Central Distributor SASD: Description of Data Elements

PAY1_N - Expected primary payer, nonuniform

Documentation Sections:

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

Variable	Description	Value	Value Description
PAY1_N	Expected primary payer, nonuniform	1	Medicare (mixed)
		2	Medicaid
		3	Blue Cross, Blue Cross PPO
		4	Commercial, PPO (mixed)
		5	Private HMO
		6	Self-pay
		7	No charge
		8	Title V
		9	Worker's Comp
		10	CHAMPUS, CHAMPVA
		11	Other Government
		12	Other
		.	Missing
		.A	Invalid
		.B	Unavailable from source (coded in 1988-1997 data only)

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State Specific Notes

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).

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 and Underinsured

Self-pay and Underinsured are categorized under Self pay (PAY1_N = 6).

Maryland

Medicare

The HCUP category "Medicare" (PAY1_N = 1) includes the source code "Medicare HMO" beginning in 1995.

Medicaid

For 1990-1994, the HCUP category "Medicaid" (PAY1_N = 2) includes the source code "Medicaid State Only (MSO)."

For all years, the HCUP category "Medicaid" (PAY1_N = 2) includes the source code "Medicaid HMO."

CHAMPUS/CHAMPVA

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

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

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

New York does not separately classify "Title V" (PAY1_N = 8). The source documentation available for New York Ambulatory Surgery data does not indicate which payer codes were used for "Title V."

Beginning in 1993, New York reports "Medicare HMO" separately from "Medicare" and "Medicaid HMO" separately from "Medicaid."

Medicare HMO was included in the HCUP category "Medicare". (PAY1_N = 1).
Medicaid HMO was included in the HCUP category "Medicaid". (PAY1_N = 2).

Beginning in 1995, New York reports "Corrections Federal," "Corrections-State," and "Corrections-Local" as distinct categories. These were 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.

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Central Distributor SASD: Description of Data Elements