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. |
Top |
Uniform Values | ||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||
Top | ||||||||||||||||||||||||||||||||||||
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
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:
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 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:
Florida 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:
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). |
||||||||||||||||||||||||||||||||||||||
Top | ||||||||||||||||||||||||||||||||||||||
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. |
Are you having problems viewing or printing pages on this website? |
If you have comments, suggestions, and/or questions, please contact hcup@ahrq.gov. |
Privacy Notice, Viewers & Players |
Last modified 8/7/24 |