AcademyHealth
Annual Research Meeting
Linking Data within the CMS Chronic
Condition Warehouse (CCW)
June 28, 2009
Linkage of CMS Administrative Data using
CCW Bene_ID
CCW Bene_ID - beneficiary unique identifier used to link
administrative CMS data across time and setting, including:
•
•
•
•
•
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Medicare Part A, B, C, D enrollment data
Medicare Part A, B claims data
Medicare Part D drug event data
MDS, OASIS, IRF-PAI, Swing Bed assessment data
Medicaid Analytic eXtract (MAX) data
CMS and CCW analytic summary files (e.g. MCBS, BASF, CC
Summary, CMS Denominator, etc.)
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Linkage of CMS Administrative Data using
CCW Bene_ID (cont.)
Process for assigning a CCW Bene_ID to administrative data:
•
Create a comprehensive Health Insurance Claim (HIC)
number history using the CMS Enrollment Database (EDB)
•
Assign CCW Bene_ID to Part A, B claims and Part D event
data
•
Use the Enterprise Cross Reference (ECR) database to cross
reference assessment and Medicaid beneficiary identifiers
with Medicare beneficiary identifiers
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Linkage of CMS Administrative Data using
CCW Bene_ID (cont.)
HIC and EDB Overview
HIC – Identifies beneficiaries but can change over time
•
For example, suppose a beneficiary is Medicare covered
under their spouses eligibility then the beneficiary might
have an unequated HIC like 123456789B
•
If their marital status changes, their unequated HIC might
change to 123456789D
•
Both these HICs equate to 123456789B
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Linkage of CMS Administrative Data using
CCW Bene_ID (cont.)
HIC and EDB Overview
EDB – 30+ Record Identification Code (RIC) files, each containing
specific beneficiary identification, demographic and
Medicare coverage information
•
RIC A contains most of the beneficiary identification and
demographic information, including the current unequated
HIC and the most recent equated XREF_HIC
•
RIC 7 contains up to 10 historical equated HICs for each
beneficiary
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Create HIC History
Initial EDB Load (Sept. 2005)
1. Assign sequential Bene_ID to each RIC A record. (May result
in multiple records with same EDB Identification Number
(EDBIN) and different Bene_IDs)
2. Create HIC History with the EDBIN and the assigned Bene_ID
for the current HIC and the XREF HIC in RIC A and the XREF
HICs in RIC 7. (Current_Sw and Kill_Cred_Sw retained)
3. Add the BIC equated HICs to HIC History as needed and set
Current_Sw to 'E' for these HICs
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Create HIC History (cont.)
Initial EDB Load (Sept. 2005)
Bene_IDs per
EDBIN
Frequency
Percent
1
46,714,187
2
172
3
2
100.00
0.00
0.00
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Create HIC History
Apply EDB Monthly Update Matching Logic
Match
EDBIN
Match HIC
&
DOB/SEX
Add New
EDBIN
Record
Add New
EDBIN
Record
No
Match
XREF HIC
& SSN or
DOB/SEX
No
Add New
Bene_ID
Yes
Match
HIC &
SSN
Add or
Update
HIC as
Needed
Update
EDBIN &
HIC
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Create HIC History (Step 1)
Apply EDB Monthly Update Matching Logic
Compare EDB EDBIN to all EDBINs in HIC History
• If EDBIN match found then compare HIC to HICs in HIC History
for specific EDBIN
If HIC match found then adjust HIC Current_Sw as needed
If HIC match not found then add new HIC History record and adjust
HIC Current_Sw (May result in multiple records with same
Bene_ID and EDBIN and different HICs)
• If EDBIN match not found then go to Step 2
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Create HIC History (Step 1 - cont.)
Apply EDB Monthly Update Matching Logic
HICs per
Bene_ID/EDBIN
Combination
Frequency
1
2
3
4
5
6
Percent
40,515,921
6,056,864
137,926
3,642
181
4
86.73
12.97
0.30
0.01
0.00
0.00
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Create HIC History (Step 2)
Apply EDB Monthly Update Matching Logic
Compare HIC and SSN to all HICs and SSNs in HIC History
• If HIC/SSN match found then add new HIC History record and
adjust Current_Sw (May result in multiple records with same
Bene_ID and HIC and different EDBINs)
• If HIC/SSN match not found then go to Step 3
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Create HIC History (Step 3)
Apply EDB Monthly Update Matching Logic
Compare HIC and DOB/Sex to all HICs and DOB/Sex
combinations in HIC History
• If HIC and DOB/Sex match found then add new HIC History
record and adjust Current_Sw as needed (May result in
multiple records with same Bene_ID and HIC and different
EDBINs)
• If HIC and DOB/Sex match not found then go to Step 4
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Create HIC History (Step 2 - cont.)
Apply EDB Monthly Update Matching Logic
EDBINs per
Bene_ID/HIC
Combination
Frequency
1
2
3
Percent
53,054,561
2,162
13
100.00
0.00
0.00
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Create HIC History (Step 4)
Apply EDB Monthly Update Matching Logic
Compare RICA_Xref_HIC to all HICs in HIC History
• If RICA_Xref_HIC match found then compare SSN to SSNs in
HIC History for specific RICA_Xref_HIC
If SSN match found then add new HIC History record for the new HIC
and EDBIN and adjust Current_Sw (May result in multiple records
with same Bene_ID and different EDBINs and HICs)
If SSN match not found then compare DOB/Sex to DOB/Sex in HIC
History for specific RICA_Xref_HIC
– If DOB/Sex match found then add new HIC History record for the new HIC and EDBIN and adjust
Current_Sw (May result in multiple records with same Bene_ID and different IEDBINs and HICs)
– If DOB/Sex match not found then go to Step 5
• If HIC match not found then go to Step 5
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Create HIC History (Step 4 - cont.)
Apply EDB Monthly Update Matching Logic
HIC/EDBIN
Combinations per
Bene_ID
Frequency
1
2
3
4
5
6
7
Percent
40,479,420
6,070,463
140,665
3,880
204
6
1
86.69
13.00
0.30
0.01
0.00
0.00
0.00
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Create HIC History (Step 5)
Apply EDB Monthly Update Matching Logic
• Add a new HIC History record with a new Bene_ID for the new
HIC and EDBIN
• Add Equated HICs to HIC History as needed and set
Current_Sw to 'E' for these HICs
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Assign CCW Bene_ID to Part A, B Claims
and Part D Events
Step 1 - Compare the unequated HIC from claim/event with HICs
in HIC History
• If unique unequated HIC match, then assign the Bene_ID from
HIC History
• If multiple unequated HIC matches, then compare
gender/DOB
If unique gender/DOB match, then assign the Bene_ID from HIC History
If multiple gender/DOB matches, then write to error research table
If no gender/DOB match, then go to Step 2
• If no unequated HIC match, then go to Step 2
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Assign CCW Bene_ID to Part A, B Claims
and Part D Events (cont.)
Step 2 - Compare the equated HIC and gender/DOB from
claim/event with HICs in HIC History
• If unique match, then assign the Bene_ID from HIC History
• Else write to error research table
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Assign CCW Bene_ID to Part A, B Claims
and Part D Events (cont.)
HICs per Bene_ID
Combination
Frequency
1
2
3
4
5
6
Percent
40,480,571
6,070,161
139,981
3,734
188
4
86.69
13.00
0.30
0.01
0.00
0.00
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Assign CCW Bene_ID to Assessment Data
Create Asmt Cross Reference History Table
Step 1 - Link the Assessment Resident Link Key (ARLK) table with
the ECR table by Asmt_Link_Key
This step adds the EDBIN and the Entrpris_Cnfdnc_Cd to the ARLK table
Step 2 - Compare the EDBIN in the ARLK table to the EDBINs in
HIC History
If unique EDBIN match found then go to Step 3
Else if multiple EDBIN matches found but there is a unique match with
the maximum Entrpris_Cnfdnc_Cd value then go to Step 3
Else write to error research table
Step 3 - Compare Entrpris_Cnfdnc_Cd value to threshold
If greater or equal then write to Asmt Cross Reference History table
Else write to error research table
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Assign CCW Bene_ID to Assessment Data
(cont.)
• 99.98% of 13,353,158 ALNs link to only one EDBIN
• Bene_IDs assigned to Medicaid State ID
– 93.54% of 12,976,886 Bene_IDs link to one Medicaid State ID
– 6.03 % of 12,976,886 Bene_IDs link to two Medicaid State ID
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Summary
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MAX linkage methodology in development
In these linkage algorithms some sensitivity is sacrificed to
obtain more specificity
Assigning a Bene_ID to Medicare administrative data allows
researchers to identify beneficiaries longitudinally across
the continuum of care
CCW can accept finder files with various beneficiary
identifiers and cross-reference the finder file identifier to a
CCW Bene_ID for data extraction
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Questions?
Visit our web site for additional information!
Buccaneer Computer Systems and Service, Inc.
www.ccwdata.org
Email: CMSdata@bcssi.com
Phone: 1-866-766-1915
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