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NIS Description of Data Elements
The NIS is set of longitudinal hospital inpatient databases included in the HCUP family. These databases are created by AHRQ through a Federal-State-Industry partnership.
 
PAY1_N - Expected primary payer, nonuniform
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

PAY1_N (where _N indicates nonuniform) preserves much of the original expected primary payer detail from the various data sources. However, some categories of PAY1_N are not available from some sources because not all sources have the same level of detail available.

The HCUP data element PAY1 contains more general categories for commercial and other payers. PAY1_X retains the expected primary payer as provided by the data source. The data element PAY1_N was discontinued in 1998.

 
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Uniform Values
VariableDescriptionValueValue Description
PAY1_NExpected primary payer, nonuniform1Medicare (mixed)
2Medicaid
3Blue Cross, Blue Cross PPO
4Commercial, PPO (mixed)
5Private HMO
6Self-pay
7No charge
8Title V
9Worker's Comp
10CHAMPUS, CHAMPVA
11Other Government
12Other
.Missing
.AInvalid
.BUnavailable from source (coded in 1988-1997 data only)
 
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State Specific Notes

Arizona

Arizona's coding of expected primary payer changes across years. For 1989-1994, PAY1_N is missing (.) for all discharges even though PAY1 is coded. This is because Arizona payer codes lacked the detail necessary to map them accurately to the nonuniform PAY1_N codes.


Beginning in 1995, Arizona reported enough detail to assign the nonuniform PAY1_N codes. Unusual pay sources were recoded as follows


Pay Source Recoded to HCUP uniform value
"Medicare Risk" Medicare (PAY1_N = 1)
"AHCCCS Health Care Group" Medicaid (PAY1_N = 2)
MEDEXCEL CHAMPUS/CHAMPVA (PAY1_N = 10)
"Children's Rehabilitation Services" Other Government (PAY1_N = 11)
"Indian Health Services" Other Government (PAY1_N = 11)
"Foreign National" Other (PAY1_N = 12)

The Arizona category "HMO/Prepaid Health Plans/Blue Cross" was recoded into the HCUP category "Alternative Delivery Systems, HMO" (PAY1_N = 5), but it represents a mix of plans that are usually divided into:

  • Blue Cross, Blue Cross PPO (PAY1_N = 3),
  • Commercial, PPO (PAY1_N = 4), and
  • Alt. delivery systems, HMO (PAY1_N = 5).

Arizona does not separately classify Title V (PAY1_N = 8). No documentation was available about which payer type(s) were used for Title V.



California
HMO Payers

The source reports "Medicare HMO payers" as "Medicare". These payers are included in the HCUP uniform category "Medicare" (PAY1_N = 1).


The source reports "Medi-Cal HMO payers" as "Medi-Cal". These payers are included in the HCUP uniform category "Medicaid" (PAY1_N = 2).


The source reports "Blue Cross/Blue Shield HMO payers" as "Blue Cross/Blue Shield." These payers are included in the HCUP uniform category "Blue Cross/Blue Shield" (PAY1_N = 3).


Title V

Beginning in 1995, the source does not separately classify "Title V" (PAY1_N = 8). No documentation was available about which payer type(s) were used for Title V.


CHAMPUS/CHAMPVA

Prior to 1995, California did not separately classify CHAMPUS/CHAMPVA payers. No documentation was available about which payer type(s) were used for CHAMPUS/CHAMPVA.


Beginning in 1995, the source reports CHAMPUS/CHAMPVA as a separate category. These records are included in the uniform category "CHAMPUS/CHAMPVA" (PAY1_N = 10).


Medically Indigent Services

A pay source of "Medically Indigent Services" is included in the HCUP uniform category "Other Government" (PAY1_N = 11).



Colorado

Colorado redefined payer codes and categories in 1993. Several of the HCUP payer recodes are affected:

HMO/PPO
1988 - 1992 The source reports only one distinct HMO/PPO payer category (PAY1_N = 5). The source documentation does not indicate whether HMO services paid for by Medicare, Medicaid, and other payers ("other liability", no fault auto insurance, and home casualty insurance) are included in the source data as HMO/PPO.
Beginning 1993 The source reports separate categories for HMO/PPO (PAY1_N = 5), Medicare HMO (PAY1_N = 1), Medicaid HMO (PAY1_N = 2), and HMO/PPO service provided by other payers "Other Liability, No Fault Auto, and Home Casualty Insurance" (PAY1_N = 4).
CHAMPUS/CHAMPVA
1988 - 1992 The source does not separately classify CHAMPUS/CHAMPVA. The documentation supplied by the data source does not indicate how these payers are coded.
Beginning 1993 The data source reports CHAMPUS/CHAMPVA as a distinct category (PAY1_N = 10).
Colorado Medically Indigent Program
1988 - 1992 The source does not separately classify Colorado Medically Indigent Program. The documentation supplied by the data source does not indicate how these payers are reported.
Beginning 1993 The data source reports Colorado Medically Indigent Program as a distinct category, which is recoded to the HCUP category "Other Government" (PAY1_N = 11).
Title V
1988 - 1992 The source reports a distinct category for Title V (PAY1_N = 8).
Beginning 1993 The source reports Title V as "Other Government" (PAY1_N = 11).


Connecticut

Beginning in 1997, a pay source of "Medicare Managed Care" is included with the usual categories coded under Medicare (PAY1_N = 1).



Florida
Medicare

In addition to the usual categories coded under Medicare (PAY1_N = 1), a pay source of "Medicare HMO" is included.


Medicaid

In addition to the usual categories coded under Medicaid (PAY1_N = 2), a pay source of "Medicaid HMO" is included.


Blue Cross

Florida does not separately classify Blue Cross. Blue Cross payers are categorized under Commercial, PPO (PAY1_N = 4).


Self-pay, Charity, and Underinsured

From 1988-1991, the payers self-pay, charity, and underinsured were categorized under Other (PAY1_N = 12), because Florida did not separately identify them.


From 1992-1996, Florida provided one payer category for "Self-pay, Charity, and Underinsured" which was categorized under the Self pay (PAY1_N = 6).


Beginning in 1997, "Charity" is identified by Florida with a separate source value and is recoded to "No Charge" (PAY1_N = 7). Self-pay and Underinsured continue to be categorized under Self pay (PAY1_N = 6).



Georgia

Georgia reports only one distinct HMO/PPO payer category (PAY1_N = 5). The source documentation does not indicate whether HMO services paid for by Medicare, Medicaid, and other payers ("other liability", no fault auto insurance, and home casualty insurance) are included in the source data as HMO/PPO.

The source category "Self Insured" is included in the HCUP category "Commercial, PPO" (PAY1_N = 4).


Georgia does not separately classify "Title V" (PAY1_N = 8). No documentation was available about which payer type(s) were used for Title V.



Hawaii

Hawaii does not separately classify:

  • Blue Cross (PAY1_N = 3),
  • No Charge (PAY1_N = 7),
  • Title V (PAY1_N = 8), or
  • CHAMPUS, CHAMPVA (PAY1_N = 10).

The source documentation indicates that CHAMPUS is included in Other Government (PAY1_N = 11). No documentation was available about which payer type(s) were used for Blue Cross, No Charge, or Title V.


The HCUP category "Medicaid" (PAY1_N = 2) includes the source codes "Quest" and "SHIP".


The source categories "No Fault", and "HMSA" are included in the HCUP category "Commercial, PPO" (PAY1_N = 4).



Illinois

The source coding of expected payer changes across years.


In 1988-1992, Illinois used individual payer codes. For example, charity admissions are identified by a unique value.


In 1993, Illinois redefined their payer codes into categories. Using the previous example, charity admissions are included under Illinois' payer category of Other and can not be separately identified.


Beginning in 1995, Illinois added a payer identification number that is used with the payer categories to once again distinguish charity and some other types of payers.

Blue Cross
1988-1992 The source reports this payer separately, and it is recoded to the HCUP non-uniform category "Blue Cross" (PAY1_N = 3).
Beginning 1993 The source reports Blue Cross with all other commercial payers, therefore Blue Cross is included in the HCUP non-uniform category "Commercial" (PAY1_N = 4).
Charity
1988-1992 The source reports this category separately, and it is recoded to the HCUP non-uniform category "No Charge" (PAY1_N = 7).
1993-1994 The source includes Charity in the payer type "Other", therefore it is included in the HCUP non-uniform category "Other" (PAY1_N = 12).
Beginning 1995 The source reports Charity as a separate category, and it is recoded to the HCUP non-uniform category "No Charge" (PAY1_N = 7).
Hill Burton Free Care
1988-1992 The source reports this category separately, and it is recoded to the HCUP non-uniform category "No Charge" (PAY1_N = 7).
1993-1994 The source includes Hill Burton Free Care in the payer type "Other," therefore it is included in the HCUP non-uniform category "Other" (PAY1_N = 12).
Beginning 1995 The source reports Hill Burton Free Care as a separate category, and it is recoded to the HCUP non-uniform category "No Charge" (PAY1_N = 7).
Worker's Compensation
1988-1992 During HCUP processing, Worker's Compensation codes had to be matched using two separate files provided by the data source to identify Worker's Compensation payers, however only 81% of Worker's Compensation payers could be matched to codes. As a result, some Worker's Compensation payers may have been assigned to the HCUP payer "Commercial, PPO" (PAY1_N = 4), instead of "Worker's Compensation" (PAY1_N = 9).
Beginning 1993 The source includes Worker's Compensation in the payer type "Other", therefore it is included in the HCUP non-uniform category "Other" (PAY1_N = 12).
CHAMPUS/CHAMPVA
1988-1992 The source reports this payer type separately, and it is recoded to the HCUP non-uniform category "CHAMPUS and CHAMPVA" (PAY1_N = 10).
1993-1994 The source includes CHAMPUS/CHAMPVA in the payer type "Other", therefore it is included in the HCUP non-uniform category "Other" (PAY1_N = 12).
Beginning 1995 The source identifies CHAMPUS/CHAMPVA as a separate category, and it is recoded to the HCUP non-uniform category "CHAMPUS and CHAMPVA" (PAY1_N = 10).
Black Lung
1988-1992 The source reports this category separately, and it is recoded to the HCUP non-uniform category "Other government" (PAY1_N = 11).
1993-1994 The source includes Black Lung in the payer type "Other", therefore it is included in the HCUP non-uniform category "Other" (PAY1_N = 12).
Beginning 1995 The source reports Black Lung as a separate category, and it is recoded to the HCUP non-uniform category "Other Government" (PAY1_N = 11).
Self-Administered Insurance Plans
All years The source category "Self-administered insurance plans or self-insured plans" is included in the HCUP category "Commercial insurance" (PAY1_N = 4).


Iowa

Iowa data do not separately classify:

  • Alternative Delivery System (PAY1_N = 5),
  • No Charge (PAY1_N = 7),
  • Title V (PAY1_N = 8), or
  • CHAMPUS, CHAMPVA (PAY1_N = 10).

The documentation indicates that Alternative Delivery Systems are included in Commercial (PAY1_N = 4). Title V and CHAMPUS, CHAMPVA are included in Other Government (PAY1_N = 11). No documentation was available about which payer type(s) were used for No Charge


Some hospitals assign the same payer source to all discharges. Examination of the data indicates that these sources are either Medicare (PAY1_N = 1), Commercial Insurance (PAY1_N = 4), or both (PAY1_N=1 and PAY1_N = 4).



Kansas

PAY1_N is missing (.) for all discharges even though PAY1 is coded. This is because Kansas payer codes lacked the detail necessary to map them accurately to the nonuniform PAY1_N codes.



Maryland

The HCUP category "Medicare" (PAY1_N = 1) includes the source code "Medicare HMO".


The HCUP category "Medicaid" (PAY1_N = 2) includes the source codes "Medicaid State Only (MSO)" and "Medicaid HMO".


In addition to the usual categories coded under the HCUP category "Other" (PAY1_N = 12), a pay source of "Donor" is included.


Maryland did not separately classify "CHAMPUS/CHAMPVA" (PAY1_N = 10). The source documentation available for Maryland did not indicate which payer type(s) were used for "CHAMPUS/CHAMPVA".



Massachusetts

For all years, Massachusetts does not separately classify Title V (PAY1_N = 8) or CHAMPUS/CHAMPVA (PAY1_N = 10). The source documentation available for Massachusetts did not indicate which payer type(s) were used for Title V or CHAMPUS/CHAMPVA.


Beginning in 1993, quarter 4, Massachusetts reports separate managed care categories:

Source Payer HCUP Payer PAY1_N
Medicare Managed Care Medicare 1
Medicaid Managed Care Medicaid 2
Blue Cross Managed Care Blue Cross, Blue Cross PPO 3
Commercial Managed Care Commercial, PPO 4
Other Non-Managed Care Other 12

Beginning in 1996, "PPO and Other Managed Care not listed elsewhere" was recoded into the uniform category "Commercial, PPO" (PAY1_N = 4). From 1993 to 1995, "PPO and Other Managed Care not listed elsewhere" was recoded into the uniform category "Other" (PAY1_N = 12).


Beginning in 1997, the source code "Point of Service" was included in the HCUP uniform category "Alternative Delivery Systems" (PAY1_N = 5).



Missouri

According to the Missouri Hospital Association, some hospitals do not separately classify "Blue Cross/Blue Shield" (PAY1_N = 3), but instead group "Blue Cross/Blue Shield" with "Commercial, PPO" (PAY1_N = 4).


Missouri does not separately classify alternate delivery systems, HMO, PHP, etc. (PAY1_N = 5). According to the documentation, these are included with "Commercial/Private Insurance" which are included in the HCUP category "Commercial, PPO" (PAY1_N = 4).


Missouri does not separately classify CHAMPUS/CHAMPVA payers (PAY1_N = 10). According to the documentation available from the hospital association, CHAMPUS and CHAMPVA are categorized as "Other Government (CHAMPUS)". These are included in the uniform category "Other Government" (PAY1_N = 11).



New Jersey

Unusual pay sources were recoded as follows:

Pay source Recoded to HCUP uniform value
"No Fault" Private Insurance, PPO (PAY1_N = 4)
"Personnel Health Plan" Other (PAY1_N = 12)
"Indigent" 1988 1992: Other (PAY1_N = 11), From 1993: Self Pay (PAY1_N = 6)

The source pay category "Indigent" was incorrectly mapped to "Other" (PAY1_N = 11) during HCUP processing of 1988-1992 data.



New York

New York does not separately classify Title V (PAY1_N = 8). The source documentation available for New York does not indicate which payer type(s) were used for Title V.


The source categories "No Fault", "Self Insured", and "Self Administered Plan" are included in the HCUP category "Commercial, PPO" (PAY1_N = 4).


Prior to 1996, the source category "Corrections (State, County or City)" is included in the HCUP category "Other Government" (PAY1_N = 11). Beginning in 1996, New York separately reported pay categories for "Corrections - Federal", "Corrections - State", and "Corrections - Local". All of these source values were recoded to the HCUP uniform category "Other Government" (PAY1_N = 11).


Beginning in 1993:

  • The source separately classifies "Medicare HMO". This is assigned to the HCUP category "Medicare" (PAY1_N = 1).
  • The source separately classifies "Medicaid HMO". This is assigned to the HCUP category "Medicaid" (PAY1_N = 2).


Oregon

Prior to 1995, Oregon did not separately classify the HCUP categories:

  • "Alternative Delivery System" (PAY1_N = 5),
  • "No Charge" (PAY1_N = 7),
  • "TITLE V" (PAY1_N = 8), or
  • "CHAMPUS, CHAMPVA" (PAY1_N = 10).

The source documentation supplied by Oregon did not indicate which source categories are used for these payers. Starting in 1995, these payers are reported as separate categories.


In 1995, two source categories for payer were added:

  • The source category "Self insured" is included in the HCUP category "Commercial insurance" (PAY1_N = 4), and
  • The source category "Managed Assistance" is included in the HCUP category "Other Government" (PAY1_N = 11).


Pennsylvania
In all years

Pennsylvania does not separately classify No Charge (PAY1_N = 7) Title V (PAY1_N = 8), and CHAMPUS/CHAMPVA (PAY1_N = 10). The source documentation available for Pennsylvania data does not indicate which code(s) were used for these payers.


Beginning in 1994

Pennsylvania redefined payer codes and categories in 1994. Several of the HCUP payer recodes are affected.


HMO/PPO
1989-1993 The source reports only one distinct HMO/PPO payer category (PAY1_N = 5). The source documentation does not indicate whether HMO services paid for by Medicare, Medicaid, and other payers ("commercial", "employers" "associations", and "auto insurance") are included in the source data as HMO/PPO.
Starting in 1994 The source reports separate categories for
  • Medicare HMO/PPO (PAY1_N = 1),
  • Medicaid HMO/PPO (PAY1_N = 2), and
  • HMO/PPO service provided by payers such as "Blue Cross
  • HMO/PPO," "Patient Direct Bill HMO/PPO," "Commercial
  • HMO/PPO," and "Employer Direct Bill HMO/PPO" (PAY1_N = 5).

Worker's Compensation
1989-1993 The source reports one distinct category for Worker's Compensation (PAY1_N = 9).
Starting in 1994 The source reports separate categories for:
  • "Commercial Workers' Compensation"
  • "Employer Direct Bill Worker's Compensation," and
  • "Other Government State Worker's Insurance".

These are recoded to the HCUP category Worker's Compensation (PAY1_N = 9).

Commercial
1989-1993 The source reports distinct categories for:
  • "Employers" (which includes self-insured employers, union and labor) and
  • "Associations" (which includes payers such as chambers of commerce and associations of retirees).

These are recoded to the HCUP category Commercial, PPO (PAY1_N = 4).

Starting in 1994 The source reports distinct categories for:
  • "Commercial",
  • "Commercial Union Health and Welfare Fund",
  • "Commercial Auto",
  • "Commercial Association",
  • "Employer Direct Bill"
  • "Employer Direct Bill Union Health and Welfare Fund", and
  • "Employer Direct Bill Association"

These are recoded to the HCUP category Commercial, PPO (PAY1_N = 4).

Health and Welfare
1989-1993 The source reports a single category for "Health and Welfare Fund" which is recoded to the HCUP category Other Government (PAY1_N = 11).
Starting in 1994 The source separates "Health and Welfare Fund" into several categories:
  • "Blue Cross Health and Welfare Fund", (PAY1_N = 3)
  • "Commercial Union Health and Welfare Fund", (PAY1_N = 4) and
  • "Employer Direct Bill Health and Welfare Fund", (PAY1_N = 4).


South Carolina

PAY1_N is missing (.) for all discharges even though PAY1 is coded. South Carolina payer codes lacked the detail necessary to map them accurately to the nonuniform PAY1_N codes.



Tennessee

Tennessee reports HMO and managed care separately for commercial, Medicare, and Medicaid payers:

  • The uniform category "Medicare" (PAY1_N = 1) includes the source payer "Medicare Managed Care".
  • The uniform category "Medicaid" (PAY1_N = 2) includes the source payer "TennCare".
  • The uniform category "HMO, PHP, etc." (PAY1_N = 5) includes the source payer "HMO/Managed Care".

Title V

Tennessee does not separately classify Title V (PAY1_N = 8). No documentation was available about which payer type(s) were used for Title V.


Other Government

The source categories "Managed Assistance", "County or State Employee", and "Division of Health Services (Vocational Rehabilitation)" are included in the HCUP category "Other Government" (PAY1_N = 11).



Utah

Utah does not separately classify:

  • No Charge (PAY1_N = 7),
  • Title V (PAY1_N = 8), or
  • CHAMPUS, CHAMPVA (PAY1_N = 10).

The source documentation indicates that No Charge is included in Other (PAY1_N = 12). No documentation was available about which payer type(s) were used for Title V or CHAMPUS.



Washington

Washington does not separately classify CHAMPUS and CHAMPVA payers (PAY1_N = 10). According to the documentation available from the state, CHAMPUS and CHAMPVA are categorized as "other sponsored patients", which are included in the HCUP category "Other" (PAY1_N = 12).


Washington does not separately classify Blue Cross payers (PAY1_N = 3). The source category "Health Care Service Contractors" includes a mix of Blue Cross, County Medical Bureaus, Washington Physicians Service, and other commercial payers. This source value was recoded into the non-uniform category "Other" (PAY1_N = 12).



Wisconsin

Wisconsin does not separately classify:

  • No Charge (PAY1_N = 7), or
  • Title V (PAY1_N = 8).

No documentation was available about which payer type(s) were used for Title V and No charge.


 
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Internet Citation: HCUP NIS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). September 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/pay1_n/nisnote.jsp.
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Last modified 9/17/08