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Central Distributor SID: Description of Data Elements

 
PAY1_N - Expected primary payer, nonuniform
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

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
 
VariableDescriptionValueValue Description
PAY1_NExpected primary 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)
 
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State Specific Notes

Arizona

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


Pay Source Recoded to HCUP uniform value
"Medicare Risk" Medicare (PAY1_N = 1)
"AHCCCS Health Care Group" Medicaid (PAY1_N = 2)
MEDEXCEL CHAMPUS/CHAMPVA (PAY1_N = 10)
"Children's Rehabilitation Services" Other Government (PAY1_N = 11)
"Indian Health Services" Other Government (PAY1_N = 11)
"Foreign National" Other (PAY1_N = 12)

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.



California
HMO Payers

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).


Title V

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.


CHAMPUS/CHAMPVA

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).


Medically Indigent Services

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



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, Charity, and Underinsured

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).



Hawaii

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).


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Internet Citation: HCUP Central Distributor SID Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). August 2024. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/siddistnote.jsp?var=pay1_n.
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Last modified 8/7/24