CRISP issued an RFI for the EQIP Program to understand Practice Transformation Consultation Services. Learn more here!
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The CCLF (Claim and Claim Line Feed) data files are a set of Medicare claims files incorporating all Medicare Part A and B claims from Inpatient Facility, Outpatient Facility, Skilled Nursing Facility, Home Health Agency, Hospice, Professional, Durable Medical Equipment, and Prescription Drug services. These files contain beneficiary claim level data including Medicare payment amounts, diagnoses, procedures, dates of service, provider identifiers, and beneficiary copayment amounts. Provider cost information is not included in the data. Drugs paid for under Part A or Part B (such as drugs administered in the hospital) are included in MADE. Part D drugs are only available for the Population Navigator and Pharmacy Analytics module.
The CCLF also includes information regarding beneficiary’s Medicare eligibility, such as the reason for Medicare eligibility (aged, disabled, ESRD), entitlement status, and months of eligibility for all Medicare beneficiaries enrolled during the year of the data set. These data sets contain a unique identifier for each beneficiary, allowing the linkage of beneficiary claims across the various claims files.
The CCLF data files only contain Medicare fee-for-service (FFS) claims (Part A and Part B) and does not contain any claims for beneficiaries enrolled in Medicare Advantage (Part C) or non-Medicare (private) insurance plans.
MADE, the MDPCP reports, the MPA reports, the MDPCP Performance Reports, and the Care Transformation Program reports are powered by the latest 36 months of data for 100% of the Maryland Medicare fee for service beneficiaries, and the CCLF are updated monthly. The CCLF includes any beneficiary with a Part A or Part B claim from a Maryland provider, regardless of the beneficiary’s residency at the time of the claim. Additionally, recent enhancements now result in the Beneficiary Denominator file containing all beneficiaries who have lived in Maryland for at least one month and have at least one month without HMO during the 36-month period. This allows CCLF to represent the universe of Medicare fee for service beneficiaries, regardless of health care usage.
Use of this data is governed by a Data Use Agreement (DUA) from the Centers for Medicare & Medicaid Services (CMS) between CMS and CRISP. Using the beneficiary’s unique identifier, all health care information is tracked across the available data. This allows for the analysis of episodes of care at the beneficiary level as well as analysis across the entire population.