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.

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

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.

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).

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.

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).

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

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

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

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

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

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

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 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 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).

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.

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).

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.

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".

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:

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).

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).

Unusual pay sources were recoded as follows:

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

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).

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 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.

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

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 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".

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

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 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 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 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.