RIC         1  2  $RIC                                  C Record Identification Code

                              11,049                    A Administrative Data
                                   0                   DU Dental Events
                                   0                   FA Facility Events
                                   0                    H HMO Supplement
                                   0                   IA Income and Assets
                                   0                   IP Inpatient Hospital Events
                                   0                   IU Institutional Events
                                   0                    K Key Record
                                   0                   KN Knowledge and Information Needs
                                   0                   MD MDS
                                   0                   MP Medical Provider Events
                                   0                    N Non-Respondent
                                   0                   OA OASIS
                                   0                   OP Outpatient Events
                                   0                   PA Patient Activation
                                   0                   PM Prescribed Medicine Events
                                   0                   PS Person Summary
                                   0                   RX Drug Coverage
                                   0                   SS Service Summary
                                   0                    X Cross Sectional Weights
                                   0                   XE Ever Enrolled Weights
                                   0                   X2 2 year Weights
                                   0                   X3 3 year Weights
                                   0                   X4 4 year Weights
                                   0                    1 Survey Identification (Demographic)
                                   0                   10 MDS/OAS Timeline
                                   0                    2 Health Status/Functioning (Community)
                                   0                   2F Health Status/Functioning (Facility)
                                   0                   2H Health Status/Functioning (Helper)
                                   0                   2P Health Status/Functioning (Prevention)
                                   0                    3 Access to Care
                                   0                    4 Health Insurance
                                   0                    5 Enumeration
                                   0                    6 Facility Residence History
                                   0                    7 Facility Characteristics
                                   0                   7S SNF Characteristics
                                   0                    8 Interview Description
                                   0                    9 Residence Timeline

VERSION     3  1  $VERSION                              C Version Number

                              11,049                    1 Version 1
                                   0                    2 Version 2
                                   0                    3 Version 3
                                   0                    4 Version 4

BASEID      4  8  $BSIDFMT                              C Unique SP Identification Number

                              11,049             LOW-HIGH BASEID Count

H_DOB      12  8  $DTE8FMT                              C Date of birth

                              11,049                      Date as YYYYMMDD

H_DOD      20  8  $DTE8FMT                              C Date of death

                              10,514                      Missing
                                 535                      Date as YYYYMMDD

H_DODSRC   28  2  $SRCFMT                               C Source of date of death

                              10,514                      No date of death
                                   0                   01 From Medicare bill
                                   0                   03 Clerical entry
                                   0                   05 Bill and clerical entry
                                 319                   10 Proven MCARE Benefits record
                                  35                   11 Proven MCARE Benefits record & bills
                                 159                   20 Unproven MCARE Benefits record
                                  22                   21 Unproven MCARE Benefits record & bills
                                   0                   23 Unproven MCARE Benefits rec & clerical
                                   0                   25 Unproven MCARE Benefit rec,bill&clerical

H_SEX      30  1  $SEXFMT                               C Sex code

                               5,045                    1 Male
                               6,004                    2 Female

H_RACE     31  1  $RACEFMT                              C Race code

                                  61                    0 Unknown
                               9,045                    1 White
                               1,281                    2 Black
                                 158                    3 Other
                                 138                    4 Asian
                                 302                    5 Hispanic
                                  64                    6 North American Native

H_AGE      32  3                                        N SP age based on CMS date of birth

D_STRAT    35  1  $AGEFMT                               C MCBS Sample age stratum

                                 988                    1  0-44
                                 999                    2 45-64
                               1,981                    3 65-69
                               1,852                    4 70-74
                               1,694                    5 75-79
                               1,659                    6 80-84
                               1,876                    7 85 +

H_ENT01    36  1  $ENTFMT                               C Medicare entitlement code for Jan

                                 452                    A Part A Medicare only
                                  49                    B Part B Medicare only
                              10,216                    C Parts A and B Medicare
                                 332                    N No Medicare entitlement

H_ENT02    37  1  $ENTFMT                               C Medicare entitlement code for Feb

                                 453                    A Part A Medicare only
                                  49                    B Part B Medicare only
                              10,188                    C Parts A and B Medicare
                                 359                    N No Medicare entitlement

H_ENT03    38  1  $ENTFMT                               C Medicare entitlement code for Mar

                                 452                    A Part A Medicare only
                                  49                    B Part B Medicare only
                              10,177                    C Parts A and B Medicare
                                 371                    N No Medicare entitlement

H_ENT04    39  1  $ENTFMT                               C Medicare entitlement code for Apr

                                 453                    A Part A Medicare only
                                  48                    B Part B Medicare only
                              10,158                    C Parts A and B Medicare
                                 390                    N No Medicare entitlement

H_ENT05    40  1  $ENTFMT                               C Medicare entitlement code for May

                                 457                    A Part A Medicare only
                                  48                    B Part B Medicare only
                              10,138                    C Parts A and B Medicare
                                 406                    N No Medicare entitlement

H_ENT06    41  1  $ENTFMT                               C Medicare entitlement code for Jun

                                 458                    A Part A Medicare only
                                  48                    B Part B Medicare only
                              10,128                    C Parts A and B Medicare
                                 415                    N No Medicare entitlement

H_ENT07    42  1  $ENTFMT                               C Medicare entitlement code for Jul

                                 441                    A Part A Medicare only
                                  45                    B Part B Medicare only
                              10,137                    C Parts A and B Medicare
                                 426                    N No Medicare entitlement

H_ENT08    43  1  $ENTFMT                               C Medicare entitlement code for Aug

                                 440                    A Part A Medicare only
                                  46                    B Part B Medicare only
                              10,116                    C Parts A and B Medicare
                                 447                    N No Medicare entitlement

H_ENT09    44  1  $ENTFMT                               C Medicare entitlement code for Sep

                                 441                    A Part A Medicare only
                                  44                    B Part B Medicare only
                              10,113                    C Parts A and B Medicare
                                 451                    N No Medicare entitlement

H_ENT10    45  1  $ENTFMT                               C Medicare entitlement code for Oct

                                 443                    A Part A Medicare only
                                  43                    B Part B Medicare only
                              10,096                    C Parts A and B Medicare
                                 467                    N No Medicare entitlement

H_ENT11    46  1  $ENTFMT                               C Medicare entitlement code for Nov

                                 440                    A Part A Medicare only
                                  44                    B Part B Medicare only
                              10,078                    C Parts A and B Medicare
                                 487                    N No Medicare entitlement

H_ENT12    47  1  $ENTFMT                               C Medicare entitlement code for Dec

                                 447                    A Part A Medicare only
                                  44                    B Part B Medicare only
                              10,066                    C Parts A and B Medicare
                                 492                    N No Medicare entitlement

H_DOE      48  8  $DTE8FMT                              C Medicare entitlement start date

                              11,049                      Date as YYYYMMDD

H_DOT      56  8  $DTE8FMT                              C Medicare entitlement end date

                              11,016                      Missing
                                  33                      Date as YYYYMMDD

H_MEDSTA   64  2  $MSCFMT                               C Medicare status code as of 12/31

                                  13                      Unknown
                               8,998                   10 Aged, no ESRD
                                  61                   11 Aged, ESRD
                               1,933                   20 Disabled, no ESRD
                                  41                   21 Disabled, ESRD
                                   3                   31 ESRD only

H_LAF      66  2  $LAFFMT                               C Status of SSA check (LAF) as of 12/31

                                   9                      Unknown
                                   0                   AD Cur pay-adj for dual entitlement
                                   0                   AF Transfer to another PSC or OIO
                                   0                   A9 Cur pay-miscellaneous adjustment
                              10,028                    C Current payment status
                                   0                   DW Deferred-Workers' Compensation
                                   2                   D2 DEF-retirement test
                                   0                   D3 DEF-D2 for primary
                                   6                   D6 DEF-recover overpayment
                                   4                   D9 DEF-miscellaneous reason
                                   1                    J Advanced filing-current pay
                                   0                   L2 Advanced filing-worked inside US
                                   0                   L3 Advanced filing-insured worked in US
                                   0                    N Not in pay status
                                   0                   PB Delayed-benefit due but not paid
                                   0                    R Cur pay-Part B reinstated
                                   0                   RN Cur pay-Part B reinstated
                                   0                    S SUSP-deferred retirement
                                   8                   SD SUSP-other
                                   0                   SF SUSP-fails to meet residence requirement
                                  53                   SH SUSP-government pension
                                   1                   SJ SUSP-alien suspension
                                   0                   SP SUSP-public assistance
                                   0                   SW SUSP-Workers' Compensation
                                   0                   S0 SUSP-continuing disability investig
                                   0                   S2 SUSP-fails retirement test
                                   0                   S3 SUSP-primary account S2
                                  11                   S6 SUSP-check returned for address
                                  10                   S7 SUSP-vocational rehab refusal
                                   1                   S8 SUSP-payee not determined
                                  26                   S9 SUSP-miscellaneous reason
                                   0                   TA TERM-prior to entitlement
                                   0                   TJ TERM-prior to entitlement,not stop debit
                                   0                   TR TERM-claim withdrawn
                                   0                   T0 TERM-benefits paid by another agency
                                 494                   T1 TERM-death of beneficiary
                                   0                   T2 TERM-death of primary
                                   0                   T3 TERM-divorce, marriage, remarriage
                                   0                   T4 TERM-dependent child attained age 18
                                   0                   T5 TERM-entitled on another account
                                   0                   T6 TERM-child no longer student, disabled
                                   1                   T8 TERM-recovery from disability
                                   0                   T9 TERM-miscellaneous
                                 366                    U Active uninsured status (no SSA check)
                                   0                   XF Transfer to another PC or DIO
                                   0                   XR Terminated -
                                  17                   X1 TERM-death of insured
                                   0                   X5 TERM-entitled to another benefit
                                  11                   X7 TERM of uninsured
                                   0                   X9 TERM miscellaneous
                                   0                   ZZ Erroneous entitlement

H_RESST    68  2  $STFMT                                C SSA State code of residence as of 12/31

                                 427                   01 Alabama
                                   0                   02 Alaska
                                 182                   03 Arizona
                                 103                   04 Arkansas
                                 774                   05 California
                                  78                   06 Colorado
                                 138                   07 Connecticut
                                   0                   08 Delaware
                                  10                   09 Washington, DC
                                 758                   10 Florida
                                 371                   11 Georgia
                                   0                   12 Hawaii
                                   0                   13 Idaho
                                 384                   14 Illinois
                                  31                   15 Indiana
                                  94                   16 Iowa
                                 109                   17 Kansas
                                 179                   18 Kentucky
                                 134                   19 Louisiana
                                   0                   20 Maine
                                 173                   21 Maryland
                                 185                   22 Massachusetts
                                 576                   23 Michigan
                                 238                   24 Minnesota
                                   0                   25 Mississippi
                                 277                   26 Missouri
                                   0                   27 Montana
                                  94                   28 Nebraska
                                 238                   29 Nevada
                                   2                   30 New Hampshire
                                 302                   31 New Jersey
                                 252                   32 New Mexico
                                 630                   33 New York
                                 571                   34 North Carolina
                                   0                   35 North Dakota
                                 591                   36 Ohio
                                  96                   37 Oklahoma
                                   0                   38 Oregon
                                 544                   39 Pennsylvania
                                 209                   40 Puerto Rico
                                   1                   41 Rhode Island
                                 115                   42 South Carolina
                                   0                   43 South Dakota
                                 309                   44 Tennessee
                                 723                   45 Texas
                                   2                   46 Utah
                                   0                   47 Vermont
                                   0                   48 Virgin Islands
                                 155                   49 Virginia
                                 405                   50 Washington
                                 137                   51 West Virginia
                                 350                   52 Wisconsin
                                  97                   53 Wyoming
                                   5                      Unknown

H_RESCTY   70  3  $CTYFMT                               C SSA county code of residence as of 12/31

                                   5                      Unknown
                              11,044                      County code

H_ZIP      73  5  $ZIPFMT                               C Postal zip code of residence as of 12/31

                                   5                      Unknown
                              11,044                      ZIP Code

H_CENSUS   78  2  $CENFMT                               C Census Region of residence as of 12/31

                                 326                   01 New England
                               1,476                   02 Middle Atlantic
                               1,932                   03 East North Central
                                 812                   04 West North Central
                               2,290                   05 South Atlantic
                                 915                   06 East South Central
                               1,056                   07 West South Central
                                 849                   08 Mountain
                               1,179                   09 Pacific
                                 209                   10 Puerto Rico
                                   5                      Unknown

H_METRO    80  1  $METFMT                               C Metro status

                               2,932                    N Non-metro area
                                   0                    U Unknown
                               8,117                    Y Metro area

H_HSBEG1   81  8  $DTE8FMT                              C Beginning date of latest hospice period

                              10,654                      Missing
                                 395                      Date as YYYYMMDD

H_HSEND1   89  8  $DTE8FMT                              C Ending date of latest hospice period

                              10,654                      Missing
                                 395                      Date as YYYYMMDD

H_HSBEG2   97  8  $DTE8FMT                              C Beginning date of 2nd hospice period

                              10,882                      Missing
                                 167                      Date as YYYYMMDD

H_HSEND2  105  8  $DTE8FMT                              C Ending date of 2nd hospice period

                              10,882                      Missing
                                 167                      Date as YYYYMMDD

H_HSBEG3  113  8  $DTE8FMT                              C Beginning date of 3rd hospice period

                              10,937                      Missing
                                 112                      Date as YYYYMMDD

H_HSEND3  121  8  $DTE8FMT                              C Ending date of 3rd hospice period

                              10,937                      Missing
                                 112                      Date as YYYYMMDD

H_HSBEG4  129  8  $DTE8FMT                              C Beginning date of 4th hospice period

                              10,960                      Missing
                                  89                      Date as YYYYMMDD

H_HSEND4  137  8  $DTE8FMT                              C Ending date of 4th hospice period

                              10,960                      Missing
                                  89                      Date as YYYYMMDD

H_ESRBEG  145  8  $DTE8FMT                              C Beginning date of ESRD period

                              10,902                      Missing
                                 147                      Date as YYYYMMDD

H_ESREND  153  8  $DTE8FMT                              C Ending date of ESRD period

                              10,972                      Missing
                                  77                      Date as YYYYMMDD

H_GHPSW   161  1  $GHPSW                                C Some group health participation in year

                               7,859                    0 No enrollment
                               3,190                    1 Some enrollment

H_PNUM    162  3                                        N Number of GHPs in bene area

H_MANUM   165  3                                        N Number of MA plans in bene area

H_PFSNUM  168  3                                        N Number of PFFS plans in bene area

H_PLPY01  171  5                                        N Medicare capitation payment for Jan

H_PLPY02  176  5                                        N Medicare capitation payment for Feb

H_PLPY03  181  5                                        N Medicare capitation payment for Mar

H_PLPY04  186  5                                        N Medicare capitation payment for Apr

H_PLPY05  191  5                                        N Medicare capitation payment for May

H_PLPY06  196  5                                        N Medicare capitation payment for Jun

H_PLPY07  201  5                                        N Medicare capitation payment for Jul

H_PLPY08  206  5                                        N Medicare capitation payment for Aug

H_PLPY09  211  5                                        N Medicare capitation payment for Sep

H_PLPY10  216  5                                        N Medicare capitation payment for Oct

H_PLPY11  221  5                                        N Medicare capitation payment for Nov

H_PLPY12  226  5                                        N Medicare capitation payment for Dec

H_PDPY01  231  5                                        N Part D capitation payment for Jan

H_PDLS01  236  1  $DLISFMT                              C LIS Indicator for Jan

                                 336                      Unknown
                               7,793                    1 No premium subsidy
                                  27                    2 25% premium subsidy
                                  30                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,835                    5 100% premium subsidy

H_PDRS01  237  1  $DRDSFMT                              C RDS Indicator for Jan

                                 337                      Unknown
                              10,044                    N Employer not subsidized for the bene
                                 668                    Y Employer subsidized for the beneficiary

H_CRED01  238  1  $YES8FMT                              C Creditable Coverage for Jan

                                  48                      Unknown
                               1,461                    1 Yes
                               9,540                    2 No

H_PDPY02  239  5                                        N Part D capitation payment for Feb

H_PDLS02  244  1  $DLISFMT                              C LIS Indicator for Feb

                                 340                      Unknown
                               7,783                    1 No premium subsidy
                                  26                    2 25% premium subsidy
                                  30                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,842                    5 100% premium subsidy

H_PDRS02  245  1  $DRDSFMT                              C RDS Indicator for Feb

                                 341                      Unknown
                              10,041                    N Employer not subsidized for the bene
                                 667                    Y Employer subsidized for the beneficiary

H_CRED02  246  1  $YES8FMT                              C Creditable Coverage for Feb

                                  48                      Unknown
                               1,468                    1 Yes
                               9,533                    2 No

H_PDPY03  247  5                                        N Part D capitation payment for Mar

H_PDLS03  252  1  $DLISFMT                              C LIS Indicator for Mar

                                 353                      Unknown
                               7,766                    1 No premium subsidy
                                  26                    2 25% premium subsidy
                                  30                    3 50% premium subsidy
                                  27                    4 75% premium subsidy
                               2,847                    5 100% premium subsidy

H_PDRS03  253  1  $DRDSFMT                              C RDS Indicator for Mar

                                 353                      Unknown
                              10,034                    N Employer not subsidized for the bene
                                 662                    Y Employer subsidized for the beneficiary

H_CRED03  254  1  $YES8FMT                              C Creditable Coverage for Mar

                                  48                      Unknown
                               1,471                    1 Yes
                               9,530                    2 No

H_PDPY04  255  5                                        N Part D capitation payment for Apr

H_PDLS04  260  1  $DLISFMT                              C LIS Indicator for Apr

                                 382                      Unknown
                               7,745                    1 No premium subsidy
                                  24                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,842                    5 100% premium subsidy

H_PDRS04  261  1  $DRDSFMT                              C RDS Indicator for Apr

                                 382                      Unknown
                              10,021                    N Employer not subsidized for the bene
                                 646                    Y Employer subsidized for the beneficiary

H_CRED04  262  1  $YES8FMT                              C Creditable Coverage for Apr

                                  48                      Unknown
                               1,477                    1 Yes
                               9,524                    2 No

H_PDPY05  263  5                                        N Part D capitation payment for May

H_PDLS05  268  1  $DLISFMT                              C LIS Indicator for May

                                 396                      Unknown
                               7,732                    1 No premium subsidy
                                  24                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,841                    5 100% premium subsidy

H_PDRS05  269  1  $DRDSFMT                              C RDS Indicator for May

                                 396                      Unknown
                              10,009                    N Employer not subsidized for the bene
                                 644                    Y Employer subsidized for the beneficiary

H_CRED05  270  1  $YES8FMT                              C Creditable Coverage for May

                                  48                      Unknown
                               1,479                    1 Yes
                               9,522                    2 No

H_PDPY06  271  5                                        N Part D capitation payment for Jun

H_PDLS06  276  1  $DLISFMT                              C LIS Indicator for Jun

                                 423                      Unknown
                               7,698                    1 No premium subsidy
                                  23                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  28                    4 75% premium subsidy
                               2,849                    5 100% premium subsidy

H_PDRS06  277  1  $DRDSFMT                              C RDS Indicator for Jun

                                 423                      Unknown
                               9,980                    N Employer not subsidized for the bene
                                 646                    Y Employer subsidized for the beneficiary

H_CRED06  278  1  $YES8FMT                              C Creditable Coverage for Jun

                                  48                      Unknown
                               1,485                    1 Yes
                               9,516                    2 No

H_PDPY07  279  5                                        N Part D capitation payment for Jul

H_PDLS07  284  1  $DLISFMT                              C LIS Indicator for Jul

                                 436                      Unknown
                               7,689                    1 No premium subsidy
                                  24                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  29                    4 75% premium subsidy
                               2,843                    5 100% premium subsidy

H_PDRS07  285  1  $DRDSFMT                              C RDS Indicator for Jul

                                 436                      Unknown
                               9,968                    N Employer not subsidized for the bene
                                 645                    Y Employer subsidized for the beneficiary

H_CRED07  286  1  $YES8FMT                              C Creditable Coverage for Jul

                                  48                      Unknown
                               1,488                    1 Yes
                               9,513                    2 No

H_PDPY08  287  5                                        N Part D capitation payment for Aug

H_PDLS08  292  1  $DLISFMT                              C LIS Indicator for Aug

                                 454                      Unknown
                               7,664                    1 No premium subsidy
                                  23                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  29                    4 75% premium subsidy
                               2,851                    5 100% premium subsidy

H_PDRS08  293  1  $DRDSFMT                              C RDS Indicator for Aug

                                 454                      Unknown
                               9,948                    N Employer not subsidized for the bene
                                 647                    Y Employer subsidized for the beneficiary

H_CRED08  294  1  $YES8FMT                              C Creditable Coverage for Aug

                                  48                      Unknown
                               1,491                    1 Yes
                               9,510                    2 No

H_PDPY09  295  5                                        N Part D capitation payment for Sep

H_PDLS09  300  1  $DLISFMT                              C LIS Indicator for Sep

                                 475                      Unknown
                               7,645                    1 No premium subsidy
                                  23                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  29                    4 75% premium subsidy
                               2,849                    5 100% premium subsidy

H_PDRS09  301  1  $DRDSFMT                              C RDS Indicator for Sep

                                 475                      Unknown
                               9,932                    N Employer not subsidized for the bene
                                 642                    Y Employer subsidized for the beneficiary

H_CRED09  302  1  $YES8FMT                              C Creditable Coverage for Sep

                                  48                      Unknown
                               1,497                    1 Yes
                               9,504                    2 No

H_PDPY10  303  5                                        N Part D capitation payment for Oct

H_PDLS10  308  1  $DLISFMT                              C LIS Indicator for Oct

                                 483                      Unknown
                               7,626                    1 No premium subsidy
                                  23                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  30                    4 75% premium subsidy
                               2,859                    5 100% premium subsidy

H_PDRS10  309  1  $DRDSFMT                              C RDS Indicator for Oct

                                 483                      Unknown
                               9,929                    N Employer not subsidized for the bene
                                 637                    Y Employer subsidized for the beneficiary

H_CRED10  310  1  $YES8FMT                              C Creditable Coverage for Oct

                                  48                      Unknown
                               1,501                    1 Yes
                               9,500                    2 No

H_PDPY11  311  5                                        N Part D capitation payment for Nov

H_PDLS11  316  1  $DLISFMT                              C LIS Indicator for Nov

                                 513                      Unknown
                               7,604                    1 No premium subsidy
                                  22                    2 25% premium subsidy
                                  28                    3 50% premium subsidy
                                  30                    4 75% premium subsidy
                               2,852                    5 100% premium subsidy

H_PDRS11  317  1  $DRDSFMT                              C RDS Indicator for Nov

                                 513                      Unknown
                               9,900                    N Employer not subsidized for the bene
                                 636                    Y Employer subsidized for the beneficiary

H_CRED11  318  1  $YES8FMT                              C Creditable Coverage for Nov

                                  48                      Unknown
                               1,507                    1 Yes
                               9,494                    2 No

H_PDPY12  319  5                                        N Part D capitation payment for Dec

H_PDLS12  324  1  $DLISFMT                              C LIS Indicator for Dec

                                 526                      Unknown
                               7,591                    1 No premium subsidy
                                  22                    2 25% premium subsidy
                                  27                    3 50% premium subsidy
                                  30                    4 75% premium subsidy
                               2,853                    5 100% premium subsidy

H_PDRS12  325  1  $DRDSFMT                              C RDS Indicator for Dec

                                 526                      Unknown
                               9,889                    N Employer not subsidized for the bene
                                 634                    Y Employer subsidized for the beneficiary

H_CRED12  326  1  $YES8FMT                              C Creditable Coverage for Dec

                                  48                      Unknown
                               1,509                    1 Yes
                               9,492                    2 No

H_MCSW    327  1  $SWFMT                                C Some Medicaid eligibility for the year

                               8,563                    N No participation
                               2,486                    Y Some participation

H_MCDE01  328  1  $MCDCFMT                              C Medicaid eligibility for Jan

                                   0                    A State Part A buy-in
                                 882                    B State Part B buy-in
                                  48                    C State Part A and B buy-in
                                  69                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,759                    N No buy-in this month
                               1,022                    Q State Part B QMB buy-in
                                 269                    S State Part B SLMB buy-in

H_MCDE02  329  1  $MCDCFMT                              C Medicaid eligibility for Feb

                                   0                    A State Part A buy-in
                                 881                    B State Part B buy-in
                                  46                    C State Part A and B buy-in
                                  69                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,769                    N No buy-in this month
                               1,016                    Q State Part B QMB buy-in
                                 268                    S State Part B SLMB buy-in

H_MCDE03  330  1  $MCDCFMT                              C Medicaid eligibility for Mar

                                   0                    A State Part A buy-in
                                 886                    B State Part B buy-in
                                  45                    C State Part A and B buy-in
                                  69                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,764                    N No buy-in this month
                               1,020                    Q State Part B QMB buy-in
                                 265                    S State Part B SLMB buy-in

H_MCDE04  331  1  $MCDCFMT                              C Medicaid eligibility for Apr

                                   0                    A State Part A buy-in
                                 882                    B State Part B buy-in
                                  45                    C State Part A and B buy-in
                                  69                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,766                    N No buy-in this month
                               1,022                    Q State Part B QMB buy-in
                                 265                    S State Part B SLMB buy-in

H_MCDE05  332  1  $MCDCFMT                              C Medicaid eligibility for May

                                   1                    A State Part A buy-in
                                 883                    B State Part B buy-in
                                  45                    C State Part A and B buy-in
                                  68                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,762                    N No buy-in this month
                               1,023                    Q State Part B QMB buy-in
                                 267                    S State Part B SLMB buy-in

H_MCDE06  333  1  $MCDCFMT                              C Medicaid eligibility for Jun

                                   1                    A State Part A buy-in
                                 892                    B State Part B buy-in
                                  45                    C State Part A and B buy-in
                                  67                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,763                    N No buy-in this month
                               1,016                    Q State Part B QMB buy-in
                                 265                    S State Part B SLMB buy-in

H_MCDE07  334  1  $MCDCFMT                              C Medicaid eligibility for Jul

                                   0                    A State Part A buy-in
                                 887                    B State Part B buy-in
                                  48                    C State Part A and B buy-in
                                  67                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,759                    N No buy-in this month
                               1,020                    Q State Part B QMB buy-in
                                 268                    S State Part B SLMB buy-in

H_MCDE08  335  1  $MCDCFMT                              C Medicaid eligibility for Aug

                                   0                    A State Part A buy-in
                                 887                    B State Part B buy-in
                                  48                    C State Part A and B buy-in
                                  68                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,765                    N No buy-in this month
                               1,014                    Q State Part B QMB buy-in
                                 267                    S State Part B SLMB buy-in

H_MCDE09  336  1  $MCDCFMT                              C Medicaid eligibility for Sep

                                   0                    A State Part A buy-in
                                 883                    B State Part B buy-in
                                  48                    C State Part A and B buy-in
                                  70                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,772                    N No buy-in this month
                               1,007                    Q State Part B QMB buy-in
                                 269                    S State Part B SLMB buy-in

H_MCDE10  337  1  $MCDCFMT                              C Medicaid eligibility for Oct

                                   0                    A State Part A buy-in
                                 894                    B State Part B buy-in
                                  47                    C State Part A and B buy-in
                                  68                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,767                    N No buy-in this month
                               1,001                    Q State Part B QMB buy-in
                                 272                    S State Part B SLMB buy-in

H_MCDE11  338  1  $MCDCFMT                              C Medicaid eligibility for Nov

                                   0                    A State Part A buy-in
                                 895                    B State Part B buy-in
                                  46                    C State Part A and B buy-in
                                  68                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,763                    N No buy-in this month
                               1,003                    Q State Part B QMB buy-in
                                 274                    S State Part B SLMB buy-in

H_MCDE12  339  1  $MCDCFMT                              C Medicaid eligibility for Dec

                                   0                    A State Part A buy-in
                                 874                    B State Part B buy-in
                                  46                    C State Part A and B buy-in
                                  68                    D State Part A and B QMB buy-in
                                   0                    E State Part A and B SLMB buy-in
                               8,809                    N No buy-in this month
                                 984                    Q State Part B QMB buy-in
                                 268                    S State Part B SLMB buy-in

H_MACY01  340  3  $MACYFMT                              C Buy-in agency for Jan

                               8,759                    N Unknown, or no buy-in
                               2,290              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY02  343  3  $MACYFMT                              C Buy-in agency for Feb

                               8,769                    N Unknown, or no buy-in
                               2,280              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY03  346  3  $MACYFMT                              C Buy-in agency for Mar

                               8,764                    N Unknown, or no buy-in
                               2,285              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY04  349  3  $MACYFMT                              C Buy-in agency for Apr

                               8,766                    N Unknown, or no buy-in
                               2,283              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY05  352  3  $MACYFMT                              C Buy-in agency for May

                               8,762                    N Unknown, or no buy-in
                               2,287              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY06  355  3  $MACYFMT                              C Buy-in agency for Jun

                               8,763                    N Unknown, or no buy-in
                               2,286              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY07  358  3  $MACYFMT                              C Buy-in agency for Jul

                               8,759                    N Unknown, or no buy-in
                               2,290              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY08  361  3  $MACYFMT                              C Buy-in agency for Aug

                               8,765                    N Unknown, or no buy-in
                               2,284              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY09  364  3  $MACYFMT                              C Buy-in agency for Sep

                               8,772                    N Unknown, or no buy-in
                               2,277              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY10  367  3  $MACYFMT                              C Buy-in agency for Oct

                               8,767                    N Unknown, or no buy-in
                               2,282              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY11  370  3  $MACYFMT                              C Buy-in agency for Nov

                               8,763                    N Unknown, or no buy-in
                               2,286              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_MACY12  373  3  $MACYFMT                              C Buy-in agency for Dec

                               8,809                    N Unknown, or no buy-in
                               2,240              S00-S99 State Agency code
                                   0              000-999 State Agency code

H_HOSSW   376  1  $UTLFMT                               C One or more hospice bills in CY

                              10,697                    0 No utilization this type
                                 352                    1 Some utilization this type

H_INPSW   377  1  $UTLFMT                               C One or more inpatient discharges in CY

                               9,505                    0 No utilization this type
                               1,544                    1 Some utilization this type

H_SNFSW   378  1  $UTLFMT                               C One or more SNF admissions in CY

                              10,484                    0 No utilization this type
                                 565                    1 Some utilization this type

H_HHASW   379  1  $UTLFMT                               C 1 = one or more HHA visits in CY

                              10,187                    0 No utilization this type
                                 862                    1 Some utilization this type

H_OUTSW   380  1  $UTLFMT                               C One or more outpatient visits in CY

                               5,478                    0 No utilization this type
                               5,571                    1 Some utilization this type

H_PBSW    381  1  $UTLFMT                               C One or more Part B claims in CY

                               3,422                    0 No utilization this type
                               7,627                    1 Some utilization this type

H_PTARMB  382  7                                        N Total Part A reimbursement in CY ($)

H_PTBRMB  389  7                                        N Total Part B reimbursement in CY ($)

H_PTAPRM  396  8                                        N Total Pt. A premium SP paid in CY ($.CC)

H_PTBPRM  404  8                                        N Total Pt. B premium SP paid in CY ($.CC)

H_LATDCH  412  8  $DTE8FMT                              C Discharge date of latest inpatient stay

                               9,505                      Missing
                               1,544                      Date as YYYYMMDD

H_LATDRG  420  3  $DRGFMT                               C DRG code for latest inpatient stay

                               9,505                      Unknown, or no discharge
                               1,544                      DRG

H_DISDES  423  2  $STATUS                               C Discharge dest for latest inpatient stay

                               9,505                      Missing
                                 735                   01 Discharged to home/self care
                                   5                   02 Discharged to other short-term hospital
                                 322                   03 Discharged to skilled nursing facility
                                  18                   04 Discharged to intermediate care facility
                                   2                   05 Disch to another type of institution
                                 269                   06 Discharged to home care of organized HMO
                                   2                   07 Left against medical advice/stopped care
                                   0                   08 Disch home under care of IV therapy prov
                                  95                   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)
                                   0                   43 Disch/Transferred to a Fed Hospital (10)
                                  25                   50 Hospice - home (eff. 96)
                                  34                   51 Hospice - medical facility (eff. 96)
                                  15                   61 Disch w/i facility to swing-bed SNF (99)
                                   6                   62 Disch inp rehab; inc distinct hosp (10)
                                   7                   63 Disch to long term care hospital (10)
                                   3                   64 Disch cert nursing; Mcaid, not Mcare(10)
                                   1                   65 Disch to psychiatric hosp or unit   (10)
                                   2                   70 Disch to other institution, no code (10)
                                   0                   71 Disch to other facility for O/P svcs(99)
                                   0                   72 Disch to this facility for O/P svcs (99)

H_INPSTY  425  2                                        N No. of inpatient stays for CY

H_INPDAY  427  3                                        N No. of inpatient covered days for CY

H_INPCHG  430  7                                        N Inpatient charges for CY ($)

H_INPCCH  437  7                                        N Inpatient covered charges for CY ($)

H_INPRMB  444  7                                        N Inpatient reimbursement for CY ($)

H_INPCDY  451  2                                        N Inpatient coinsurance days used in CY

H_INPCAM  453  5                                        N Total inpatient coinsurance amt CY ($)

H_SNFSTY  458  2                                        N Total SNF stays in CY

H_SNFDAY  460  3                                        N Total SNF covered days in CY

H_SNFCHG  463  7                                        N Total SNF charges in CY  ($)

H_SNFCCH  470  7                                        N Total SNF covered charges in CY ($)

H_SNFRMB  477  7                                        N Total SNF reimbursement in CY ($)

H_SNFCDY  484  3                                        N Total SNF coinsurance days in CY

H_SNFCAM  487  7                                        N Total SNF coinsurance amount in CY ($)

H_HHAVST  494  5                                        N Total HHA visits in CY

H_HHACCH  499  7                                        N Total HHA covered charges in CY ($)

H_HHACHO  506  7                                        N Total HHA other covered charges CY ($)

H_HHRMBA  513  7                                        N Total HHA reimbursement in CY ($), Pt. A

                 Notes: Prior to 1998 this was included in H_HHARMB.
                        First available in 1998

H_HHRMBB  520  7                                        N Total HHA reimbursement in CY ($), Pt. B

                 Notes: Prior to 1998 this was included in H_HHARMB.
                        First available in 1998

H_HSDAYS  527  3                                        N Total covered hospice days in CY

H_HSTCHG  530  7                                        N Total hospice charges CY ($)

H_HSREIM  537  7                                        N Total hospice reimbursement in CY ($)

H_OUTBIL  544  3                                        N Total outpatient bills in CY

H_OUTCHG  547  7                                        N Total outpatient covered charges CY ($)

H_OUTRMB  554  7                                        N Total outpatient reimbursement CY ($)

H_PMTCLM  561  4                                        N Total physician/supplier claims in CY

H_PMTLIN  565  4                                        N Total phys./supplier line items in CY

H_PMTSCH  569  7                                        N Total submitted phys/supplier charge ($)

H_PMTACH  576  7                                        N Total allowed phys/supplier charges ($)

H_PMTRMB  583  7                                        N Total phys/supplier reimbursement ($)

H_PMTVST  590  3                                        N Total office visits in CY

H_PMTCHO  593  7                                        N Total office visit charges in CY ($)

H_DMECLM  600  4                                        N Total DME supplier claims in CY

                 Notes: Prior to 1998 this was included in H_PMTCLM.
                        First available in 1998

H_DMELIN  604  4                                        N Total DME supplier line items in CY

                 Notes: Prior to 1998 this was included in H_PMTLIN.
                        First available in 1998

H_DMESCH  608  7                                        N Total DME supplier submitted charges ($)

                 Notes: Prior to 1998 this was included in H_PMTSCH.
                        First available in 1998

H_DMEACH  615  7                                        N Total DME supplier allowed charges ($)

                 Notes: Prior to 1998 this was included in H_PMTACH.
                        First available in 1998

H_DMERMB  622  7                                        N Total DME supplier reimbursement ($)

                 Notes: Prior to 1998 this was included in H_PMTRMB.
                        First available in 1998

DUAL_JAN  629  2  $DUALMON                              C Dual eligibility code for Jan

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,264                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 332                   00 Not enrolled in MCARE for the month
                                 271                   01 QMB-only
                               1,318                   02 QMB & full MCAID coverage, + Rx drugs
                                 203                   03 SLMB-only
                                  85                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 111                   06 Qualifying individuals
                                 462                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_FEB  631  2  $DUALMON                              C Dual eligibility code for Feb

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,241                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 359                   00 Not enrolled in MCARE for the month
                                 277                   01 QMB-only
                               1,315                   02 QMB & full MCAID coverage, + Rx drugs
                                 200                   03 SLMB-only
                                  79                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 109                   06 Qualifying individuals
                                 466                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_MAR  633  2  $DUALMON                              C Dual eligibility code for Mar

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,230                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 371                   00 Not enrolled in MCARE for the month
                                 279                   01 QMB-only
                               1,309                   02 QMB & full MCAID coverage, + Rx drugs
                                 201                   03 SLMB-only
                                  73                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 112                   06 Qualifying individuals
                                 472                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   2                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_APR  635  2  $DUALMON                              C Dual eligibility code for Apr

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,214                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 390                   00 Not enrolled in MCARE for the month
                                 278                   01 QMB-only
                               1,315                   02 QMB & full MCAID coverage, + Rx drugs
                                 211                   03 SLMB-only
                                  78                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 109                   06 Qualifying individuals
                                 451                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_MAY  637  2  $DUALMON                              C Dual eligibility code for May

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,194                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 406                   00 Not enrolled in MCARE for the month
                                 282                   01 QMB-only
                               1,311                   02 QMB & full MCAID coverage, + Rx drugs
                                 214                   03 SLMB-only
                                  76                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 105                   06 Qualifying individuals
                                 458                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_JUN  639  2  $DUALMON                              C Dual eligibility code for Jun

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,180                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 415                   00 Not enrolled in MCARE for the month
                                 287                   01 QMB-only
                               1,313                   02 QMB & full MCAID coverage, + Rx drugs
                                 210                   03 SLMB-only
                                  75                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 106                   06 Qualifying individuals
                                 460                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_JUL  641  2  $DUALMON                              C Dual eligibility code for Jul

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,176                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 426                   00 Not enrolled in MCARE for the month
                                 289                   01 QMB-only
                               1,310                   02 QMB & full MCAID coverage, + Rx drugs
                                 209                   03 SLMB-only
                                  70                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 113                   06 Qualifying individuals
                                 453                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_AUG  643  2  $DUALMON                              C Dual eligibility code for Aug

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,155                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 447                   00 Not enrolled in MCARE for the month
                                 281                   01 QMB-only
                               1,314                   02 QMB & full MCAID coverage, + Rx drugs
                                 212                   03 SLMB-only
                                  69                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 112                   06 Qualifying individuals
                                 456                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   3                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_SEP  645  2  $DUALMON                              C Dual eligibility code for Sep

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,160                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 451                   00 Not enrolled in MCARE for the month
                                 283                   01 QMB-only
                               1,308                   02 QMB & full MCAID coverage, + Rx drugs
                                 214                   03 SLMB-only
                                  70                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 104                   06 Qualifying individuals
                                 455                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   4                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_OCT  647  2  $DUALMON                              C Dual eligibility code for Oct

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,142                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 467                   00 Not enrolled in MCARE for the month
                                 278                   01 QMB-only
                               1,314                   02 QMB & full MCAID coverage, + Rx drugs
                                 208                   03 SLMB-only
                                  70                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 109                   06 Qualifying individuals
                                 457                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   4                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_NOV  649  2  $DUALMON                              C Dual eligibility code for Nov

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,124                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 487                   00 Not enrolled in MCARE for the month
                                 283                   01 QMB-only
                               1,303                   02 QMB & full MCAID coverage, + Rx drugs
                                 213                   03 SLMB-only
                                  73                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 110                   06 Qualifying individuals
                                 452                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   4                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

DUAL_DEC  651  2  $DUALMON                              C Dual eligibility code for Dec

                                   0                   ** Bene enrold PtA &/or PtB, no PtD enroll
                               8,132                   NA Non-MCAID
                                   0                   XX Bene enrold PtA &/or PtB, no '06-'09 PtD
                                 491                   00 Not enrolled in MCARE for the month
                                 281                   01 QMB-only
                               1,296                   02 QMB & full MCAID coverage, + Rx drugs
                                 211                   03 SLMB-only
                                  76                   04 SLMB & full MCAID coverage, + Rx drugs
                                   0                   05 QDWI
                                 111                   06 Qualifying individuals
                                 447                   08 Other dual(Not QMB,SLMB,QWDI,QI)MCAID+Rx
                                   4                   09 Other dual eligible, no MCAID coverage
                                   0                   99 Unknown

OP_MDCD   653  1  $DUALFMT                              C MCARE-MCAID dual elig indicator (annual)

                               2,046                    1 FULL-Bene eligible full MCAID benefits
                               8,330                    2 NONDUAL-Bene not eligible MCAID benefits
                                 363                    3 PARTIAL-Bene eligible part MCAID-not QMB
                                 310                    4 QMB ONLY-Bene elig for part MCAID-QMB

PTCPRM1   654  8                                        N Part C Premium for Jan

PTCPRM2   662  8                                        N Part C Premium for Feb

PTCPRM3   670  8                                        N Part C Premium for Mar

PTCPRM4   678  8                                        N Part C Premium for Apr

PTCPRM5   686  8                                        N Part C Premium for May

PTCPRM6   694  8                                        N Part C Premium for Jun

PTCPRM7   702  8                                        N Part C Premium for Jul

PTCPRM8   710  8                                        N Part C Premium for Aug

PTCPRM9   718  8                                        N Part C Premium for Sep

PTCPRM10  726  8                                        N Part C Premium for Oct

PTCPRM11  734  8                                        N Part C Premium for Nov

PTCPRM12  742  8                                        N Part C Premium for Dec

PTDPRM1   750  8                                        N Part D Premium for Jan

PTDPRM2   758  8                                        N Part D Premium for Feb

PTDPRM3   766  8                                        N Part D Premium for Mar

PTDPRM4   774  8                                        N Part D Premium for Apr

PTDPRM5   782  8                                        N Part D Premium for May

PTDPRM6   790  8                                        N Part D Premium for Jun

PTDPRM7   798  8                                        N Part D Premium for Jul

PTDPRM8   806  8                                        N Part D Premium for Aug

PTDPRM9   814  8                                        N Part D Premium for Sep

PTDPRM10  822  8                                        N Part D Premium for Oct

PTDPRM11  830  8                                        N Part D Premium for Nov

PTDPRM12  838  8                                        N Part D Premium for Dec

PARTD_01  846  1  $YNO8FMT                              C Part D plan flag for Jan

                               3,160                    N No
                               7,889                    Y Yes

PARTD_02  847  1  $YNO8FMT                              C Part D plan flag for Feb

                               3,163                    N No
                               7,886                    Y Yes

PARTD_03  848  1  $YNO8FMT                              C Part D plan flag for Mar

                               3,174                    N No
                               7,875                    Y Yes

PARTD_04  849  1  $YNO8FMT                              C Part D plan flag for Apr

                               3,176                    N No
                               7,873                    Y Yes

PARTD_05  850  1  $YNO8FMT                              C Part D plan flag for May

                               3,192                    N No
                               7,857                    Y Yes

PARTD_06  851  1  $YNO8FMT                              C Part D plan flag for Jun

                               3,198                    N No
                               7,851                    Y Yes

PARTD_07  852  1  $YNO8FMT                              C Part D plan flag for Jul

                               3,198                    N No
                               7,851                    Y Yes

PARTD_08  853  1  $YNO8FMT                              C Part D plan flag for Aug

                               3,198                    N No
                               7,851                    Y Yes

PARTD_09  854  1  $YNO8FMT                              C Part D plan flag for Sep

                               3,206                    N No
                               7,843                    Y Yes

PARTD_10  855  1  $YNO8FMT                              C Part D plan flag for Oct

                               3,200                    N No
                               7,849                    Y Yes

PARTD_11  856  1  $YNO8FMT                              C Part D plan flag for Nov

                               3,231                    N No
                               7,818                    Y Yes

PARTD_12  857  1  $YNO8FMT                              C Part D plan flag for Dec

                               3,247                    N No
                               7,802                    Y Yes

MAFLAG01  858  3  $MAFLAG                               C MA flag for January

                                 332                      No Entitlement
                               7,466                  FFS Original Medicare/FFS
                               3,251                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG02  861  3  $MAFLAG                               C MA flag for February

                                 359                      No Entitlement
                               7,455                  FFS Original Medicare/FFS
                               3,235                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG03  864  3  $MAFLAG                               C MA flag for March

                                 371                      No Entitlement
                               7,439                  FFS Original Medicare/FFS
                               3,239                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG04  867  3  $MAFLAG                               C MA flag for April

                                 390                      No Entitlement
                               7,441                  FFS Original Medicare/FFS
                               3,218                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG05  870  3  $MAFLAG                               C MA flag for May

                                 406                      No Entitlement
                               7,422                  FFS Original Medicare/FFS
                               3,221                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG06  873  3  $MAFLAG                               C MA flag for June

                                 415                      No Entitlement
                               7,406                  FFS Original Medicare/FFS
                               3,228                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG07  876  3  $MAFLAG                               C MA flag for July

                                 426                      No Entitlement
                               7,388                  FFS Original Medicare/FFS
                               3,235                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG08  879  3  $MAFLAG                               C MA flag for August

                                 447                      No Entitlement
                               7,371                  FFS Original Medicare/FFS
                               3,231                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG09  882  3  $MAFLAG                               C MA flag for September

                                 451                      No Entitlement
                               7,359                  FFS Original Medicare/FFS
                               3,239                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG10  885  3  $MAFLAG                               C MA flag for October

                                 467                      No Entitlement
                               7,346                  FFS Original Medicare/FFS
                               3,236                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG11  888  3  $MAFLAG                               C MA flag for November

                                 487                      No Entitlement
                               7,330                  FFS Original Medicare/FFS
                               3,232                   MA MA/Other Medicare Capitated Payment Plan

MAFLAG12  891  3  $MAFLAG                               C MA flag for December

                                 492                      No Entitlement
                               7,324                  FFS Original Medicare/FFS
                               3,233                   MA MA/Other Medicare Capitated Payment Plan

PTDPBP01  894  3                                        C PtD Plan Benefit Packge Jan

PTDPBP02  897  3                                        C PtD Plan Benefit Packge Feb

PTDPBP03  900  3                                        C PtD Plan Benefit Packge Mar

PTDPBP04  903  3                                        C PtD Plan Benefit Packge Apr

PTDPBP05  906  3                                        C PtD Plan Benefit Packge May

PTDPBP06  909  3                                        C PtD Plan Benefit Packge Jun

PTDPBP07  912  3                                        C PtD Plan Benefit Packge Jul

PTDPBP08  915  3                                        C PtD Plan Benefit Packge Aug

PTDPBP09  918  3                                        C PtD Plan Benefit Packge Sep

PTDPBP10  921  3                                        C PtD Plan Benefit Packge Oct

PTDPBP11  924  3                                        C PtD Plan Benefit Packge Nov

PTDPBP12  927  3                                        C PtD Plan Benefit Packge Dec

PTDSGM01  930  3                                        C Part D Segment ID - Jan

PTDSGM02  933  3                                        C Part D Segment ID - Feb

PTDSGM03  936  3                                        C Part D Segment ID - Mar

PTDSGM04  939  3                                        C Part D Segment ID - Apr

PTDSGM05  942  3                                        C Part D Segment ID - May

PTDSGM06  945  3                                        C Part D Segment ID - Jun

PTDSGM07  948  3                                        C Part D Segment ID - Jul

PTDSGM08  951  3                                        C Part D Segment ID - Aug

PTDSGM09  954  3                                        C Part D Segment ID - Sep

PTDSGM10  957  3                                        C Part D Segment ID - Oct

PTDSGM11  960  3                                        C Part D Segment ID - Nov

PTDSGM12  963  3                                        C Part D Segment ID - Dec

PTDCRT01  966  5                                        C Part D Contract ID - Jan

PTDCRT02  971  5                                        C Part D Contract ID - Feb

PTDCRT03  976  5                                        C Part D Contract ID - Mar

PTDCRT04  981  5                                        C Part D Contract ID - Apr

PTDCRT05  986  5                                        C Part D Contract ID - May

PTDCRT06  991  5                                        C Part D Contract ID - Jun

PTDCRT07  996  5                                        C Part D Contract ID - Jul

PTDCRT08 1001  5                                        C Part D Contract ID - Aug

PTDCRT09 1006  5                                        C Part D Contract ID - Sep

PTDCRT10 1011  5                                        C Part D Contract ID - Oct

PTDCRT11 1016  5                                        C Part D Contract ID - Nov

PTDCRT12 1021  5                                        C Part D Contract ID - Dec

PTDDED01 1026  8                                        N Part D Deductible - Jan

PTDDED02 1034  8                                        N Part D Deductible - Feb

PTDDED03 1042  8                                        N Part D Deductible - Mar

PTDDED04 1050  8                                        N Part D Deductible - Apr

PTDDED05 1058  8                                        N Part D Deductible - May

PTDDED06 1066  8                                        N Part D Deductible - Jun

PTDDED07 1074  8                                        N Part D Deductible - Jul

PTDDED08 1082  8                                        N Part D Deductible - Aug

PTDDED09 1090  8                                        N Part D Deductible - Sep

PTDDED10 1098  8                                        N Part D Deductible - Oct

PTDDED11 1106  8                                        N Part D Deductible - Nov

PTDDED12 1114  8                                        N Part D Deductible - Dec

PRPY1    1122  1  PRPY                                  N Primary Payer

                              10,453                    1 Medicare
                                 339                    2 Employer/Large Group Health Plan
                                 257                    3 Other Liability (Auto, WC, etc.)

PRPY2    1123  1  PRPY                                  N Primary Payer - 2nd code

                              11,012                    . No additional codes/payers
                                   0                    1 Medicare
                                   9                    2 Employer/Large Group Health Plan
                                  28                    3 Other Liability (Auto, WC, etc.)

PRPY3    1124  1  PRPY                                  N Primary Payer - 3rd code

                              11,047                    . No additional codes/payers
                                   0                    1 Medicare
                                   0                    2 Employer/Large Group Health Plan
                                   2                    3 Other Liability (Auto, WC, etc.)

