imputed

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

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                               4,635                    0 Not imputed
                                  10                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               4,624                    0 Not imputed
                                  21                    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

                                 738                      Missing
                               2,011                   01 Discharged to home/self care
                                  89                   02 Discharged to other short-term hospital
                                 782                   03 Discharged to skilled nursing facility
                                  68                   04 Discharged to intermediate care facility
                                  20                   05 Disch to another type of institution
                                 536                   06 Discharged to home care of organized HMO
                                  28                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                 119                   20 Expired (did not recover Christian Sci)
                                   9                   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)
                                  40                   50 Hospice - home (eff. 10/96)
                                  24                   51 Hospice - medical facility (eff. 10/96)
                                  42                   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)
                                 139                      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?

                               3,784                    0 Event not provided by HMO
                                 861                    1 Event provided by HMO

