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Central Distributor SEDD: Description of Data Elements

 
PAYER1_X - Expected primary payer identifier, plan specific
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

PAYER1_X retains the expanded, detailed expected primary payer plan codes provided by the data source. PAY1_X contains payer categories (e.g., commercial insurance); more detailed, plan-specific codes are reported in PAYER1_X (e.g., AETNA and United Healthcare). The original values have not been recoded into uniform HCUP values and are source-specific.

 
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Uniform Values
 
VariableDescriptionValueValue Description
PAYER1_XExpected primary payer identifier, plan specificn(a)State specific coding - See the "State Specific Notes" section for details
 
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State Specific Notes

Maryland

Beginning with 2021 data, MD supplies a 3-digit expected payer code. *In addition, coding was transitioned to new FY values begin with 2021 Q3 data - however, the old coding system, which began in 2015, remains in effect through 2021 Q2. However, in in the 2021 Q1/Q2 a 0 is appended to the beginning of each value: for example, value 30, still defined as Aetna Health, will appear as 030 for 2021 Q1/Q2 data only.




Code Description
(Beginning 2021 Q3)
Commercial HMO/POS/PPO/PPN/TPA
101 AETNA HEALTHPLANS
102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
103 CIGNA
104 GENERIC TPA/COMMERCIAL PLANS
105 GENERIC COMMERCIAL EMPLOYEE HEALTH PLANS
106 HUMANA
107 KAISER PERMANENTE 
108 UNITED HEALTHCARE 
125 JOHNS HOPKINS EMPLOYEE HEALTH PLANS
126 UNIVERSITY OF MD EMPLOYEE HEALTH PLANS 
127 MEDSTAR EMPLOYEE HEALTH PLANS 
MD Medicaid MCO
98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW
101 AETNA HEALTHPLANS
102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
107 KAISER PERMANENTE
108 UNITED HEALTHCARE
109 AMERIGROUP COMMUNITY CARE
110 JAI MEDICAL SYSTEMS
111 MARYLAND PHYSICIANS CARE 
112 MEDSTAR FAMILY CHOICE 
113 PRIORITY PARTNERS 
118 OPTUM MARYLAND (MD MEDICAID) (previously Beacon Health)
Medicare Advantage
98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW
101 AETNA HEALTHPLANS
102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
103 CIGNA
106 HUMANA
107 KAISER PERMANENTE 
108 UNITED HEALTHCARE 
109 AMERIGROUP COMMUNITY CARE
115 JOHNS HOPKINS ADVANTAGE MD 
116 PROVIDER PARTNERS HEALTH PLAN (NEW)
128 HORIZONS MEDICARE DIRECT
Behavioral Health
98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW
107 KAISER PERMANENTE
119 MAGELLAN 
120 CIGNA BEHAVIORAL HEALTH 
121 COMPSYCH
122 MANAGE HEALTH NETWORK
123 OPTUM BEHAVIORAL HEALTH (Commercial) 
124 BEACON HEALTH OPTIONS 



Code Description
(Effective 2009-2020 Q2*)
Commerical HMO/POS:
30 Aetna Health, Inc.
31 CareFirst Bluechoice
32 Cigna Healthcare of Mid-Atlantic (Discontinued 6/30/16)
33 Coventry Health Care of Delaware, Inc.(Discontinued 6/30/20)
34 Kaiser Permanente of the Mid-Atlantic States
35 MAMSI (Discontinued 6/30/16)
36 United Healthcare of the Mid-Atlantic, Inc. (includes Allsavers)
37 Other HMO/POS
38 Evergreen Health Cooperative, Inc. (Discontinued 6/30/20)
39 Optum Maryland (Medicaid behavioral health) (effective 7/1/2020)
40 Beacon Health Option (effective 7/1/2020)
MD Medicaid MCO:
42 Amerigroup
43 Coventry Health Plan of Delaware (Diamond Plan)
44 MedStar Family Choice, Inc.
45 JAI Medical Group
46 Value Options / Beacon (Discontinued 6/30/20)
47 Maryland Physicians Care
48 Priority Partners
49 United Healthcare Community Plan
50 Other Medicaid MCO/HMO
51 2009-6/30/2019: Riverside Health. 7/1/2019-6/30/2020: CAREFIRST BLUECROSS BLUESHIELD COMMUNITY HEALTH PLAN MARYLAND (formerly called UNIVERISTY OF MARYLAND HEALTH PARTNERS BEFORE)
52 Kaiser MCO (Effective 7/1/16)
53 PROVIDER PARTNERS HEALTH PLAN (Effective 7/1/2020)
Medicare MA:
55 Aetna Medicare Advantage
58 Other Medicare HMO
59 InforMed (discontinued 6/30/2020)
60 Cigna Healthspring (Bravo)
61 Kaiser Foundation Health Plan
62 CAREFIRST BLUECROSS BLUESHIELD MEDICARE ADVANTAGE (formerly known as UNIVERSITY OF MARYLAND HEALTH ADVANTAGE HMO before 02/01/2020 (Effective 7/1/16)
63 Medstar Medicare Choice (includes choice Dual Advantage & Care Advantage) (Effective 7/1/16 - discontinued 6/30/2020)
64 Johns Hopkins Medicine Medicare Plan (Advantage MD) (Effective 7/1/16)
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65 Aetna Life and Health Insurance Company
66 CareFirst of MD Inc. (CFMI)
67 Carefirst Group Hospitalization and Medical Services Inc. (GHMSI)
68 CCN/First Health (Discontinued 6/30/16)
69 Cigna Life and Health Insurance Company, Inc. (includes connecticut General Life Insurance Companry Inc.)
70 Employer Health Plan (EHP)
71 Fidelity Benefits Administrator (Discontinued 6/30/16)
72 Great West One Plan (Discontinued 6/30/16)
73 Kaiser Permanente Insurance Company (includes Harringon Health and Health Plan Services (TPA to Kaiser)
74 United Healthcare Insurance Company (i.e. One Net PPO, MAMSI Life and Health) Optimum choice, Golden Rule Insurance Companry, MD Individual Practice Association, UMR Inc.)
75 Carefirst Administrators LLC/National Capital Administrative Services (discontinued 6/30/2020)
76 Private Health Care Systems (PHCS)
77 Other Commercial, PPO, PPN, TPA (N/A effective 2020 Q3)
78 Anthem BC/BS (Discontinued 6/30/16)
79 Coresource, Inc. (Effective 7/1/16)
80 Group Benefit Services, Inc. (Effective 7/1/16)
81 Coventry Health and Life Insurance Company / Coventry Nnational Network
82 Healthsmart Benefit Solutions, Inc. (Effective 7/1/16)
83 Humana (Effective 7/1/16)
Behavioral Health:
84 Carefirst PPO Behavioral Health (discontinued 6/30/2020)
85 American Psychiatric Systems (APS) (Discontinued 6/30/16)
86 Cigna Behavioral Health
87 ComPsych
88 Magellan
89 Managed Health Network
90 United Optum Behavioral Health (includes Optum Behavioral Solutions effective 7/1/2020)
91 Value Options (discontinued 6/30/2020)
92 Other Behavioral Health
Other Government Programs (Including Out-of-State Medicaid Programs):
54 Out-of-State (Non-MD) Medicaid
93 MD Health Insurance Plan (MHIP) EPO (discontinued 6/30/2020)
94 MD Health Insurance Plan (MHIP) PPO (discontinued 6/30/2020)
95 Tricare - example: Health Net
96 Uniformed Services Family Health Plan (USFHP)
97 Other miscellaneous government programs (includes non-MD Medicaid)
Other:
00 Not applicable
01 Other Health Plan Payers [including Qualified Dental Plans (QDPs) and Pharmacy Benefit Managers (PBMs)] (Effective 7/1/16)
99 Unknown



Code Description
(Effective 2009-2014)
Primary Adult Care (PAC) MCO:
01 Amerigroup
02 Jai Medical Group
03 Maryland Physicians Care
04 Priority Partners
05 United HealthCare
HMO/POS:
30 Aetna Health Plans
31 CareFirst Blue Choice
32 Cigna Healthcare of Mid-Atlantic
33 Coventry Health Plan of Delaware
34 Kaiser Permanente
35 MAMSI
36 United Healthcare
37 Other HMO/POS
Medicaid MCO/HMO:
42 Amerigroup
43 Coventry Health Plan of Delaware (Diamond Plan)
44 MedStar Family Choice, Inc.
45 JAI Medical Group
46 Value Options
47 Maryland Physicians Care
48 Priority Partners
49 United Healthcare (Americhoice)
50 Other Medicaid MCO/HMO
51 Riverside Health
Medicare HMO:
55 Aetna (Golden Choice)
56 ElderHealth
57 United Healthcare (Evercare)
58 Other Medicare HMO
59 InforMed
60 Bravo Health
61 Kaiser Foundation Health Plan
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65 Aetna
66 CareFirst- CareFirst of Maryland, Inc (CFMI (Maryland)) (PPO, POS, Blue Preferred, REP)
67 CareFirst- Group Hospitalization and Medical Services Inc (DC) (PPO, POS, Blue Preferred) Federal Employee Program (FEP)
68 CCN/First Health
69 Cigna
70 Employer Health Plan (EHP)
71 Fidelity Benefits Administrator
72 Great West One Plan
73 Kaiser Permanente
74 MAMSI (Alliance PPO and MAMSI Life and Health)
75 National Capital PPO (NCPPO)
76 Private Health Care Systems (PHCS)
77 Other Commercial, PPO, PPN, TPA
78 Anthem BC/BS
Behavioral Health:
85 American Psychiatric Systems (APS)
86 Cigna Behavioral Health
87 ComPsych
88 Magellan
89 Managed Health Network
90 United Behavioral Health
91 Value Options
92 Other Behavioral Health
Other Government Programs:
93 MD Health Insurance Plan (MHIP) EPO
94 MD Health Insurance Plan (MHIP) PPO
95 Tricare - example: Health Net
96 Uniformed Services Family Health Plan (USFHP)
97 Other miscellaneous government programs (includes non-MD Medicaid)
Other
0 Not applicable
99 Unknown



Beginning in 2006, PAYER values 01-29 are eliminated. Please see the new values below.

Code Description
(Beginning in 2006)
Primary Health Plan Payer HMO/POS:
30 Aetna Health Plans
31 CareFirst Blue Choice
32 Cigna Healthcare of Mid-Atlantic
33 Coventry Health Plan of Delaware
34 Kaiser Permanente
35 MAMSI
36 United Healthcare
37 Other HMO/POS
Medicaid MCO/HMO:
42 Amerigroup
43 Coventry Health Plan of Delaware (Diamond Plan)
44 Helix Family Choice, Inc.
45 JAI Medical Group
46 Medicaid/Uninsured APS €“ Maryland (psychiatric payer)
47 Maryland Physicians Care
48 Priority Partners
49 United Healthcare (Americhoice)
50 Other Medicaid MCO/HMO
Medicare HMO:
55 Aetna (Golden Choice)
55 Aetna (Golden Choice)
56 ElderHealth
57 United Healthcare (Evercare)
58 Other Medicare HMO
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65 Aetna
66 CareFirst- CareFirst of Maryland, Inc (BC/BS Plan #190/690)
67 CareFirst- Group Hospitalization and Medical Services Inc (Non HMO) (BC/BS Plan #080/580) Federal Employee Program
68 CCN/First Health
69 Cigna
70 Employer Health Plan (EHP)
71 Fidelity Benefits Administrator
72 Great West One Plan
73 Kaiser Permanente
74 MAMSI (that is, Alliance PPO and MAMSI Life and Health)
75 National Capital PPO (NCPPO)
74 MAMSI (that is, Alliance PPO and MAMSI Life and Health)
76 Private Health Care Systems (PHCS)
77 Other Commercial, PPO, PPN, TPA
Behavioral Health:
85 American Psychiatric Systems (APS)
86 Cigna Behavioral Health
87 ComPsych
88 Magellan
89 Managed Health Network
90 United Behavioral Health
91 Value Options
92 Other Behavioral Health
Other Government Programs:
93 MD Health Insurance Plan (MHIP) EPO
94 MD Health Insurance Plan (MHIP) PPO
95 Tricare - example: Health Net
96 Uniformed Services Family Health Plan (USFHP)
97 Other miscellaneous government programs
00 Not applicable
99 Unknown



Beginning in 2003, HCUP retained the managed care payer information on the AS/ED files. PAYER1_X includes the plan name of the managed care payer. This includes the health maintenance organizations (HMO), managed care organizations (MCO), and provider sponsored organizations (PSO). Source definitions are

Code Description
(Prior to 2006)
01 AETNA Health Plan Atlantic
02 CapitalCare (Blue Cross National Capital Area)
03 CFS Health Group (Carefirst, Freestate, Potomac Health)
04 Chesapeake Health Plan
05 CIGNA Healthcare MidAtlantic Inc.
06 Columbia Medical Plan
07 Delmarva Health Plan
08 Humana Group Health Plan
09 GWU Health Plans
10 NYL Care (HealthPlus, Inc., Sanus, New York Life Care, New York Life)
11 Kaiser Permanente
12 MAMSI (MDIPA, Optimum Choice, Alliance)
13 Total Health Care
14 U.S. Healthcare
15 Prudential Healthcare Plan - Mid Atlantic
16 Principal Health Care of Mid Atlantic
17 Preferred Health Network of MD
18 Physicians Health Plan Inc.
19 Principal Health\Care of Delaware, Inc.
20 Maryland Physicians Care
21 Helix Family Health
22 JAI Medical
23 Priority Partners
24 United HealthCare
25 New American Health
26 Prime Health
29 Other HMO/MCO/PSO

Source values for "Not Applicable" and "Unknown" are recoded to missing (PAYER1_X = " ").



New York

New York provides information on payer using the Public Health Data Standards Consortium Source of Payment Typology, Version 3.0. Details on the payer typology are available at https://www.health.ny.gov/statistics/sparcs/sysdoc/appp.htm.



Vermont

Detailed payer information is available in the 5-character alphanumeric payer variable PAYER1_X.

The first character indicates the type of payer:

1st character - Type of Payer Description
B Blue Cross/Blue Shield
C Champus
D Medicaid
E Other Government Plans
G MVP (effective 1/1/20)
H HMO
I Commercial
M Medicare
P Self Pay
W Workers Comp
X Charity (effective 1/1/20)
Z Medically Indigent/Free
U Unknown

The second through fifth characters indicate the payer sub ID:

2nd -5th character - Payer Sub ID Description
1001 Maine
1002 Massachusetts
1003 National
1004 New Hampshire
1005 New York
1006 Vermont
1111 ACO (effective 1/1/20)
1919 Covid 19 HRSA (effective 1/1/20)
2001 BC
2002 CHP Kaiser
2003 VHAP
3001 Healthsource/Cigna
3002 TVHP
3003 Mathew Thronton
3004 MVHP (Discontinued 12/31/19)
4001 Standard Managed Care
4002 Managed Care
8888 No Sub ID
9009 Other

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Internet Citation: HCUP Central Distributor SEDD Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). September 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/sedddistnote.jsp?var=payer1_x.
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Last modified 9/11/08