RIC         1  2                                        C Record Identification Code

VERSION     3  1                                        C Version number

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                               3,786             LOW-HIGH BASEID Count

EVNTNUM    14  4  $EVNTNUM                              C Unique event identifier

                               1,238            C000-C999 Event created from claim
                               2,548            0000-9999 Survey-reported event

OREVTYPE   18  2  $EVNTTYP                              C Original reported event type

                               1,238                      Missing
                                   0                   DU Dental
                                  57                   ER Emergency Room
                               2,342                   IP Inpatient
                                  62                   IU Institutional utilization
                                   0                   MP Medical provider
                                   0                   OM Other medical expense
                                  87                   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

                                   4                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,781                      Year

EVBEGMM    29  2  $EVENTMM                              C Event begin month

                                  12                   -8 Don't know
                                   2                   -9 Not ascertained
                                   0                   95 Still in progress
                               3,772                      Month

EVBEGDD    31  2  $EVENTDD                              C Event begin day

                                 139                   -8 Don't know
                                   2                   -9 Not ascertained
                               3,645                      Day of month

EVENDYY    33  2  $EVENTYY                              C Event end year

                                   6                   -8 Don't know
                                   1                   -9 Not ascertained
                               3,779                      Year

EVENDMM    35  2  $EVENTMM                              C Event end month

                                   9                   -8 Don't know
                                   2                   -9 Not ascertained
                                   0                   95 Still in progress
                               3,775                      Month

EVENDDD    37  2  $EVENTDD                              C Event end day

                                  94                   -8 Don't know
                                   2                   -9 Not ascertained
                               3,690                      Day of month

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

                                 683                    1 Survey only
                               1,238                    2 Claims only
                               1,865                    3 Both survey & claims

SITCODE    40  1  $SITCODE                              C Community or facility setting?

                                   6                    B Both community & facility
                               3,004                    C Community
                                 160                    D Deemed community
                                 450                    F Facility
                                  23                    G Deemed facility
                                 143                    S SNF

AMTTOT     41  9                                        N Total payment

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

                               2,680                    0 Not imputed
                               1,106                    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?

                               3,782                    0 Not imputed
                                   4                    1 Imputed

IMPACARE   79  1  IMPFLAG                               N AMTCARE payment amount imputed?

                               3,705                    0 Not imputed
                                  81                    1 Imputed

AMTCAID    80  9                                        N Amount paid by Medicaid

IMPSCAID   89  1  IMPFLAG                               N AMTCAID payment source imputed?

                               3,521                    0 Not imputed
                                 265                    1 Imputed

IMPACAID   90  1  IMPFLAG                               N AMTCAID payment amount imputed?

                               3,244                    0 Not imputed
                                 542                    1 Imputed

AMTHMOM    91  9                                        N Amount paid by Medicare HMO

IMPSHMOM  100  1  IMPFLAG                               N AMTHMOM payment source imputed?

                               3,513                    0 Not imputed
                                 273                    1 Imputed

IMPAHMOM  101  1  IMPFLAG                               N AMTHMOM payment amount imputed?

                               3,342                    0 Not imputed
                                 444                    1 Imputed

AMTHMOP   102  9                                        N Amount paid by private HMO

IMPSHMOP  111  1  IMPFLAG                               N AMTHMOP payment source imputed?

                               3,690                    0 Not imputed
                                  96                    1 Imputed

IMPAHMOP  112  1  IMPFLAG                               N AMTHMOP payment amount imputed?

                               3,666                    0 Not imputed
                                 120                    1 Imputed

AMTVA     113  9                                        N Amount paid by Veterans Administration

IMPSVA    122  1  IMPFLAG                               N AMTVA payment source imputed?

                               3,781                    0 Not imputed
                                   5                    1 Imputed

IMPAVA    123  1  IMPFLAG                               N AMTVA payment amount imputed?

                               3,756                    0 Not imputed
                                  30                    1 Imputed

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

IMPSPRVE  133  1  IMPFLAG                               N AMTPRVE payment source imputed?

                               3,450                    0 Not imputed
                                 336                    1 Imputed

IMPAPRVE  134  1  IMPFLAG                               N AMTPRVE payment amount imputed?

                               3,357                    0 Not imputed
                                 429                    1 Imputed

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

IMPSPRVI  144  1  IMPFLAG                               N AMTPRVI payment source imputed?

                               3,540                    0 Not imputed
                                 246                    1 Imputed

IMPAPRVI  145  1  IMPFLAG                               N AMTPRVI payment amount imputed?

                               3,465                    0 Not imputed
                                 321                    1 Imputed

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

IMPSPRVU  155  1  IMPFLAG                               N AMTPRVU payment source imputed?

                               3,739                    0 Not imputed
                                  47                    1 Imputed

IMPAPRVU  156  1  IMPFLAG                               N AMTPRVU payment amount imputed?

                               3,739                    0 Not imputed
                                  47                    1 Imputed

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

IMPSOOP   166  1  IMPFLAG                               N AMTOOP payment source imputed?

                               3,289                    0 Not imputed
                                 497                    1 Imputed

IMPAOOP   167  1  IMPFLAG                               N AMTOOP payment amount imputed?

                               3,142                    0 Not imputed
                                 644                    1 Imputed

AMTDISC   168  9                                        N Amount of uncollected SP liability

IMPSDISC  177  1  IMPFLAG                               N AMTDISC payment source imputed?

                               3,569                    0 Not imputed
                                 217                    1 Imputed

IMPADISC  178  1  IMPFLAG                               N AMTDISC payment amount imputed?

                               3,554                    0 Not imputed
                                 232                    1 Imputed

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

IMPSOTH   188  1  IMPFLAG                               N AMTOTH payment source imputed?

                               3,776                    0 Not imputed
                                  10                    1 Imputed

IMPAOTH   189  1  IMPFLAG                               N AMTOTH payment amount imputed?

                               3,763                    0 Not imputed
                                  23                    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

                                 683                      Missing
                               1,487                   01 Discharged to home/self care
                                  76                   02 Discharged to other short-term hospital
                                 574                   03 Discharged to skilled nursing facility
                                  55                   04 Discharged to intermediate care facility
                                   7                   05 Disch to another type of institution
                                 527                   06 Discharged to home care of organized HMO
                                  16                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                 129                   20 Expired (did not recover Christian Sci)
                                   3                   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)
                                  35                   50 Hospice - home (eff. 10/96)
                                  31                   51 Hospice - medical facility (eff. 10/96)
                                  36                   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)
                                 127                      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?

                               2,884                    0 Event not provided by HMO
                                 902                    1 Event provided by HMO

