Outpatient Provider Specific File (OPSF) Metadata Dictionary

The identification code of the medicare carrier for the provider.

00001-89999, or the rural area, (blank) (blank) (blank) 2 digit numeric State code such as _ _ _3 6 for Ohio, where the facility is physically located.

Enter the appropriate code for the CBSA, 0000189999, or the rural area, (blank)(blank)(blank) (2 digit numeric State code) such as _ _ _ 3 6 for Ohio, to which a hospital has been reclassified due to its prevailing wage rates. Leave blank or enter the Actual Geographic Location CBSA, if not reclassified. Pricer will automatically default to the actual location CBSA if this field is left blank. Does not apply to ESRD Facilities.

Enter “Y” if the hospital’s wage index location has been reclassified for the year. Enter “N” if it has not been reclassified for the year. Adjust annually. Does not apply to ESRD Facilities.

This is the Cost of Living Adjustment (previously called Payment-to-Cost Ratio).

The County Code. Must be 5 numbers.

Derived from the latest available cost report data. Does not apply to ESRD Facilities.

Must be numeric, CCYYMMDD. This is the effective date of the provider's first OPPS period. For subsequent OPPS periods, the effective date is the date of a change to the PROV file. If a termination date is present for this record, the effective date must be equal to or less than the termination date.

Children’s Hospitals for End Stage Renal Disease (ESRD) Facilities: Enter the code applicable to the ESRD Quality Incentive Program (QIP): Blank = no reduction; 1 = ½ percent payment reduction; 2 = 1 percent payment reduction; 3 = 1 ½ percent payment reduction; 4 = 2 percent payment reduction

Must be numeric, CCYYMMDD. Date file created/run date of the PROV report for submittal to CMS CO.

Must be numeric, CCYYMMDD. Month: 01-12 Day: 01-31 The date must be greater than 19990630.

Hospital: Enter the code to indicate whether the hospital meets data submission criteria per HOP QDRP requirements. 1 = Hospital quality reporting standards have been met or hospital is not required to submit quality data (e.g., hospitals that are specifically excluded rom the IPPS or which are not paid under the OPPS, including psychiatric, rehabilitation, long-term care and children’s and cancer hospitals, Maryland hospitals, Indian Health Service hospitals, or hospital units; or hospitals that are located in Puerto Rico or the U.S. territories). The reduction does not apply to hospices, CORFs, HHAs, CMHCs, critical access hospitals or to any other provider type that is not a hospital. Blank = Hospital does not meet criteria. Independent and Hospital-based End Stage Renal Disease (ESRD)Facilities: Enter the code applicable to the ESRD Quality Incentive Program (QIP): Blank = no reduction; 1 = ½ percent payment reduction; 2 = 1 percent payment reduction; 3 = 1 ½ percent payment reduction; 4 = 2 percent payment reduction

The intermediary number of the Medicare Administrative Contractor (MAC).

A date formatted as YYYY-MM-DD, specifying the date that the provider record was last updated.

The locality identification code for the area (or county) where the provider is located.

Enter the MPA percentage calculated and published by the Centers for Medicare & Medicaid Services (CMS).

Enter the appropriate code for MSA, 0040–9965, or the rural area, (blank) (blank) 2-digit numeric State code, such as _ _ 3 6 for Ohio, where the facility is physically located.

The appropriate code for the MSA, 0040-9965, or the rural area, (blank)(blank) (2 digit numeric State code) such as _ _ 3 6 for Ohio, to which a hospital has been reclassified for wage index. Leave blank or enter the actual location MSA if not reclassified. Does not apply to ESRD Facilities.

Alpha-numeric 10 character provider number.

Derived from the latest available cost report data. Does not apply to ESRD Facilities.

Enter the appropriate code for the CBSA, 0000189999, or the rural area, (blank)(blank)(blank) (2 digit numeric State code) such as _ _ _ 3 6 for Ohio, to which a hospital has been reclassified due to its prevailing wage rates. Leave blank or enter the Actual Geographic Location CBSA, if not reclassified. Pricer will automatically default to the actual location CBSA if this field is left blank. Does not apply to ESRD Facilities.

Derived from payment model Technical Direction Letter.

Alpha-numeric 6-13 character provider number. Also known as the Oscar number previously.

This identifies the provider type, such as short term facility, long-term, psychiatric, rehabilitation facility, and so on.

Indicates the type of special locality provision that applies. For End Stage Renal Disease (ESRD) facilities value “Y” equals low volume adjustment applicable.

The following codes indicate the type of special payment provision that applies. Blank = not applicable; Y = reclassified; 1 = special wage index indicator; 2 = both special wage index indicator and reclassified; D = Dual Reclassified

Enter the special wage index that certain providers may be assigned. Enter zeroes unless the Special Payment Indicator equals a “1” or “2.”

Enter the 2-digit state where the provider is located. Enter only the first (lowest) code for a given state. For example, effective October 1, 2005, Florida has the following State Codes: 10, 68 and 69. Contractors shall enter a “10” for Florida’s State Code. List of valid State Codes is located in Pub. 10007, Chapter 2, Section 2779A1.

Enter the supplemental wage index that certain providers may be assigned. Enter zeroes if it does not apply.

Enter the supplemental wage index flag: 1=Prior Year Wage Index 2=Future use 3=Future use Enter blank if it does not apply.

Must be numeric, CCYYMMDD. Must be zeroes or contain a termination date. (Once the official “tie-out” notice from CMS is received). Must be equal to or greater than the effective date. (Termination date is the date on which the reporting contractor ceased servicing he provider in question).

Enter the code to indicate whether TOPs applies or not. Y = qualifies for TOPs; N = does not qualify for TOPs

Enter a “Y” or “N.” Y = waived (provider is not under OPPS) For End Stage Renal Disease (ESRD) facilities provider waived blended payment, pay full PPS. N = not waived (provider is under OPPS) For ESRD facilities provider did not waive blended payment. Pay according to transitional payment method for ESRD PPS through 2013.