Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Item Field Size Position Comment Description
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
Age Group
Male90_94
Age Group
Male95_GT
Medicaid Female
Disabled
Medicaid Female
Aged
Medicaid Male
Disabled
Medicaid Male
Aged
Originally
Disabled Female
Originally
Disabled Male
Disease
Coefficients
HCC1
Disease
Coefficients
HCC2
Disease
Coefficients
HCC5
Disease
Coefficients
HCC7
Disease
Coefficients
HCC8
Disease
Coefficients
HCC9
Disease
Coefficients
HCC10
Disease
Coefficients
HCC15
Disease
Coefficients
HCC16
Disease
Coefficients
HCC17
Disease
Coefficients
1 74 Set to "1" if applicable,
otherwise "0"
1 75 Set to "1" if applicable,
otherwise "0"
1 76 Set to "1" if applicable,
otherwise "0"
1 77 Set to "1" if applicable,
otherwise "0"
1 78 Set to "1" if applicable,
otherwise "0"
1 79 Set to "1" if applicable,
otherwise "0"
1 80 Set to "1" if applicable,
otherwise "0"
1 81 Set to "1" if applicable,
otherwise "0"
1 82 Set to "1" if applicable,
otherwise "0"
1 83 Set to "1" if applicable,
otherwise "0"
1 84 Set to "1" if applicable,
otherwise "0"
1 85 Set to "1" if applicable,
otherwise "0"
1 86 Set to "1" if applicable,
otherwise "0"
1 87 Set to "1" if applicable,
otherwise "0"
1 88 Set to "1" if applicable,
otherwise "0"
1 89 Set to "1" if applicable,
otherwise "0"
1 90 Set to "1" if applicable,
otherwise "0"
1 91 Set to "1" if applicable,
otherwise "0"
1 92 Set to "1" if applicable,
otherwise "0"
The sex and age group for the
beneficiary based on a given as of
date: male between ages of 90
and 94, inclusive
The sex and age group for the
beneficiary based on a given as of
date: male, age 95 or greater
Beneficiary is a female disabled
and also entitled to Medicaid.
Beneficiary is a female aged (>
64) and also entitled to Medicaid.
Beneficiary is a male disabled and
also entitled to Medicaid.
Beneficiary is a male aged (> 64)
and also entitled to Medicaid.
Beneficiary is a female and
original Medicare entitlement was
due to disability.
Beneficiary is a male and original
Medicare entitlement was due to
disability.
HIV/AIDS
Septicemia/Shock
Opportunistic Infections
Metastatic Cancer and Acute
Leukemia
Lung, Upper Digestive Tract, and
Other Severe Cancers
Lymphatic, Head and Neck,
Brain, and Other Major Cancers
Breast, Prostate, Colorectal and
Other Cancers and Tumors
Diabetes with Renal or Peripheral
Circulatory Manifestation
Diabetes with Neurologic or
Other Specified Manifestation
Diabetes with Acute
Complications
Diabetes with Ophthalmologic or
Unspecified Manifestation
December 28, 2012 F-55 Part C Risk Adjustment Model Output
Data File