Payment Year
2008
2009
2010
2011
Birth Date (MM/DD/YYYY) or Age
Gender
Male
Female
Demogragphic Risk Factors
Institutional
Medicaid
Current Medicare Eligibility due to
Aged
Disabled
Original Medicare Eligibility due to Disablility
Yes
No
HCC
Description
Override
Score
DX1
DX2
DX3
DX4
DX5
DX6
DX7
DX8
DX9
DX10