Provider Specific File

The Provider Specific File is developed by the Medicare intermediaries for use in the hospital prospective payment system (PPS) pricing mechanism. A reimbursement price is computed for an individual inpatient hospital stay depending on the Diagnosis Related Group (DRG) the stay is classified in. The Provider Specific File is used in the central office to support DRG recalibration; its completeness is measured by comparison to the Provider of Service File and the MEDPAR file. Each fiscal intermediary (FI) submits the file quarterly to central office via magnetic tape by duplicating the history of provider specific data elements from its PRICER software. In addition to completion checks, HCFA edits the record for its conformity to provider number ranges, data parameters, code range checks, and minimum/maximum dollar amounts. FIs are alerted if submissions are incomplete or in error and are required to resubmit a corrected version of the file.

 

Source: HCFA

Size: 1 MB / year

Years: 1987 - 1990, 1993 (annually, by fiscal year beginning and ending in December)

Media: Original: 9-track tape

Format: EBCDIC Fixed Length

RecordLength: 1987 - 1989 = 80; 1990 = 160

Structure: 1 record per PPS Hospital

Complexity: Moderate; an operating system utility is available for converting EBCDIC records of fixed length to ASCII.