Data Dictionary

Version 1.2 September 25, 2012 HCCIs data holdings include claims for over 40 million people covered by employer-sponsored insurance between 2007 and 2011. From these claims, a common set of data elements was developed to support the HCCI reports on costs and utilization. This data dictionary is a listing of those elements. It is not the full listing of variables available for researchers. Researchers interested in a full data dictionary should contact HCCI directly.

Admissions Date: Admission Date Allowed Amount: The portion of submitted charges considered for payment. This amount is before member contributions (e.g., copays, deductibles, and coinsurance) and after discounts, savings, benefit limits, reduction amounts due to duplicates. Bill type: Type of bill Birth Year: Year of member's birth. Business Line: Identifies the type of business the product is intended to service, such as commercial and Medicare Advantage. CBSA: Core Based Statistical Area code, a geographic entity defined by the US Census Bureau. Only "Metro" codes, representing populations of 50,000+, are included. This variable is available for both providers and insureds. Claim ID: Encrypted Claim ID Claim Type: Claim form type, such as UB-92 or CMS 1500.

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Coinsurance: The amount (usually calculated as a percent of the provider's submitted charges) the member pays for a specific service as defined in their benefit plan. For example, 20% of the cost of an outpatient physical therapy visit. Copay: The fixed amount the member pays for a specific service as defined in their benefit plan. For example, $10 for an office visit. CPT/HCPC: Procedure code that describes the service provided. This is generally the line item CPT/HCPC codes off CMS 1500 claim forms. This field is generally CPT-4/HCPC codes for NonFacility Services. Date claim paid: The date that appears on the check for claims payment. Days Supplied: Estimated day count the drug supply should last. Deductible: The set amount a member pays for services until they reach a specified limit. After the limit is reached, the member's payment for services changes. Diagnosis 1: First level ICD-9 code as entered on the claim (without decimal point). ICD-9-CM is an accepted national standard for coding diagnostic and disease information. This represents the most important diagnosis (also known as Primary Diagnosis) responsible for the medical services. Diagnosis 2: Second level ICD-9 code as entered on the claim (without decimal point). ICD-9CM is an accepted national standard for coding diagnostic and disease information. Diagnosis 3: Third level ICD-9 code as entered on the claim (without decimal point). ICD-9-CM is an accepted national standard for coding diagnostic and disease information. Discharge Date: Date insured was discharged. DRG: The Diagnosis Related Group (DRG) Code assigned by the source system. A DRG classifies patients by diagnostic or surgical procedure into major diagnostic categories for determining payment of hospitalization charges. Drug Quantity: Quantity of drug dispensed in metric units. Effective Date: Eligibility Effective Date. First effective for counting purposes under HEDIS/NCQA reporting standards.

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End Date: Eligibility End Date. The member coverage is no longer effective for counting purposes under HEDIS/NCQA reporting standards for this month/day/year. ESI Type: Identifies ASO (self-funded) versus fully insured. Used for commercial insurance only. Fill Date: Date the prescription was filled by the pharmacy. Flag High Deductible: Identifier for High Deductible / Consumer Driven Health Plans Flag Mail Order: Indicates if the type of pharmacy utilized to fill the prescription was Mail Order. Flag Mental Health Coverage: Identifies members who have mental health benefits as part of their plan coverage. Flag Pharmacy: Identifies members with pharmacy coverage. Flag RX Specialty: Indicates if the pharmacy is a specialty pharmacy. Gender: A code identifying the sex of the insured. Hospital Referral Region: Regional market indicators for tertiary medical care, as defined by the Dartmouth Atlas of Health Care. Market Segment: Indicates the relative size of the customer based on the number of employees. NDC: The unique code that identifies a drug product as defined by the National Drug Data File Net Paid: The actual amount paid to the provider for the service performed after all deductions and calculations are performed. This does not include the amount paid fee for service on a capitated service. Patient ID: A random, system-generated number that identifies an individual across multiple groups/policies. This identifier is not derived from information about the individual, and is compliant with HIPAA 164.514c. POS: AMA Place of Service code Procedure 1: First procedure code that describes services provided. This is generally the ICD-9CM codes for Facility services off UB04 claim forms.

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Procedure 2: Second procedure code that describes services provided. This is generally the ICD-9-CM codes for Facility services off UB04 claim forms. Procedure 3: Third procedure code that describes services provided. This is generally the ICD9-CM codes for Facility services off UB04 claim forms. Product line: Type of benefit structure, such as HMO, Preferred Provider Organization (PPO), etc. Provider Category: Contains the four-character provider category code to indicate the type of provider for the provider responsible for the service. Provider ID: A system-generated number assigned to a service provider. This blinded ID is neither related to nor derived from DEA or NPI identifiers. Relationship Code: A code identifying relationship of member to policyholder. Revenue Code: Identifies a specific accommodation, ancillary service, or billing calculation for facility claims. Service End Date: The ending date for the service, event, or confinement being billed by the provider. Service Start Date: The beginning date for the service, event, or confinement being billed by the provider. State: The two-character state Postal Code of the member's state. Units: The revised number of units of service based on the reasonable number of units for that service type.

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