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NIS Description of Data Elements

 
PAY2_N - Expected secondary payer, nonuniform
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

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.

 
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Uniform Values
VariableDescriptionValueValue Description
PAY2_NExpected secondary 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)
.CInconsistent: in 1998-1997 data, ED951, ED952
 
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State Specific Notes

Connecticut

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



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
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).


Kansas

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.



Maryland

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."



Massachusetts

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:

Source Payer HCUP Payer PAY2_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" (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).



Missouri

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).



New Jersey

Unusual pay sources were recoded as follows:

Pay Source Recoded to HCUP uniform value
"No Fault" Private Insurance, PPO (PAY2_N = 4)
"Personnel Health Plan" Other (PAY2_N = 12)
"Indigent" 1988 1992: Other (PAY2_N = 11), From 1993: Self Pay (PAY2_N = 6)


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



New York

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).


Oregon

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).


Pennsylvania

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.

HMO/PPO

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).
Worker's Compensation

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).

Commercial

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).

Health and Welfare

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).


South Carolina

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

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."
Title V

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



Utah

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

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

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.


 
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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/pay2_n/nisnote.jsp.
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Last modified 9/17/08