RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version Number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                                 921             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                                 572            C000-C999 Event created from claim
                                 349            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVN1TYP                              C Original reported event type

                                 572                      Missing
                                   0                   DU Dental
                                   0                   ER Emergency room
                                  83                   IP Inpatient
                                 266                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                   0                   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

                                   7                   -8 Don't know
                                 914                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                  15                   -8 Don't know
                                   0                   95 Still in progress
                                 906                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                  40                   -8 Don't know
                                 881                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   9                   -8 Don't know
                                 912                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                  19                   -8 Don't know
                                   0                   95 Still in progress
                                 902                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                  39                   -8 Don't know
                                 882                      Day of month

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

                                 146                    1 Survey only
                                 572                    2 Claims only
                                 203                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                   0                    B Both community & facility
                                 136                    C Community
                                   3                    D Deemed community
                                   7                    F Facility
                                   1                    G Deemed facility
                                 774                    S SNF

AMTTOT     41  9                                        N Total payment

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

                                 599                    0 Not imputed
                                 322                    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?

                                 917                    0 Not imputed
                                   4                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                                 909                    0 Not imputed
                                  12                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                                 812                    0 Not imputed
                                 109                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                                 720                    0 Not imputed
                                 201                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                                 879                    0 Not imputed
                                  42                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                                 873                    0 Not imputed
                                  48                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                                 907                    0 Not imputed
                                  14                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                                 907                    0 Not imputed
                                  14                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                                 916                    0 Not imputed
                                   5                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                                 916                    0 Not imputed
                                   5                    1 Imputed

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

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                                 843                    0 Not imputed
                                  78                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                                 832                    0 Not imputed
                                  89                    1 Imputed

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

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                                 872                    0 Not imputed
                                  49                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                                 871                    0 Not imputed
                                  50                    1 Imputed

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

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                                 831                    0 Not imputed
                                  90                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                                 831                    0 Not imputed
                                  90                    1 Imputed

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

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                                 693                    0 Not imputed
                                 228                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                                 626                    0 Not imputed
                                 295                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                                 892                    0 Not imputed
                                  29                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                                 889                    0 Not imputed
                                  32                    1 Imputed

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

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                                 916                    0 Not imputed
                                   5                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                                 916                    0 Not imputed
                                   5                    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

PROV      207  6                                        C Medicare provider number from claim

STATUS    213  2                                        C Beneficiary status as of claim thru date

UTLZNDAY  215  3                                        N Number of covered days of care

COINDAY   218  2                                        N Total number of coinsurance days

HMO       220  1  $HMO                                  C Event provided by an HMO?

                                 765                    0 Event not provided by HMO
                                 156                    1 Event provided by HMO

