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NEDS Description of Data Elements

 
PAY1 - Expected primary payer, uniform
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

PAY1 indicates the expected primary payer (Medicare, Medicaid, private insurance, etc.). To ensure uniformity of coding across data sources, PAY1 combines detailed categories in the more general groups. For example,

  • Medicare includes both fee-for-service and managed care Medicare patients.
  • Medicaid includes both fee-for-service and managed care Medicaid patients.
  • Private insurance (PAY1 = 3) includes Blue Cross, commercial carriers, and private HMOs and PPOs.
  • Other (PAY1 = 6) includes Worker's Compensation, CHAMPUS, CHAMPVA, Title V, and other government programs.

The HCUP data element PAY1_X retains the expected primary payer as provided by the data source. The State Specific Notes for PAY1 include information on how the source values contained in the PAY1_X are recoded into the HCUP uniform values of PAY1.

When there is a generic category for managed care such as "HMO/PPO" reported under PAY1_X, it is mapped to private insurance (PAY1 = 3) in the HCUP databases. However, it is possible that hospitals may inadvertently include patients covered by a Medicare managed care program administered by a private insurance company under a generic managed care category.

In the 1988-1997 data, the data element PAY1_N provides more detailed categories for private insurance and other payers. This data element is discontinued beginning in the 1998 data because of the difficulty of coding the information uniformly across States.

If information on secondary or tertiary payers is provided by the data source, the coding of the associated HCUP variables (PAY2, PAY2_X, PAY3, and PAY3_X) is included under the State Specific Notes for PAY1.

 
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Uniform Values
VariableDescriptionValueValue Description
PAY1Expected primary payer, uniform1Medicare
2Medicaid
3Private insurance
4Self-pay
5No charge
6Other
.Missing
.AInvalid
.BUnavailable from source (coded in 1988-1997 data only)
 
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State Specific Notes

Arizona (SID and SEDD)
Arizona
(Valid beginning 2003 SID, Valid beginning 2005 SEDD)
PAY1_X PAY1
Value Description Value Description
05, 5 Medicare 1 Medicare
11 Medicare Risk
06 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group/ Medicaid 2 Medicaid
08 Children's Rehab Services (valid beginning 2013)
01 Commercial (Indemnity) 3 Private Insurance
02 HMO
03, 3 PPO
04 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group (for the self employed, small businesses (under 50 employees), and the uninsured employees of political subdivisions) Discontinued/Reserved beginning 2014
00 Self pay 4 Self pay
12 Charity 5 No charge
07 TRICARE 6 Other
08 Children's Rehab Services (Valid through 2012)
09 Worker's Compensation
10 Indian Health Services
13 Foreign National
14 Other
15 Tobacco Tax (beginning in 1998)(discontinued 2007)
    . Missing
Blank Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid July 2002 through December 2002 SID)
PAY1_X PAY1
Value Description Value Description
F Medicare 1 Medicare
L Medicare Risk
G AHCCCS/Medicaid 2 Medicaid
B Commercial (Indemnity) 3 Private Insurance
C HMO
D PPO
E Arizona Health Care Cost Containment System (AHCCCS) Health Care Group (for the self employed, small businesses (under 50 employees), and the uninsured employees of political subdivisions)
A Self pay 4 Self pay
M Charity 5 No charge
H CHAMPUS/MEDEXCEL 6 Other
I Children's Rehab Services
J Worker's Compensation
K Indian Health Services
N Foreign National
O Other
?, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid 1995 to June 2002 SID)
PAY1_X PAY1
Value Description Value Description
05, 5 Medicare 1 Medicare
11 Medicare Risk
04 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group 2 Medicaid
06 AHCCCS/Medicaid
01 Commercial (Indemnity) 3 Private Insurance
02 HMO
03, 3 PPO
00 Self pay 4 Self pay
12 Charity 5 No charge
07 CHAMPUS/MEDEXCEL 6 Other
08 Children's Rehab Services
09 Worker's Compensation
10 Indian Health Services
13 Foreign National
14 Other
15 Tobacco Tax (Beginning in 1998)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid from 1989-1994 SID)
PAY1_X PAY1
Value Description Value Description
3 Medicare 1 Medicare
4 AHCCCS/Medicaid 2 Medicaid
1 Commercial 3 Private Insurance
2 HMO/PHP/Blue Cross
--   4 Self-pay
--   5 No charge
5 Other (self-pay, unknown, charity, etc.) 6 Other
Blank   . Missing
Other Values   .A Invalid


California (SEDD)
California
PAY1_X PAY1
Value Description Value Description
16 Health Maintenance Organization (HMO) Medicare Risk - Includes Medicare Patients covered under an HMO arrangement only. 1 Medicare
MA Medicare Part A - Defined by Title XVIII of the Social Security Act. Covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care.
MB Medicare Part B - Defined by Title XVIII of the Social Security Act. Covers some outpatient hospital care and some home health services.
MC Medi-Cal or Medi-Cal Managed Care Plan - Defined by Titile XIX of the Social Security Act and Title I of the Federal Medicare Act (PL 89-97). Includes all Medi-Cal including Fee for Service, PPO, POS, EPO, and HMO. 2 Medicaid
12 Preferred Provider Organization (PPO) - Includes Blue Cross/Blue Shield or commercial insurance companies under a PPO arrangement. Does not include Medi-Cal patients under a PPO arrangement. 3 Private insurance*
13 Point of Service (POS) - Includes Blue Cross/Blue Shield or commercial insurance companies under a POS arrangement
14 Exclusive Provider Organization (EPO) - Includes Blue Cross/Blue Shield or commercial insurance companies under an EPO arrangement
BL Blue Cross/Blue Shield - Includes only BC/BS Fee for Service payments
CI Commercial Insurance Company - Includes payments from insurance carriers on a Fee for Services basis; Excludes PPO, POS, and EPO payments
AM Automobile Medical - Includes PPO, POS, EPO, HMO and Fee for Service or any other payment resulting from automobile coverage
HM Health Maintenance Organization - HMO payment payers. Does not include Medicare HMO or Medi-Cal HMO
09 Self Pay - Payment directly by the patient, personal guarantor, relatives, or friends. The greatest share of patient's bill is not expected to be paid by any form of insurance or other health plan 4 Self-pay
-- -- 5 No charge
11 Other Non-federal programs - Include any form of payment from local, county, or state government agencies 6 Other
CH CHAMPUS (TRICARE) - Includes any PPO, POS, EPO, HMO, Fee for Service, or other payment from the Civilian Heath and Medical Program of the Uniformed Services or from TRICARE
DS Disability - Payments resulting from disability coverage
OF Other Federal Program - Federal programs not covered by any other category
TV Title V - Defined by the Federal Medicare Act (PL 89-97) for Maternal and Child Health. Title V of the Social Security Act is administered by the Health Resources and Services Administration, Public Health Service, Department of Health and Human Services. Includes California Children Services and Maternal and Child Health program payments not covered under Medi-Cal
VA Veterans Affairs Plan - Includes any PPO, POS, EPO, HMO, Fee for Service or other payment resulting from Veterans Administration coverage
WC Workers' Compensation Health Claim - Includes payments from Workers' Compensation Health Claim insurance
00 Other
99, "-" Missing . Missing
(blank) blank
(other)   .A Invalid
* HMOs are regulated in California under the Knox Keene Health Care Service Plan Act of 1975.


California (SID)
California
(Valid beginning in 1999)
PAY1_X PAY1
Value Description Value Description
010, 01- Medicare 1 Medicare
011 Medicare (HMO)
012 Medicare (Managed care - Other)
013 Medicare (fee for service)
020, 02- Medi-Cal 2 Medi-Cal
021 Medi-Cal (HMO)
022 Medi-Cal (Managed care - Other)
023 Medi-Cal (fee for service)
030, 03- Private Coverage 3 Private insurance
031 Private Coverage (HMO)
032 Private Coverage (Managed care - Other)
033 Private Coverage (fee for service)
08n, where n=0-3 or "-" Self-pay 4 Self-pay
07n, where n=0-3 or "-" Other Indigent (includes charity care) (Valid beginning in 2017) 5 No charge
04n, where n=0-3 or "-" Worker's Compensation 6 Other
05n, where n=0-3 or "-" County Indigent Programs
06n, where n=0-3 or "-" Other Government
07n, where n=0-3 or "-" Other Indigent (includes charity care) (Valid 1999-2016)
09n, where n=0-3 or "-" Other
0, -0, 000 Not Reported . Missing
(blank), "-", "-", or "-" blank, missing
(other)   .A Invalid

The first two digits of PAY1_X describes the payer category (e.g., Medicare (01), Medi-Cal (02), Private coverage (03), Workers' Compensation (04), County Indigent Programs (05), Other Government (06), Other Indigent (07), Self Pay (08), and Other Payer (09)).

The third digit of PAY1_X describes the type of coverage (e.g., Knox-Keene (HMO)* or Medi-Cal County Organized Health Systems (MCOHS) plan (1), Managed Care Other (PPO, IPO, POS, etc.) (2), traditional coverage (fee for service) (3), and type of coverage not considered applicable to the payer category (0).

* HMOs are regulated in California under the Knox-Keene Health Care Service Plan Act of 1975.




California
(Valid from 1995-1998)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Even if HMO or PPO) 1 Medicare
02 Medi-Cal (even if HMO or PPO) 2 Medicaid
07 HMO 3 Private insurance
08 PPO
09 Private Insurance Company (not HMO, not PPO)
10 Blue Cross/Blue Shield (not HMO, not PPO)
11 Self-pay 4 Self-pay
12 Charity 5 No charge
13 No Charge
03 Worker's Compensation 6 Other
04 County Indigent Programs
05 CHAMPUS/CHAMPVA/VA
06 Other Governmental
14 Other Non-Governmental
00, Blank Missing . Missing
Any values not documented by the data source .A Invalid



California
(Valid from 1988-1994)
PAY1_X PAY1
Value Description Value Description
01 Medicare 1 Medicare
02 Medi-Cal 2 Medicaid
06 Blue Cross/Blue Shield 3 Private insurance
07 Insurance Company
08 HMO/PHP
09 Self-pay 4 Self-pay
10 No-charge (free charity, special research, or teaching) 5 No charge
04 Title V 6 Other
03 Workers' Compensation
05, 12 Other government; Medically indigent services under Section 17000
11 Other non-government
Blank Valid before 1994 . Missing
00 Valid in 1994 . Missing
Other Values   .A Invalid


Connecticut (SID and SEDD)
Connecticut
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
C Medicare 1 Medicare
M Medicare managed care
D Medicaid 2 Medicaid
J Medicaid managed care (beginning in 1998)
F Commercial Insurance 3 Private insurance
G Blue Cross (Blue Cross PPOs are coded as PPOs, value "T")
S HMO
T PPO
A Self-pay 4 Self-pay
R No charge 5 No charge
B Worker's Comp 6 Other
E Other Federal Program
H Champus
I Other
Q Title V
U Charter Oak (Beginning in 2009)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Connecticut
(Valid from 1993-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
C, M (1997 only) Medicare 1 Medicare
D Medicaid 2 Medicaid
G Blue Cross 3 Private Insurance
F, T Commercial Insurance: PPO
S HMO
A Self-pay 4 Self-pay
R No charge 5 No charge
Q Title V 6 Other
B Workers' Compensation
H CHAMPUS
E Other federal programs
I Other
Blank   . Missing
Other Values   .A Invalid


Florida (SID)
Florida
(Valid beginning in 2010)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
B Medicare Managed Care
C Medicaid 2 Medicaid
D Medicaid Managed Care
O KidCare (Valid beginning 2017)
E Commercial Health Insurance 3 Private Insurance
Q Commercial Liability Coverage
L Self pay 4 Self-pay
N Non-payment 5 No charge
H Worker's Compensation 6 Other
I TriCare or Other Federal Government
J VA
K Other State/Local Government
M Other
O KidCare (Valid prior to 2017)
Blank Missing . Missing
Other Any undocumented value .A Invalid


Florida (SEDD)
Florida
(Valid beginning in 2010)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
B Medicare Managed Care
C Medicaid 2 Medicaid
D Medicaid Managed Care
O KidCare (Valid beginning 2017)
E Commercial Health Insurance 3 Private Insurance
Q Commercial Liability Coverage
L Self pay 4 Self-pay
N Non-payment 5 No charge
H Worker's Compensation 6 Other
I TriCare or Other Federal Government
J VA
K Other State/Local Government
M Other
O KidCare (Valid prior to 2017)
P Unknown . Missing
. Missing
Other Any undocumented value .A Invalid


Florida (SID and SEDD)
Florida
(Valid 1998-2009 SID and SASD, Valid 2005-2009 SEDD)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
B Medicare HMO or Medicare PPO
C Medicaid 2 Medicaid
D Medicaid HMO
E Commercial Insurance 3 Private Insurance
F Commercial HMO
G Commercial PPO
L Self pay/Under-insured (No third party coverage or less than 30% estimated insurance coverage) 4 Self-pay
N Charity 5 No charge
H Worker's Compensation 6 Other
I Champus
J VA
K Other State/Local Government
M Other
O KidCare (Healthy Kids, MediKids, and Children's Medical Services - beginning 2003)
P (SEDD and SASD only) Unknown. Reported only if information is not available, and type of service is "2" and patient status is "7" . Missing
Blank Missing
Any values not documented by the data source .A Invalid



Florida
(Valid for 1997 SID and SASD)
PAY1_X PAY1
Value Description Value Description
A, B Medicare, Medicare HMO 1 Medicare
C, D Medicaid, Medicaid HMO 2 Medicaid
E, G Commercial insurance (includes self-insured and Blue Cross/Blue Shield); Commercial PPO 3 Private Insurance
F Commercial HMO
L Self-pay, charity, underinsured 4 Self-pay
N Charity 5 No charge
H Workers' Compensation 6 Other
I, J CHAMPUS; VA
K Other state/local government
M Other
Blank   . Missing
Other values   .A Missing



Florida
(Valid from 1992-1996 SID)
PAY1_X PAY1
Value Description Value Description
A, B Medicare, Medicare HMO 1 Medicare
C, D Medicaid, Medicaid HMO 2 Medicaid
E, G Commercial insurance (includes self-insured and Blue Cross/Blue Shield); Commercial PPO 3 Private Insurance
F Commercial HMO
L Self-pay, charity, underinsured 4 Self-pay
--   5 No charge
H Workers' Compensation 6 Other
I, J CHAMPUS; VA
K Other state/local government
M Other
Blank   . Missing
Other values   .A Invalid



Florida
(Valid from 1988-1991 SID)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
C Medicaid 2 Medicaid
E Commercial insurance (includes self-insured and Blue Cross/Blue Shield) 3 Private Insurance
--   4 Self-pay
--   5 No charge
M Other 6 Other
Blank   . Missing
Other values   .A Invalid


Georgia (SID and SEDD)
Georgia
(Valid beginning 1998 SID, Valid beginning 2002 SASD and SEDD)
PAY1_X, PAY2_X, PAY3_X PAY1, PAY2, PAY3
Value Description Value Description
1 Medicare 1 Medicare
11 Medicare (Managed Care)
111 Medicare HMO
1111 Aetna Inc.
1112 Coventry Health Care, Inc.
1113 Humana Inc.
1114 Kaiser Foundation Health Plan, Inc.
1115 United HealthCare of Georgia, Inc.
1116 Wellcare of Georgia
1117 WellPoint, Inc.
1118 Other Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care (Other)
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
124 Medicare Drug Benefit (Part D)
129 Medicare Non-managed Care (Other)
19 Medicare (Other)
2 Medicaid 2 Medicaid
21 Medicaid (Managed Care)
211 Medicaid HMO
2111 Amerigroup CMO
2112 PeachState CMO
2113 WellCare CMO
2114 Medicaid Caresource HMO (Starting in 2017)
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Management)
219 Medicaid Managed Care (Other)
22 Medicaid (Non-managed Care Plan)
23 Medicaid/SCHIP
24 Medicaid Applicant
25 Medicaid (Out of State)
29 Medicaid (Other)
361 State SCHIP Program (Starting in 2017)
5 Private Health Insurance (other than Blue Cross/Blue Shield) 3 Private Insurance
51 Managed Care (Private)
511 Commercial Managed Care (HMO)
512 Commercial Managed Care (PPO)
513 Commercial Managed Care (POS)
514 Exclusive Provider Organization
519 Managed Care, Other (non-HMO)
52 Private Health Insurance (Indemnity)
521 Indemnity (e.g. high option/low option)
522 ERISA ASO Plan
523 Commercial Indemnity
524 Self-insured (ERISA) ASO Plan
525 Medicare Supplemental Policy (as secondary payor)
53 Commercial (Indemnity or Managed Care, unspecified)
54 Organized Delivery System
55 Small Employer Purchasing Group
59 Other Private Insurance, not BC or Kaiser
6 Blue Cross/Blue Shield
61 BC Managed Care
611 BC Managed Care (HMO)
612 BC Managed Care (PPO)
613 BC Managed Care (POS)
619 BC Managed Care (Other)
62 BC Indemnity
63 BC Indemnity or Managed Care (Out of State)
64 BC Indemnity or Managed Care (Unspecified)
69 BC Indemnity or Managed Care (Other)
7 Managed Care (Unspecified)
71 HMO
72 PPO
73 POS
79 Other Managed Care (Unknown if public or private)
96 Auto Insurance (no fault) (Starting in 2017)
8 NOPAYMENT from an Organization/Agency/Program/Private Payor Listed 4 Self-pay
81 Self-pay
82 No Charge (Prior to 2009)
821 Charity (prior to 2013)
822 Professional Courtesy (prior to 2013)
823 Research/Clinical Trial (prior to 2013)
83 Refusal to Pay/Bad Debt (prior to 2013)
84 Hill Burton Free Care (Prior to 2012)
85 Research/Donor (prior to 2013 SID)
89 No Payment (Other - Prior to 2009)
82 No Charge (Begin 2009) 5 No charge
821 Charity (Begin 2013)
822 Professional Courtesy (begin 2013 SID)
823 Research/Clinical Trial (begin 2013 SID)
83 Refusal to Pay/Bad Debt (begin 2013 SID)
84 Hill Burton Free Care (begin 2012)
85 Research/Donor (begin 2013 SID)
89 No Payment (Other - begin 2009)
3 Other Government (Federal/State/Government) 6 Other
31 Department of Defense
311 CHAMPUS
3111 Indemnity
3112 TriCare
312 CHAMPVA
319 Department of Defense (not CHAMPUS)
32 VA
321 VA (Priority Veteran)
322 VA (Enrolled Veteran with Copay)
329 VA (Other)
33 Indian Health Service or Tribe
331 Indian Health Service (Regular)
332 Indian Health Service (Contract)
333 Indian Health Service (Managed Care)
334 Indian Tribe (Sponsored Coverage)
34 HRSA Program
341 Title V (MCH Block Grant)
342 Migrant Health Program
343 Ryan White Act
349 Other
35 Black Lung
36 State Government
361 State SCHIP Program (Prior to 2017)
362 Specific State Programs
369 State, not otherwise specified (other state)
37 Local Government
371 Local (Managed Care)
3711 Local government HMO
3712 Local government POS
3713 Local government PPO
372 FFS/Indemnity
379 Local, not otherwise specified (other local, county)
38 Other Government (Federal, State, Local not specified)
381 Federal, State, Local not specified (FFS)
382 Federal, State, Local not specified (HMO)
383 Federal, State, Local not specified (PPO)
384 Federal, State, Local not specified (POS)
389 Federal, State, Local not specified (Other)
39 Other Federal
4 Department of Corrections
41 Corrections Federal
42 Corrections State
43 Corrections Local
44 Corrections (Unknown Level)
9 Miscellaneous/Other
91 Foreign National
92 Other (Non-government)
93 Disability Insurance
94 Long-term Care Insurance
95 Worker's Compensation
951 Worker's Comp (Fee-for-Service)
952 Worker's Comp (HMO)
953 Worker's Comp (Other Managed Care)
96 Auto Insurance (no fault) (prior to 2017)
97 Other (not specified)
98 Other specified (includes Hospice - Unspecified plan)
99 Other Unspecified
blank Not reported . Missing
- Invalid Code Scheme
ZZZ Missing Data
Any values not documented by the data source .A Invalid


Georgia (SID)
Georgia
(Valid for 1997 SID)
PAY1_X PAY1
Value Description Value Description
M Medicare 1 Medicare
D Medicaid 2 Medicaid
B Blue Cross and Blue Shield 3 Private Insurance
I, S Other Insurance Companies; Self Insured
H HMO-PPO
P Self-pay 4 Self-pay
Z Free 5 No charge
W Workers' Comp 6 Other
C CHAMPUS
E, N Other Government
L, O Other
3, 5, A, F, G, J, K, Y Unknown . Missing
Other values   .A Invalid


Hawaii (SID and SEDD)

In 2008, source value 24 (QUEST (Any QUEST Plan except AlohaCare, HMSA Quest, Kaiser Quest)) was mapped to Private Insurance instead of Medicaid; not too many records were affected, but they have now been fixed starting in 2009.

Hawaii
(Valid beginning in 2003 SID, Valid beginning 2007 SASD, Valid beginning 2003 SEDD)
PAY1_X PAY1
Value Description Value Description
01 Medicare 1 Medicare
18 HMSA 65C+
19 Kaiser Senior Advantage/Kaiser 65C+ - beginning 2003
25 Secure Horizons Medicare Advantage - beginning 2008
26 AlohaCare Advantage/Advantage Plus - beginning 2008
28 HMSA Akamai Advantage
31 Other Medicare Advantage Plan
32 AARP Medicare Complete
33 Humana (Choice/GoldChoice/GoldPlus) Medicare Advantage Plans
34 United Healthcare Dual Complete Advantage Special Needs Plans (SNPs)
02 Medicaid 2 Medicaid
13 Hawaii QUEST (managed care) Beginning in 2006, the general QUEST category was discontinued and split into plan-specific categories
15 AlohaCare (plan participating in QUEST) beginning in 2003
22 HMSA QUEST - beginning 2006
23 Kaiser QUEST - beginning 2006
24 QUEST (Any QUEST Plan except AlohaCare, HMSA Quest, Kaiser Quest) - beginning 2006
29 Ohana Health Plan QUEST
30 United Healthcare Community Plan QUEST
14 HMSA's Health Plan Hawaii beginning in 2003 3 Private Insurance
16 Hawaii Management Alliance Association (HMAA) beginning in 2003
17 University Health Alliance (UHA) beginning in 2003
27 Summerlin Insurance
04 HMSA (any other HMSA plan)
05 Kaiser
06 Other Insurance
08 No Fault
07 Self pay/Charity Care 4 Self pay
--   5 No charge
09 Worker's Compensation 6 Other
10 Tricare/CHAMPUS/VA/Other Government - Discontinued in 2006
12 Department of Defense
20 Veterans Administration (VA) - Beginning 2006
21 Tricare/CHAMPUS/Other Government - Beginning 2006
11, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid


Hawaii (SID)
Hawaii
(Valid 1998-2002)
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
13 QUEST
4 HMSA (Blue Cross/Blue Shield affiliate that provides HMO, PPO and Fee for Service plans) 3 Private Insurance
5 Kaiser
6 Other Insurance
8 No Fault
7 Self pay 4 Self pay
--   5 No charge
9 Worker's Compensation 6 Other
10 CHAMPUS/VA/Other Government
12 Department of Defense
11, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Hawaii
(Valid from 1996-1997)
PAY1_X PAY1
Value Description Value Description
"Medicare" Medicare 1 Medicare
"Medicaid", "SHIP", "Quest" Medicaid; SHIP; Quest 2 Medicaid
"Other Insurance", "HMSA", "No Fault" Other Insurance, HMSA, No Fault 3 Private Insurance
"Kaiser" Kaiser
"Self Pay" Self-pay 4 Self-pay
--   5 No charge
"Workers Comp" Worker's Comp 6 Other
"Champus", "DOD" CHAMPUS/VA/Other Government; Department of Defense
"Unknown", Blank Unknown . Missing
Other values   .A Invalid


Illinois (SID)
Illinois
(Valid beginning in 1998 SID)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
A98910 Medicare 1 Medicare
A98945 Medicare Managed Care/Advantage Plan (beginning in 2011)
B98916 Illinois Medicaid 2 Medicaid
B98917 Out of State Medicaid (beginning in 2011), Other Medicaid (prior to 2011)
B98935 Medicaid Managed Care (beginning in 2011)
C40010 Blue Cross Blue Shield Commercial (POS, PPO, etc.) (beginning in 2016) 3 Private Insurance
C40020 United Healthcare Commercial (POS, PPO, etc.) (beginning in 2016)
C40030 Aetna (POS, PPO, etc.) (beginning in 2016)
C40150 Humana Commercial (POS, PPO, etc. ) (beginning in 2016)
C40160 Health Alliance Commercial (POS, PPO, etc.) (beginning in 2016)
C87726 United Healthcare Advan
C98950 Commercial Insurance
Cnnn, where nnn is a 3-digit number Blue Cross Insurance
Cnnnnnnnnn, where nnnnnnnnn is a 9-digit number Commercial Insurance (may include TPA and Worker's Compensation coverage)
C98920 Other Commercial Insurance (PPO, POS etc) other than 400 series
D40015 Blue Cross Blue Shield Commercial HMO (beginning in 2016)
D40025 United Healthcare Commercial HMO (beginning in 2016)
D40035 Aetna Commercial HMO (beginning in 2016)
D40155 Humana Commercial HMO (beginning in 2016)
D40165 Health Alliance Commercial HMO (beginning in 2016)
Dnnnnnnnnn, where nnnnnnnnn is a 9-digit number Commercial HMO
D98925 Commercial HMO other than 400 series
Ennnnnnnnn, where nnnnnnnnn is a 9-digit number Self-administered or Self-insured plans
E98930 Other Self-administered or Self-insured plans
F98918 Self-pay 4 Self-pay
H98912 Charity 5 No charge
H98913 Hill Burton Free Care
H98911 Black Lung 6 Other
H98914 CHAMPUS
H98915 CHAMPVA
H98919 Miscellaneous
H00121 Blue Cross Blue Shield, other than Medicare or commercial plan (Starting in 2013)
H36335 HFN Inc, other than Medicare or commercial plan (Starting in 2013)
H77950 Health Alliance Medical
H87726 United Healthcare Advantage, other than Medicare or commercial plan (Starting in 2013)
H95964 COVID HRSA Uninsured Fund
H00000 Other (valid prior to 2018)
Blank Missing . Missing
H00000 (discontinued beginning in 2018), H99999 or any values not documented by the data source .A Invalid

Primary, secondary, and tertiary expected payer information was provided in two fields: a one character payer category ("A" through "H") and detailed payer identifier of 3, 5, or 9 digits. The 3-digit identifiers refer to Blue Cross plans, but no source documentation was available to link the 3-digit identifier to a Blue Cross plan name. The 9-digit identifiers refer to commercial, HMO, and self-administered plans, but no source documentation was available to link the 9-digit identifier to a plan name. The Illinois Department of Insurance may have a list of the plan names for the 9-digit codes. All 5-digit identifiers were named. This information is included in the above table.

The one-character payer category and the detailed payer identifier were concatenated together to create the HCUP variables PAY1_X, PAY2_X, and PAY3_X.

During HCUP processing, PAY1/PAY2 and HMOPPO1/HMOPPO2 were assigned using the first character of PAY1_X/PAY2_X (e.g., "A", "B", "C", etc.) with the following exception. When PAY1_X/PAY2_X started with "H", PAY1/PAY2 and HMOPPO1/HMOPPO2 were assigned using the 6 character code.




Illinois
(Valid from 1995-1997)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
A98910 Medicare 1 Medicare
B98916 Illinois Medicaid 2 Medicaid
B98917 Other Medicaid
Cnnn, where nnn is a 3-digit number Blue Cross Insurance 3 Private Insurance
Cnnnnnnnnn, where nnnnnnnnn is a 9-digit number Commercial Insurance (may include TPA and Worker's Compensation coverage)
C98920 Other Commercial Insurance
Dnnnnnnnnn, where nnnnnnnnn is a 9-digit number Commercial HMO
Ennnnnnnnn, where nnnnnnnnn is a 9-digit number Self-administered or Self-insured plans
E98930 Other Self-administered or Self-insured plans
F98918 Self-pay 4 Self-pay
H98912 Charity 5 No charge
H98913 Hill Burton Free Care
H98911 Black Lung 6 Other
H98914 CHAMPUS
H98915 CHAMPVA
H98919 Miscellaneous
Blank Missing . Missing
Any values not documented by the data source .A Invalid

Primary, secondary, and tertiary expected payer information was provided in two fields: a one character payer category ("A" through "H") and detailed payer identifier of 3, 5, or 9 digits. The 3-digit identifiers refer to Blue Cross plans, but no source documentation was available to link the 3-digit identifier to a Blue Cross plan name. The 9-digit identifiers refer to commercial, HMO, and self-administered plans, but no source documentation was available to link the 9-digit identifier to a plan name. The Illinois Department of Insurance may have a list of the plan names for the 9-digit codes. All 5-digit identifiers were named. This information is included in the above table.

The one-character payer category and the detailed payer identifier were concatenated together to create the HCUP variables PAY1_X, PAY2_X, and PAY3_X.

During HCUP processing, PAY1/PAY2 were assigned using the first character of PAY1_X/PAY2_X (e.g., "A", "B", "C", etc.) with the following exception. When PAY1_X/PAY2_X started with "H", PAY1/PAY2 were assigned using the 6 character code.




Illinois
(Valid from 1993-1994)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
A Medicare 1 Medicare
B Medicaid 2 Medicaid
C, E Commercial, PPO; Self-administered 3 Private Insurance
D HMO
F Self-pay 4 Self-pay
--   5 No charge
H Other 6 Other
Blank   . Missing
Other Values   .A Invalid



Illinois
(Valid from 1988-1992)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
98910 Medicare 1 Medicare
98916 Illinois Medicaid 2 Medicaid
98917 Other Medicaid
3-digit codes Blue Cross Insurance 3 Private Insurance
061055955 HMO/PHP
232312490 HMO/PHP
237137598 HMO/PHP
361236610 HMO/PHP
362171705 HMO/PHP
362302593 HMO/PHP
362748320 HMO/PHP
362835382 HMO/PHP
362858588 HMO/PHP
363050287 HMO/PHP
363156930 HMO/PHP
363208585 HMO/PHP
363232147 HMO/PHP
363242084 HMO/PHP
363251800 HMO/PHP
363257067 HMO/PHP
363261533 HMO/PHP
363280214 HMO/PHP
363290114 HMO/PHP
363293099 HMO/PHP
363300107 HMO/PHP
363303922 HMO/PHP
363303927 HMO/PHP
363333675 HMO/PHP
363334929 HMO/PHP
363346492 HMO/PHP
363357619 HMO/PHP
363359925 HMO/PHP
363363036 HMO/PHP
363379945 HMO/PHP
363385638 HMO/PHP
363387762 HMO/PHP
363410844 HMO/PHP
363426222 HMO/PHP
363447577 HMO/PHP
363464332 HMO/PHP
363513970 HMO/PHP
363576982 HMO/PHP
36361797l HMO/PHP
363617971 HMO/PHP
363784962 HMO/PHP
363807756 HMO/PHP
363837523 HMO/PHP
363864486 HMO/PHP
371076964 HMO/PHP
371105481 HMO/PHP
371139917 HMO/PHP
371153402 HMO/PHP
371190216 HMO/PHP
371192892 HMO/PHP
371216698 HMO/PHP
371221007 HMO/PHP
371241037 HMO/PHP
371260731 HMO/PHP
376000511 HMO/PHP
421172640 HMO/PHP
421282065 HMO/PHP
431131852 HMO/PHP
431141117 HMO/PHP
431361841 HMO/PHP
431372307 HMO/PHP
431386495 HMO/PHP
541252797 HMO/PHP
611013183 HMO/PHP
611056884 HMO/PHP
741844335 HMO/PHP
953762261 HMO/PHP
954053288 HMO/PHP
963762261 HMO/PHP
98920 Other commercial insurance
98930 Other self-administered or self-insured plans
98918 Self-pay 4 Self-pay
98912 Charity 5 No charge
98913 Hill Burton Free Care
020140690 Workers' Compensation 6 Other
020172170 Workers' Compensation
020177030 Workers' Compensation
020304627 Workers' Compensation
020308052 Workers' Compensation
020311919 Workers' Compensation
020342937 Workers' Compensation
020349547 Workers' Compensation
030316876 Workers' Compensation
041027270 Workers' Compensation
041282020 Workers' Compensation
041288420 Workers' Compensation
041543470 Workers' Compensation
041590940 Workers' Compensation
041924000 Workers' Compensation
042177185 Workers' Compensation
042475442 Workers' Compensation
042656602 Workers' Compensation
042680300 Workers' Compensation
042739160 Workers' Compensation
042794993 Workers' Compensation
042974375 Workers' Compensation
043058503 Workers' Compensation
043058504 Workers' Compensation
046017710 Workers' Compensation
050303803 Workers' Compensation
050393243 Workers' Compensation
060237820 Workers' Compensation
060291290 Workers' Compensation
060294398 Workers' Compensation
060303275 Workers' Compensation
060303520 Workers' Compensation
060336212 Workers' Compensation
060383030 Workers' Compensation
060464510 Workers' Compensation
060480695 Workers' Compensation
060529570 Workers' Compensation
060566050 Workers' Compensation
060640218 Workers' Compensation
060732738 Workers' Compensation
060848755 Workers' Compensation
060876835 Workers' Compensation
060907370 Workers' Compensation
060949141 Workers' Compensation
061008026 Workers' Compensation
061008792 Workers' Compensation
061010609 Workers' Compensation
061024360 Workers' Compensation
061053492 Workers' Compensation
061055955 Workers' Compensation
061067463 Workers' Compensation
061092819 Workers' Compensation
061117063 Workers' Compensation
061182357 Workers' Compensation
061206728 Workers' Compensation
061222527 Workers' Compensation
061325038 Workers' Compensation
066032187 Workers' Compensation
066033504 Workers' Compensation
066033509 Workers' Compensation
066105395 Workers' Compensation
131675535 Workers' Compensation
131941868 Workers' Compensation
131941984 Workers' Compensation
131963495 Workers' Compensation
131963496 Workers' Compensation
131988169 Workers' Compensation
132559805 Workers' Compensation
132611663 Workers' Compensation
132653231 Workers' Compensation
132661002 Workers' Compensation
132669000 Workers' Compensation
132673100 Workers' Compensation
132758523 Workers' Compensation
132781282 Workers' Compensation
132791458 Workers' Compensation
132832845 Workers' Compensation
135277930 Workers' Compensation
135283360 Workers' Compensation
135303710 Workers' Compensation
135316370 Workers' Compensation
135339725 Workers' Compensation
135358230 Workers' Compensation
135379820 Workers' Compensation
135459190 Workers' Compensation
135460208 Workers' Compensation
135481330 Workers' Compensation
135539046 Workers' Compensation
135540698 Workers' Compensation
135616275 Workers' Compensation
135617450 Workers' Compensation
135669461 Workers' Compensation
136081895 Workers' Compensation
136104845 Workers' Compensation
136107326 Workers' Compensation
136108722 Workers' Compensation
150476880 Workers' Compensation
156020948 Workers' Compensation
160366830 Workers' Compensation
220731810 Workers' Compensation
221608585 Workers' Compensation
221708002 Workers' Compensation
221721944 Workers' Compensation
221721950 Workers' Compensation
221964135 Workers' Compensation
221964136 Workers' Compensation
222005057 Workers' Compensation
222053189 Workers' Compensation
222227328 Workers' Compensation
222227331 Workers' Compensation
222342710 Workers' Compensation
230342560 Workers' Compensation
230580680 Workers' Compensation
230723970 Workers' Compensation
230959220 Workers' Compensation
230961349 Workers' Compensation
231330959 Workers' Compensation
231471444 Workers' Compensation
231502700 Workers' Compensation
231614367 Workers' Compensation
231620527 Workers' Compensation
231624911 Workers' Compensation
231641984 Workers' Compensation
231642962 Workers' Compensation
231740414 Workers' Compensation
231742051 Workers' Compensation
231892289 Workers' Compensation
231903575 Workers' Compensation
232182777 Workers' Compensation
232640501 Workers' Compensation
232643432 Workers' Compensation
250410420 Workers' Compensation
250687550 Workers' Compensation
251118791 Workers' Compensation
310396250 Workers' Compensation
310501234 Workers' Compensation
310542366 Workers' Compensation
310708754 Workers' Compensation
310826946 Workers' Compensation
310926059 Workers' Compensation
310970750 Workers' Compensation
311160863 Workers' Compensation
311241230 Workers' Compensation
314177100 Workers' Compensation
314177110 Workers' Compensation
314316080 Workers' Compensation
314423946 Workers' Compensation
340368340 Workers' Compensation
340438190 Workers' Compensation
341022544 Workers' Compensation
341172650 Workers' Compensation
341316396 Workers' Compensation
341532771 Workers' Compensation
346513736 Workers' Compensation
346516838 Workers' Compensation
350145400 Workers' Compensation
350198580 Workers' Compensation
350293728 Workers' Compensation
350293730 Workers' Compensation
350410010 Workers' Compensation
350410420 Workers' Compensation
350913391 Workers' Compensation
350988041 Workers' Compensation
351044900 Workers' Compensation
351288885 Workers' Compensation
351372324 Workers' Compensation
351492884 Workers' Compensation
351495207 Workers' Compensation
351495208 Workers' Compensation
351524574 Workers' Compensation
356018566 Workers' Compensation
356021485 Workers' Compensation
360705950 Workers' Compensation
360719665 Workers' Compensation
360727430 Workers' Compensation
360727470 Workers' Compensation
360810360 Workers' Compensation
360901240 Workers' Compensation
361022580 Workers' Compensation
361236610 Workers' Compensation
361404320 Workers' Compensation
361410470 Workers' Compensation
361412255 Workers' Compensation
361475332 Workers' Compensation
361649210 Workers' Compensation
361877247 Workers' Compensation
361999760 Workers' Compensation
362114545 Workers' Compensation
362349119 Workers' Compensation
362403971 Workers' Compensation
362467238 Workers' Compensation
362489372 Workers' Compensation
362490086 Workers' Compensation
362512064 Workers' Compensation
362542404 Workers' Compensation
362545393 Workers' Compensation
362594678 Workers' Compensation
36260579 Workers' Compensation
362661515 Workers' Compensation
362661954 Workers' Compensation
362663083 Workers' Compensation
362667627 Workers' Compensation
362674180 Workers' Compensation
362678778 Workers' Compensation
362690333 Workers' Compensation
362694846 Workers' Compensation
362704643 Workers' Compensation
362704802 Workers' Compensation
362705935 Workers' Compensation
362709121 Workers' Compensation
362711653 Workers' Compensation
362719165 Workers' Compensation
362722478 Workers' Compensation
362738349 Workers' Compensation
362742183 Workers' Compensation
362748320 Workers' Compensation
362748795 Workers' Compensation
362753986 Workers' Compensation
362755546 Workers' Compensation
362756532 Workers' Compensation
362759195 Workers' Compensation
362760101 Workers' Compensation
362763106 Workers' Compensation
362781080 Workers' Compensation
362789296 Workers' Compensation
362797073 Workers' Compensation
362797074 Workers' Compensation
362811124 Workers' Compensation
362857399 Workers' Compensation
362874262 Workers' Compensation
362930605 Workers' Compensation
362944577 Workers' Compensation
362950161 Workers' Compensation
362994662 Workers' Compensation
362999368 Workers' Compensation
362999370 Workers' Compensation
363027848 Workers' Compensation
363028761 Workers' Compensation
363030511 Workers' Compensation
363040078 Workers' Compensation
363051031 Workers' Compensation
363078103 Workers' Compensation
363101262 Workers' Compensation
363105508 Workers' Compensation
363105737 Workers' Compensation
363141762 Workers' Compensation
363155373 Workers' Compensation
363186541 Workers' Compensation
363230348 Workers' Compensation
363312218 Workers' Compensation
363316692 Workers' Compensation
363341779 Workers' Compensation
363423817 Workers' Compensation
363426425 Workers' Compensation
363432551 Workers' Compensation
363441652 Workers' Compensation
363468793 Workers' Compensation
363492700 Workers' Compensation
363510294 Workers' Compensation
363522250 Workers' Compensation
363529298 Workers' Compensation
363530161 Workers' Compensation
363579407 Workers' Compensation
363585968 Workers' Compensation
363586255 Workers' Compensation
363614264 Workers' Compensation
363649555 Workers' Compensation
363672824 Workers' Compensation
363714287 Workers' Compensation
363715387 Workers' Compensation
363765116 Workers' Compensation
363774557 Workers' Compensation
363789786 Workers' Compensation
363789787 Workers' Compensation
363806723 Workers' Compensation
366033855 Workers' Compensation
366033921 Workers' Compensation
366042949 Workers' Compensation
366043106 Workers' Compensation
366049887 Workers' Compensation
366054328 Workers' Compensation
366064756 Workers' Compensation
366067575 Workers' Compensation
366071400 Workers' Compensation
366077839 Workers' Compensation
366084669 Workers' Compensation
366115679 Workers' Compensation
370268670 Workers' Compensation
370277830 Workers' Compensation
370301640 Workers' Compensation
370344310 Workers' Compensation
370396180 Workers' Compensation
370420520 Workers' Compensation
370530080 Workers' Compensation
370533080 Workers' Compensation
370533100 Workers' Compensation
370558630 Workers' Compensation
370637646 Workers' Compensation
370807507 Workers' Compensation
370815476 Workers' Compensation
370855395 Workers' Compensation
370915434 Workers' Compensation
371054042 Workers' Compensation
371111076 Workers' Compensation
371184187 Workers' Compensation
371277771 Workers' Compensation
376028411 Workers' Compensation
380315280 Workers' Compensation
380828980 Workers' Compensation
380829210 Workers' Compensation
380865250 Workers' Compensation
381184490 Workers' Compensation
381630841 Workers' Compensation
381869912 Workers' Compensation
382145898 Workers' Compensation
382312731 Workers' Compensation
382430150 Workers' Compensation
390264050 Workers' Compensation
390273710 Workers' Compensation
390301590 Workers' Compensation
390333950 Workers' Compensation
390475300 Workers' Compensation
390712210 Workers' Compensation
390941450 Workers' Compensation
390972608 Workers' Compensation
391190263 Workers' Compensation
391338397 Workers' Compensation
391341459 Workers' Compensation
391401314 Workers' Compensation
396058596 Workers' Compensation
396062860 Workers' Compensation
410299900 Workers' Compensation
410406690 Workers' Compensation
410417460 Workers' Compensation
410729473 Workers' Compensation
410881659 Workers' Compensation
410963301 Workers' Compensation
410986076 Workers' Compensation
411232071 Workers' Compensation
411353943 Workers' Compensation
520976199 Workers' Compensation
521050076 Workers' Compensation
420111280 Workers' Compensation
420223390 Workers' Compensation
420234980 Workers' Compensation
420245990 Workers' Compensation
420301440 Workers' Compensation
420594770 Workers' Compensation
420618271 Workers' Compensation
420645088 Workers' Compensation
420645088 Workers' Compensation
421015537 Workers' Compensation
421019055 Workers' Compensation
421234898 Workers' Compensation
426054959 Workers' Compensation
430613000 Workers' Compensation
431037123 Workers' Compensation
431139865 Workers' Compensation
431245798 Workers' Compensation
431249228 Workers' Compensation
436028696 Workers' Compensation
440194612 Workers' Compensation
440237557 Workers' Compensation
440307890 Workers' Compensation
440648645 Workers' Compensation
440652707 Workers' Compensation
440666926 Workers' Compensation
460368854 Workers' Compensation
470159155 Workers' Compensation
470355979 Workers' Compensation
470360368 Workers' Compensation
470444314 Workers' Compensation
470490411 Workers' Compensation
470498866 Workers' Compensation
470574325 Workers' Compensation
470698507 Workers' Compensation
476022701 Workers' Compensation
476024508 Workers' Compensation
480470690 Workers' Compensation
480921045 Workers' Compensation
510098159 Workers' Compensation
520266645 Workers' Compensation
520403120 Workers' Compensation
520515280 Workers' Compensation
520616768 Workers' Compensation
521137203 Workers' Compensation
586020487 Workers' Compensation
590733942 Workers' Compensation
591027412 Workers' Compensation
591320184 Workers' Compensation
591847174 Workers' Compensation
610904881 Workers' Compensation
621101490 Workers' Compensation
630598629 Workers' Compensation
741280541 Workers' Compensation
741296673 Workers' Compensation
750620550 Workers' Compensation
751444207 Workers' Compensation
751670124 Workers' Compensation
756013587 Workers' Compensation
756013697 Workers' Compensation
756017952 Workers' Compensation
756020448 Workers' Compensation
760154296 Workers' Compensation
840513811 Workers' Compensation
840583213 Workers' Compensation
840982643 Workers' Compensation
850165753 Workers' Compensation
850277191 Workers' Compensation
850282785 Workers' Compensation
860274508 Workers' Compensation
880119246 Workers' Compensation
910341780 Workers' Compensation
910449750 Workers' Compensation
910895822 Workers' Compensation
911115311 Workers' Compensation
920040526 Workers' Compensation
940781581 Workers' Compensation
941032958 Workers' Compensation
941390273 Workers' Compensation
941517098 Workers' Compensation
941610280 Workers' Compensation
942532388 Workers' Compensation
946078058 Workers' Compensation
951077060 Workers' Compensation
951078160 Workers' Compensation
951429618 Workers' Compensation
951479095 Workers' Compensation
951542353 Workers' Compensation
952371728 Workers' Compensation
952575892 Workers' Compensation
956016640 Workers' Compensation
980032627 Workers' Compensation
980033230 Workers' Compensation
990041610 Workers' Compensation
98914 CHAMPUS
98915 CHAMPVA
98911 Black Lung
98919 Miscellaneous
Blank, "000000000" Unknown . Missing
Other Values   .A Invalid


Illinois (SEDD)
Illinois
(Valid beginning 2009 SASD and SEDD)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
A Medicare 1 Medicare
B Medicaid 2 Medicaid
C Commercial 3 Private Insurance
D HMO
E Self-Administered
F Self Pay 4 Self Pay
-   5 No charge
H Other 6 Other
Blank Missing . Missing
other   .A Invalid


Iowa (SID and SEDD)

In 2011 and 2012, the expected payer (PAYn and PAYn_X) was set to missing for hospitals with incorrectly reported payer data. The incorrect payer coding was identified by the Iowa Hospital Association.

Iowa
(Valid beginning in 2003 SID, SASD, SEDD)
PAY1_X PAY1
Value Description Value Description
1, 01 Medicare - Non-managed Care (Title 18) 1 Medicare
11 Medicare Managed Care (e.g. HMO, PPO) beginning 2008
2, 02 Medicaid - Non-managed Care (Title 19) (valid through 3/31/16) 2 Medicaid
12 Medicaid Managed Care (e.g. HMO, PPO, PCCM) (beginning 2008 - valid through 3/31/16)
20 Medicaid - Fee for Service (valid beginning 4/1/16)
21 Amerigroup Iowa, Inc. (valid beginning 4/1/16)
22 AmeriHealth caritas Iowa, Inc. (valid beginning 4/1/16)
23 UnitedHealthcare Plan of the River Valley, Inc. (valid beginning 4/1/16)
25 Medicaid - Out of State (valid beginning 4/1/16)
26 Iowa Total Care (vallid beginning 2019)
6, 06 Blue Cross (e.g. Blue Cross Alliance Select, Blue Cross Unity Choice) 3 Private Insurance
7, 07 Commercial (private or group plans including HMO, PPO, ODS)
8, 08 Self pay (The patient has no insurance, is ineligible for governmental assistance and is not a "no charge" patient.) 4 Self-pay
10 No Charge (The account has "$0.00" total charges and the patient is not billed for the admission, i.e. cancelled procedure, etc.) 5 No charge
3, 03 Iowa State Government (e.g. Mental Health State Papers, Iowa Cares, etc.) (valid through 3/31/16) 6 Other
4, 04 County/Local Government
5, 05 Other Federal Government (e.g. Champus, Veterans, Title V, Railroad, Crippled Children, DOD/Tricare, Veteran's Affairs, Indian health services, Black Lung)
9, 09 Workers Compensation
Blank Missing . Missing
Any values not documented by the data source .A Invalid


Iowa (SID)
Iowa
(Valid 1998-2002 SID)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
11 Medicare Managed Care (Presently no predominant plans in Iowa)
02 Medicaid (Title 19) 2 Medicaid
12 Medicaid Managed Care (e.g., Medipass, Heritage National, Care Choices, Principal Health Care)
06 Blue Cross (e.g., Blue Cross Alliance Select should be recorded as PPO; Blue Cross Unity Choice should be recorded as HMO) 3 Private Insurance
07 Commercial (private or group plans other than HMO, PPO, ODS)
13 HMO (e.g., Care Choices, Medical Associates Health Plan, Inc., Principal Health Care of Iowa, Heritage National Healthplan, Inc., John Deere Family Health Plan, Principal Health Care of Nebraska, United Healthcare of the Midlands, Unity Choice)
14 PPO (e.g., Alliance Select, Healthcare Preferred, Plaines Health Network)
15 Organized Delivery Systems (ODS) (e.g., SecureCare of Iowa)
08 Self-pay (the patient has no insurance, is ineligible for governmental assistance and is not a "no charge" patient) 4 Self-pay
10 No charge 5 No charge
03 Other State (including State Papers) 6 Other
04 County
05 CHAMPUS
09 Workers Compensation
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Iowa
(Valid from 1991-1997 SID)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
02 Medicaid (Title 19) 2 Medicaid
06 Blue Cross (of Iowa, Western Iowa, or other state Blue Cross plans) 3 Private Insurance
08 Self-pay or relative 4 Self-pay
--   5 No charge
09 Workers' Compensation 6 Other
03, 04, 05 Other state; county (including state papers); Other federal government (including CHAMPUS, Veterans, Title V, Railroad, Hill-Burton, Crippled Children, etc.)
Blank   . Missing
Other Values   .A Invalid



Iowa
(Valid from 1988-1990 SID)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
02 Medicaid (Title 19) 2 Medicaid
06 Blue Cross (of Iowa, Western Iowa, or other state Blue Cross plans) 3 Private Insurance
07 Commercial (private or group)
08 Self-pay or relative 4 Self-pay
--   5 No charge
09 Workers' Compensation 6 Other
03, 04, 05 Other state government; Other county government; Other federal government
10 Other non-government
Blank   . Missing
Other Values   .A Invalid


Indiana (SID and SEDD)

Starting in 2016, there may be inconsistent reporting of primary and secondary payer (PAY1 and PAY2) by hospitals.

Indiana
(Valid beginning in 2008 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
02 Medicare Advantage
03 Medicaid 2 Medicaid
04 Medicaid Managed Care
05 Medicaid HIP plans
06 Medicaid Out of State
07 Anthem Commercial 3 Private Insurance
08 Other Commercial
11 Self-pay 4 Self-pay
12 No Charge 5 No Charge
09 Workers Compensation 6 Other
10 Other Federal Government
Blank Missing . Missing
Other   .A Invalid



Indiana
(Valid 2003 - 2007 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
4 Commercial Insurance 3 Private Insurance
5 Managed Care
6 Self-pay 4 Self-pay
--   5 No charge
3 Other/Government 6 Other
7 Other/Unknown
Blank (PAY1_X only), Blank; 0 (PAY2_X only) Missing . Missing
Any values not documented by the data source .A Invalid


Kansas (SID and SEDD)
Kansas
(Valid beginning in 2017 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
001, 1, 01 Medicare 1 Medicare
101 Medicare Managed Care
002, 2, 02 Medicaid 2 Medicaid
102 Medicaid Managed Care
103 HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)
004, 4, 04 Blue Cross/Blue Shield 3 Private Insurance
007, 7, 07 Commercial/Private
104 Blue Cross/Blue Shield Managed Care
107 All Commercial Payers Managed Care
006, 6, 06 Self-pay 4 Self-pay
008, 8 Charity/No Charge 5 No charge
005, 5,05 Workers Compensation 6 Other
009, 9, 09 Other Government
010, 10 Champus
011, 11 Other
105 Workers Compensation Managed Care
109 Other Government Managed Care (not Champus)
110 Champus Managed Care
111 Other Managed Care
Blank, 00, 000 Missing . Missing
Any values not documented by the data source .A Invalid



Kansas
(Valid 2003-2016 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
001, 1, 01 Medicare 1 Medicare
101 Medicare Managed Care
002, 2, 02 Medicaid 2 Medicaid
102 Medicaid Managed Care
004, 4, 04 Blue Cross/Blue Shield 3 Private Insurance
007, 7, 07 Commercial/Private
104 Blue Cross/Blue Shield Managed Care
107 All Commercial Payers Managed Care
006, 6, 06 Self-pay 4 Self-pay
008, 8 Charity/No Charge 5 No charge
005, 5,05 Workers Compensation 6 Other
009, 9, 09 Other Government
010, 10 Champus
011, 11 Other
103 HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)
105 Workers Compensation Managed Care
109 Other Government Managed Care (not Champus)
110 Champus Managed Care
111 Other Managed Care
Blank, 00, 000 Missing . Missing
Any values not documented by the data source .A Invalid


Kansas (SID)
Kansas
(Valid 1993-2002 SID)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
3 Blue Cross 3 Private Insurance
4 Commercial
5 Self-pay 4 Self-pay
--   5 No charge
6 Other 6 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid

Separate information on HMO and PPO providers is not provided.



Kentucky (SID and SEDD)
Kentucky
(Valid beginning 2015)
PAY1_X, PAY2_X, PAY3_X PAY1 and PAY2
Value Description Value Description
98910 Medicare (excluding Medicare Managed Care) 1 Medicare
98945 Medicare Managed Care
98916 In State Medicaid 2 Medicaid
98917 Out of State Medicaid
98929 Humana Medicaid Managed Care
98940 Passport Medicaid Managed Care
98943 Medicaid MCO Pending (effective 10/1/18)
98944 United Healthcare Medicaid Managed Care (effective 2021)
98970 Coventry Cares of Kentucky Medicaid Managed Care (effective prior to 10/1/18)
98970 Aetna Better Health of KY Medicaid Managed Care (effective 10/1/18)
98980 Wellcare of Kentucky Medicaid Managed Care
98990 Kentucky Spirit Medicaid Managed Care
98991 BCBS Medicaid Managed Care (effective prior to 10/1/18)
98991 Anthem Medicaid Managed Care (effective 10/1/18)
98901 Commercial - Aetna Health HMO Plan (effective 10/1/18) 3 Private insurance
98902 Commercial - Aetna Health PPO Plan (effective 10/1/18)
98903 Commercial - Humana POS Plan (effective 10/1/18)
98904 Commercial - Humana HMO Plan (effective 10/1/18)
98905 Commercial - Humana PPO Plan (effective 10/1/18)
98906 Commercial - Anthem Health Plans of KY POS Plan (effective 10/1/18)
98907 Commercial - Anthem Health Plans of KY FFS Plan (effective 10/1/18)
98908 Commercial - Anthem Health Plans of KY HMO Plan (effective 10/1/18)
98920 Other Commercial Insurance (HMO, PPO, Alliance) (effective 1/1/15)
98921 Commercial - Indemnity
98922 Commercial - HMO
98923 Commercial - PPO
98924 Commercial - Other
98926 Auto Insurance
98930 Other Self Administered Plan
98931 Commercial - United Healthcare POS Plan (effective 10/1/18)
98932 Commercial - United Healthcare FFS Plan (effective 10/1/18)
98933 Commercial - United Healthcare PPO Plan (effective 10/1/18)
98934 Commercial - United Healthcare of KY POS Plan (effective 10/1/18)
98935 Commercial - United Healthcare of KY HMO Plan (effective 10/1/18)
98936 Commercial - United Healthcare of Ohio POS Plan (effective 10/1/18)
98937 Commercial - Cigna Health & Life FFS Plan (effective 10/1/18)
98938 Commercial - Cigna Health & Life PPO Pla (effective 10/1/18)
98939 Commercial - Nippon Life Insurance Company of America (effective 10/1/18)
98941 Commercial - Caresource Kentucky HMO Plan (effective 10/1/18)
98942 Commercial - Wellcare Health Plans of KY HMO Plan (effective 10/1/18)
98960 Blue Cross Blue Shield (effective prior to 10/1/18)
98960 Commercial - Anthem Health Plans of KY PPO Plan (effective 10/1/18)
98992 Wellcare Health Commercial Plan (effective 1/1/15)
98993 Care Source KY Commercial Plan (effective 1/1/15)
98994 Kentucky Health Cooperative Health Plan
98918 Self Pay 4 Self-pay
98912 Charity defined according to the hospital policy at time of discharge 5 No charge
98913 Hill Burton Free Care
00000 Other 6 Other
98911 Black Lung
98914 Tricare (Champus)
98915 ChampVA
98925 VA
98927 Other Facility
98928 Pending Insurance
98950 Workers' Compensation
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Kentucky
(Valid 2011 - 2014)
PAY1_X, PAY2_X, PAY3_X PAY1 and PAY2
Value Description Value Description
C Medicare 1 Medicare
R Medicare Managed Care
D Medicaid 2 Medicaid
P Passport Medicaid Managed Care (beginning with 2003 data)
Q Kentucky Spirit Medicaid Managed Care
T Coventry Cares of KY Medicaid Managed Care
U WellCare of Kentucky Medicaid Managed Care
X BCBS Medicaid Managed Care (starting in 2014)
Z Humana Medicaid Managed Care
F Commercial - Unknown (Prior to 2011) 3 Private insurance
G Commercial - Unknown (Prior to 2011)
J Commercial - Indemnity
K Commercial - Preferred Provider
L Commercial - HMO
M Commercial - Other Managed Care (Prior to 2011)
N Commercial - Mix
A Self Pay 4 Self-pay
S Charity 5 No charge
B Workers' Compensation 6 Other
E Other federal programs
H Champus
I Other
O Other Faciity Direct Bill
V VA
W Auto Insurance
Y Pending Insurance
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Kentucky
(Valid 2009 - SID, SASD, SEDD)
PAY1_X, PAY2_X, PAY3_X PAY1 and PAY2
Value Description Value Description
98910 Medicare (Excluding Medicare Managed Care) 1 Medicare
98945 Medicare Managed Care
98916 In State Medicaid (Excluding Passport) 2 Medicaid
98917 Out of State Medicaid
98940 Passport Medicaid Managed Care
98921 Commercial - Indemnity 3 Private insurance
98923 Commercial - PPO
98922 Commercial - HMO
98924 Commercial - Other
98930 Other Self Administered Plan
98918 Self Pay 4 Self-pay
98912 Charity 5 No charge
98913 Hill Burton Free Care
98911 Black Lung 6 Other
98950 Workers' Compensation
98914 Champus
98915 Champva
00000 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Kentucky
(Valid prior to 2009 - SID, SASD, SEDD)
PAY1_X, PAY2_X, PAY3_X PAY1 and PAY2
Value Description Value Description
C Medicare 1 Medicare
D Medicaid 2 Medicaid
R Medicare Managed Care (incorrectly mapped to Medicaid)
P Passport Medicaid Managed Care (beginning with 2003 data)
F Commercial - Unknown 3 Private insurance
G Commercial - Unknown
J Commercial - Indemnity
K Commercial - Preferred Provider
L Commercial - HMO
M Commercial - Managed Care
N Commercial - Mix
A Self Pay 4 Self-pay
S Charity 5 No charge
B Workers' Compensation 6 Other
E Other Federal programs
H Champus
I Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid


Maine (SID and SEDD)
Maine
(Valid beginning in 1999 - SID, Valid beginning in 2006 - SASD, SEDD)
PAY1_X, PAY2_X, PAY3_X PAY1, PAY 2
Value Description Value Description
01 Medicare 1 Medicare
12 MEDICARE ADVANTAGE
02 Medicaid 2 Medicaid
05 Blue Cross (Valid prior to 2015) 3 Private insurance
06 Other commercial carriers
10 HMO/PPO (valid prior to 2011)
08 Self-pay 4 Self-pay
07 Charity 5 No charge
03 U.S. Title V (Valid 2003 and before) 6 Other
04 CHAMPUS/USVA
09 Worker's Compensation
11 Unknown (Valid prior to 2011), Other (Beginning 2015)
00, 99, blank Missing . Missing
other   .A Invalid


Maryland (SID and SEDD)
Maryland
(Valid beginning with 2021 Q3 SID, SASD, SEDD)
PAY1_X, PAY2_X, and PAY3_X PAY1, PAY2, and PAY3
Value Description Value Description
01 Medicare FFS 1 Medicare
15 Medicare Advantage Managed Care (payer specified in PAYER1_X/PAYER2_X)
02 MD Medicaid FFS only and Pending MD Medicaid 2 Medicaid
14 MD Medicaid MCO (payer specified in PAYER1_X/PAYER2_X)
05 Commercial Insurance (HMO/POS/PPO/PPN/TPA) 3 Private Insurance
19 Behavioral Health Plan
06 Other government program 6 Other
07 Worker's Compensation
10 Other
18 International (beginning 7/1/2014)
77, 98, 99 Unknown . Missing
Blank Missing
27, 29, 37, 67 Unknown/invalid values .A Invalid
Any values not documented by the data source



Maryland
(Valid beginning in 2017-2021 Q2 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare FFS 1 Medicare
15 Medicare Managed Care (payer specified in PAYER1_X/PAYER2_X)
02 MD Medicaid FFS only and Pending MD Medicaid 2 Medicaid
14 MD Medicaid HMO (payer specified in PAYER1_X/PAYER2_X)
04 Blue Cross of Maryland 3 Private Insurance
16 Blue Cross of the National Capital Area
17 Blue Cross (other state)
05 Commercial Insurance, Other Than Blue Cross
12 HMO (payer specified in PAYER1_X/ PAYER2_X)
08 Self-pay 4 Self-pay
09 Charity - no charge 5 No charge
11 Donor
03 Title V 6 Other
06 Other government program, including out-of-state (non-MD) Medicaid
07 Worker's Compensation
10 Other
18 International (beginning 7/1/14)
98, 99 Unknown . Missing
Blank Missing
13 Do not use .A Invalid
27, 29, 37, 67, 77 Unknown/invalid values
Any values not documented by the data source



Maryland
(Valid beginning in 1998-2016 SID, SASD, SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare FFS 1 Medicare
15 Medicare Managed Care (payer specified in PAYER1_X/PAYER2_X)
02 MD Medicaid FFS only and Pending MD Medicaid 2 Medicaid
14 MD Medicaid HMO (payer specified in PAYER1_X/PAYER2_X)
04 Blue Cross of Maryland 3 Private Insurance
16 Blue Cross of the National Capital Area
17 Blue Cross (other state)
05 Commercial Insurance, Other Than Blue Cross
12 HMO (payer specified in PAYER1_X/ PAYER2_X)
08 Self-pay 4 Self-pay
09 Charity - no charge 5 No charge
03 Title V 6 Other
06 Other government program, including out-of-state (non-MD) Medicaid
07 Worker's Compensation
10 Other
11 Donor
18 International (beginning 7/1/14)
98, 99 Unknown . Missing
Blank Missing
13 Do not use .A Invalid
27, 29, 37, 67, 77 Unknown/invalid values
Any values not documented by the data source



Maryland
(Valid from 1996-1997 SID, SASD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1, 15 Medicare; Medicare HMO 1 Medicare
2,14 Medicaid; Medicaid HMO 2 Medicaid
4, 16, 17 Blue Cross; Blue Cross NCA; Blue Cross - other State 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Primary Payer Unknown; missing . Missing
99, 77, blank Secondary Payer Unknown; not applicable; missing . Missing
Other Values   .A Invalid



Maryland
(Valid from 1993-1995 SID, SASD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2, 13,14 Medicaid; Medicaid (state only); Medicaid HMO 2 Medicaid
4 Blue Cross 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Primary Payer Unknown; missing . Missing
99, 77, blank Secondary Payer Unknown; not applicable; missing . Missing
Other Values   .A Invalid



Maryland
(Valid from 1990-1992 SID, SASD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2, 13,14 Medicaid; Medicaid (state only); Medicaid HMO 2 Medicaid
4 Blue Cross 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Unknown; missing . Missing
Other Values   .A Invalid


Massachusetts (SEDD)
Massachusetts
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3 Medicare 1 Medicare
F Medicare Managed Care (includes Medicare Advantage)
S Senior Care Options/Integrated Care Organization (Effective 10/01/2020)
2 Medicaid 1 Medicare
4 Medicaid
A Medicaid Accountable Care Organization (Effective 10/01/2020)
6 Blue Cross (valid prior to 10/01/2020) 3 Private Insurance
C Blue Cross Managed Care (valid prior to 10/01/2020)
C Commercial Accountable Care Organization (Effective 10/01/2020)
7 Other Commercial Insurance not listed elsewhere
D Commercial Managed Care
8 HMO
E PPO and Other Managed Care not listed elsewhere
J Point of Service Plan
K Exclusive Provider Plan
T Auto Insurance
Z Dental Plans
1 Self-pay 4 Self-pay
9 Free care (No charge,charity care) 5 No charge
H Health Safety Net (Beginning in 2009) 6 Other
2 Worker's Compensation
5 Other government payment
0 Other non-managed care plans
Q Commonwealth Care Plans(CommCare)
N, Blank None, Missing . Missing
Any values not documented by the data source .A Invalid



In the first version of the 2009 MA SEDD (dated prior to August 2012), 4.8% of the SEDD discharges had the data element for expected payer (PAY1 or PAY2) miscoded. These records are concentrated in the fourth quarter of the year (DQTR=4). The provided file includes the corrected mapping of payer codes. Most of the affect records (3.6%) had the payer code set to invalid when it should have been set to private insurance, other insurance, or Medicare. Another 0.9% had the payer code set to private, Medicare, or Medicaid, when it should be coded as invalid. A corrected version of the 2009 MA SEDD was created in August 2012.

Massachusetts
(Valid beginning 2012 through 2019 - SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
121 Medicare 1 Medicare
125 Medicare HMO - Fallon Senior Plan
127 Medicare HMO - Health New England Medicare Wrap
128 Medicare HMO - HMO Blue for Seniors
129 Medicare HMO - Kaiser Medicare Plus Plan
131 Medicare HMO - Pilgrim Enhance 65
133 Medicare HMO -Tufts Medicare Supplement (TMS)
134 Medicare HMO - Other (not listed elsewhere)
135 Out-Of-State Medicare
168 Advantra Freedom
173 Aetna Medicare Open
180 Fresenius Medical Care Health Plan (Medicare Advantage Plan)
210 Medicare HMO - Pilgrim Preferred 65
211 Medicare HMO - Neighborhood Health Plan Senior Health Plus
212 Medicare HMO - Healthsource CMHC Central Care Supplement
213 Medicare HMO - Medicare Complete Plans offered by SecureHorizons
214 Medicare HMO - Harvard Pilgrim Health Plan - Medicare Enhance
215 Tufts Medicare HMO - Medicare Preferred
216 Medicare Special Needs Plan - Commonwealth Care Alliance
217 Medicare Special Needs Plan - Fallon Community Health Plan
218 Medicare Special Needs Plan - Senior Whole Health
219 Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IP
220 Medicare HMO - Blue Care 65
221 Medicare HMO - Harvard Community Health Plan 65
223 Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus
224 Medicare HMO - Tufts Secure Horizons
225 Medicare HMO - US Healthcare
230 Medicare HMO - HCHP First Seniority Freedom
231 Medicare HMO - Pilgrim Prime
232 Medicare HMO - Senior Care Direct
233 Medicare HMO - Senior Care Plus
234 Medicare HMO - Managed Blue for Seniors
245 Trail Blazer Health Enterprises, LLC
252 Health New England (HNE) Medicare Advantage Plan
253 Blue Medicare PFFS
254 Cigna Medicare Access Plans
255 Health Net Pearl
256 Humana Gold PFFS
257 Today's Options Premier from Universal American
258 Unicare Security Choice
273 MassHealth Senior Care Options
275 Medicare SCO - NaviCare (HMO)
276 Medicare SCO - Tufts Senior Care Options
277 Medicare SCO - United Health Care
278 Medicare SCO - Commonwealth Care Alliance
279 Medicare One Care - Fallon Total Care
280 Medicare One Care - Network Health
281 Medicare One Care - Commonwealth Care Alliance
824 Principal Plan Dental
912 Beacon Health Partners (effective 10/01/2020)
103 Medicaid (includes MassHealth) 2 Medicaid
104 Medicaid Managed Care - Primary Care Clinician (PCC)
107 Medicaid Managed Care - Community Health Plan
108 Medicaid Managed Care - Fallon Community Health Plan
110 Medicaid Managed Care - Health New England
111 Medicaid Managed Care - HMO Blue
113 Medicaid Managed Care - Neighborhood Health Plan
114 Medicaid Managed Care - United Health Plans of NE
115 Medicaid Managed Care - Pilgrim Health Care
116 Medicaid Managed Care Tufts Associated Health Plan
118 Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership
119 Medicaid Managed Care Other (not listed elsewhere)
120 Out-Of-State Medicaid (valid beginning in 2016)
207 Network Health (Cambridge Health Alliance MCD Program)
208 HealthNet (Boston Medical Center MCD Program)
273 MassHealth Senior Care Options
274 Medicaid Managed Care - Network Health
282 BMC MassHealth CarePlus
283 Fallon MassHealth CarePlus
284 NHP MassHealth CarePlus
285 Network Health MassHealth CarePlus
286 Celticare MassHealth CarePlus
287 MassHealth CarePlus
311 Medicaid: Other ACO
312 Medicaid: Fallon 365 Care (ACO)
313 Medicaid: Be Healthy Partnership with Health New England (ACO)
314 Medicaid: Berkshire Fallon Health Collaborative (ACO)
315 Medicaid: BMC HealthNet Plan Community Alliance (ACO)
316 Medicaid: BMC HealthNet Plan Mercy Alliance (ACO)
317 Medicaid: BMC HealthNet Plan Signature Alliance (ACO)
318 Medicaid: BMC HealthNet Plan Southcoast Alliance (ACO)
320 Medicaid: Community Care Cooperative (ACO)
321 Medicaid: My Care Family with AllWays Health Plan (ACO)
322 Medicaid: Partners Healthcare Choice (ACO)
323 Medicaid: Steward Health Choice (ACO)
324 Medicaid: Tufts Health Together with Atrius Health (ACO)
325 Medicaid: Tufts Health Together with BIDCO (ACO)
326 Medicaid: Tufts Health Together with Boston Children's (ACO)
327 Medicaid: Tufts Health Together with CHA (ACO)
328 Medicaid: Wellforce Care Plan (ACO)
816 DentaQuest MassHealth
821 Guardian Dental
1 Harvard Community Health Plan 3 Private
2 Bay State - a product of HMO Blue
3 Network Blue (PPO)
4 Fallon Community Health Plan
7 or 07 Tufts Associated Health Plan
8 Pilgrim Health Care
9 United Health Plan of New England (Ocean State)
10 Pilgrim Advantage - PPO
11 Blue Care Elect
13 Community Health Plan Options (New York)
19 Matthew Thornton
21 Commonwealth PPO
22 Aetna Open Choice PPO
23 Guardian Life Insurance Company PPO
24 Health New England Inc.
25 Pioneer Plan
28 Great West Life PPO
30 CIGNA (Indemnity)
31 One Health Plan HMO (Great West Life)
35 United Healthcare Insurance Company - HMO(New for 1997)
36 United Healthcare Insurance Company - PPO (new for 1997)
37 HCHP - Pilgrim HMO (integrated product)
38 Health New England Select (self-funded)
40 Kaiser Foundation
42 ConnectiCare of Massachusetts
46 Blue ChiP (BCBS Rhode Island)
47 Neighborhood Health Plan
48 US Healthcare
49 Healthsource CMHC Plus PPO
51 Aetna Life Insurance
55 Guardian Life Insurance
56 Hartford L & A Insurance
57 John Hancock Life Insurance
62 Mutual of Omaha Insurance
70 Union Labor LIfe Insurance
71 ADMAR
74 United Healthcare Insurance Company
75 Prudential Healthcare HMO
77 Options for Healthcare PPO
79 Pioneer Health Care PPO
80 Tufts Total Health Plan PPO
81 HMO Blue
82 John Hancock Preferred
84 Private Healthcare Systems PPO
85 Liberty Mutal
87 CIGNA PPO
88 Freedom Care
89 Great West/NE Care
93 Psychological Health Plan
95 Pilgrim Select - PPO
96 Metrahealth (United Health Care of NE)
97 Unicare
99 or 099 Other POS (not listed elsewhere)
102 Wausau Insurance Company
136 BCBS Medex
137 AARP/Medigap Supplement
138 Banker's Life and Casualty Insurance
140 Combined Insurance Company of America **
141 Other Medigap (not listed elsewhere)
142 Blue Cross Indemnity
147 Other Commercial (not listed elsewhere)
148 Other HMO (not listed elsewhere)
149 PPO and Other Managed Care (not listed elsewhere)
154 BCBS Other (not listed elsewhere)
155 Blue Cross Managed Care Other (not listed elsewhere)
156 Out of State BCBS
157 Metrahealth - PPO (United Health Care of NE)
158 Metrahealth - HMO (United Health Care of NE)
160 Blue Choice
161 Aetna Managed Choice POS
162 Great West Life POS
163 United Healthcare Insurance Company - POS(New for 1997)
166 Private Healthcare Systems POS
167 Fallon POS
171 CIGNA POS
174 Aetna Health Inc. - Quality POS
175 Aetna Health Inc - HMO
176 Carelink (CIGNA & Tufts)
177 Chesapeake Life Insurance Company
179 First Health Life and Health Insurance Company
182 Unicare Preferred Plus Managed Access EPO
184 Private Healthcare Systems EPO
185 Connecticut General Life - Indemnity
186 Connecticut General Life - POS
187 Connecticut General Life - PPO
188 Fallon Flex POS
189 Fallon Major Medical - Indemnity
190 Fallon Preferred Care - PPO
191 Genworth Preferred PPO
192 Guarantee Trust Life Insurance Company - PPO
193 Harvard Pilgrim - Indemnity
194 Harvard Pilgrim - POS
195 Harvard Pilgrim - PPO
196 Harvard Pilgrim Health Care, Inc. (HMO)
197 Health Insurance Plan of New York (HIP)
198 John Alden Life Insurance Company
199 Other EPO (not listed elsewhere)
200 Hartford Life Insurance Co.
201 Mutual of Omaha
204 Christian Brothers Employee
205 Health New England Select Premier PPO
206 Health New England Guaranteed Issue - Individual Plans
209 Mid-West National Life Insurance Company of Tennessee
226 United Health Care of New England, Inc.
227 Northeast Health Direct - PPO
228 Oxford Health Plans
229 Professional Insurance Company (Indemnity)
235 Trustmark Life Insurance Company
236 Tufts Health Maintenance Organization, Inc. (TAHMO)
237 Tufts Insurance Company PPO
238 Tufts Associated Health Maintenance Organization, Inc. PPO
239 Tufts Associated Health Maintenance Organization, Inc. POS Plan
240 Unicare PPO
241 Union Security Insurance Company
242 Wellcare Health Plans, Inc.
243 Pioneer Health Network
244 Tufts Medicare Complement (TMC)
246 Preferred Blue PPO
247 Humana Insurance Company
248 Mail Handlers Benefit Plan
249 MEGA Life and Health Insurance Company
250 CIGNA HMO
251 Healthsource CMHC HMO
259 Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX)
270 UniCare Preferred Plus PPO
272 Auto Insurance
295 Meritain
310 Other: Commercial ACO Plan
800 Aetna Dental
801 Aflac
802 AllState
803 Altus Dental
804 Ameritas Life Insurance Corp
805 Anthem Blue Cross Blue Shield
806 Assurant
807 Blue Cross Blue Shield of MA
808 Blue Cross Blue Shield of RI
810 Cigna Dental
811 Creative PLan Dental Administrators
812 Delta Dental of MA
813 Delta Dental - Other
814 Delta Dental of New York
817 DentaQuest Senior Whole Heatlh
818 EverCare Dental
819 Fallon Health Plus
820 Great West Dental
822 Harvard Pilgrim Health Care
823 MetLife Dental
825 Unicare Dental
827 United HealthCare: Dental
828 Alicare
829 Adventist Risk Management INC
830 Blue Cross Blue Shield of Texas
831 Brokers National LIfe Insurance
832 Cba Blue Dental
833 Chesterfield Resources
834 Companion Life insurance
835 Dental Health Alliance
836 EBS Benefit Solutions
837 Empire Blue Cross
838 Excellus Blue Cross
839 Fortis
840 GEHA Connection Dental
841 GHI
842 Lincoln Financial Group
843 London Health Administrators
844 Midwest Life Insurance
845 Premier Access Dental Plans
846 Sentry Life Insurance
847 Sonoco
848 Sun Life Dental Benefits
849 Symetra Life Insurance Company
851 Dentemax Insurance
901 Other Commercial Managed Care (not listed elsewhere)
910 Allways Health Partners (effective 10/01/2020)
911 Anthem (effective 10/01/2020)
913 Health Plans Inc. (effective 10/01/2020)
914 Insurance Programmers (effective 10/01/2020)
915 Key Benefit (effective 10/01/2020)
916 Lifetime Benefit Solutions (effective 10/01/2020)
917 Nationwide (effective 10/01/2020)
918 QCC Insurance Company (effective 10/01/2020)
919 State Farm (effective 10/01/2020)
920 UMR Inc. (effective 10/01/2020)
145 Self-Pay 4 Self-pay
143 Free Care 5 No charge
990 Free Care - Co-pay, deductible or co-insurance (when billing for free care services use #143)
996 Charity Care
26 CHAMPUS/TriCare (effective 10/01/2020) 6 Other
98 Healthy Start
120 Out-Of-State Medicaid (valid prior to 2016)
144 Other Government
146 Worker's Compensation
150 Other Non-Managed Care (not listed elsewhere)
151 CHAMPUS
152 Foundation
153 Grant
178 Children's Medical Security Plan (CMSP)
288 Boston Medical Center HealthNet ConnectorCare
289 CeltiCareConnectorCare
290 Fallon ConnectorCare
291 Health New England ConnectorCare
292 Minuteman Health ConnectorCare
293 Neighborhood Health ConnectorCare
294 Network Health ConnectorCare
296 Commonwealth Care Alliance (effective 10/01/2020)
300 CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan can be identified)
301 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I
302 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II
303 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III
400 CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan can be identified)
401 CommCare: Cambridge Network Health Forward - Plan Type I
402 CommCare: Cambridge Network Health Forward - Plan Type II
403 CommCare: Cambridge Network Health Forward - Plan Type III
500 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - General Classification (For use only when no specific level for this plan can be identified)
501 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077)
502 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220)
503 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221)
600 CommCare: Neighborhood Health Plan- General Classification (For use only when no specific level for this plan can be identified)
601 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type I (9CC1)
602 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type II (9CC2)
603 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type III (9CC3)
700 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification
701 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 1
702 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 2
703 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 3
704 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care Bridge Program
809 Children's Medical Security
815 DentaQuest Commonwealth Care
826 United Concordia
850 Tricare Dental
903 Unlisted International Source
905 Other Connector Care Plan (not listed elsewhere)
921 Zenith (effective 10/01/2020)
922 Senior Whole Health (effective 10/01/2020)
930 VA Benefits (not listed elsewhere) (effective 10/01/2020)
931 Other Government Program (not listed elsewhere) (effective 10/01/2020)
932 Other Third Party Programs (not listed elsewhere) (ex. Vision TPA, Hospice, Transplant programs) (effective 10/01/2020)
995 Health Safety Net
Blank Missing . Missing
159 None (valid only for secondary source of payment) .A Invalid for PAY1
159 None (valid only for secondary source of payment) . Missing for PAY2
Other not documented values, 800-827 .A Invalid



Massachusetts
(Valid beginning 2010 through 2011 - SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
121 Medicare 1 Medicare
125 Medicare HMO - Fallon Senior Plan
128 Medicare HMO - HMO Blue for Seniors
131 Medicare HMO - Pilgrim Enhance 65
133 Medicare HMO -Tufts Medicare Supplement (TMS)
134 Medicare HMO - Other (not listed elsewhere)
135 Out-Of-State Medicare
168 Advantra Freedom
173 Aetna Medicare Open
180 Fresenius Medical Care Health Plan (Medicare Advantage Plan)
210 Medicare HMO - Pilgrim Preferred 65
213 Medicare HMO - Medicare Complete Plans offered by SecureHorizons
214 Medicare HMO - Harvard Pilgrim Health Plan - Medicare Enhance
215 Tufts Medicare HMO - Medicare Preferred
216 Medicare Special Needs Plan - Commonwealth Care Alliance
217 Medicare Special Needs Plan - Fallon Community Health Plan
218 Medicare Special Needs Plan - Senior Whole Health
219 Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IP
220 Medicare HMO - Blue Care 65
224 Medicare HMO - Tufts Secure Horizons
230 Medicare HMO - HCHP First Seniority Freedom
231 Medicare HMO - Pilgrim Prime
232 Medicare HMO - Senior Care Direct
233 Medicare HMO - Senior Care Plus
234 Medicare HMO - Managed Blue for Seniors
245 Trail Blazer Health Enterprises, LLC
252 Health New England (HNE) Medicare Advantage Plan
253 Blue Medicare PFFS
254 Cigna Medicare Access Plans
255 Health Net Pearl
256 Humana Gold PFFS
257 Today's Options Premier from Universal American
258 Unicare Security Choice
273 MassHealth Senior Care Options 2 Medicare for PAY 1
273 MassHealth Senior Care Options 2 Medicaid for PAY 2
103 Medicaid (includes MassHealth) 2 Medicaid
104 Medicaid Managed Care-Primary Care Clinician (PCC)
108 Medicaid Managed Care-Fallon Community Health Plan
113 Medicaid Managed Care-Neighborhood Health Plan
118 Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership
119 Medicaid Managed Care Other (not listed elsewhere)
207 Network Health (Cambridge Health Alliance MCD Program)
208 HealthNet (Boston Medical Center MCD Program)
11 Blue Care Elect 3 Private
136 BCBS Medex
142 Blue Cross Indemnity
154 BCBS Other (not listed elsewhere)
156 Out of State BCBS
30 CIGNA (Indemnity)
51 Aetna Life Insurance
55 Guardian Life Insurance
57 John Hancock Life Insurance
62 Mutual of Omaha Insurance
74 United Healthcare Insurance Company
89 Great West/NE Care
97 Unicare
102 Wausau Insurance Company
137 AARP/Medigap Supplement
138 Banker's Life and Casualty Insurance
141 Other Medigap (not listed elsewhere)
147 Other Commercial (not listed elsewhere)
176 Carelink (CIGNA & Tufts)
177 Chesapeake Life Insurance Company
179 First Health Life and Health Insurance Company
185 Connecticut General Life - Indemnity
189 Fallon Major Medical - Indemnity
193 Harvard Pilgrim - Indemnity
197 Health Insurance Plan of New York (HIP)
198 John Alden Life Insurance Company
206 Health New England Guaranteed Issue - Individual Plans
209 Mid-West National Life Insurance Company of Tennessee
228 Oxford Health Plans
229 Professional Insurance Company (Indemnity)
235 Trustmark Life Insurance Company
241 Union Security Insurance Company
242 Wellcare Health Plans, Inc.
244 Tufts Medicare Complement (TMC)
247 Humana Insurance Company
248 Mail Handlers Benefit Plan
249 MEGA Life and Health Insurance Company
4 Fallon Community Health Plan
38 Health New England Select (self-funded)
42 ConnectiCare of Massachusetts
46 Blue ChiP (BCBS Rhode Island)
47 Neighborhood Health Plan
148 Other HMO (not listed elsewhere)
174 Aetna Health Inc. - Quality POS
175 Aetna Health Inc - HMO
194 Harvard Pilgrim - POS
195 Harvard Pilgrim - PPO
196 Harvard Pilgrim Health Care, Inc. (HMO)
236 Tufts Health Maintenance Organization, Inc. (TAHMO)
238 Tufts Associated Health Maintenance Organization, Inc. PPO
239 Tufts Associated Health Maintenance Organization, Inc. POS Plan
243 Pioneer Health Network
259 Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX)
81 HMO Blue
155 Blue Cross Managed Care Other (not listed elsewhere)
160 Blue Choice
246 Preferred Blue PPO
161 Aetna Managed Choice POS
162 Great West Life POS
171 CIGNA POS
182 Unicare Preferred Plus Managed Access EPO
190 Fallon Preferred Care - PPO
191 Genworth Preferred PPO
192 Guarantee Trust Life Insurance Company - PPO
226 United Health Care of New England, Inc.
250 CIGNA HMO
28 Great West Life PPO
31 One Health Plan HMO (Great West Life)
36 United Healthcare Insurance Company - PPO (new for 1997)
82 John Hancock Preferred
84 Private Healthcare Systems PPO
149 PPO and Other Managed Care (not listed elsewhere)
187 Connecticut General Life - PPO
205 Health New England Select Premier PPO
227 Northeast Health Direct - PPO
237 Tufts Insurance Company PPO
240 Unicare PPO
99 Other POS (not listed elsewhere)
166 Private Healthcare Systems POS
186 Connecticut General Life - POS
188 Fallon Flex POS
184 Private Healthcare Systems EPO
199 Other EPO (not listed elsewhere)
272 Auto Insurance
22 Aetna Open Choice PPO
23 Guardian Life Insurance Company PPO
87 CIGNA PPO
24 Health New England Inc.
79 Pioneer Health Care PPO
145 Self-Pay 4 Self-pay
996 Charity Care 5 No charge
98 Healthy Start 6 Other
150 Other Non-Managed Care (not listed elsewhere)
152 Foundation
153 Grant
146 Worker's Compensation
120 Out-Of-State Medicaid
144 Other Government
151 CHAMPUS
178 Children's Medical Security Plan (CMSP)
995 Health Safety Net
300 CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan can be identified)
301 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I
302 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II
303 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III
400 CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan can be identified)
401 CommCare: Cambridge Network Health Forward - Plan Type I
402 CommCare: Cambridge Network Health Forward - Plan Type II
403 CommCare: Cambridge Network Health Forward - Plan Type III
500 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - General Classification (For use only when no specific level for this plan can be identified)
501 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077)
502 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220)
503 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221)
600 CommCare: Neighborhood Health Plan- General Classification (For use only when no specific level for this plan can be identified)
601 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type I (9CC1)
602 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type II (9CC2)
603 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type III (9CC3)
700 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification
701 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 1
702 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 2
703 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 3
704 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care Bridge Program
159 None (valid only for secondary source of payment) . Missing for PAY2
Blank Missing . Missing
159 None (valid only for secondary source of payment) .A Invalid for PAY1
Other not documented values, 800-827 .A Invalid



Massachusetts
(Valid 2002 through 2009 - SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
121 Medicare 1 Medicare
220 Medicare HMO - Blue Care 65
125 Medicare HMO - Fallon Senior Plan
221 Medicare HMO - Harvard Community Health Plan 65
223 Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus
230 Medicare HMO - HCHP First Seniority
127 Medicare HMO - Health New England Medicare Wrap
222 Medicare HMO - Healthsource CMHC
212 Medicare HMO - Healthsource CMHC Central Care Supplement
128 Medicare HMO - HMO Blue for Seniors
129 Medicare HMO - Kaiser Medicare Plus Plan
234 Medicare HMO - Managed Blue for Seniors
132 Medicare HMO - Matthew Thornton Senior Plan
211 Medicare HMO - Neighborhood Health Plan Senior Health Plus
134 Medicare HMO - Other (not listed elsewhere)
131 Medicare HMO - Pilgrim Enhance 65
210 Medicare HMO - Pilgrim Preferred 65
231 Medicare HMO - Pilgrim Prime
232 Medicare HMO - Seniorcare Direct
233 Medicare HMO - Seniorcare Plus
224 Medicare HMO - Tufts Secure Horizons
225 Medicare HMO - US Healthcare
133 Medicare HMO - Tufts Medicare Supplement (TMS)
135 Out-of-State Medicare
208 HealthNet (Boston Medical Center MCD Program) 2 Medicaid
103 Medicaid (includes MassHealth)
107 Medicaid Managed Care - Community Health Plan
108 Medicaid Managed Care - Fallon Community Health Plan
109 Medicaid Managed Care - Harvard Community Health Plan
110 Medicaid Managed Care - Health New England
111 Medicaid Managed Care - HMO Blue
112 Medicaid Managed Care - Kaiser Foundation Plan
113 Medicaid Managed Care - Neighborhood Health Plan
115 Medicaid Managed Care - Pilgrim Health Care
114 Medicaid Managed Care - United Health Plans of NE (Ocean State Physician's Plan)
119 Medicaid Managed Care Other (not listed elsewhere)
106 Medicaid Managed Care - Central Mass. Health Care
104 Medicaid Managed Care - Primary Care Clinician (PCC)
116 Medicaid Managed Care - Tufts Associated Health Plan
118 Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnerships
207 Network Health (Cambridge Health Alliance MCD Program)
120 Out-of-State Medicaid
71 ADMAR 3 Private Insurance
137 AARP/Medigap supplement
51 Aetna Life Insurance
161 Aetna Managed Choice POS
22 Aetna Open Choice PPO
272 Auto Insurance
138 Banker's Life and Casualty Insurance
139 Banker's Multiple LIne
2 Bay State - a product of HMO Blue
136 BCBS Medex
11 Blue Care Elect
46 Blue Chip (BCBS Rhode Island)
160 Blue Choice (incl. Healthflex Blue) - POS
142 Blue Cross Indemnity
50 Blue Health Plan for Kids
52 Boston Mutual Insurance
154 BCBS Other (not listed elsewhere)
155 Blue Cross Managed Care Other (not listed elsewhere)
204 Christian Brothers Employee
30 CIGNA (Indemnity)
250 CIGNA HMO
171 CIGNA POS
87 CIGNA PPO
140 Combined Insurance Company of America
21 Commonwealth PPO
44 Community Health Plan
13 Community Health Plan Options (New York)
42 ConnectiCare of Massachusetts
54 Continental Assurance Insurance
69 Corporate Health Insurance Liberty Plan
4 Fallon Community Health Plan (includes Fallon Plus, Fallon Affiliates, Fallon Umass)
167 Fallon POS
67 First Allmerica Financial Life Insurance
181 First Allmerica Financial Life Insurance EPO
27 First Allmerica Financial Life Insurance PPO
88 Freedom Care
162 Great West Life POS
28 Great West Life PPO
89 Great West/NE Care
55 Guardian Life Insurance
23 Guardian Life Insurance Company PPO
56 Hartford L & A Insurance
200 Hartford Life Insurance Co.
1 Harvard Community Health Plan
20 HCHP of New England (formerly RIGHA)
37 HCHP - Pilgrim HMO (integrated product)
14 Health New England Advantage POS
38 Health New England Select (self funded)
24 Health New England, Inc.
45 Health Source New Hampshire
251 Healthsource CMHC HMO
164 Healthsource CMHC Plus POS
49 Healthsource CMHC Plus PPO
72 Healthsource New Hampshire
165 Healthsource New Hampshire POS (self funded)
90 Healthsource Preferred (self funded)
271 Hillcrest HMO
81 HMO Blue
57 John Hancock Life Insurance
82 John Hancock Preferred
169 Kaiser Added Choice
40 Kaiser Foundation
58 Liberty Life Insurance
85 Liberty Mutual
59 Lincoln National Insurance
19 Matthew Thornton
43 MEDTAC
96 Metrahealth (United Care of NE)
158 Metrahealth - HMO (United Care of NE)
172 Metrahealth - POS (United Care of NE)
157 Metrahealth - PPO (United Care of NE)
201 Mutual of Omaha
62 Mutual of Omaha Insurance
33 Mutual of Omaha PPO
47 Neighborhood Health Plan
3 Network Blue (PPO)
91 New England Benefits
63 Mutual of Omaha Insurance (Valid 2002 only)
63 New England Mutual Insurance (Valid beginning in 2003)
64 New York Life Care Indemnity (New York Life Insurance)
34 New York Life Care PPO
202 New York Life Insurance
199 Other EPO (not listed elsewhere)
31 One Health Plan HMO (Great West Life)
77 Options for Healthcare PPO
147 Other commercial insurance (not listed elsewhere)
148 Other HMO (not listed elsewhere)
141 Other Medigap (not listed elsewhere)
99 Other POS (not listed elsewhere)
156 Out-of-State BCBS
65 Paul Revere Life Insurance
78 Phoenix Preferred PPO
10 Pilgrim Advantage - PPO
39 Pilgrim Direct
8 Pilgrim Health Care
95 Pilgrim Select - PPO
183 Pioneer Health Care EPO
79 Pioneer Health Care PPO
25 Pioneer Plan
149 PPO and Other Managed Care (not listed elsewhere)
203 Principal Financial Group (Prinicipal Mutual Life)
184 Private Healthcare Systems EPO
166 Private Healthcare Systems POS
84 Private Healthcare Systems PPO
75 Prudential Healthcare HMO
17 Prudential Healthcare POS
18 Prudential Healthcare PPO
66 Prudential Insurance
93 Psychological Health Plan
101 Quarto Claims
94 Time Insurance Co.
100 Transport Life Insurance
7 Tufts Associated Health Plan
80 Tufts Total Health Plan PPO
97 Unicare
182 Unicare Preferred Plus Managed Access PPO
270 Unicare Preferred Plus PPO
70 Union Labor LIfe Insurance
86 United Health & Life PPO (subsidiary of United Health Plans of NE)
73 United Health & Life (subsidiary of United Health Plans of NE)
9 United Health Plan of New England (Ocean State)
74 United Healthcare Insurance Company
35 United Healthcare Insurance Company - HMO (new for 1997)
163 United Healthcare Insurance Company - POS (new for 1997)
36 United Healthcare Insurance Company - PPO (new for 1997)
48 US Healthcare
83 US Healthcare Quality Network Choice PPO
170 US Healthcare Quality POS
102 Wausau Insurance Company
145 Self-Pay 4 Self-pay
143 Free Care 5 No charge
990 Free Care - co-pay, deductible, or co-insurance (when billing for free care services use #143)
98 Healthy Start
151 CHAMPUS 6 Other
152 Foundation
153 Grant
144 Other Government
150 Other Non-Managed Care (not listed elsewhere)
146 Worker's Compensation
Blank Missing . Missing
159 None (Valid only for secondary source of payment)
Any values not documented by the data source .A Invalid


Massachusetts (SID)
Massachusetts
(Valid beginning in 1998 - SID)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3 Medicare 1 Medicare
F Medicare Managed Care (includes Medicare Advantage)
S Senior Care Options/Integrated Care Organization (Effective 10/01/2020)
4 Medicaid 2 Medicaid
A Medicaid Accountable Care Organization (Effective 10/01/2020)
B Medicaid Managed Care/MCO
6 Blue Cross (valid prior to 10/01/2020) 3 Private Insurance
C Blue Cross Managed Care (valid prior to 10/01/2020)
C Commercial Accountable Care Organization (Effective 10/01/2020)
7 Other Commercial Insurance not listed elsewhere
D Commercial Managed Care
8 HMO
E PPO and Other Managed Care not listed elsewhere
J Point of Service Plan
K Exclusive Provider Plan
T Auto Insurance
Z Dental Plans
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Worker's Compensation 6 Other
H Health Safety Net (Beginning in 2009)
5 Other government payment
0 Other non-managed care plans
Q CommCare
N, Blank None, Missing . Missing
Any values not documented by the data source .A Invalid



Massachusetts
(Valid from 1996-1997 - SID)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3, F Medicare; Medicare managed care 1 Medicare
4, B Medicaid; Medicaid managed care 2 Medicaid
6, C Blue Cross; Blue Cross managed care 3 Private Insurance
7, D, E Commercial Insurance; Commercial managed care; PPO and other managed care not listed elsewhere
8, J HMO; Point of Service (added 4th Qtr 1997)
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Worker's Compensation 6 Other
5 Other government payment
0 Primary Payer: Other non-managed care
0, A Secondary Payer: Other non-managed care; Other or principal source of payment covered in full
Blank Primary Payer: . Missing
Blank Secondary Payer: . Missing
Other values   .A Invalid



Massachusetts
(Valid from Quarter 4, 1993 through 1995 - SID)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3, F Medicare; Medicare managed care 1 Medicare
4, B Medicaid; Medicaid managed care 2 Medicaid
6, C Blue Cross; Blue Cross managed care 3 Private Insurance
7, D Commercial Insurance; Commercial managed care
8, J HMO
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Workers' Compensation 6 Other
5 Other government payment
0, E Primary Payer: Other non-managed care; PPO and other managed care not listed elsewhere
0, A, E Secondary Payer: Other non-managed care; Other or principal source of payment covered in full; PPO and other managed care not listed elsewhere
Blank Primary Payer: . Missing
"N",Blank Secondary Payer:None . Missing
Other values   .A Invalid



Massachusetts
(Valid from 1988 through Quarter 3, 1993 - SID)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3 Medicare 1 Medicare
4 Medicaid 2 Medicaid
6 Blue Cross 3 Private Insurance
7 Commercial Insurance
8 HMO
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Workers' Compensation 6 Other
5 Other government payment
0 Primary Payer: Other
0, A Secondary Payer: Other; Other or principal source of payment covered in full
Blank Primary Payer: . Missing
"N",Blank Secondary Payer:None . Missing
Other values   .A Invalid


Minnesota (SID and SEDD)
Minnesota
(Valid beginning in 2001 - SID, SASD, SEDD)
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
2000000 Medicare 1 Medicare
6000003 Blue Cross, Medicare
6000103 Blue Cross, MN, Medicare
6009903 Blue Cross, Other, Medicare
7000102 Medica - Choice, Medicare
7000202 Group Health, Medicare
7000402 Medica - Primary, Medicare
7000502 MedCenters, Medicare
7000602 UCare, Medicare
7000702 Blue Plus, Medicare
7000802 Metro. Health Plan, Medicare
7001002 Health Partners, Medicare
7001302 First Plan HMO, Medicare
7001402 Altru Health Plan, Medicare
7001502 Sioux Valley, Medicare
7000902 Blue Cross HMO, Medicare
7009902 Other HMO, Medicare
8000302 SelectCare, Medicare
8000402 Preferred One, Medicare
8000502 America's PPO, Medicare
8000602 Aetna PPO, Medicare
8000902 Blue Cross PPO, Medicare
8001302 Private Health Care System, Medicare
8001502 LaborCare PPO, Medicare
8009902 Other PPO, Medicare
3000000 Medicaid 2 Medicaid
3000001 Medicaid Pending
3000100 Medicaid, Minnesota
3000101 Pending, MN, Medicaid
3000200 Medicaid, Wisconsin
3000201 Medicaid, Wisconsin, Pending
7000301 Ramsey Care, Medicaid
3000900 Medicaid, South Dakota
3000901 Medicaid, South Dakota, Pending
3001101 Medicaid, Iowa, Pending
3001000 Medicaid, North Dakota
3001100 Medicaid, Iowa
3009900 Medicaid, Other
3009901 Medicaid, Other, Pending Eligible
4000500 General Assistance Medical Care (GAMC)/GA/Welfare (Starting in 2010)
4000800 PrimeWest, Cty Based Purchased (Starting in 2010)
4000900 Itasca Medical Care, CBP (Starting in 2010)
4001000 So. Country Hlth Alliance, CBP (Starting in 2010)
7000101 Medica - Choice, Medicaid
7000103 Medica - Choice, GAMC (Starting in 2010)
7000201 Group Health, Medicaid
7000301 Ramsey Care, Medicaid
7000303 Ramsey Care, GAMC, etc. (Starting in 2010)
7000401 Medica - Primary, Medicaid
7000501 MedCenters, Medicaid
7000601 Ucare, Medicaid
7000603 Ucare, GAMC, etc. (Starting in 2010)
7000701 Blue Plus, Medicaid
7000703 Blue Plus, GAMC, etc. (Starting 2010)
7000801 Metro. Health Plan, Medicaid
7000803 Metro. Health Plan, GAMC, etc. (Starting in 2010)
7000901 Blue Cross HMO, Medicaid
7001001 Health Partners, Medicaid
7001003 Health Partners, GAMC, etc. (Starting in 2010)
7001201 Northwest National Life (NWNL) Health Network, Medicaid
7001301 First Plan HMO, Medicaid
7001401 Altru Health Plan, Medicaid
7001501 Sioux Valley, Medicaid
7009901 Other HMO, Medicaid
7009903 Other HMO, GAMC/GA/Welfare (Starting in 2010)
8000301 SelectCare, Medicaid
8000401 Preferred One, Medicaid
8000501 America's PPO, Medicaid
8000701 Group Health PPO, Medicaid
8000901 Blue Cross PPO, Medicaid
8001001 Medica Choice PPO, Medicaid
8001501 LaborCare PPO, Medicaid
8009901 Other PPO, Medicaid
5000000 Commercial 3 Private insurance
5009900 Commercial
5009901 Commercial (Regina)
6000000 Blue Cross
6000001 Blue Cross, Aware
6000100 Blue Cross, MN
6000101 Blue Cross, MN, Aware
6000102 Blue Cross, Preferred Gold
6000200 Blue Cross, North Dakota
6000201 Blue Cross, North Dakota, Aware
6000202 Blue Cross, North Dakota, Preferred Gold
6009900 Blue Cross, Non-MN
6009901 Blue Cross, Non-MN Aware
6009902 Blue Cross, Other, Preferred Gold
7000000 Other HMO
7000100 Medica - Choice
7000200 Group Health
7000300 Ramsey Health
7000400 Medica - Primary
7000500 MedCenters
7000600 Ucare
7000700 Blue Plus
7000800 Metro. Health Plan
7000900 Blue Cross HMO
7001000 Health Partners
7001200 Northwest National Life (NWNL) Health Network
7001300 First Plan HMO
7001400 Altru Health Plan
7001500 Sioux Valley
7009900 Other HMO
8000000 Other PPO
8000300 SelectCare
8000320 SelectCare, Union
8000400 Preferred One
8000420 Preferred One, Union
8000500 ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO)
8000520 ARAZ (formerly Ethix Midwest; also known as America's PPO)
8000600 Aetna PPO
8000620 Aetna PPO, Union
8000700 Group Health PPO
8000800 HealthEast Care, Inc.
8000900 Blue Cross PPO
8001000 Medica Choice PPO
8001020 Medica, Union
8001200 Northwest National LIfe (NWNL) PPO
8002300 Private Health Care System
8001400 Prudential Plus
8001500 LaborCare PPO
8001520 LaborCare PPO, Union
8500100 Self Insured, Choice Plus
8509900 Other Self Insured
8009900 Other PPO
8009920 Other PPO, union
9001000 Other, Self-Insured Co.
9002000 Other, Unions
1000000 Self-Pay 4 Self-Pay
1000100 Self-Pay
1000102 Self-Pay
1000200 Self-Pay, No Charge
-- -- 5 No charge
3060000 Minnesota Care 6 Other
3060100 Minnesota Care
4000000 Other Government
4000100 Title V
4000200 Worker's Comp
4000201 Worker's Comp, Minnesota (Starting in 2015)
4000202 Worker's Comp, Out of State (Starting in 2015)
4000203 Worker's Comp, Federal (Starting in 2015)
4000300 TRICARE/CHAMPUS
4000400 MN Comp. Health Care
4000402 MN Comp. Health Care (Out of State) (Starting in 2015)
4000500 General Assistance Medical Care (GAMC)/GA/Welfare (Prior to 2010)
4000600 Aid to Families with Dependent Children (AFDC)
4000700 Children's Health Plan
4000800 PrimeWest, Cty Based Purchased (Prior to 2010)
4000900 Itasca Medical Care, CBP (Prior to 2010)
4001000 So. Country Hlth Alliance, CBP (Prior to 2010)
4009900 Other Govt., Other
7000103 Medica - Choice, GAMC (Prior to 2010)
7000104 Medica-Choice, MNCare
7000204 HMO, Group Health Plan, MNCARE
7000303 Ramsey Care, GAMC, etc. (Prior to 2010)
7000404 Medica-Primary, MNCare
7000603 Ucare, GAMC, etc. (Prior to 2010)
7000604 U-Care, MNCare
7000703 Blue Plus, GAMC, etc. (Prior to 2010)
7000704 Blue Plus, MNCare
7000803 Metro. Health Plan, GAMC, etc. (Prior to 2010)
7000804 Metro. Health Plan, MNCare
7000904 Blue Cross HMO, MNCare
7001003 Health Partners, GAMC, etc. (Prior to 2010)
7001004 Health Partners, MNCare
7001304 First Plan HMO, MNCare
7001404 Altru Health Plan, MNCare
7001504 Sioux Valley, MNCare
7009903 Other HMO, GAMC/GA/Welfare (Prior to 2010)
7009904 Other HMO, MNCare
8000404 Preferred One, MNCare
8000504 America's PPO, MNCare
8000604 Aetna PPO, MNCare
8000804 HealthEast Care, Inc. MNCare
8000920 PPO, Blue Cross PPO, Union
8000904 Blue Cross PPO, MNCare
8001304 Private Hlth Care Sys MNCare
8001404 Prudential Plus, MNCare
8001504 LaborCare PPO MNCare
8009904 Other PPO, MNCare
9000000 Other
9009900 Other
Blank Missing . Missing
8888888 Missing/Unknown (or insurance master)
9999999 Missing/Unknown (not on insurance master)
Any values not documented by the data source .A Invalid


Missouri (SID and SEDD)
Missouri
(Valid beginning in 1995 - SID, Valid beginning in 1999 - SASD and SEDD)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
02 Medicaid 2 Medicaid
04 Blue Cross/Blue Shield 3 Private Insurance
07 Commercial/Private Insurance
06 Self-pay 4 Self-pay
08 No charge (charity) 5 No charge
03 Maternal and Child Health 6 Other
05 Worker's Compensation
09 Other government (CHAMPUS)
10 Other
99, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid

Separate information on HMO and PPO providers is not provided.



Nebraska (SID and SEDD)

Prior to data year 2016, some Medicaid managed care patients may have been categorized in the data under private insurance instead of Medicaid because the Medicaid program was managed by a commercial insurance company. Beginning with data year 2016, there are large increases in the number of Medicaid records and proportionate decreases in records categorized as private insurance because the Nebraska Partner organization improved the process for the identification of patients covered by Medicaid managed care programs managed by commercial insurance companies.

Nebraska
Value Description Value Description
(Begin in 2020)
MA Medicare Part A 1 Medicare
MB Medicare Part B
16 Health Maintenance Organization (HMO) Medicare Risk
MC Medicaid 2 Medicaid
AM Automobile Medical 3 Private Insurance
BL Blue Cross/BlueShield
CI Commercial Insurance Co.
FI Federal Employees Program
HM Health Maintenance Organization
LI Liability
LM Liability Medical
10 Central Certification
12 Preferred Provider Organization (PPO)
13 Point of Service (POS)
14 Exclusive Provider Organization (EPO)
15 Indemnity Insurance
15 Indemnity Insurance
17 Dental Maintenance Organization
09 Self-pay 4 Self-pay
-- -- 5 No charge
CH Champus/Champva 6 Other
11 Other Non-Federal Programs
DS Disability
OF Other Federal Program
TV Title V
VA Veteran Administration Plan
WC Workers' Compensation Health Claim
Blank, ZZ Missing . Missing
Any values not documented by the data source .A Invalid



Nebraska
(Valid SID, SASD, SEDD)
PAY1_X, PAY2_X and PAY3_X PAY1
Value Description Value Description
(Prior to 2020)
02 Medicare 1 Medicare
04 Medicaid 2 Medicaid
12 Medicaid
01 Commercial Insurance 3 Private Insurance
03 Commercial Insurance
08 Commercial Insurance
11 Commercial Insurance
13 Commercial Insurance
14 Commercial Insurance
09, 9 Self-pay 4 Self-pay
-- -- 5 No charge
05 Worker's Compensation 6 Other
06 Champus/Champva
07 Other Federal and State Programs
10 Other (For PAY2 and PAY3 only, a value of other was reported instead of missing in the 2014 data.)
Blank Missing . Missing
Any values not documented by the data source .A Invalid


Nevada (SID and SEDD)
Nevada
(Valid beginning 2012 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
10 Medicare 1 Medicare
27 Medicare HMO
16 Nevada Medicaid 2 Medicaid
17 Other Medicaid
28 Nevada Medicaid HMO
20 Commercial Insurer 3 Private insurance
21 Negotiated Discounts e.g. Preferred Provider Organization (PPO)
22 Health Maintenance Organization (HMO)
18 Self Pay 4 Self-pay
12 Charity 5 No charge
13 Hill-Burton Free Care (HBFC) (starting in 2012)
11 Black Lung 6 Other
13 Hill-Burton Free Care (HBFC) (prior to 2012)
14 CHAMPUS / CHAMPVA
19 Miscellaneous - does not fit any of the other categories. This field covers insurers that are not licensed to sell insurance in Nevada
23 County Indigent Referral (Patient has already been approved for County Coverage)
24 All Worker's Compensation Cases
29 Section 1011 undocumented Aliens/unknown
99, Blank Missing, unknown . Missing
other   .A Invalid



Nevada
(Valid 2008-2011 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
10 Medicare 1 Medicare
27 Medicare HMO
16 Nevada Medicaid 2 Medicaid
17 Other Medicaid
28 Nevada Medicaid HMO
20 Commercial Insurer 3 Private insurance
21 Negotiated Discounts e.g. Preferred Provider Organization (PPO)
22 Health Maintenance Organization (HMO)
24 All Worker's Compensation Cases
25 Nevada Blue Cross / Blue Shield
26 Other Blue Cross / Blue Shield
18 Self Pay 4 Self-pay
12 Charity 5 No charge
11 Black Lung (beginning in 2006, Black Lung was coded as 11 instead of 6) 6 Other
13 Hill-Burton Free Care (HBFC)
14 CHAMPUS / CHAMPVA
19 Miscellaneous - does not fit any of the other categories. This field covers insurers that are not licensed to sell insurance in Nevada
23 County Indigent Referral (Patient has already been approved for County Coverage)
29 Section 1011 undocumented Aliens/unknown
99, Blank Missing . Missing
Any values not documented by the data source .A Invalid



Expected payer information from two hospitals in the 2006 Nevada source data was unreliable; consequently, PAY1 was set to "Invalid" (.A) for these two hospitals.

Nevada
(Valid 2002-2007 - SID)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
10 Medicare 1 Medicare
27 Medicare HMO
16 Nevada Medicaid 2 Medicaid
17 Other Medicaid
28 Medicaid HMO
20 Commercial Insurer 3 Private insurance
21 Negotiated Discounts e.g. Preferred Provider Organization (PPO)
22 Health Maintenance Organization (HMO)
24 State Industrial Insurance System (SIIS) (beginning in 2005)
25 Nevada Blue Cross/Blue Shield (BC)
26 Other Blue Cross/Blue Shield (BS)
18 Self Pay 4 Self-pay
12 Charity 5 No charge
11 Black Lung (beginning in 2006, Black Lung was coded as 11 instead of 6) 6 Other
13 Hill-Burton Free Care (HBFC)
14 CHAMPUS (or successor)
15 CHAMPVA (or successor)
19 Miscellaneous - does not fit any of the other categories. This field covers insurers that are not licensed to sell insurance in Nevada
23 County Indigent Referral (those already qualified for, or being referred to, the County Indigent program)
29 Section 1011 undocumented Aliens/unknown
99, Blank Missing . Missing
Any values not documented by the data source .A Invalid


New Hampshire (SID and SEDD)
New Hampshire
(Valid beginning in 2019)
PAY1_X PAY1
Value Description Value Description
MEDICARE Medicare 1 Medicare
MEDICAID Medicaid 2 Medicaid
COMMERCIAL Commercial 3 Private Insurance
UNINSURED Uninsured 4 Self-pay
SELF-PAY Self-pay
OTHER FEDERAL GOVERNMENT Other Federal Government 6 Other
WORKER COMPENSATION workers Compensation
OTHER Other
Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid


New Hampshire
(Valid through 2009)
PAY1_X PAY1
Value Description Value Description
3 Medicare 1 Medicare
10 Medicare Managed Care
4 Medicaid 2 Medicaid
11 Medicaid Managed Care
5 HMO 3 Private Insurance
7 Blue Cross
8 Commercial insurance
1 Self-Pay 4 Self-pay
--   5 No charge
2 Worker's Compensation 6 Other
6 Other government
9 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid


New Jersey (SID and SEDD)
New Jersey
(Valid beginning 2020 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
100Medicare1Medicare
110Medicare Managed Care
111Medicare HMO
112Medicare PPO
113Medicare POS
119Medicare Manage Care Other
120Medicare Non-Managed Care
121Medicare FFS
122Medicare Drug Benefit
123Medicare medical Savings Account
129Medicare Non-Managed Care Other
130Medicare Hospice
140Dual Eligibility Medicare/Medicaid
190Medicare Other
191Medicare Pharmacy Benefit Manager
523Medicare Supplemental Policy
008NJ Family Care2Medicaid
200Medicaid
210Medicaid Managed Care
211Medicaid HMO
212Medicaid PPO
213Medicaid Primary Care Case Management
219Medicaid Managed care Other
220Medicaid Non-Managed Care Plan
230Medicaid/SCHIP
250Medicaid-Out of State
260Medicaid-Long Term Care
290Medicaid Other
291Medicaid Pharmacy Benefit Manager
299Medicaid-Dental
361State SCHIP Program
199Other Commercial Insurance3Private Insurance
500Private Heath Insurance
510Managed Care-Private
511Commercial Managed Care-HMO
512Commercial Managed Care-PPO
513Commercial Managed Care-POS
514Exclusive Provider Organization
515Gatekeeper PPO
516Commerical Managed Care-Pharmacy Benefit Manager
517Commercial managed Care-Dental
519Other Managed Care, Non HMO
520Private Heath Insurance-Indemnity
521Commercial Indemnity
522Self-Insured Administrative Services
524Imdenity Insurance-Dental
529Other Commercial Indemnity Private
530Managed Care (Private) or Private Health Insurance (Indemnity) Not Otherwise Specified
540Organized Delivery System
550Small Employer Purchasing Group
560Specialized Stand Alone Plan
590Other Private Insurance
600Blue Cross/Blue Shield
610Blue Cross Managed Care
611Blue Cross Managed Care-HMO
612Blue Cross Managed Care-PPO
613Blue Cross Managed Care-POS
614Blue Cross Managed Care-Dental
619Other Blue Cross Managed Care
621Blue Cross Indemnity
622Blue Cross Self-Insured
623Blue Cross Medicare Supplemental
624Blue Cross Indemnity-Dental
710HMO
720PPO
730POS
790Other Manage Care
960Auto Insurance (includes No Fault)
039 Other Source of Patient Payment4Self-Pay
800No Payment from an organization/agency/program/private payer listed
810Self-Pay
083Refusal to pay/bad debt5No Charge
820No Charge
821Charity Care
822Professional Courtesy
823Research/Clinical Trial
300Other Government (Federal, State, Local)6Other
310Department of Defense
311Champus
312Military Treatment Facility
313Dental-Stand Alone
320Department of Veterans Affairs
321Veteran Care
322Non-Veteran Care
330Indian Health Service or Tribe
331Indian Health Service-Regular
332Indian Health Service-Contract
333Indian Health Service-Managed Care
334Indian Health-Sponsored Coverage
340HRSA Progam
341HRSA Title V
342Migrant Health Program
343Ryan White Act
349Other HRSA Program
362Specific State Program
369State, Not Otherwise Specified
370Local Government
371Local Managed Care
372FFS/Indemnity
379Other Local, County
380Other Government (Federal, State, Local Not Specified)
381Federal, State, Local Not Specified Managed Care
382Federal, State, Local Not Specified-FFS
383Federal, State, Local Not Specified-HMO
384Federal, State, Local Not Specified-PPO
385Federal, State, Local Not Specified-POS
386Federal, State, Local Not Specified-Not Specified Managed Care
389Federal, State, Local Not Specified-Other
390Other Federal
391Federal Employee Health Plan
400Departments of Corrections
410Corrections Federal
420Corrections State
430Corrections Local
440Corrections Unknown Level
910Foreign/National
920Other (Non-government)
921Other (Government)
930Disability Insurance
940Long-Term Care Insurance
950Workers Compensation
951Workers Compensation HMO
953Workers Compensation FFS
954Workers Compensation Other Managed Care
959Workers Compensation Other Unspecified
970Legal Liability
980Other Specified but not otherwise classifiable
990No Typology Code Available for Payment Source.Missing
999Unavailable/No Payer Specified/Blank.Missing
BlankNot Available, Missing.Missing
Any values not documented by the data source.AInvalid



New Jersey
(Valid from 2017-2019 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Medicare: Other 1 Medicare
011 Medicare Part A
015 Medicare Part B
017 Medicare Part B
082 Medicare HMO (Beginning in 2003)
008 NJ Family Care 2 Medicaid
012 Title XIX (Medicaid)
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan 3 Private Insurance
018 State Employee Insurance (Beginning in 1998)
020 Blue Cross Plan
022 Blue Cross Plan
025 Blue Cross Plan
026 Blue Cross Plan
029 Blue Cross Plan
030 Blue Cross Plan
040 Blue Cross Plan
041 Blue Cross Plan (1994 only)
042 Blue Cross Plan (1994 only)
050 Blue Cross Plan
060 Blue Cross Plan
070 Blue Cross Plan
080 Blue Cross Plan
090 Blue Cross Plan
100 Blue Cross Plan (1994 only)
101 Blue Cross Plan
110 Blue Cross Plan
121 Blue Cross Plan
130 Blue Cross Plan
140 Blue Cross Plan
141 Blue Cross Plan (discontinued 1/1/15)
150 Blue Cross Plan
160 Blue Cross Plan
170 Blue Cross Plan
180 Blue Cross Plan
190 Blue Cross Plan
200 Blue Cross Plan
210 Blue Cross Plan
220 Blue Cross Plan
230 Blue Cross Plan
240 Blue Cross Plan
241 Blue Cross Plan
250 Blue Cross Plan
260 Blue Cross Plan
265 Blue Cross Plan
270 Blue Cross Plan
280 Blue Cross Plan
281 Blue Cross Plan (valid beginning 1/93)
290 Blue Cross Plan
300 Blue Cross Plan (1994 only)
301 Blue Cross Plan
303 Blue Cross Plan
304 Blue Cross Plan
305 Blue Cross Plan
306 Blue Cross Plan
307 Blue Cross Plan (1994 only)
308 Blue Cross Plan (1994 only)
310 Blue Cross Plan
320 Blue Cross Plan
331 Blue Cross Plan (1994 only)
332 Blue Cross Plan
333 Blue Cross Plan
334 Blue Cross Plan (1994 only)
335 Blue Cross Plan (1994 only)
337 Blue Cross Plan (1994 only)
338 Blue Cross Plan (1994 only)
340 Blue Cross Plan
350 Blue Cross Plan
351 Blue Cross Plan
360 Blue Cross Plan (1994 only)
361 Blue Cross plan
362 Blue Cross Plan
363 Blue Cross plan
364 Blue Cross plan
370 Blue Cross plan
380 Blue Cross plan
390 Blue Cross Plan
392 Blue Cross Plan
400 Blue Cross plan
410 Blue Cross plan
415 Blue Cross plan
423 Blue Cross plan
424 Blue Cross Plan (1994 only)
430 Blue Cross Plan
441 Blue Cross Plan (1994 only)
443 Blue Cross Plan
444 Blue Cross Plan (1994 only)
450 Blue Cross Plan
460 Blue Cross Plan
470 Blue Cross Plan
471 Blue Cross Plan (effective beginning 1/93)
865 Blue Cross Plan (effective beginning 1/95)
932 Blue Cross Plan (1994 only)
936 Blue Cross Plan (1994 only)
971 Blue Cross Plan (1994 only)
105 Commercial
106 Commercial
107 Commercial (effective beginning 4/1/95)
115 Commercial
120 Commercial
125 Commercial
131 Commercial
135 Commercial
142 Commercial
145 Commercial
151 Commercial
155 Commercial
161 Commercial
165 Commercial
171 Commercial
175 Commercial
181 Commercial
185 Commercial
186 Commercial
187 Commercial
188 Commercial
189 Commercial
191 Commercial
192 Commercial
193 Commercial
194 Commercial
195 Commercial
196 Commercial
197 Commercial
198 Commercial
199 Commercial
032 HMO (effective 11/96)
033 HMO (effective 11/96)
034 HMO (effective 8/96)
035 HMO (effective 11/95)
036 HMO (effective 8/97)
037 HMO (effective 8/97)
043 HMO (1994 only)
044 HMO (1994 only)
045 HMO
046 HMO (1994 only)
047 HMO
048 HMO
049 HMO (1994 only)
051 HMO (1994 only)
052 HMO (1994 only)
053 HMO (discontinued 6/98)
054 HMO (1994 only)
055 HMO (1994 only)
056 HMO
057 HMO (1994 only)
058 HMO
059 HMO
061 HMO (discontinued 6/98)
062 HMO (discontinued 6/98)
063 HMO (1994 only)
064 HMO (1994 only)
065 HMO (1994 only)
066 HMO (discontinued 6/98)
067 HMO (discontinued 6/98)
068 HMO (discontinued 6/98)
069 HMO (discontinued 6/98)
071 HMO (discontinued 6/98)
072 HMO
073 HMO
074 HMO
075 HMO (1994 only)
077 HMO
078 HMO
081 HMO (effective 11/96)
082 HMO (discontinued 6/98)
083 HMO (discontinued 6/98)
084 HMO (effective 11/96)
085 HMO (discontinued 6/98)
086 HMO (discontinued 6/98)
087 HMO (effective 11/96)
088 HMO (effective 11/96)
089 HMO (discontinued 6/98)
094 HMO (effective 11/96)
097 HMO (effective 11/96)
076 Miscellaneous
091 Miscellaneous: Union Insurance
093 Miscellaneous (effective 1/95)
096 Miscellaneous (effective 1/95)
309 No Fault
311 No Fault
315 No Fault
399 No Fault
095 Miscellaneous (discontinued 2012) 4 Self-pay
031 Patient
039 Patient
098 Miscellaneous: Hospital Responsibility 5 No charge
007 Affordable Care Health Insurance (effective 1/1/14) This code may include some newly eligible Medicaid enrollees 6 Other
014 Champus
016 Other Government
092 Personnel Health Program
095 Indigent (effective starting 2013): New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance)
099 Miscellaneous: Other
018 Other Government (effective between 1988 and 1997)
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation
211 Worker's Compensation
215 Worker's Compensation
221 Worker's Compensation
225 Worker's Compensation
231 Worker's Compensation
299 Worker's Compensation
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid beginning 2011-2016 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Medicare: Other 1 Medicare
011 Medicare Part A
015 Medicare Part B
017 Medicare Part B
082 Medicare HMO (Beginning in 2003)
008 NJ Family Care 2 Medicaid
012 Title XIX (Medicaid)
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan 3 Private Insurance
018 Other Government (beginning in 1998)
020 Blue Cross Plan
022 Blue Cross Plan
025 Blue Cross Plan
026 Blue Cross Plan
029 Blue Cross Plan
030 Blue Cross Plan
040 Blue Cross Plan
041 Blue Cross Plan (1994 only)
042 Blue Cross Plan (1994 only)
050 Blue Cross Plan
060 Blue Cross Plan
070 Blue Cross Plan
080 Blue Cross Plan
090 Blue Cross Plan
100 Blue Cross Plan (1994 only)
101 Blue Cross Plan
110 Blue Cross Plan
121 Blue Cross Plan
130 Blue Cross Plan
140 Blue Cross Plan
141 Blue Cross Plan (discontinued 1/1/15)
150 Blue Cross Plan
160 Blue Cross Plan
170 Blue Cross Plan
180 Blue Cross Plan
190 Blue Cross Plan
200 Blue Cross Plan
210 Blue Cross Plan
220 Blue Cross Plan
230 Blue Cross Plan
240 Blue Cross Plan
241 Blue Cross Plan
250 Blue Cross Plan
260 Blue Cross Plan
265 Blue Cross Plan
270 Blue Cross Plan
280 Blue Cross Plan
281 Blue Cross Plan (valid beginning 1/93)
290 Blue Cross Plan
300 Blue Cross Plan (1994 only)
301 Blue Cross Plan
303 Blue Cross Plan
304 Blue Cross Plan
305 Blue Cross Plan
306 Blue Cross Plan
307 Blue Cross Plan (1994 only)
308 Blue Cross Plan (1994 only)
310 Blue Cross Plan
320 Blue Cross Plan
331 Blue Cross Plan (1994 only)
332 Blue Cross Plan
333 Blue Cross Plan
334 Blue Cross Plan (1994 only)
335 Blue Cross Plan (1994 only)
337 Blue Cross Plan (1994 only)
338 Blue Cross Plan (1994 only)
340 Blue Cross Plan
350 Blue Cross Plan
351 Blue Cross Plan
360 Blue Cross Plan (1994 only)
361 Blue Cross plan
362 Blue Cross Plan
363 Blue Cross plan
364 Blue Cross plan
370 Blue Cross plan
380 Blue Cross plan
390 Blue Cross Plan
392 Blue Cross Plan
400 Blue Cross plan
410 Blue Cross plan
415 Blue Cross plan
423 Blue Cross plan
424 Blue Cross Plan (1994 only)
430 Blue Cross Plan
441 Blue Cross Plan (1994 only)
443 Blue Cross Plan
444 Blue Cross Plan (1994 only)
450 Blue Cross Plan
460 Blue Cross Plan
470 Blue Cross Plan
471 Blue Cross Plan (effective beginning 1/93)
865 Blue Cross Plan (effective beginning 1/95)
932 Blue Cross Plan (1994 only)
936 Blue Cross Plan (1994 only)
971 Blue Cross Plan (1994 only)
105 Commercial
106 Commercial
107 Commercial (effective beginning 4/1/95)
115 Commercial
120 Commercial
125 Commercial
131 Commercial
135 Commercial
142 Commercial
145 Commercial
151 Commercial
155 Commercial
161 Commercial
165 Commercial
171 Commercial
175 Commercial
181 Commercial
185 Commercial
186 Commercial
187 Commercial
188 Commercial
189 Commercial
191 Commercial
192 Commercial
193 Commercial
194 Commercial
195 Commercial
196 Commercial
197 Commercial
198 Commercial
199 Commercial
032 HMO (effective 11/96)
033 HMO (effective 11/96)
034 HMO (effective 8/96)
035 HMO (effective 11/95)
036 HMO (effective 8/97)
037 HMO (effective 8/97)
043 HMO (1994 only)
044 HMO (1994 only)
045 HMO
046 HMO (1994 only)
047 HMO
048 HMO
049 HMO (1994 only)
051 HMO (1994 only)
052 HMO (1994 only)
053 HMO (discontinued 6/98)
054 HMO (1994 only)
055 HMO (1994 only)
056 HMO
057 HMO (1994 only)
058 HMO
059 HMO
061 HMO (discontinued 6/98)
062 HMO (discontinued 6/98)
063 HMO (1994 only)
064 HMO (1994 only)
065 HMO (1994 only)
066 HMO (discontinued 6/98)
067 HMO (discontinued 6/98)
068 HMO (discontinued 6/98)
069 HMO (discontinued 6/98)
071 HMO (discontinued 6/98)
072 HMO
073 HMO
074 HMO
075 HMO (1994 only)
077 HMO
078 HMO
081 HMO (effective 11/96)
082 HMO (discontinued 6/98)
083 HMO (discontinued 6/98)
084 HMO (effective 11/96)
085 HMO (discontinued 6/98)
086 HMO (discontinued 6/98)
087 HMO (effective 11/96)
088 HMO (effective 11/96)
089 HMO (discontinued 6/98)
094 HMO (effective 11/96)
097 HMO (effective 11/96)
076 Miscellaneous
091 Miscellaneous
093 Miscellaneous (effective 1/95)
096 Miscellaneous (effective 1/95)
309 No Fault
311 No Fault
315 No Fault
399 No Fault
095 Miscellaneous (discontinued 2012) 4 Self-pay
031 Patient
039 Patient
098 Hospital Responsibility 5 No charge
007 Affordable Care Health Insurance (effective 1/1/14) This code may include some newly eligible Medicaid enrollees 6 Other
014 Champus
016 Other Government
092 Miscellaneous
095 Indigent (effective starting 2013): New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance)
099 Miscellaneous: Other
018 Other Government (effective between 1988 and 1997)
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation
211 Worker's Compensation
215 Worker's Compensation
221 Worker's Compensation
225 Worker's Compensation
231 Worker's Compensation
299 Worker's Compensation
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2010 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Medicare: Other 1 Medicare
011 Medicare Part A
015 Medicare Part B
017 Medicare Part B
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan 3 Private Insurance
018 Other Government (beginning in 1998)
020 Blue Cross Plan
022 Blue Cross Plan
025 Blue Cross Plan
026 Blue Cross Plan
029 Blue Cross Plan
030 Blue Cross Plan
040 Blue Cross Plan
041 Blue Cross Plan (1994 only)
042 Blue Cross Plan (1994 only)
050 Blue Cross Plan
060 Blue Cross Plan
070 Blue Cross Plan
080 Blue Cross Plan
090 Blue Cross Plan
100 Blue Cross Plan (1994 only)
101 Blue Cross Plan
110 Blue Cross Plan
121 Blue Cross Plan
130 Blue Cross Plan
140 Blue Cross Plan
141 Blue Cross Plan
150 Blue Cross Plan
160 Blue Cross Plan
170 Blue Cross Plan
180 Blue Cross Plan
190 Blue Cross Plan
200 Blue Cross Plan
210 Blue Cross Plan
220 Blue Cross Plan
230 Blue Cross Plan
240 Blue Cross Plan
241 Blue Cross Plan
250 Blue Cross Plan
260 Blue Cross Plan
265 Blue Cross Plan
270 Blue Cross Plan
280 Blue Cross Plan
281 Blue Cross Plan (valid beginning 1/93)
290 Blue Cross Plan
300 Blue Cross Plan (1994 only)
301 Blue Cross Plan
303 Blue Cross Plan
304 Blue Cross Plan
305 Blue Cross Plan
306 Blue Cross Plan
307 Blue Cross Plan (1994 only)
308 Blue Cross Plan (1994 only)
310 Blue Cross Plan
320 Blue Cross Plan
331 Blue Cross Plan (1994 only)
332 Blue Cross Plan
333 Blue Cross Plan
334 Blue Cross Plan (1994 only)
335 Blue Cross Plan (1994 only)
337 Blue Cross Plan (1994 only)
338 Blue Cross Plan (1994 only)
340 Blue Cross Plan
350 Blue Cross Plan
351 Blue Cross Plan
360 Blue Cross Plan (1994 only)
361 Blue Cross plan
362 Blue Cross Plan
363 Blue Cross plan
364 Blue Cross plan
370 Blue Cross plan
380 Blue Cross plan
390 Blue Cross Plan
392 Blue Cross Plan
400 Blue Cross plan
410 Blue Cross plan
415 Blue Cross plan
423 Blue Cross plan
424 Blue Cross Plan (1994 only)
430 Blue Cross Plan
441 Blue Cross Plan (1994 only)
443 Blue Cross Plan
444 Blue Cross Plan (1994 only)
450 Blue Cross Plan
460 Blue Cross Plan
470 Blue Cross Plan
471 Blue Cross Plan (effective beginning 1/93)
865 Blue Cross Plan (effective beginning 1/95)
932 Blue Cross Plan (1994 only)
936 Blue Cross Plan (1994 only)
971 Blue Cross Plan (1994 only)
105 Commercial
106 Commercial
107 Commercial (effective beginning 4/1/95)
115 Commercial
120 Commercial
125 Commercial
131 Commercial
135 Commercial
142 Commercial
145 Commercial
151 Commercial
155 Commercial
161 Commercial
165 Commercial
171 Commercial
175 Commercial
181 Commercial
185 Commercial
186 Commercial
187 Commercial
188 Commercial
189 Commercial
191 Commercial
192 Commercial
193 Commercial
194 Commercial
195 Commercial
196 Commercial
197 Commercial
198 Commercial
199 Commercial
032 HMO (effective 11/96)
033 HMO (effective 11/96)
034 HMO (effective 8/96)
035 HMO (effective 11/95)
036 HMO (effective 8/97)
037 HMO (effective 8/97)
043 HMO (1994 only)
044 HMO (1994 only)
045 HMO
046 HMO (1994 only)
047 HMO
048 HMO
049 HMO (1994 only)
051 HMO (1994 only)
052 HMO (1994 only)
053 HMO (discontinued 6/98)
054 HMO (1994 only)
055 HMO (1994 only)
056 HMO
057 HMO (1994 only)
058 HMO
059 HMO
061 HMO (discontinued 6/98)
062 HMO (discontinued 6/98)
063 HMO (1994 only)
064 HMO (1994 only)
065 HMO (1994 only)
066 HMO (discontinued 6/98)
067 HMO (discontinued 6/98)
068 HMO (discontinued 6/98)
069 HMO (discontinued 6/98)
071 HMO (discontinued 6/98)
072 HMO
073 HMO
074 HMO
075 HMO (1994 only)
077 HMO
078 HMO
081 HMO (effective 11/96)
082 HMO (discontinued 6/98)
083 HMO (discontinued 6/98)
084 HMO (effective 11/96)
085 HMO (discontinued 6/98)
086 HMO (discontinued 6/98)
087 HMO (effective 11/96)
088 HMO (effective 11/96)
089 HMO (discontinued 6/98)
094 HMO (effective 11/96)
097 HMO (effective 11/96)
076 Miscellaneous
091 Miscellaneous
093 Miscellaneous (effective 1/95)
096 Miscellaneous (effective 1/95)
309 No Fault
311 No Fault
315 No Fault
399 No Fault
095 Miscellaneous 4 Self-pay
031 Patient
039 Patient
098 Miscellaneous 5 No charge
014 Champus 6 Other
016 Other Government
092 Miscellaneous
099 Miscellaneous
018 Other Government (effective between 1988 and 1997)
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation
211 Worker's Compensation
215 Worker's Compensation
221 Worker's Compensation
225 Worker's Compensation
231 Worker's Compensation
299 Worker's Compensation
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2009 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Section 1011 Undocumented Aliens 1 Medicare
011 Title XVII (Medicare) Part A
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
018 New Jersey State Health Benefits Plan
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
430 Blue Cross Plan: Alaska/Washington
443 Blue Cross Plan: West Virginia - all other groups
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
045 HMO: HIP of NJ
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
058 HMO: PruCare of NJ
059 HMO: Other HMO
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
084 HMO: First Option Health Plan (effective 11/96)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2008 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Section 1011 Undocumented Aliens 1 Medicare
011 Title XVII (Medicare) Part A
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroad Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
082 HMO: ChubbHealth Plan (discontinued 6/98)
083 HMO: Community Health Care and Development Corp (discontinued 6/98)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
018 New Jersey State Health Benefits Plan
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2007 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Section 1011 Undocumented Aliens 1 Medicare
011 Title XVII (Medicare) Part A
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroad Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
018 New Jersey State Health Benefits Plan
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2005-2006 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
011 Title XVII (Medicare) Part A 1 Medicare
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroad Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
018 New Jersey State Health Benefits Plan
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2003-2004 - SID, SASD, SEDD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
011 Title XVII (Medicare) Part A 1 Medicare
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroad Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
018 New Jersey State Health Benefits Plan
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 2001-2002 - SID, SASD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
011 Title XVII (Medicare) Part A 1 Medicare
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
012 Title XIX (Medicaid) 2 Medicaid
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroad Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
082 HMO: ChubbHealth Plan (discontinued 6/98)
083 HMO: Community Health Care and Development Corp (discontinued 6/98)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
018 New Jersey State Health Benefits Plan
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid 1998-2000 - SID, SASD)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
011 Title XVII (Medicare) Part A 1 Medicare
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
012 Title XIX (Medicaid) 2 Medicaid
010 Blue Cross Plan: Alabama 3 Private Insurance
020 Blue Cross Plan: Arkansas
022 Blue Cross Plan: New Jersey - FEP
025 Blue Cross Plan: New Jersey - Garden State
026 Blue Cross Plan: New Jersey - Host
029 Blue Cross Plan: Other Blue Cross
030 Blue Cross Plan: Arizona
040 Blue Cross Plan: California - all other groups
041 Blue Cross Plan: Oakland, CA (1994 only)
042 Blue Cross Plan: San Francisco, CA (1994 only)
050 Blue Cross Plan: Colorado
060 Blue Cross Plan: Connecticut
070 Blue Cross Plan: Delaware
080 Blue Cross Plan: District of Columbia
090 Blue Cross Plan: Florida
100 Blue Cross Plan: Columbus, GA (1994 only)
101 Blue Cross Plan: Georgia - all other groups
110 Blue Cross Plan: Idaho
121 Blue Cross Plan: Illinois
130 Blue Cross Plan: Indiana
140 Blue Cross Plan: Iowa - all other groups
141 Blue Cross Plan: Sioux City, IA (1994 only)
150 Blue Cross Plan: Kansas
160 Blue Cross Plan: Kentucky
170 Blue Cross Plan: Louisiana
180 Blue Cross Plan: Maine
190 Blue Cross Plan: Maryland
200 Blue Cross Plan: Massachusetts
210 Blue Cross Plan: Michigan
220 Blue Cross Plan: Minnesota
230 Blue Cross Plan: Mississippi
240 Blue Cross Plan: Missouri - Kansas City
241 Blue Cross Plan: Missouri - St. Louis
250 Blue Cross Plan: Montana
260 Blue Cross Plan: Nebraska
265 Blue Cross Plan: Nevada
270 Blue Cross Plan: New Hampshire
280 Blue Cross Plan: New Jersey - all other groups
281 Blue Cross Plan: New Jersey - non group line of business
290 Blue Cross Plan: New Mexico
300 Blue Cross Plan: Albany, NY (1994 only)
301 Blue Cross Plan: New York - Buffalo
303 Blue Cross Plan: New York - New York
304 Blue Cross Plan: New York - Rochester
305 Blue Cross Plan: New York - Syracuse
306 Blue Cross Plan: New York - Utica
307 Blue Cross Plan: Watertown, NY (1994 only)
308 Blue Cross Plan: Part A only (NY) (1994 only)
310 Blue Cross Plan: North Carolina
320 Blue Cross Plan: North Dakota
331 Blue Cross Plan: Canton, OH (1994 only)
332 Blue Cross Plan: Ohio, Cincinnati
333 Blue Cross Plan: Ohio - Cleveland
334 Blue Cross Plan: Columbus, OH (1994 only)
335 Blue Cross Plan: Lima, OH (1994 only)
337 Blue Cross Plan: Toledo, OH (1994 only)
338 Blue Cross Plan: Youngstown, OH (1994 only)
340 Blue Cross Plan: Oklahoma
350 Blue Cross Plan: Oregon
351 Blue Cross Plan: Portland
360 Blue Cross Plan: Allentown, PA (1994 only)
361 Blue Cross plan: Pennsylvania - Harrisburg
362 Blue Cross Plan: Pennsylvania - Philadelphia
363 Blue Cross plan: Pennsylvania - Pittsburgh
364 Blue Cross plan: Pennsylvania - Wilks-Barre
370 Blue Cross plan: Rhode Island
380 Blue Cross plan: South Carolina
390 Blue Cross Plan: Tennessee - Chattanooga
392 Blue Cross Plan: Tennessee - Memphis
400 Blue Cross plan: Texas
410 Blue Cross plan: Utah
415 Blue Cross plan: Vermont
423 Blue Cross plan: Virginia - all other groups
424 Blue Cross Plan: Roanoke, VA (1994 only)
430 Blue Cross Plan: Alaska/Washington
441 Blue Cross Plan: Charleston, WV (1994 only)
443 Blue Cross Plan: West Virginia - all other groups
444 Blue Cross Plan: Wheeling, WV (1994 only)
450 Blue Cross Plan: Wisconsin
460 Blue Cross Plan: Wyoming
470 Blue Cross Plan: Puerto Rico
471 Blue Cross Plan: Hawaii - all other groups
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95)
932 Blue Cross Plan: Seattle, WA/AK (1994 only)
936 Blue Cross Plan: Spokane, WA/AK (1994 only)
971 Blue Cross Plan: Blue Shield (HI) (1994 only)
105 Commercial: Aetna
106 Commercial: NJ Carpenter's Health Fund
107 Commercial: AARP (effective 4/95)
115 Commercial: Connecticut General
120 Commercial: Continental Assurance
125 Commercial: Equitable
131 Commercial: Guardian Life
135 Commercial: Intercontinental
142 Commercial: John Hancock
145 Commercial: Massachusetts Mutual
151 Commercial: Metropolitan Life
155 Commercial: Mutual of Omaha
161 Commercial: New York Life
165 Commercial: Provident Alliance
171 Commercial: Prudential
175 Commercial: Travelers
181 Commercial: Washington National Insurance
185 Commercial: New Jersey Auto Dealers Association
186 Commercial: Allstate
187 Commercial: Mutual Life of New York
188 Commercial: National Association of Letter Carriers
189 Commercial: Local Union Insurance
191 Commercial: Lincoln National
192 Commercial: New Jersey Turnpike Authority
193 Commercial: Rasmussen
194 Commercial: Inter County Health Plan
195 Commercial: American Postal Workers
196 Commercial: Leader Administrators
197 Commercial: Fred S. James (James Benefit)
198 Commercial: Mail Handlers Benefit Plan
199 Commercial: Other Commercial Insurance
032 HMO: Americaid Inc. (effective 11/96)
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96)
034 HMO: United Health Care (effective 8/96)
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95)
036 HMO: Principal HMO (effective 8/97)
037 HMO: Mission Health Plans (effective 8/97)
043 HMO: Crossroads Health Plan (1994 only)
044 HMO: Cumberland Regional Health Plan (1994 only)
045 HMO: HIP of NJ
046 HMO: HIP of Greater NJ (1994 only)
047 HMO: HMO Blue (Medigroup Central)
048 HMO: HMO of PA-NJ (US Healthcare) & (Aetna Health Plans of NJ, Inc.)
049 HMO: Rutgers Community Health Plan (1994 only)
051 HMO: Southern Inter-County Med Assn (1994 only)
052 HMO: Valley Health Plan (1994 only)
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98)
054 HMO: HMO of NJ (1994 only)
055 HMO: Omni Care (1994 only)
056 HMO: CIGNA Healthcare of Northern NJ, Inc.
057 HMO: Bergen County IPA (1994 only)
058 HMO: PruCare of NJ
059 HMO: Other HMO
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98)
062 HMO: Garden State Health Plan (discontinued 6/98)
063 HMO: HMO of PA (1994 only)
064 HMO: PruCare (1994 only)
065 HMO: MAXICARE (1994 only)
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98)
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98)
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98)
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98)
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98)
072 HMO: Oxford Health Plan
073 HMO: NYL Care Health Plans of NJ, Inc.
074 HMO: CIGNA Health Care of NJ, Inc. South
075 HMO: Corporate Health Administrators (1994 only)
077 HMO: QUALMED/Greater Atlantic Health Services
078 HMO: Amerihealth HMO, Inc.
081 HMO: Atlanticare Health Plan (effective 11/96)
082 HMO: ChubbHealth Plan (discontinued 6/98)
083 HMO: Community Health Care and Development Corp (discontinued 6/98)
084 HMO: First Option Health Plan (effective 11/96)
085 HMO: Harmony Health Plan (discontinued 6/98)
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98)
087 HMO: Liberty Health Plan (effective 11/96)
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96)
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98)
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96)
097 HMO: University Health Plans, Inc. (effective 11/96)
076 Miscellaneous: Premier Preferred Care of New Jersey
091 Miscellaneous: Union Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95)
096 Miscellaneous: QualCare (effective 1/95)
309 No Fault: Allstate
311 No Fault: New Jersey Manufacturers
315 No Fault: State Farm
399 No Fault: Other
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personal Health Program
099 Miscellaneous: Other
018 New Jersey State Health Benefits Plan
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid


New York (SID)
New York
(Valid beginning 2017)
Payer typology mapping for Version 7.0 Effective June 2016
PAY1_X, PAY2_X, PAY3_X PAY1, PAY2, PAY3
Value Description Value Description
1 Medicare 1 Medicare
11 Medicare Managed Care (Includes Medicare Advantage Plans)
111 Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care Other
1111 Dual Eligible Special Needs Plan (D-SNP)
1112 Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNP)
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
129 Medicare Non-managed Care (Other)
13 Medicare Hospice
14 Dual Eligibility Medicare/Medicaid Organization
141 Medicare Chronic Condition Special Needs Plan (C-SNP)
142 Medicare Chronic Condition Special Needs Plan (C-SNP)
19 Medicare (Other)
191 Medicare Pharmacy Benefit Manager
2 Medicaid 2 Medicaid
21 Medicaid (Managed Care)
211 Medicaid HMO
2111 Family Health Plus (NYS ADDITION)*
2112 Healthy New York (NYS ADDITION)*
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Management)
219 Medicaid Managed Care (Other)
22 Medicaid (Non-managed Care Plan)
23 Medicaid/SCHIP
24 Medicaid Applicant
25 Medicaid (Out of State)
26 Medicaid - Long Term Care
29 Medicaid (Other)
291 Medicaid Pharmacy Benefit Manager
299 Medicaid - Dental
361 State SCHIP Program
391 Federal Employee Health Plan (beginning 2020) 3 Private Insurance
5 Private Health Insurance (other than Blue Cross/Blue Shield)
51 Managed Care (Private)
511 Commercial Managed Care (HMO)
512 Commercial Managed Care (PPO)
513 Commercial Managed Care (POS)
514 Exclusive Provider Organization
515 Gatekeeper PPO (GPPO)
516 Commercial Managed Care - Pharmacy Benefit Manager
517 Commercial Managed Care - Dental
519 Managed Care, Other (non-HMO)
52 Private Health Insurance (Indemnity)
521 Commercial Indemnity (e.g. high option/low option)
522 Self-insured (ERISA) Administrative Services Only (ASO) plan
523 Medicare supplemental policy (as second payer)
524 Indemnity Insurance - Dental
529 Private health insurance-other commercial Indemnity
53 Private Managed Care or private health insurance (indemnity), not otherwise specified
54 Private Organized Delivery System
55 Small Employer Purchasing Group
56 Specialized Stand Alone Plan
59 Other Private Insurance*
561 Specialized Stand Alone Plan - Dental
562 Specialized Stand Alone Plan - Vision
6 Blue Cross/Blue Shield
61 BC Managed Care
611 BC Managed Care (HMO)
612 BC Managed Care (PPO)
613 BC Managed Care (POS)
614 BC Managed Care (Dental)
619 BC Managed Care (Other)
62 BC Insurance Indemnity
621 BC Indemnity
622 BC Self-insured (ERISA) Administrative Services Only (ASO) Plan
623 BC Medicare Supplemental Plan
629 BC Indemnity - Dental
63 BC (Indemnity or Managed Care) - Out of State*
64 BC (Indemnity or Managed Care) - Unspecified*
69 BC (Indemnity or Managed Care) - Other*
7 Managed Care (to be used only if one can't distinguish public from private)
71 Managed care (public or private) - HMO
72 Managed care (public or private) - PPO
73 Managed care (public or private) - POS
79 Managed care (public or private) - Other
96 Auto Insurance (no fault)
8 NOPAYMENT from an Organization/Agency/Program/Private Payor Listed 4 Self Pay
81 Self Pay
82 No Charge 5 No charge
821 Charity
822 Professional Courtesy
823 Research/Clinical Trial
83 Refusal to Pay/Bad Debt
84 Hill Burton Free Care
85 Research/Donor
89 No Payment
3 Other Government (Federal/State/Government) 6 Other
31 Department of Defense
311 TRICARE (CHAMPUS)
3111 TRICARE Prime-HMO
3112 TRICARE Extra-PPO
3113 TRICARE Standard - fee for service
3114 TRICARE For Life - Medicare Supplement
3115 TRICARE Reserve Select
3116 Uniformed Services Family Health Plan (USFHP) -- HMO
3119 Department of Defense - (other)
312 Military Treatment Facility (MTF)
3121 MTF - Enrolled Prime-HMO
3122 MTF - Non-enrolled Space Available
3123 MTF - TRICARE For Life (TFL)
313 Department of Defense - Dental Stand Alone
32 Department of Veterans Affairs (VA)
321 VA - Care provided to Veterans
3211 VA - Direct Care in VA facilities
3212 VA - Indirect Care (outside VA facilities)
32121 VA - Indirect Care - Fee basis
32122 VA - Indirect Care - Foreign Medical program
32123 VA - Indirect Care - Community Nursing Home
32124 VA - Indirect Care - State Veterans Home
32125 VA - Indirect Care - Sharing Agreements
32126 VA - Indirect Care - Other Federal Agency
32127 VA - Indirect Care - Dental Care
32128 VA - Indirect Care - Vision Care
322 VA - Non-veteran care
3221 VA - Civilian Health and Medical Program for the VA
3222 VA - Spina Bifida Health Care Program
3223 VA - Children of Women Vietnam Veterans
3229 VA - Other non-veteran care
33 Indian Health Service or Tribe
331 Indian Health Service (Regular)
332 Indian Health Service (Contract)
333 Indian Health Service (Managed Care)
334 Indian Tribe (Sponsored Coverage)
34 HRSA Program
341 Title V (MCH Block Grant)
342 Migrant Health Program
343 Ryan White Act
344 Disaster-related (includes Covid-19) (valid beginning 2020)
349 Other
35 Black Lung
36 State Government
362 Specific State Programs
369 State, not otherwise specified (other state)
37 Local Government
371 Local (Managed Care)
3711 Local government HMO
3712 Local government POS
3713 Local government PPO
372 FFS/Indemnity
379 Local, not otherwise specified (other local, county)
38 Other Government (Federal, State, Local not specified)
381 Federal, State, Local not specified (Managed care)
3811 Federal, State, Local not specified (HMO)
3812 Federal, State, Local not specified (PPO)
3813 Federal, State, Local not specified (POS)
3819 Federal, State, Local not specified (Other managed care)
382 Federal, State, Local not specified (FFS)
389 Federal, State, Local not specified (Other)
39 Other Federal
4 Department of Corrections
41 Corrections Federal
42 Corrections State
43 Corrections Local
44 Corrections (Unknown Level)
9 Miscellaneous/Other
91 Foreign National
92 Other (Non-government)
93 Disability Insurance
94 Long-term Care Insurance
95 Worker's Compensation
951 Worker's Comp (HMO)
953 Worker's Comp (Fee-for-Service)
954 Worker's Comp (Other Managed Care)
959 Worker's Comp (Other unspecified)
97 Legal Liability / Liability Insurance
98 Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)
99 No Typology Code available for payment source
blank Not reported . Missing
9999 No payer specified
ZZZ Missing Data
Any values not documented by the data source .A Invalid
*Based on NY documentation of values



New York
(Valid from 1993-2016)
PAY1_X, (PAY2_X beginning in 1995), (PAY3_X beginning in 1998) PAY1, PAY2, PAY3
Value Description Value Description
03 Medicare 1 Medicare
16 Medicare HMO
04 Medicaid 2 Medicaid
17 Medicaid HMO
06 Blue Cross 3 Private Insurance
08 Commercial Insurance Company
11 HMO (Other)
13 No-fault
15 Self-insured, Self-administered plans
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Workers' Compensation 6 Other
07 Other Government
10 Other
12 CHAMPUS/VA
18 Corrections Federal (starting in 1996)
19 Corrections State (starting in 1996)
20 Corrections Local (starting in 1996)
Blank Missing . Missing
Other   .A Invalid



New York
(Valid for 1988-1992)
PAY1_X PAY1
Value Description Value Description
03 Medicare 1 Medicare
04 Medicaid 2 Medicaid
06 Blue Cross 3 Private Insurance
08 Commercial Insurance
11 Other HMO
13 No-fault (starting in 1992)
15 Self-insured, Self-administered plans (starting in 1992)
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Worker's Compensation 6 Other
07 Other Government
14 Corrections (federal, state, or local)
10 Other
12 CHAMPUS/VA (starting in 1992)
Blank Primary . Missing
Blank, 00 Missing
Other values   .A Invalid



New York
(Valid for 1992)
PAY1_X PAY1
Value Description Value Description
03 Medicare 1 Medicare
04 Medicaid 2 Medicaid
06 Blue Cross 3 Private Insurance
08, 13, 15 Commercial Insurance; no-fault; self-insured, self-administered plan
11 Other HMO
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Workers' Compensation 6 Other
12 CHAMPUS/VA
07, 14 Other government; Corrections (state, county, or city)
10 Other
Blank Primary . Missing
Blank, 00 Secondary . Missing
Other Values   .A Invalid



New York
(Valid from 1988-1991)
PAY1_X PAY1
Value Description Value Description
03 Medicare 1 Medicare
04 Medicaid 2 Medicaid
06 Blue Cross 3 Private Insurance
08 Commercial Insurance
11 Other HMO
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Workers' Compensation 6 Other
07 Other government; Corrections (state, county, or city)
10 Other
Blank Primary: . Missing
Blank, 00 Secondary: . Missing
Other Values   .A Invalid


New York (SEDD)

For 2018, New York did not provide payer code 2 and 3.

New York
(Valid beginning 2017)
Payer typology mapping for Version 7.0 Effective June 2016
PAY1_X, PAY2_X, PAY3_X PAY1, PAY2, PAY3
Value Description Value Description
1 Medicare 1 Medicare
11 Medicare (Managed Care)
111 Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care (Other)
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
129 Medicare Non-managed Care (Other)
13 Medicare Hospice
14 Dual Eligibility Medicare/Medicaid Organization
19 Medicare (Other)
191 Medicare Pharmacy Benefit Manager
2 Medicaid 2 Medicaid
21 Medicaid (Managed Care)
211 Medicaid HMO
2111 Family Health Plus (NYS ADDITION)*
2112 Healthy New York (NYS ADDITION)*
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Management)
219 Medicaid Managed Care (Other)
22 Medicaid (Non-managed Care Plan)
23 Medicaid/SCHIP
24 Medicaid Applicant
25 Medicaid (Out of State)
26 Medicaid - Long Term Care
29 Medicaid (Other)
291 Medicaid Pharmacy Benefit Manager
299 Medicaid - Dental
361 State SCHIP Program
5 Private Health Insurance (other than Blue Cross/Blue Shield) 3 Private Insurance
51 Managed Care (Private)
511 Commercial Managed Care (HMO)
512 Commercial Managed Care (PPO)
513 Commercial Managed Care (POS)
514 Exclusive Provider Organization
515 Gatekeeper PPO (GPPO)
516 Commercial Managed Care - Pharmacy Benefit Manager
517 Commercial Managed Care - Dental
519 Managed Care, Other (non-HMO)
52 Private Health Insurance (Indemnity)
521 Commercial Indemnity (e.g. high option/low option)
522 Self-insured (ERISA) Administrative Services Only (ASO) plan
523 Medicare supplemental policy (as second payer)
524 Indemnity Insurance - Dental
529 Private health insurance-other commercial Indemnity
53 Private Managed Care or private health insurance (indemnity), not otherwise specified
54 Private Organized Delivery System
55 Small Employer Purchasing Group
56 Specialized Stand Alone Plan
59 Other Private Insurance*
561 Specialized Stand Alone Plan - Dental
562 Specialized Stand Alone Plan - Vision
6 Blue Cross/Blue Shield
61 BC Managed Care
611 BC Managed Care (HMO)
612 BC Managed Care (PPO)
613 BC Managed Care (POS)
614 BC Managed Care (Dental)
619 BC Managed Care (Other)
62 BC Insurance Indemnity
621 BC Indemnity
622 BC Self-insured (ERISA) Administrative Services Only (ASO) Plan
623 BC Medicare Supplemental Plan
629 BC Indemnity - Dental
63 BC (Indemnity or Managed Care) - Out of State*
64 BC (Indemnity or Managed Care) - Unspecified*
69 BC (Indemnity or Managed Care) - Other*
7 Managed Care (to be used only if one can't distinguish public from private)
71 Managed care (public or private) - HMO
72 Managed care (public or private) - PPO
73 Managed care (public or private) - POS
79 Managed care (public or private) - Other
96 Auto Insurance (no fault)
8 NOPAYMENT from an Organization/Agency/Program/Private Payor Listed 4 Self Pay
81 Self Pay
82 No Charge 5 No charge
821 Charity
822 Professional Courtesy
823 Research/Clinical Trial
83 Refusal to Pay/Bad Debt
84 Hill Burton Free Care
85 Research/Donor
89 No Payment
3 Other Government (Federal/State/Government) 6 Other
31 Department of Defense
311 TRICARE (CHAMPUS)
3111 TRICARE Prime-HMO
3112 TRICARE Extra-PPO
3113 TRICARE Standard - fee for service
3114 TRICARE For Life - Medicare Supplement
3115 TRICARE Reserve Select
3116 Uniformed Services Family Health Plan (USFHP) -- HMO
3119 Department of Defense - (other)
312 Military Treatment Facility (MTF)
3121 MTF - Enrolled Prime-HMO
3122 MTF - Non-enrolled Space Available
3123 MTF - TRICARE For Life (TFL)
313 Department of Defense - Dental Stand Alone
32 Department of Veterans Affairs (VA)
321 VA - Care provided to Veterans
3211 VA - Direct Care in VA facilities
3212 VA - Indirect Care (outside VA facilities)
32121 VA - Indirect Care - Fee basis
32122 VA - Indirect Care - Foreign Medical program
32123 VA - Indirect Care - Community Nursing Home
32124 VA - Indirect Care - State Veterans Home
32125 VA - Indirect Care - Sharing Agreements
32126 VA - Indirect Care - Other Federal Agency
32127 VA - Indirect Care - Dental Care
32128 VA - Indirect Care - Vision Care
322 VA - Non-veteran care
3221 VA - Civilian Health and Medical Program for the VA
3222 VA - Spina Bifida Health Care Program
3223 VA - Children of Women Vietnam Veterans
3229 VA - Other non-veteran care
33 Indian Health Service or Tribe
331 Indian Health Service (Regular)
332 Indian Health Service (Contract)
333 Indian Health Service (Managed Care)
334 Indian Tribe (Sponsored Coverage)
34 HRSA Program
341 Title V (MCH Block Grant)
342 Migrant Health Program
343 Ryan White Act
349 Other
35 Black Lung
36 State Government
362 Specific State Programs
369 State, not otherwise specified (other state)
37 Local Government
371 Local (Managed Care)
3711 Local government HMO
3712 Local government POS
3713 Local government PPO
372 FFS/Indemnity
379 Local, not otherwise specified (other local, county)
38 Other Government (Federal, State, Local not specified)
381 Federal, State, Local not specified (Managed care)
3811 Federal, State, Local not specified (HMO)
3812 Federal, State, Local not specified (PPO)
3813 Federal, State, Local not specified (POS)
3819 Federal, State, Local not specified (Other managed care)
382 Federal, State, Local not specified (FFS)
389 Federal, State, Local not specified (Other)
39 Other Federal
391 Federal Employee Health Plan
4 Department of Corrections
41 Corrections Federal
42 Corrections State
43 Corrections Local
44 Corrections (Unknown Level)
9 Miscellaneous/Other
91 Foreign National
92 Other (Non-government)
93 Disability Insurance
94 Long-term Care Insurance
95 Worker's Compensation
951 Worker's Comp (HMO)
953 Worker's Comp (Fee-for-Service)
954 Worker's Comp (Other Managed Care)
959 Worker's Comp (Other unspecified)
97 Legal Liability / Liability Insurance
98 Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)
99 No Typology Code available for payment source
blank Not reported . Missing
9999 No payer specified
ZZZ Missing Data
Any values not documented by the data source .A Invalid
*Based on NY documentation of values



New York
(Applies to PAY1_X and PAY1 2005 - 2016)
PAY1_X PAY1
Value Description Value Description
03 Medicare 1 Medicare
16 Medicare HMO
04 Medicaid 2 Medicaid
17 Medicaid HMO
06 Blue Cross 3 Private Insurance
08 Commercial Insurance Company
11 HMO (Other)
13 No-fault
15 Self-insured, Self-administered plans
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Worker's Compensation 6 Other
07 Other Government
10 Other
12 CHAMPUS/VA
18 Corrections Federal
19 Corrections State
20 Corrections Local
Blank Missing . Missing
Any values not documented by the data source .A Invalid



New York
(Applies to PAY1_X and PAY1 for 2007-2010; PAY2_X, PAY2, and PAY3_X starting in 2005; and PAY3 starting in 2010)
PAYn_X PAYn
Value Description Value Description
C Medicare 1 Medicare
D Medicaid 2 Medicaid
F Insurance Company, HMO, PHSP (Medicaid managed care patients may be reported under this source value, in addition to privately insured managed care patients. Starting in data year 2011, Medicaid managed care patients are reported under a separate source value.) 3 Private Insurance
G Blue Cross
L Automobile Medical (effective prior to 2015)
A Self-pay 4 Self-pay
B Workers' Compensation 6 Other
E Other Federal Program
H CHAMPUS
I Other Non-Federal Program
J Disability
K Title V
L Unknown . Missing
Blank Missing
Any values not documented by the data source .A Invalid

New York Note: New York reports source of payment on their ED records instead of expected payer. The coding scheme uses alphabetic characters A through L defined in the recode table. New York reports expected payer for ambulatory surgery data (coding scheme is numeric). For 2007-2010, NY used both alphabetic characters A through L and numeric coding schemes for PAY1_X. If an ambulatory surgery record has evidence of ED services (either ED charge or an admission source), then the record is also included in the HCUP SEDD.



North Carolina (SID and SEDD)

Beginning in Q4 2010, the payer data element was modified to two characters in length and the values change. Records with PAYn_X assigned Autmobile Medical (AM) were erroneously mapped to PAYn as "Invalid" instead of "Private Insurance".

North Carolina
(Valid from October 2010)
PAY1_X, PAY2_X, and PAY3_X PAY1, PAY2, and PAY3
Value Description Value Description
MA Medicare 1 Medicare
M Medicare Part A (Valid 2011-2015)
MB Medicare Part B
MC Medicaid 2 Medicaid
MM Medicaid Managed Care (starting in 2020)
BL Blue Cross 3 Private insurance
B Blue Cross & Blue Shield (Valid 2011-2015)
H HMO - PPO (Valid 2012-2015)
HM HMO - PPO
CI Commercial Insurance
A Automobile Medical (Valid 2012-2015)
AM Automobile Medical
14 Exclusive Provider Org
16 Health Maintenance Org
15 Indemnity Insurance
17 Dental Maintenance Organization (starting in 2020)
FI Federal Employees Program (starting in 2020)
LI Liability
LM Liability Medical
13 Point of Service
12 Preferred Provider Org
S Self Insured (Valid 2011-2015)
Y POS (Valid 2012-2015)
09, 9 Self-pay 4 Self-pay
P Self-pay (Valid 2011-2015)
--   5 No charge
CH Champus 6 Other
C Champus (Valid 2011-2015)
DS Disability
G Disability (Valid 2011-2015)
OF Other Federal Program
E Other Government (Valid 2012-2015)
N Other Government (Valid 2011-2015)
11 Other Non-Federal Program
X Other Non-Federal Program (Valid 2011-2015)
TV Title V
VA Veteran Administration Plan
WC Workers' Compensation
O Other (Valid 2011-2015)
99 Missing (starting in 2020) . Missing
ZZ Mutually Defined (starting in 2020)
00, U, UN, ZZ, Blank Documented by source as unknown values
98 Invalid (starting in 2020) .A Invalid
Any values not documented by the data source



North Carolina
(Valid January 2010 through September 2010)
PAY1_X, PAY2_X, and PAY3_X PAY1, PAY2, and PAY3
Value Description Value Description
MA Medicare 1 Medicare
M Medicare Part A (Valid 2011)
MB Medicare Part B
MC Medicaid 2 Medicaid
BL Blue Cross 3 Private insurance
B Blue Cross & Blue Shield (Valid 2011)
HM HMO - PPO
CI Other Insurance Companies
AM Automobile Medical
14 Exclusive Provider Org
16 Health Maintenance Org
15 Indemnity Insurance
LI Liability
LM Liability Medical
13 Point of Service
12 Preferred Provider Org
S Self Insured
09, 9 Self-pay 4 Self-pay
--   5 No charge
CH Champus 6 Other
DS Disability
OF Other Federal Program
11 Other Non-Federal Program
TV Title V
VA Veteran Administration Plan
WC Workers' Compensation
00, U, UN, ZZ, Blank Documented by source as unknown values . Missing
Any values not documented by the data source .A Invalid



North Carolina
(Valid prior to 2010)
PAY1_X, PAY2_X, and PAY3_X PAY1, PAY2, and PAY3
Value Description Value Description
M Medicare 1 Medicare
T Medicare Part B
D Medicaid 2 Medicaid
B Blue Cross 3 Private insurance
H HMO - PPO
I Other Insurance Companies
A Automobile Medical
J Exclusive Provider Org
K Health Maintenance Org
L Indemnity Insurance
Q Liability
R Liability Medical
Y Point of Service
Z Preferred Provider Org
P Self-pay 4 Self-pay
--   5 No charge
C Champus 6 Other
O Other
G Disability
V Other Federal Program
X Other Non-Federal Program
1 Title V
2 Veteran Administration Plan
W Workers' Compensation
U, Blank Documented by source as unknown values . Missing
Any values not documented by the data source .A Invalid


North Dakota (SID and SEDD)
North Dakota
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
2000000 Medicare 1 Medicare
6000003 Blue Cross, Medicare
6000103 Blue Cross, MN, Medicare
6009903 Blue Cross, Other, Medicare
7000102 Medica - Choice, Medicare
7000202 Group Health, Medicare
7000402 Medica - Primary, Medicare
7000502 MedCenters, Medicare
7000602 UCare, Medicare
7000702 Blue Plus, Medicare
7000802 Metro. Health Plan, Medicare
7001002 Health Partners, Medicare
7001302 First Plan HMO, Medicare
7001402 Altru Health Plan, Medicare
7001502 Sioux Valley, Medicare
7000902 Blue Cross HMO, Medicare
7009902 Other HMO, Medicare
8000302 SelectCare, Medicare
8000402 Preferred One, Medicare
8000502 America's PPO, Medicare
8000602 Aetna PPO, Medicare
8000902 Blue Cross PPO, Medicare
8001302 Private Health Care System, Medicare
8001502 LaborCare PPO, Medicare
8009902 Other PPO, Medicare
3000000 Medicaid 2 Medicaid
3000001 Medicaid Pending
3000100 Medicaid, Minnesota
3000101 Pending, MN, Medicaid
3000200 Medicaid, Wisconsin
3000201 Medicaid, Wisconsin, Pending
3000900 Medicaid, South Dakota
3000901 Medicaid, South Dakota, Pending
3001101 Medicaid, Iowa, Pending
3001000 Medicaid, North Dakota
3001100 Medicaid, Iowa
3009900 Medicaid, Other
3009901 Medicaid, Other, Pending Eligible
4000500 General Assistance Medical Care (GAMC)/GA/Welfare (Starting 2014)
4000800 PrimeWest, Cty Based Purchased (Starting 2014)
4000900 Itasca Medical Care, CBP (Starting 2014)
4001000 So. Country Hlth Alliance, CBP (Starting 2014)
7000101 Medica - Choice, Medicaid
7000103 Medica - Choice, GAMC (Starting 2014)
7000201 Group Health, Medicaid
7000301 Ramsey Care, Medicaid
7000303 Ramsey Care, GAMC, etc. (Starting 2014)
7000401 Medica - Primary, Medicaid
7000501 MedCenters, Medicaid
7000601 Ucare, Medicaid
7000603 Ucare, GAMC, etc. (Starting 2014)
7000701 Blue Plus, Medicaid
7000703 Blue Plus, GAMC, etc. (Starting 2014)
7000801 Metro. Health Plan, Medicaid
7000803 Metro. Health Plan, GAMC, etc. (Starting 2014)
7000901 Blue Cross HMO, Medicaid
7001001 Health Partners, Medicaid
7001003 Health Partners, GAMC, etc. (Starting 2014)
7001201 Northwest National Life (NWNL) Health Network, Medicaid
7001301 First Plan HMO, Medicaid
7001401 Altru Health Plan, Medicaid
7001501 Sioux Valley, Medicaid
7009901 Other HMO, Medicaid
7009903 Other HMO, GAMC/GA/Welfare (Starting 2014)
8000301 SelectCare, Medicaid
8000401 Preferred One, Medicaid
8000501 America's PPO, Medicaid
8000701 Group Health PPO, Medicaid
8000901 Blue Cross PPO, Medicaid
8001001 Medica Choice PPO, Medicaid
8001501 LaborCare PPO, Medicaid
8009901 Other PPO, Medicaid
5000000 Commercial 3 Private insurance
5009900 Commercial
5009901 Commercial (Regina)
6000000 Blue Cross
6000001 Blue Cross, Aware
6000100 Blue Cross, MN
6000101 Blue Cross, MN, Aware
6000102 Blue Cross, Preferred Gold
6000200 Blue Cross, North Dakota
6000201 Blue Cross, North Dakota, Aware
6000202 Blue Cross, North Dakota, Preferred Gold
6009900 Blue Cross, Non-MN
6009901 Blue Cross, Non-MN Aware
6009902 Blue Cross, Other, Preferred Gold
7000000 Other HMO
7000100 Medica - Choice
7000200 Group Health
7000300 Ramsey Health
7000400 Medica - Primary
7000500 MedCenters
7000600 Ucare
7000700 Blue Plus
7000800 Metro. Health Plan
7000900 Blue Cross HMO
7001000 Health Partners
7001200 Northwest National Life (NWNL) Health Network
7001300 First Plan HMO
7001400 Altru Health Plan
7001500 Sioux Valley
7009900 Other HMO
8000000 Other PPO
8000300 SelectCare
8000320 SelectCare, Union
8000400 Preferred One
8000420 Preferred One, Union
8000500 ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO)
8000520 ARAZ (formerly Ethix Midwest; also known as America's PPO)
8000600 Aetna PPO
8000620 Aetna PPO, Union
8000700 Group Health PPO
8000800 HealthEast Care, Inc.
8000900 Blue Cross PPO
8001000 Medica Choice PPO
8001020 Medica, Union
8001200 Northwest National LIfe (NWNL) PPO
8002300 Private Health Care System
8001400 Prudential Plus
8001500 LaborCare PPO
8001520 LaborCare PPO, Union
8500100 Self Insured, Choice Plus
8509900 Other Self Insured
8009900 Other PPO
8009920 Other PPO, union
9001000 Other, Self-Insured Co.
9002000 Other, Unions
1000000 Self-Pay 4 Self-Pay
1000100 Self-Pay
1000102 Self-Pay (Prior to 2014)
1000200 Self-Pay, Charity Care
-- -- 5 No charge
3060000 Minnesota Care 6 Other
3060100 Minnesota Care
4000000 Other Government
4000100 Title V
4000200 Worker's Comp
4000201 Worker's Comp, Minnesota (Starting in 2015)
4000202 Worker's Comp, Out of State (Starting in 2015)
4000203 Worker's Comp, Federal (Starting in 2015)
4000300 TRICARE/CHAMPUS
4000400 MN Comp. Health Care
4000500 General Assistance Medical Care (GAMC)/GA/Welfare (Prior to 2014)
4000600 Aid to Families with Dependent Children (AFDC)
4000700 Children's Health Plan
4000800 PrimeWest, Cty Based Purchased (Prior to 2014)
4000900 Itasca Medical Care, CBP (Prior to 2014)
4001000 So. Country Hlth Alliance, CBP (Prior to 2014)
4009900 Other Govt., Other
7000103 Medica - Choice, GAMC (Prior to 2014)
7000104 Medica-Choice, MNCare
7000204 HMO, Group Health Plan, MNCARE
7000303 Ramsey Care, GAMC, etc. (Prior to 2014)
7000404 Medica-Primary, MNCare
7000603 Ucare, GAMC, etc. (Prior to 2014)
7000604 U-Care, MNCare
7000703 Blue Plus, GAMC, etc. (Prior to 2014)
7000704 Blue Plus, MNCare
7000803 Metro. Health Plan, GAMC, etc. (Prior to 2014)
7000804 Metro. Health Plan, MNCare
7000904 Blue Cross HMO, MNCare
7001003 Health Partners, GAMC, etc. (Prior to 2014)
7001004 Health Partners, MNCare
7001304 First Plan HMO, MNCare
7001404 Altru Health Plan, MNCare
7001504 Sioux Valley, MNCare
7009903 Other HMO, GAMC/GA/Welfare (Prior to 2014)
7009904 Other HMO, MNCare
8000404 Preferred One, MNCare
8000504 America's PPO, MNCare
8000604 Aetna PPO, MNCare
8000804 HealthEast Care, Inc. MNCare
8000920 PPO, Blue Cross PPO, Union
8000904 Blue Cross PPO, MNCare
8001304 Private Hlth Care Sys MNCare
8001404 Prudential Plus, MNCare
8001504 LaborCare PPO MNCare
8009904 Other PPO, MNCare
9000000 Other
9009900 Other
Blank Missing . Missing
8888888 Missing/Unknown (or insurance master)
9999999 Missing/Unknown (not on insurance master)
Any values not documented by the data source .A Invalid


Ohio (SID and SEDD)
Ohio
(Beginning in 2006)
PAY1_X PAY1
Value Description Value Description
C Medicare 1 Medicare
O Medicare Managed Care
D Medicaid 2 Medicaid
M Medicaid Managed Care
F Commercial Insurance 3 Private insurance
G Blue Cross Crossover
J Blue Cross
K HMO
L PPO
N Blue Cross HMO
A Self Pay 4 Self-pay
P Bad Debt - beginning with 2003 5 No charge
Q Charity - beginning with 2003
B Workers Compensation 6 Other
E Other Government
H Champus
I Other
R Hospital Care Assurance Program (HCAP) - beginning with 2003
Z International Payor
00, Blank, not provided Unknown, Missing, not provided . Missing
Any values not documented by the data source .A Invalid


Ohio (SID and SEDD)
Ohio
(Prior to 2006)
PAY1_X PAY1
Value Description Value Description
03 Medicare 1 Medicare
15 Medicare HMO
04 Medicaid 2 Medicaid
13 Medicaid HMO
06 Commercial Insurance 3 Private insurance
07 Blue Cross Crossover
10 Blue Cross Primary
11 HMO
12 PPO
14 Blue Cross HMO
01 Self Pay 4 Self-pay
16 Bad Debt - beginning with 2003 5 No charge
17 Charity - beginning with 2003
02 Workers Compensation 6 Other
05 Other Federal
08 Champus
09 Other
18 Hospital Care Assurance Program (HCAP) - beginning with 2003
00, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid


Rhode Island (SID and SEDD)
Rhode Island
(Valid Beginning 2020)
PAY1_X PAY1
Value Description Value Description
0 Medicare 1 Medicare
1 Medicaid 2 Medicaid
G RIte Care
5 Blue Cross 3 Private Insurance
E Blue Cross
H Neighborhood Health Plan of RI
6 Commercial Insurance
D United Healthcare
7 Self-pay 4 Self-pay
B CHAMPUS 6 Other
8 Other
4 Workers' Compensation
X, Y, Z, Blank Insurance error, Missing Info . Missing
Any values not documented by the data source .A Invalid



Rhode Island
(Valid Prior 2020)
PAY1_X PAY1
Value Description Value Description
B 4000 Out of State Blue Cross, Medicare (managed care) 1 Medicare
H 4000 Coordinated Health Partners, Medicare (managed care)
M Medicare Fee for Service
M 2000 Medicare Fee for Service, commercial carrier (Effective 2015-2016)
M 4000 Medicare Managed Care (Effective 2013-2016)
N 4000 Neighborhood Health Plan, Medicare (Start in 2017)
O 4000 Other, Medicare (managed care)
R 4000 Medicare managed care by Rhode Island Blue Cross Starting 2015)
U 4000 UHC, Medicare (managed care)
B 3000 Out of State Blue Cross, Medicaid (managed care) 2 Medicaid
D Medicaid Fee for Service
D 3000 Medicaid Managed Care (Starting 2013)
H 3000 Coordinated Health Partners, Medicaid (managed care)
N 3000 Neighborhood Health Plan, Medicaid (managed care)
O 3000 Other, Medicaid (managed care)
R 3000 Rhode Island Blue Cross, Medicaid (Sart in 2017)
U 3000 UHC, Medicaid (managed care)
B 2000 Out of State Blue Cross 3 Private Insurance
H 2000 Coordinated Health Partners
N 2000 Neighborhood Health Plan
O 2000 Other Commercial Insurance Plan
R Rhode Island Blue Cross
R 2000 Rhode Island Blue Cross (Commercial Insurance Plan)
U 2000 United Health Care
P Self-pay 4 Self-pay
Z Free (Effective prior to 2017) 5 No charge
C CHAMPUS 6 Other
O Other (Start in 2017)
W Workers' Compensation
W 2000 Workers' Compensation (Starting 2015)
Y, Z, Blank Insurance error, Missing Info . Missing
Any values not documented by the data source .A Invalid



Rhode Island
(Valid through 2002)
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
2 Medicare managed care
3 Medicaid fee for service 2 Medicaid
4 Rite Care, Rhode Island's Medicaid managed care program
5 Medicaid managed care, not otherwise specified
9 Commercial 3 Private Insurance
6 Blue Cross
7 Blue Chip, HMO Rhode Island
8 United
13 Self-pay 4 Self-pay
14 Free care, no charge 5 No charge
10 CHAMPUS 6 Other
11 Worker's Comp
12 Other
99, Blank Error, Missing . Missing
Any values not documented by the data source .A Invalid


South Carolina (SID and SEDD)
South Carolina
(Valid beginning in 2002)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
4 Commercial (including Blue Cross) 3 Private insurance
5 HMO
6 Self-Pay 4 Self-pay
--   5 No charge
9 Workers' Compensation 6 Other
10 Tricare, CHAMPUS, CHAMPVA
12 Other Agency, Charity (i.e. Medical Indigent Assistance Program (MAIP), Hill Burton, County Government, etc.)
13 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid
South Carolina
(Valid 2000-2001)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
13 Medicare managed care
2 Medicaid 2 Medicaid
14 Medicaid managed care
4 Commercial, PPO 3 Private insurance
5 HMO
6 Self-Pay 4 Self-pay
--   5 No charge
9 Workers' Compensation 6 Other
10 CHAMPUS, CHAMPVA
12 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid



South Carolina
(Valid from 1998-1999)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
6 Medicare 1 Medicare
7 Medicaid 2 Medicaid
12 Commercial, unspecified 3 Private insurance
13 Commercial, unspecified
14 Commercial, unspecified
16 HMO
1 Self-pay 4 Self-pay
--   5 No charge
2 State or county indigent program, unspecified 6 Other
3 State or county indigent program, unspecified
4 State or county indigent program, unspecified
5 Champus
8 State or county indigent program, unspecified
9 Worker's Compensation
10 State or county indigent program, unspecified
11 State or county indigent program, unspecified
15, Blank Not Stated, Missing . Missing
Any values not documented by the data source .A Invalid



South Carolina
(Valid from 1993-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
02 Medicare 1 Medicare
03 Medicaid 2 Medicaid
04, 16 Blue Cross/Commercial; HMO 3 Private insurance
01 Self-pay 4 Self-pay
--   5 No charge
05, 06, 07 Workers' Comp; Indigent/Charity; Other government 6 Other
08, Blank Missing . Missing
-- Other .A Invalid


South Dakota (SID and SEDD)
South Dakota
(Beginning in 2004)
PAY1_X PAY1
Value Description Value Description
1, 01 Medicare (Title 18) 1 Medicare
11 Medicare - Managed Care (e.g. HMO, PPO, PCCM) (beginning 2008)
2, 02 Medicaid (Title 19) 2 Medicaid
12 M