PAY2_N (where _N indicates nonuniform) preserves much of the original expected secondary payer detail from the various data sources. However, some categories of PAY2_N are not available from some sources because not all sources have the same level of detail available. The data element PAY2_N was discontinued in 1998.

The HCUP data element PAY2_X retains the expected secondary payer as provided by the data source.

In the 1988-1997 HCUP databases, the secondary pay source (PAY2_N) was set to inconsistent (.C) if the primary pay source and the secondary pay source are the same and the source is one of the following:

• Medicare (ED951),
• Medicaid (ED951),
• CHAMPUS (ED952),
• Worker's Compensation (ED952), and
• Title V (ED952).

No edit checks were performed on the payer data elements beginning in the 1998 databases.

Beginning in 1997, a pay source of "Medicare Managed Care" is included with the usual categories coded under Medicare (PAY2_N = 1).

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.

PAY2_N is missing (.) for all discharges even though PAY2 is coded. This is because Kansas payer codes lacked the detail necessary to map them accurately to the nonuniform PAY2_N codes.

The HCUP category "Medicare" (PAY2_N = 1) includes the source code "Medicare HMO."

The HCUP category "Medicaid" (PAY2_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" (PAY2_N = 12), a pay source of "Donor" is included.

Maryland did not separately classify "CHAMPUS/CHAMPVA" (PAY2_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 (PAY2_N = 8) or CHAMPUS/CHAMPVA (PAY2_N = 10). The source documentation available for Massachusetts did not indicate which payer type(s) were used for Title V or CHAMPUS/CHAMPVA.
• The source payer codes for "Other or principal source covered payment in full" were included in the HCUP category "Other" (PAY2_N = 12).

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" (PAY2_N = 4). From 1993 to 1995, "PPO and Other Managed Care not listed elsewhere" was recoded into the uniform category "Other" (PAY2_N = 12).

Beginning in the 4th quarter of 1997, the source code "Point of Service" was included in the HCUP uniform category "Alternative Delivery Systems" (PAY2_N = 5).

According to the Missouri Hospital Association, some hospitals do not separately classify "Blue Cross/Blue Shield" (PAY2_N = 3), but instead group "Blue Cross/Blue Shield" with "Commercial, PPO" (PAY2_N = 4).

Missouri does not separately classify alternate delivery systems, HMO, PHP, etc. (PAY2_N = 5). According to the documentation, these are included with "Commercial/Private Insurance" which are included in the HCUP category "Commercial, PPO" (PAY2_N = 4).

Missouri does not separately classify CHAMPUS/CHAMPVA payers (PAY2_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" (PAY2_N = 11).

Unusual pay sources were recoded as follows:

The source pay category "Indigent" was incorrectly mapped to "Other" (PAY2_N = 11) during HCUP processing of 1988 1992 data.

New York does not separately classify Title V (PAY2_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" (PAY2_N = 4).

Prior to 1996, the source category "Corrections (State, County or City)" is included in the HCUP category "Other Government" (PAY2_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" (PAY2_N = 11).

Beginning in 1993:

• The source separately classifies "Medicare HMO." This is assigned to the HCUP category "Medicare" (PAY2_N = 1).
• The source separately classifies "Medicaid HMO." This is assigned to the HCUP category "Medicaid" (PAY2_N = 2).

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

• "Alternative Delivery System" (PAY2_N = 5),
• "No Charge" (PAY2_N = 7),
• "TITLE V" (PAY2_N = 8), or
• "CHAMPUS, CHAMPVA" (PAY2_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" (PAY2_N = 4), and
• The source category "Managed Assistance" is included in the HCUP category "Other Government" (PAY2_N = 11).

Beginning in 1995, Pennsylvania supplied an expected secondary and tertiary payer in addition to the expected primary payer.

Pennsylvania does not separately classify No Charge (PAY2_N = 7) Title V (PAY2_N = 8), and CHAMPUS/CHAMPVA (PAY2_N = 10). The source documentation available for Pennsylvania data does not indicate which code(s) were used for these payers.

The source reports separate categories for

• Medicare HMO/PPO (PAY2_N = 1),
• Medicaid HMO/PPO (PAY2_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" (PAY2_N = 5).

The source reports separate categories for

• "Commercial Worker's Compensation,"
• "Employer Direct Bill Worker's Compensation," and
• "Other Government State Worker's Insurance."

These are recoded to the HCUP category Worker's Compensation (PAY2_N = 9).

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 (PAY2_N = 4).

The source separates "Health and Welfare Fund" into several categories:

• "Blue Cross Health and Welfare Fund," (PAY2_N = 3)
• "Commercial Union Health and Welfare Fund," (PAY2_N = 4) and
• "Employer Direct Bill Health and Welfare Fund" (PAY2_N = 4).

PAY2_N is missing (.) for all discharges even though PAY2 is coded. South Carolina payer codes lacked the detail necessary to map them accurately to the nonuniform PAY2_N codes.

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

• The uniform category "Medicare" (PAY2_N = 1) includes the source payer "Medicare Managed Care."
• The uniform category "Medicaid" (PAY2_N = 2) includes the source payer "TennCare."
• The uniform category "HMO, PHP, etc." (PAY2_N = 5) includes the source payer "HMO/Managed Care."

Tennessee does not separately classify Title V (PAY2_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" (PAY2_N = 11).

Utah does not separately classify:

• No Charge (PAY2_N = 7),
• Title V (PAY2_N = 8), or
• CHAMPUS, CHAMPVA (PAY2_N = 10).

The source documentation indicates that No Charge is included in Other (PAY2_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 (PAY2_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" (PAY2_N = 12).

Washington does not separately classify Blue Cross payers (PAY2_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" (PAY2_N = 12).

Wisconsin does not separately classify:

• No Charge (PAY2_N = 7), or
• Title V (PAY2_N = 8).

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