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File Version: CCW record layout accessed May, 2019; CMS MAX 2014 data dictionary Aug 18, 2016

SAS NameVariable Name
1BENE_IDEncrypted 723 CCW Beneficiary ID
2MSIS_IDEncrypted MSIS Identification Number
4YR_NUMYear of MAX Record
5EL_DOB Birth date
7EL_RACE_ETHNCY_CDRace/ethnicity (from MSIS)
8RACE_CODE_1Race - White (from MSIS)
9RACE_CODE_2Race - Black (from MSIS)
10RACE_CODE_3Race - Am Indian/Alaskan (from MSIS)
11RACE_CODE_4Race - Asian (from MSIS)
12RACE_CODE_5Race - Hawaiian/Pac Islands (from MSIS)
13ETHNICITY_CODEEthnicity - Hispanic (from MSIS)
14EL_SS_ELGBLTY_CD_LTSTState specific eligibility - most recent
15EL_SS_ELGBLTY_CD_MOState specific eligibility - mo of svc
16EL_MAX_ELGBLTY_CD_LTSTMAX eligibility - most recent
17EL_MAX_ELGBLTY_CD_MOMAX eligibility - mo of svc
18EL_MDCR_ANN_XOVR_OLDCrossover code (Annual) old values
19MSNG_ELG_DATA Missing eligibility data
20EL_MDCR_XOVR_CLM_BSD_CDCrossover code (from claims only)
21EL_MDCR_ANN_XOVR_99Crossover code (Annual)
22MSIS_TOS MSIS Type of Service (TOS)
23MSIS_TOPMSIS Type of Program (TOP)
52HCBS_TXNMY_WVR_CDHome and community-based services (HCBS) taxonomy code for waviers
25CLTC_FLAGCommunity-based LT care (CLTC) flag
24MAX_TOSMAX Type of Service (TOS)
26PRVDR_ID_NMBR Billing provider identification number (MAX)
27NPI National Provider Identifier (MAX)
28TAXONOMY Provider Taxonomy
29TYPE_CLM_CD Type of claim
30ADJUST_CDAdjustment code
31PHP_TYPEManaged care type of plan code
32PHP_IDManaged care plan identification code
33MDCD_PYMT_AMTMedicaid payment amount
34TP_PYMT_AMTThird party payment amount
35PYMT_DTPayment/adjudication date
36CHRG_AMTCharge amount
37PHP_VALPrepaid plan value
38MDCR_COINSUR_PYMT_AMTMedicare coinsurance payment amount
39MDCR_DED_PYMT_AMTMedicare deductible payment amount
40SRVC_BGN_DTBeginning date of service
41SRVC_END_DTEnding date of service
42PRCDR_CD_SYSProcedure (service) coding system
43PRCDR_CDProcedure (service) code
44PRCDR_SRVC_MDFR_CDProcedure (service) code modifier
45DIAG_CD_1Principle Diagnosis code
46DIAG_CD_2 Diagnosis codes (2nd diagnosis)
47QTY_SRVC_UNITSQuantity of service
48SRVC_PRVDR_ID_NMBRServicing provider identification number (MAX)
49SRVC_PRVDR_SPEC_CDServicing provider specialty code (MAX)
50PLC_OF_SRVC_CDPlace of service
51UB_92_REV_CDUB-92 revenue code