Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Member Enrollment Fields
Data Set #1
X
X
X
X
X
X
Data Set #2
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
Description
Patient Identifier (encrypted)
E_PATID
Character
X
Enrollment Month
Enrollment Year
Gender
Year of Birth
Age Band Code
Relationship Code
State
State (for Rural or micropolitan CBSAs)
Member Zip Code
MNTH
YR
GDR
YBIRTH
AGE_BAND_CD
REL_CD
STATE
STATE_RURAL
MBR_ZIP_5_CD
Character
Character
Character
Character
Character
Character
Character
Character
Character
X
X
Member CBSA Code
MBR_CBSA_CD
Character
Encrypted, unique identifier for all members in data set. PATID is unique over time and across HCCI data
contributors.
Calendar Month of active member enrollment.
Calendar Year of active member enrollment.
Member Gender: Male (1), Female (2), Unknown (9).
Year of Member birth.
A code identifying the age range of the member.
Identifies relationship of member to policy holder.
Standard two character indicator of Member's state of residence.
Standard two character indicator of Member's state of residence where CBSA is '00000'.
The number assigned by the US Postal Service to a geographic area for the purposes of efficient mail sorting
and delivery.
Only zip codes corresponding to populations of greater than 1350 individuals per 2010 US Census
ZCTA file are present.
Geographic Indicator, US Census Core Based Statistical Area. Only "Metro" codes, representing populations of
50,000+, are included.
Member Hospital Referral Region Code
HRR_CD
Business Line
Product
Consumer Driven Health Plan Flag
Funding
Prescription Coverage Flag
Mental Health Coverage Flag
Market Segment Code
Standard Industry Classification Code
BUS_LINE
PROD
CDHP_CD
FUNDING
RX_CVG_IND
MH_COV_IND
MKT_SGMNT_CD
SIC
Character
Character
Character
Character
Character
Character
Character
Character
Dual Eligibility Flag (Medicare only)
End Stage Renal Disease Flag (Medicare only)
Hospice Flag (Medicare only)
Institutional Flag (Medicare only)
Group ID (encrypted)
(aka Customer Segment System ID)
DUAL_ELIG_CD
ESRD_STATUS
HOSPICE_STATUS
INSTITUTE_STATUS
E_GROUP_ID
Character
Character
Character
Character
Character
Exchange Indicator
Exchange Category
Metallic Level of Plan
Individual Market Flag
Medicare Advantage/Non Commercial Flag
Age over 65 Flag
EXCH_IND
EXCH_CAT
METALLIC_LVL
INDV_FLAG
NONCOM_FLAG
OVER65_FLAG
Character
Varchar
Character
Character
Character
Character
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Integer
X
X
X
X
X
X
X
X
X
X
X
X
Identifies a member's regional market for tertiary medical care based on the Dartmouth Atlas Hospital Referral
Regions.
Identifies the book of business (Commercial, Medicare, Medicaid).
Type of benefit plan commonly used by the health care industry to identify the product.
Identifies a member enrolled in a High Deductible / Consumer Driven Health Plan.
Identifies ASO (self funded) versus fully insured. Used for commercial products only.
Identifies a member with pharmacy benefits coverage.
Identifies members who have mental health benefits as part of their plan coverage.
Indicates the relative size of the customer based on the number of covered lives.
A federally assigned Standard Industry Classification number that identifies companies by industry. Values have
been aggregated into 8 broad categories.
Medicare Advantage Only -- Identifies member's who have dual eligiblility with Medicare and Medicaid.
Medicare Advantage Only -- Patient diagnosed with End Stage Renal Disease (ESRD).
Medicare Advantage Only -- Patient placed in Hospice care.
Medicare Advantage Only -- Patient placed in an institutional setting (excludes confinement stays).
Encrypted, system generated identification number assigned to the member according to which customer
segment or employer-specific group plan the member is affiliated with. Close equivalent to Group Number.
ACA indicator Commercial Only: Yes/No indicator of whether plan is offered through an HIE.
ACA indicator Commercial Only: Type of Exchange plan is listed on (Federal, State, Private, etc.).
ACA indicator Commercial Only: Coverage level (Platinum, Gold, Silver, Bronze, Catastrophic).
Derived flag for purposes of data set filtering. Value of '1' indicates an Individual Market policy.
Derived flag for purposes of data set filtering. Value of '1' indicates a Medicare Advantage policy.
Derived flag for purposes of data set filtering. Value of '1' indicates member age of 65+.
Copyright 2017 Health Care Cost Institute Inc. Unless explicitly noted, the content of this document is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 4.0 License.
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Inpatient
Data Set #1
X
X
X
X
X
X
X
X
X
X
X
X
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
Description
Patient Identifier (encrypted)
E_PATID
Character
X
Medical Claim ID (encrypted)
Claim Sequence Code
Claim Incurred Year
Claim Incurred Month
Claim Form Type
Type of Bill
First Service Date
Last Service Date
Admit Date
Discharge Date
Admit ID
Admit Type
Admit Record Flag
E_CLMID
CLMSEQ
YR
MNTH
CLM_FRM_TYP
TOB
FST_DT
LST_DT
FST_ADMTDT
LAST_DISCHDT
ADMIT_ID
ADMIT_TYPE
ADMITS
Character
Character
Character
Character
Character
Character
Date
Date
Date
Date
Character
Character
Numeric
X
Length of Stay
LOS
Numeric
X
Major Diagnostic Category
Claim Paid Date
Charge Amount
MDC
PAID_DT
CHARGE
Varchar
Date
Numeric
X
Net Paid Amount
AMT_NET_PAID
Numeric
Coinsurance Amount
COINS
Numeric
Copayment Amount
COPAY
Numeric
Deductible Amount
Calculated Allowed Amount
Total Member Cost Share
Units
Diagnosis 1
Diagnosis 2
Diagnosis 3
Diagnosis Related Group
Diagnosis Related Group Type
Discharge Status
Procedure Code (CPT/HCPCS)
Procedure Code 1 (ICD-9)
DEDUCT
CALC_ALLWD
TOT_MEM_CS
UNITS
DIAG1
DIAG2
DIAG3
DRG
DRG_TYPE
DSTATUS
PROC_CD
PROC1
Numeric
Numeric
Numeric
Number
Varchar
Varchar
Varchar
Varchar
Varchar
Character
Varchar
Varchar
Encrypted, unique identifier for all members in data set. PATID is unique over time and across HCCI data
contributors.
Encrypted Claim ID.
Number assigned in the source system to the service within the claim. Used with E_CLMID.
Incurred year of service in format 'YYYY'.
Incurred month of service in format 'MM'.
Claim form type.
Type Of Bill indicator for facility claims.
The beginning date for the service, event, or confinement being billed by the provider.
The ending date for the service, event, or confinement being billed by the provider.
Admission Date for Inpatient confinement.
Discharge Date for Inpatient confinement.
Encrypted, unique identifier for an inpatient confinement. Only present on Inpatient claims.
Source of patients admission.
A derived column that flags admissions according to the sum of the allowed dollars. Values of -1, 0, or 1,
representing negative, zero, or positive dollars, respectively. Use in combination with ADMIT_ID for counting
Admissions (utilization count). Only present on Inpatient claims.
Length of Stay for Inpatient confinement. Use in combination with ADMIT_ID for counting total inpatient days.
Only present on Inpatient claims.
Major Diagnostic Category. Only present on Inpatient claims.
The date that appears on the check or EFT for claims payment.
The submitted charges less any non-covered expenses due to: 1. Ineligible charges 2. Ineligible patients or
providers 3. Incomplete information. It is used as the baseline for evaluating the effectiveness of network
arrangements.
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. Values may be positive
$ amount or zero or negative $ amount or null.
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.
Values may be positive $ amount or zero or negative $ amount or null.
The fixed amount the member pays for a specific service as defined in their benefit plan. For example, $10 for
an office visit. Values may be positive $ amount or zero or negative $ amount or null.
The amount applied to the member's deductible.
The sum of the plan payment plus member cost-share. AMT_NET_PAID + COINS + COPAY + DEDUCT.
The sum of COINS + COPAY + DEDUCT.
The number of units of service/procedure.
First level ICD-9 as entered on the claim.
Second level ICD-9 as entered on the claim.
Third level ICD-9 as entered on the claim.
The Diagnosis Related Group (DRG) Code.
Type of DRG code used in claims calculation. 'MS' or 'CMS'.
Discharge Status Code. Valid for hospital stays only.
CPT/HCPCS code.
ICD-9-CM code. Inpatient claims only.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Inpatient
Data Set #1
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Procedure Code 2 (ICD-9)
Procedure Code 3 (ICD-9)
Procedure Code Modifier (CPT/HCPCS)
Revenue Code
Place of Service
National Provider Identifier (encrypted)
PROC2
PROC3
PROCMOD
RVNU_CD
POS
HNPI
Varchar
Varchar
Varchar
Varchar
Varchar
Character
Derived
X
National Provider Identifier (encrypted) backfill flag
HNPI_FILL_FLG
Character
X
National Provider Identifier (encrypted) of billing entity
HNPI_BE
Character
National Provider Identifier (encrypted) of billing entity
backfill flag
Provider Category
Provider Zip Code
HNPI_BE_FILL_FLG
Character
PROVCAT
PROV_ZIP_5_CD
Character
Character
Provider Zip Code backfill flag
PROV_ZIP5_FILL_FLG
Character
Provider CBSA Code
PROV_CBSA_CD
Character
Network Indicator
Primary Coverage Indicator
HCCI High Level Service Category
HCCI Detailed Service Category
Individual Market Flag
Medicare Advantage/Non Commercial Flag
Age over 65 Flag
NTWRK_IND
PRIMARY_COV_IND
HCCI_HL_CAT
HCCI_DET_CAT
INDV_FLAG
NONCOM_FLAG
OVER65_FLAG
Varchar
Varchar
Varchar
Varchar
Character
Character
Character
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Description
ICD-9-CM code. Inpatient claims only.
ICD-9-CM code. Inpatient claims only.
Identifies more detail about the specific procedure provided or service performed.
Identifies a specific accommodation, ancillary service or billing calculation for facility claims.
AMA Place of Service code.
National Provider Identifier (NPI) of the health care provider authorized to prescribe medications. NPI is
assigned by NPPES/CMS to a qualified health care provider. This number is encrypted to be consistent across
HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
National Provider Identifier (NPI) of the health care billing entity delivering the service. NPI is assigned by
NPPES/CMS to a qualified health care provider. This number is a one-way hash encrypted value consistent
across HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
Provider category code that indicates the specialty of the health care professional.
The number assigned by the US Postal Service to a geographic area for the purposes of efficient mail sorting
and delivery.
Derived flag indicating whether the PROV_ZIP_5 is a native value as received by payer ('0') or has been
backfilled by Optum ('1').
Core Based Statistical Area code, a geographic entity defined by the US Census Bureau. Only "Metro" codes,
representing populations of 50,000+, are included.
Indicates whether a claim was paid in or out of network.
Indicates whether a claim was paid primary, secondary, tertiary, etc.
Derived "High Level" service category.
Derived detailed service category.
Derived flag for purposes of data set filtering. Value of '1' indicates an Individual Market policy.
Derived flag for purposes of data set filtering. Value of '1' indicates a Medicare Advantage policy.
Derived flag for purposes of data set filtering. Value of '1' indicates member age of 65+.
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Outpatient
Data Set #1
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
Description
Patient Identifier (encrypted)
E_PATID
Character
X
Medical Claim ID (encrypted)
Claim Sequence Code
Claim Incurred Year
Claim Incurred Month
Claim Form Type
Type of Bill
First Service Date
Last Service Date
Claim First Date
Visit ID
Visit Record Flag
E_CLMID
CLMSEQ
YR
MNTH
CLM_FRM_TYP
TOB
FST_DT
LST_DT
CLM_FST_DT
VISITID
VISITS
Character
Character
Character
Character
Character
Character
Date
Date
Date
Character
Numeric
X
Procedure Record Flag
PROCS
Numeric
X
Claim Paid Date
Charge Amount
PAID_DT
CHARGE
Date
Numeric
Net Paid Amount
AMT_NET_PAID
Numeric
Coinsurance Amount
COINS
Numeric
Copayment Amount
COPAY
Numeric
Deductible Amount
Calculated Allowed Amount
Total Member Cost-Share
Units
Diagnosis 1
Diagnosis 2
Diagnosis 3
Diagnosis Related Group
DEDUCT
CALC_ALLWD
TOT_MEM_CS
UNITS
DIAG1
DIAG2
DIAG3
DRG
Numeric
Numeric
Numeric
Number
Varchar
Varchar
Varchar
Varchar
Encrypted, unique identifier for all members in data set. PATID is unique over time and across HCCI data
contributors.
Encrypted Claim ID.
Number assigned in the source system to the service within the claim. Used with E_CLMID.
Incurred year of service in format 'YYYY'.
Incurred month of service in format 'MM'.
Claim form type.
Type Of Bill indicator for facility claims.
The beginning date for the service, event, or confinement being billed by the provider.
The ending date for the service, event, or confinement being billed by the provider.
Minimum FST_DT across all lines of a claim for an Outpatient visit.
Unique identifier for an outpatient visit. Only present on Outpatient claims.
A derived column that flags visits according to the sum of the allowed dollars. Values of -1, 0, or 1, representing
negative, zero, or positive dollars, respectively. Use in combination with VISITID for counting Visits (utilization
count). Only present on Outpatient claims.
A derived column that flags procedures according to the sum of the allowed dollars. Values of -1, 0, or 1,
representing negative, zero, or positive dollars, respectively. Used for counting Procedures (utilization count).
Only present on Outpatient or Physician claims.
The date that appears on the check or EFT for claims payment.
The submitted charges less any non-covered expenses due to: 1. Ineligible charges 2. Ineligible patients or
providers 3. Incomplete information. It is used as the baseline for evaluating the effectiveness of network
arrangements.
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. Values may be positive
$ amount or zero or negative $ amount or null.
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.
Values may be positive $ amount or zero or negative $ amount or null.
The fixed amount the member pays for a specific service as defined in their benefit plan. For example, $10 for
an office visit. Values may be positive $ amount or zero or negative $ amount or null.
The amount applied to the member's deductible.
The sum of the plan payment plus member cost-share. AMT_NET_PAID + COINS + COPAY + DEDUCT.
The sum of COINS + COPAY + DEDUCT.
The number of units of service/procedure.
First level ICD-9 as entered on the claim.
Second level ICD-9 as entered on the claim.
Third level ICD-9 as entered on the claim.
The Diagnosis Related Group (DRG) Code.
Diagnosis Related Group Type
Discharge Status
Procedure Code (CPT/HCPCS)
Procedure Code 1 (ICD-9)
Procedure Code 2 (ICD-9)
DRG_TYPE
DSTATUS
PROC_CD
PROC1
PROC2
Varchar
Character
Varchar
Varchar
Varchar
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Type of DRG code used in claims calculation. 'MS' or 'CMS'.
Discharge Status Code. Valid for hospital stays only.
CPT/HCPCS code.
ICD-9-CM code. Inpatient claims only.
ICD-9-CM code. Inpatient claims only.
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Outpatient
Data Set #1
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Procedure Code 3 (ICD-9)
Procedure Code Modifier (CPT/HCPCS)
Revenue Code
Place of Service
National Provider Identifier (encrypted)
PROC3
PROCMOD
RVNU_CD
POS
HNPI
Varchar
Varchar
Varchar
Varchar
Character
Derived
X
National Provider Identifier (encrypted) backfill flag
HNPI_FILL_FLG
Character
X
National Provider Identifier (encrypted) of billing entity
HNPI_BE
Character
National Provider Identifier (encrypted) of billing entity
backfill flag
Provider Category
Provider Zip Code
HNPI_BE_FILL_FLG
Character
PROVCAT
PROV_ZIP_5_CD
Character
Character
Provider Zip Code backfill flag
PROV_ZIP5_FILL_FLG
Character
Provider CBSA Code
PROV_CBSA_CD
Character
Network Indicator
Primary Coverage Indicator
HCCI High Level Service Category
HCCI Detailed Service Category
Individual Market Flag
Medicare Advantage/Non Commercial Flag
Age over 65 Flag
NTWRK_IND
PRIMARY_COV_IND
HCCI_HL_CAT
HCCI_DET_CAT
INDV_FLAG
NONCOM_FLAG
OVER65_FLAG
Varchar
Varchar
Varchar
Varchar
Character
Character
Character
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Description
ICD-9-CM code. Inpatient claims only.
Identifies more detail about the specific procedure provided or service performed.
Identifies a specific accommodation, ancillary service or billing calculation for facility claims.
AMA Place of Service code.
National Provider Identifier (NPI) of the health care provider authorized to prescribe medications. NPI is
assigned by NPPES/CMS to a qualified health care provider. This number is encrypted to be consistent across
HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
National Provider Identifier (NPI) of the health care billing entity delivering the service. NPI is assigned by
NPPES/CMS to a qualified health care provider. This number is a one-way hash encrypted value consistent
across HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
Provider category code that indicates the specialty of the health care professional.
The number assigned by the US Postal Service to a geographic area for the purposes of efficient mail sorting
and delivery.
Derived flag indicating whether the PROV_ZIP_5 is a native value as received by payer ('0') or has been
backfilled by Optum ('1').
Core Based Statistical Area code, a geographic entity defined by the US Census Bureau. Only "Metro" codes,
representing populations of 50,000+, are included.
Indicates whether a claim was paid in or out of network.
Indicates whether a claim was paid primary, secondary, tertiary, etc.
Derived "High Level" service category.
Derived detailed service category.
Derived flag for purposes of data set filtering. Value of '1' indicates an Individual Market policy.
Derived flag for purposes of data set filtering. Value of '1' indicates a Medicare Advantage policy.
Derived flag for purposes of data set filtering. Value of '1' indicates member age of 65+.
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Physician
Data Set #1
X
X
X
X
X
X
X
X
X
X
X
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
Description
Patient Identifier (encrypted)
E_PATID
Character
X
Medical Claim ID (encrypted)
Claim Sequence Code
Claim Incurred Year
Claim Incurred Month
Claim Form Type
Type of Bill
First Service Date
Last Service Date
Procedure Record Flag
E_CLMID
CLMSEQ
YR
MNTH
CLM_FRM_TYP
TOB
FST_DT
LST_DT
PROCS
Character
Character
Character
Character
Character
Character
Date
Date
Numeric
X
Claim Paid Date
Charge Amount
PAID_DT
CHARGE
Date
Numeric
Net Paid Amount
AMT_NET_PAID
Numeric
Coinsurance Amount
COINS
Numeric
Copayment Amount
COPAY
Numeric
Deductible Amount
Calculated Allowed Amount
Total Member Cost-Share
Units
Diagnosis 1
Diagnosis 2
Diagnosis 3
Diagnosis Related Group
Diagnosis Related Group Type
Discharge Status
Procedure Code (CPT/HCPCS)
Procedure Code 1 (ICD-9)
Procedure Code 2 (ICD-9)
Procedure Code 3 (ICD-9)
Procedure Code Modifier (CPT/HCPCS)
Revenue Code
Place of Service
DEDUCT
CALC_ALLWD
TOT_MEM_CS
UNITS
DIAG1
DIAG2
DIAG3
DRG
DRG_TYPE
DSTATUS
PROC_CD
PROC1
PROC2
PROC3
PROCMOD
RVNU_CD
POS
Numeric
Numeric
Numeric
Number
Varchar
Varchar
Varchar
Varchar
Varchar
Character
Varchar
Varchar
Varchar
Varchar
Varchar
Varchar
Varchar
Encrypted, unique identifier for all members in data set. PATID is unique over time and across HCCI data
contributors.
Encrypted Claim ID.
Number assigned in the source system to the service within the claim. Used with E_CLMID.
Incurred year of service in format 'YYYY'.
Incurred month of service in format 'MM'.
Claim form type.
Type Of Bill indicator for facility claims.
The beginning date for the service, event, or confinement being billed by the provider.
The ending date for the service, event, or confinement being billed by the provider.
A derived column that flags procedures according to the sum of the allowed dollars. Values of -1, 0, or 1,
representing negative, zero, or positive dollars, respectively. Used for counting Procedures (utilization count).
Only present on Outpatient or Physician claims.
The date that appears on the check or EFT for claims payment.
The submitted charges less any non-covered expenses due to: 1. Ineligible charges 2. Ineligible patients or
providers 3. Incomplete information. It is used as the baseline for evaluating the effectiveness of network
arrangements.
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. Values may be positive
$ amount or zero or negative $ amount or null.
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.
Values may be positive $ amount or zero or negative $ amount or null.
The fixed amount the member pays for a specific service as defined in their benefit plan. For example, $10 for
an office visit. Values may be positive $ amount or zero or negative $ amount or null.
The amount applied to the member's deductible.
The sum of the plan payment plus member cost-share. AMT_NET_PAID + COINS + COPAY + DEDUCT.
The sum of COINS + COPAY + DEDUCT.
The number of units of service/procedure.
First level ICD-9 as entered on the claim.
Second level ICD-9 as entered on the claim.
Third level ICD-9 as entered on the claim.
The Diagnosis Related Group (DRG) Code.
Type of DRG code used in claims calculation. 'MS' or 'CMS'.
Discharge Status Code. Valid for hospital stays only.
CPT/HCPCS code.
ICD-9-CM code. Inpatient claims only.
ICD-9-CM code. Inpatient claims only.
ICD-9-CM code. Inpatient claims only.
Identifies more detail about the specific procedure provided or service performed.
Identifies a specific accommodation, ancillary service or billing calculation for facility claims.
AMA Place of Service code.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Medical Claim Fields - Physician
Data Set #1
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
National Provider Identifier (encrypted)
HNPI
Character
X
National Provider Identifier (NPI) of the health care provider authorized to prescribe medications. NPI is
assigned by NPPES/CMS to a qualified health care provider. This number is encrypted to be consistent across
HCCI data contributors using a 32-byte algorithm developed by Humana.
National Provider Identifier (encrypted) backfill flag
HNPI_FILL_FLG
Character
X
National Provider Identifier (encrypted) of billing entity
HNPI_BE
Character
National Provider Identifier (encrypted) of billing entity
backfill flag
Provider Category
Major Physician Specialty
Primary Care Physician Flag
Provider Zip Code
HNPI_BE_FILL_FLG
Character
PROVCAT
MAJ_SPEC
PCP
PROV_ZIP_5_CD
Character
Varchar
Character
Character
X
X
Provider Zip Code backfill flag
PROV_ZIP5_FILL_FLG
Character
X
Provider CBSA Code
PROV_CBSA_CD
Character
Network Indicator
Primary Coverage Indicator
HCCI High Level Service Category
HCCI Detailed Service Category
Individual Market Flag
Medicare Advantage/Non Commercial Flag
Age over 65 Flag
NTWRK_IND
PRIMARY_COV_IND
HCCI_HL_CAT
HCCI_DET_CAT
INDV_FLAG
NONCOM_FLAG
OVER65_FLAG
Varchar
Varchar
Varchar
Varchar
Character
Character
Character
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
National Provider Identifier (NPI) of the health care billing entity delivering the service. NPI is assigned by
NPPES/CMS to a qualified health care provider. This number is a one-way hash encrypted value consistent
across HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
Provider category code that indicates the specialty of the health care professional.
Derived Major Physician Specialty, based on PROVCAT field.
Derived field for Primary Care Physician, based on PROVCAT field.
The number assigned by the US Postal Service to a geographic area for the purposes of efficient mail sorting
and delivery.
Derived flag indicating whether the PROV_ZIP_5 is a native value as received by payer ('0') or has been
backfilled by Optum ('1').
Core Based Statistical Area code, a geographic entity defined by the US Census Bureau. Only "Metro" codes,
representing populations of 50,000+, are included.
Indicates whether a claim was paid in or out of network.
Indicates whether a claim was paid primary, secondary, tertiary, etc.
Derived "High Level" service category.
Derived detailed service category.
Derived flag for purposes of data set filtering. Value of '1' indicates an Individual Market policy.
Derived flag for purposes of data set filtering. Value of '1' indicates a Medicare Advantage policy.
Derived flag for purposes of data set filtering. Value of '1' indicates member age of 65+.
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Description
Two Statistically De-identified Views DISCLAIMER: The contents of this document are for informative purposes only and could be subject to change. HCCI cannot warrant how fully populated a variable listed below may be, data is provided "as is".
are available for selection, Data Set Note: Two statistically de-identified data views are available for research, Data Set #1 and Data Set #2. To ensure the data remains de-identified, researchers may only request a single data set, Data Set #1 OR Data Set #2, for a
#1 and Data Set #2. Fields available research project.
under each view are denoted with an
'X'.
Pharmacy Claim Fields
Data Set #1
Data Set #2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Field Name
Field ID
Data Type
Derived
Description
Patient Identifier (encrypted)
E_PATID
Character
X
Pharmacy Claim ID (encrypted)
Claim Incurred Year
Claim Incurred Month
Claim Payment Year and Month
Prescription Fill Date
Claim Paid Date
Net Paid Amount
Copayment Amount
E_CLMID
YR
MNTH
YRMNTH_PD
FILL_DT
CHK_DT
AMT_NET_PAID
COPAY
Character
Character
Character
Character
Date
Date
Numeric
Numeric
X
X
X
X
Coinsurance Amount
COINS
Numeric
Deductible Amount
Calculated Allowed Amount
Total Member Cost-Share
Dispensing Fee
Quantity
National Provider Identifier of Prescriber (encrypted)
DEDUCT
CALC_ALLWD
TOT_MEM_CS
DISPFEE
QUANTITY
HNPI
Numeric
Numeric
Numeric
Numeric
Numeric
Character
National Provider Identifier of Prescriber (encrypted) backfill
flag
Dispense as Written Code
First Fill Flag
Number of Days Supplied
Prescription Refill Number
Prescription Record Flag
HNPI_FILL_FLG
Character
DAW
FST_FILL
DAYS_SUP
RFL_NBR
SCRIPTS
Character
Character
Numeric
Varchar
Numeric
Encrypted, unique identifier for all members in data set. PATID is unique over time and across HCCI data
contributors.
Encrypted Claim ID.
Year the prescription was filled by the pharmacy in format 'YYYY'.
Month the prescription was filled by the pharmacy in format 'MM'.
Year and month the prescription claim was paid in format 'YYYYMM'.
Date the prescription was filled by the pharmacy.
The date that appears on the check for claims payment.
The amount the pharmacy is reimbursed. Also referred to as the net amount.
The fixed amount the member pays for a specific service as defined in their benefit plan. For example, $10 for a
prescription fill.
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 a prescription.
The amount applied to the member's deductible.
The sum of the plan payment plus member cost-share. AMT_NET_PAID + COINS + COPAY + DEDUCT.
The sum of COINS + COPAY + DEDUCT.
Amount the pharmacy charged to fill the prescription.
Quantity of drug dispensed in metric units.
National Provider Identifier (NPI) of the health care provider authorized to prescribe medications. NPI is
assigned by NPPES/CMS to a qualified health care provider. This number is encrypted to be consistent across
HCCI data contributors using a 32-byte algorithm developed by Humana.
Derived flag indicating whether the HNPI is a native value as received by payer ('0') or has been backfilled by
Optum ('1').
Identifies if a prescription was filled as written or altered by Pharmacy, Physician or Member.
Indicates if this is the first time a prescription is being filled.
Estimated day count the drug supply should last.
Indicates if this is the first, second, or subsequent refill for the prescription.
A derived column that flags prescriptions according to the allowed dollars. Values of -1, 0, or 1, representing
negative, zero, or positive dollars, respectively. Used for counting Prescriptions (utilization count).
National Drug Code
NDC
Character
AHFS Major Therapeutic Class
MAJ_THRPTC_CL
Character
X
Generic Drug Flag
Specialty Pharmacy Flag
Mail Order Pharmacy Flag
HCCI High Level Service Category
HCCI Detailed Product Category
Individual Market Flag
Medicare Advantage/Non Commercial Flag
Age over 65 Flag
GNRC_IND
SPCLT_IND
MAIL_IND
HCCI_HL_CAT
HCCI_DET_CAT
INDV_FLAG
NONCOM_FLAG
OVER65_FLAG
Character
Character
Character
Varchar
Varchar
Character
Character
Character
X
X
X
X
X
X
X
X
X
X
X
X
The unique code that identifies a drug product as defined by the National Drug Data File (all drug products
regulated by the FDA must use an NDC).
American Hospital Formulary Service (AHFS) "first tier" classification consisting of 31 categories of drugs
sharing similar pharmacologic, therapeutic, and/or chemical characteristics, based on the NDC code.
Identifier of brand medication versus generic.
Indicates if the pharmacy is a specialty pharmacy.
Indicates if the pharmacy is a mail order pharmacy.
Derived "High Level" service category (always 'RX').
Derived detailed product category.
Derived flag for purposes of data set filtering. Value of '1' indicates an Individual Market policy.
Derived flag for purposes of data set filtering. Value of '1' indicates a Medicare Advantage policy.
Derived flag for purposes of data set filtering. Value of '1' indicates member age of 65+.