Central Distributor SID: Description of Data Elements

PAYER1_X - Expected primary payer identifier, plan specific

Documentation Sections:

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

Variable	Description	Value	Value Description
PAYER1_X	Expected primary payer identifier, plan specific	n(a)	State specific coding - See the "State Specific Notes" section for details

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State Specific Notes

California

The 4-digit plan code numbers provided by California represent the name of the Knox-Keene licensed plan or Medi-Cal County Organized Health System. In California, HMOs are regulated under the Knox-Keene Health Care Service Plan Act of 1975.

If the plan code numbers are the same and the plan names are different, it means they belong to the same "parent" plan.

Knox-Keene Licensed Plans and Plan Code Numbers
Plan Code Numbers	Plan Code Names
0000	Plan Code not applicable
0176	Aetna Health Plans of California, Inc.
0328	Alameda Alliance for Health
0322	American Family Care
0303	Blue Cross of California
0043	Blue Shield of California
0314	BPS HMO
0352	Brown and Toland Medical Group
0365	Calaveras Provider Network
0326	Care 1st Health Plan
0234	Careamerca-Southern California, Inc.
0278	Chinese Community Health Plan
0152	Cigna Healthcare of California, Inc.
0200	Community Health Group
0248	Community Health Plan (County of Los Angeles)
0360	Concentrated Care, Inc.
0054	Contra Costa Health Plan
0350	FPA Medical Management of California, Inc.
0327	Great American Health Plan
0317	Greater Pacific HMO, Inc.
0292	HAI
0277	Healthmax America
0300	Health Net
0126	Health Plan of America (HPA)
0159	Health Plan of the Redwoods
0357	Heritage Provider Network, Inc.
0346	Inland Empire Health Plan
0151	Inter Valley Health Plan
0289	Kaiser Foundation Added Choice Health Plan
0055	Kaiser Foundation Health Plan, Inc.
0335	Kern Health Systems, Inc.
0343	Key Health Plan of California
0142	Lifeguard, Inc.
0355	LA Care Health Plan
0196	Managed Health Network
0002	Maxicare
0298	MCC Behavioral Care of California, Inc.
0345	MedPartners Provider Network, Inc.
0266	Metrahealth Care Plan
0288	Merit Behavioral Care of California, Inc.
0270	Monarch Plan, Inc.
0222	National Health Plans
0222	National HMO
0235	Occupational Health Services (OHS)
0238	Omni Healthcare, Inc.
0325	One Health Plan of California, Inc.
0301	Pacificare Behavioral Health of California, Inc.
0126	Pacificare of California
0237	Priorityplus of California
0296	Prucare Plus
0300	Qualmed Plans for Health
0354	Regents of the University of California
0349	San Francisco Health Plan
0351	Santa Clara County Family Health Plan
0126	Secure Horizons
0310	Sharp Health Plan
0212	Smartcare Health Plan
0338	The Health Plan of San Joaquin
0324	Tower Health Service
0266	UHC Healthcare
0008	UHP Healthcare
0209	Universal Care
0236	Valley Health Plan
0293	Value Behavioral Health of California, Inc.
0344	Ventura County Health Care Plan
0102	Vista Behavioral Health Plan
0348	Western Health Advantage
8000	Other

Medi-Cal County Organized Health Systems and Plan Code Numbers
Plan Code Numbers	Plan Code Names
0000	Plan Code not applicable
9030	Cal Optima (Orange County)
9041	Health Plan of San Mateo (San Mateo County)
9042	Santa Barbara Health Authority (Santa Barbara County)
9044	Santa Cruz County Health Options (Santa Cruz County)
9048	Solano Partnership Health Plan (Solano County)

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 PERMANENTEÂ
108	UNITED HEALTHCAREÂ
125	JOHNS HOPKINS EMPLOYEE HEALTH PLANS
126	UNIVERSITY OF MD EMPLOYEE HEALTH PLANSÂ
127	MEDSTAR EMPLOYEE HEALTH PLANSÂ
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 CAREÂ
112	MEDSTAR FAMILY CHOICEÂ
113	PRIORITY PARTNERSÂ
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 PERMANENTEÂ
108	UNITED HEALTHCAREÂ
109	AMERIGROUP COMMUNITY CARE
115	JOHNS HOPKINS ADVANTAGE MDÂ
116	PROVIDER PARTNERS HEALTH PLAN (NEW)
128	HORIZONS MEDICARE DIRECT
Behavioral Health
98	HEALTH PLAN PAYERS NOT SPECIFIED BELOW
107	KAISER PERMANENTE
119	MAGELLANÂ
120	CIGNA BEHAVIORAL HEALTHÂ
121	COMPSYCH
122	MANAGE HEALTH NETWORK
123	OPTUM BEHAVIORAL HEALTH (Commercial)Â
124	BEACON HEALTH OPTIONSÂ

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 â€“ 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 = " ").

Massachusetts

PAYER1_X includes specific payment plan identifiers. Valid 10/01/2020

Payer Source Code	Health Plan
4	Fallon Community Health Plan
7	Tufts Associated Health Plan
23	Guardian Life Insurance Company
24	Health New England
26	CHAMPUS/TriCare
30	CIGNA
40	Kaiser Foundation
42	ConnectiCare Of Massachusetts
46	Blue CHiP (BCBS Rhode Island)
47	Neighborhood Health Plan
51	Aetna
57	John Hancock Life Insurance
74	United Healthcare Insurance Company
84	Private Healthcare Systems
85	Liberty Mutual
97	UniCare
102	Wausau Insurance Company
103	Medicaid (MassHealth)
118	Mass Behavioral Health Partnership
120	Out-of-State Medicaid
121	Medicare
134	Medicare HMO - Other (not listed elsewhere)
137	AARP/Medigap Supplement
143	Free Care
145	Self-Pay
146	Worker's Compensation
147	Other Commercial (not listed elsewhere)
151	CHAMPUS
154	BCBS Other (Not listed elsewhere)
156	Out of state BCBS
159	None (Valid only for Secondary Source of Payment)
162	Great West Life
178	Children's Medical Security Plan (CMSP)
179	First Health Life and Health Insurance Company
185	Connecticut General Life
207	Network Health
209	Mid-West National Life Insurance Company of Tennessee
226	United Health Care of New England, Inc.
228	Oxford Health Plans
247	Humana Insurance Company
249	MEGA Life and Health Insurance Company
272	Auto Insurance
288	Boston Medical Center HealthNet
295	Meritain
296	Commonwealth Care Alliance
311	Other ACO
320	Community Care Cooperative (ACO)
322	Partners Healthcare Choice (ACO)
323	Steward Health Choice (ACO)
328	Wellforce Care Plan (ACO)
400	Cambridge Network Health Forward
807	Blue Cross Blue Shield of MA
808	Blue Cross Blue Shield of RI
822	Harvard Pilgrim Health Care
826	United Concordia
903	Unlisted International Source
910	Allways Health Partners
911	Anthem
912	Beacon Health Partners
913	Health Plans Inc.
914	Insurance Programmers
915	Key Benefit
916	Lifetime Benefit Solutions
917	Nationwide
918	QCC Insurance Company
919	State Farm
920	UMR Inc.
921	Zenith
922	Senior Whole Health
930	VA Benefits (not listed elsewhere)
931	Other Government Program (not listed elsewhere)
932	Other Third Party Programs (not listed elsewhere) (ex. Vision TPA, Hospice, Transplant programs)
995	Health Safety Net Office
996	Charity Care

PAYER1_X includes specific payment plan identifiers. Valid 10/01/10-9/31/20

Pay Code	Source of Payment
1	Harvard Community Health Plan
3	Network Blue (PPO)
4	Fallon Community Health Plan
7	Tufts Associated Health Plan
8	Pilgrim Health Care
9	United Health Plan of New England (Ocean State)
11	Blue Care Elect
19	Matthew Thornton
22	Aetna Open Choice PPO
23	Guardian Life Insurance Company PPO
24	Health New England Inc.
28	Great West Life PPO
30	CIGNA (Indemnity)
31	One Health Plan HMO (Great West Life)
35	United Healthcare Insurance Company - HMO
36	United Healthcare Insurance Company - PPO (new for 1997)
37	HCHP - Pilgrim HMO (integrated product)
38	Health New England Select (self-funded)
40	Kaiser Foundation
42	ConnectiCare of Massachusetts
46	Blue ChiP (BCBS Rhode Island)
47	Neighborhood Health Plan
48	US Healthcare
51	Aetna Life Insurance
55	Guardian Life Insurance
57	John Hancock Life Insurance
62	Mutual of Omaha Insurance
74	United Healthcare Insurance Company
77	Options for Healthcare PPO
79	Pioneer Health Care PPO
80	Tufts Total Health Plan PPO
81	HMO Blue
82	John Hancock Preferred
84	Private Healthcare Systems PPO
85	Liberty Mutual
87	CIGNA PPO
89	Great West/NE Care
93	Psychological Health Plan
95	Pilgrim Select - PPO
96	Metrahealth (United Health Care of NE)
97	Unicare
98	Healthy Start
99	Other POS (not listed elsewhere) ***
102	Wausau Insurance Company
103	Medicaid (includes MassHealth)
104	Medicaid Managed Care-Primary Care Clinician (PCC)
108	Medicaid Managed Care-Fallon Community Health Plan
110	Medicaid Managed Care - Health New England
113	Medicaid Managed Care-Fallon Community Health Plan
114	Medicaid Managed Care - United Health Plans of NE
116	Medicaid Managed Care -Tufts Associated Health Plan
118	Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership
119	Medicaid Managed Care Other (not listed elsewhere) ***
120	Out-Of-State Medicaid
121	Medicare
125	Medicare HMO - Fallon Senior Plan****
128	Medicare HMO - HMO Blue for Seniors****
131	Medicare HMO - Pilgrim Enhance 65
133	Medicare HMO -Tufts Medicare Supplement (TMS)
134	Medicare HMO - Other (not listed elsewhere)***
207	Network Health (Cambridge Health Alliance MCD Program)
208	HealthNet (Boston Medical Center MCD Program)
209	Mid-West National Life Insurance Company of Tennessee
210	Medicare HMO - Pilgrim Preferred 65
213	Medicare HMO - Medicare Complete Plans offered by SecureHorizons
214	Medicare HMO - Harvard Pilgrim Health Plan - Medicare Enhance
215	Tufts Medicare HMO - Medicare Preferred
216	Medicare Special Needs Plan - Commonwealth Care Alliance
217	Medicare Special Needs Plan - Fallon Community Health Plan
218	Medicare Special Needs Plan - Senior Whole Health
219	Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IP
220	Medicare HMO - Blue Care 65
221	Medicare HMO - Harvard Community Health Plan 65
223	Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus
224	Medicare HMO - Tufts Secure Horizons
225	Medicare HMO - US Healthcare
226	United Health Care of New England, Inc.
260-269	Reserved
270	UniCare Preferred Plus PPO
272	Auto Insurance
273	MassHealth Senior Care Options****
274	Medicaid Managed Care - Network Health
275	Medicare SCO - NaviCare (HMO)
276	Medicare SCO - Tufts Senior Care Options
277	Medicare SCO - United Health Care
278	Medicare SCO - Commonwealth Care Alliance
279	Medicare One Care - Fallon Total Care
280	Medicare One Care - Network Health
281	Medicare One Care - Commonwealth Care Alliance
300	CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan can be identified)
301	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I
302	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II
303	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III
311	Medicaid: Other ACO
312	Medicaid: Fallon 365 Care (ACO)
313	Medicaid: Be Healthy Partnership with Health New England (ACO)
314	Medicaid: Berkshire Fallon Health Collaborative (ACO)
315	Medicaid: BMC HealthNet Plan Community Alliance (ACO)
316	Medicaid: BMC HealthNet Plan Mercy Alliance (ACO)
317	Medicaid: BMC HealthNet Plan Signature Alliance (ACO)
318	Medicaid: BMC HealthNet Plan Southcoast Alliance (ACO)
320	Medicaid: Community Care Cooperative (ACO)
321	Medicaid: My Care Family with AllWays Health Partners (ACO) - formerly named My Care Family with Neighborhood Health Plan
322	Medicaid: Partners Healthcare Choice (ACO)
323	Medicaid: Steward Health Choice (ACO)
324	Medicaid: Tufts Health Together with Atrius Health (ACO)
325	Medicaid: Tufts Health Together with BIDCO (ACO) (Beginning in 2019)
326	Medicaid: Tufts Health Together with Boston Childrenâ€™s ACO (Beginning in 2019)
327	Medicaid: Tufts Health Together with CHA (ACO)
328	Medicaid: Wellforce Care Plan (ACO)
400	CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan can
401	CommCare: Cambridge Network Health Forward - Plan Type I
402	CommCare: Cambridge Network Health Forward - Plan Type II
403	CommCare: Cambridge Network Health Forward - Plan Type III
500	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - General Classification (For use only when no specific level for this plan can be identified)
501	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077)
502	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220)
503	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221)
600	CommCare: Neighborhood Health Plan - General Classification (For use only when no specific level for this plan can be identified)
601	CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type I (9CC1)
602	CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type II (9CC2)
603	CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type III (9CC3)
700	CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification
701	CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 1
702	CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 2
703	CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 3
704	CommCare: Celticare Health Plan of Massachusetts / Comonwealth Care Bridge Program
800	Aetna Dental (Beginning in 2010)
801	Aflac (Beginning in 2010)
802	AllState (Beginning in 2010)
803	Altus Dental (Beginning in 2010)
804	Ameritas Life Insurance Corp (Beginning in 2010)
805	Anthem Blue Cross Blue Shield (Beginning in 2010)
806	Assurant (Beginning in 2010)
807	Blue Cross Blue Shield of MA (Beginning in 2010)
808	Blue Cross Blue Shield of RI (Beginning in 2010)
809	Children's Medical Society (Beginning in 2010)
810	Cigna Dental (Beginning in 2010)
811	Creative Plan Dental Administrators (Beginning in 2010)
812	Delta Dental of MA (Beginning in 2010)
813	Delta Dental of Michigan (Beginning in 2010)
814	Delta Dental of New York (Beginning in 2010)
815	DentaQuest Commonwealth Care (Beginning in 2010)
816	DentaQuest MassHealth (Beginning in 2010)
817	DentaQuest Senior Whole Health (Beginning in 2010)
818	EverCare Dental (Beginning in 2010)
819	Fallon Health Plan (Beginning in 2010)
820	Great West Dental (Beginning in 2010)
821	Guardian Dental (Beginning in 2010)
822	Harvard Pilgrim Health Care (Beginning in 2010)
823	MetLife Dental (Beginning in 2010)
824	Principal Plan Dental (Beginning in 2010)
825	Unicare Dental (Beginning in 2010)
826	United Concordia (Beginning in 2010)
827	United HealthCare: Dental (Beginning in 2010)
828	Alicare
829	Adventist Risk Management INC
830	Blue Cross Blue Shield of Texas
831	Brokers National Life insurance
832	Cba Blue Dental
833	Chesterfield Resources
834	Companion Life insurance
835	Dental Health Alliance
836	EBS Benefit Solutions
837	Empire Blue Cross
838	Excellus Blue cross
839	Fortis
840	GEHA Connection Dental
841	GHI
842	Lincoln Financial Group
843	London Health Administrators
844	Midwest Life Insurance
845	Premier Access Dental Plans
846	Sentry Life Insurance
847	Sonoco
848	Sun Life Dental Benefits
849	Symetra Life Insurance Company
850	Tricare Dental
851	Dentemax Insurance
901	Other Commercial Managed Care (not listed elsewhere)
902	Other Dental (not listed elsewhere)
903	Unlisted International Source
904	Unlisted Military Source
905	Other Connector Care Plan (not listed elsewhere)
990	Free Care - co-pay deductible, or co-insurance (when billing for free care service use #143)
995	Health Safety Net
996	Charity Care

Prior to 10/1/10, Massachusetts used the source definitions below.

Pay Code	Source of Payment
1	Harvard Community Health Plan
2	Bay State - a product of HMO Blue
3	Network Blue (PPO)
4	Fallon Community Health Plan (includes Fallon Plus, Fallon Affiliates, Fallon UMass)
5	Invalid (replaced by #9)
6	Invalid (replaced by #251)
7	Tufts Associated Health Plan
8	Pilgrim Health Care
9	United Health Plan of New England (Ocean State)
10	Pilgrim Advantage - PPO
11	Blue Care Elect
12	Invalid (replaced by #49)
13	Community Health Plan Options (New York)
14	Health New England Advantage POS
15	Invalid (replaced by #158)
16	Invalid (replaced by #172)
17	Prudential Healthcare POS
18	Prudential Healthcare PPO
19	Matthew Thornton
20	HCHP of New England (formerly RIGHA)
21	Commonwealth PPO
22	Aetna Open Choice PPO
23	Guardian Life Insurance Company PPO
24	Health New England, Inc.
25	Pioneer Plan
26	Invalid (replaced by #75)
27	First Allmerica Financial Life Insurance PPO
28	Great West Life PPO
29	Invalid (replaced by #171 and 250)
30	CIGNA (Indemnity)
31	One Health Plan HMO (Great West Life)
32	Invalid (replaced by #157 and 158)
33	Mutual of Omaha PPO
34	New York Life Care PPO
35	United Healthcare Insurance Company - HMO (New for 1997)
36	United Healthcare Insurance Company - PPO (New for 1997)
37	HCHP-Pilgrim HMO (integrated product)
38	Health New England Select (self-funded)
39	Pilgrim Direct
40	Kaiser Foundation
41	Invalid (replaced by #157)
42	ConnectiCare of Massachusetts
43	MEDTAC
44	Community Health Plan
45	Health Source New Hampshire
46	Blue CHiP (BCBS Rhode Island)
47	Neighborhood Health Plan
48	US Healthcare
49	Healthsource CMHC Plus PPO
50	Blue Health Plan for Kids
51	Aetna Life Insurance
52	Boston Mutual Insurance
53	Invalid (no replacement)
54	Continental Assurance Insurance
55	Guardian Life Insurance
56	Hartford L&A Insurance
57	John Hancock Life Insurance
58	Liberty Life Insurance
59	Lincoln National Insurance
60	Invalid (replaced by #97)
61	Invalid (replaced by #96)
62	Mutual of Omaha Insurance
63	New England Mutual Insurance
64	New York Life Care Indemnity (New York Life Insurance)
65	Paul Revere Life Insurance
66	Prudential Insurance
67	First Allmercia Financial Life Insurance
68	Invalid (replaced by #96)
69	Corporate Health Insurance Liberty Plan
70	Union Labor Life Insurance
71	ADMAR
72	Healthsource New Hampshire
73	United Health and Life (subsidiary of United Health Plans of NE)
74	United Healthcare Insurance Company (New for 1997)
75	Prudential HMO
76	Invalid (replaced by #270)
77	Options for Healthcare PPO
78	Phoenix Preferred PPO
79	Pioneer Health Care PPO
80	Tufts Total Health Plan PPO
81	HMO Blue
82	John Hancock Preferred
83	US Healthcare Quality Network Choice-PPO
84	Private Healthcare Systems PPO
85	Liberty Mutual
86	United Health & Life PPO (Subsidiary of United Health Plans of NE)
87	CIGNA PPO
88	Freedom Care
89	Great West/NE Care
90	Healthsource Preferred (self-funded)
91	New England Benefits
92	Invalid (replaced by #84, 166, 184)
93	Psychological Health Plan
94	Time Insurance Co.
95	Pilgrim Select - PPO
96	Metrahealth (United Health Care of NE)
97	UniCare
98	Healthy Start
99	Other POS (not listed elsewhere)
100	Transport Life Insurance
101	Quarto Claims
102	Wausau Insurance Company
103	Medicaid
104	Medicaid Managed Care-Primary Care Clinician (PCC)
105	Invalid (replaced by #111)
106	Medicaid Managed Care-Central Mass Health Care
107	Medicaid Managed Care-Community Health Plan
108	Medicaid Managed Care-Fallon Community Health Plan
109	Medicaid Managed Care-Harvard Community Health Plan
110	Medicaid Managed Care-Health New England
111	Medicaid Managed Care-HMO Blue
112	Medicaid Managed Care-Kaiser Foundation Plan
113	Medicaid Managed Care-Neighborhood Health Plan
114	Medicaid Managed Care-United Health Plans of NE (Ocean State Physician's Plan)
115	Medicaid Managed Care-Pilgrim Health Care
116	Medicaid Managed Care-Tufts Associated Health Plan
117	Invalid (no replacement)
118	Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership
119	Medicaid Managed Care Other (not listed elsewhere) ***
120	Out-of-State Medicaid
121	Medicare
122	Invalid (replaced by #235)
123	Invalid (no replacement)
124	Invalid (replaced by #230)
125	Medicare HMO - Fallon Senior Plan
126	Invalid (replaced by #230)
127	Medicare HMO - Health New England Medicare Wrap **
128	Medicare HMO - HMO Blue for Seniors **
129	Medicare HMO - Kaiser Medicare Plus Plan **
130	Invalid (replaced by #232 and 233)
131	Medicare HMO - Pilgrim Enhance 65 **
132	Medicare HMO - Matthew Thornton Senior Plan
133	Medicare HMO - Tufts Medicare Supplement (TMS)
134	Medicare HMO - Other (not listed elsewhere) ***
135	Out-of-State Medicare
136	BCBS Medex **
137	AARP/Medigap supplement **
138	Banker's Life and Casualty Insurance **
139	Bankers Multiple Line **
140	Combined Insurance Company of America **
141	Other Medigapy (not listed elsewhere) ***
142	Blue Cross Indemnity
143	Free Care
144	Other Government
145	Self-Pay
146	Worker's Compensation
147	Other Commercial (not listed elsewhere) ***
148	Other HMO (not listed elsewhere) ***
149	PPO and Other Managed Care (not listed elsewhere) ***
150	Other Non-Managed care (not listed elsewhere) ***
151	CHAMPUS
152	Foundation
153	Grant
154	BCBS Other (not listed elsewhere) ***
155	Blue Cross Managed Care Other (not listed elsewhere) ***
156	Out of state BCBS
157	Metrahealth - PPO (United Health Care of NE)
158	Metrahealth - HMO (United Health Care of NE)
159	None (valid only for secondary source of payment)
160	Blue Choice (includes Healthflex Blue) - POS
161	Aetna Managed Choice POS
162	Great West Life POS
163	United Healthcare Insurance Company - POS (New for 1997)
164	Healthsource CMHC Plus POS
165	Healthsource New Hampshire POS (self-funded)
166	Private Healthcare Systems POS
167	Fallon POS
168	Reserved
169	Kaiser Added Choice
170	US Healthcare Quality POS
171	CIGNA POS
172	Metrahealth - POS (United Health Care of NE)
173-180	Reserved
181	First Allmercia Financial Life Insurance EPO
182	UniCare Preferred Plus Managed Access EPO
183	Pioneer Health Care EPO
184	Private Healthcare Systems EPO
185-198	Reserved
199	Other EPO (not listed elsewhere) ***
200	Hartford Life Insurance Co.
201	Mutual of Omaha **
202	New York Life Insurance **
203	Principal Financial Group (Principal Mutual Life)
204	Christian Brothers Employee
207	Network Health (Cambridge Health Alliance MCD Program)
208	HealthNet (Boston Medical Center MCD Program)
205-209	Reserved
210	Medicare HMO - Pilgrim Preferred 65 **
211	Medicare HMO - Neighborhood Health Plan Senior Health Plus **
212	Medicare HMO - Healthsource CMHC Central Care Supplement **
213-219	Reserved
220	Medicare HMO - Blue Care 65
221	Medicare HMO - Harvard Community Health Plan 65
222	Medicare HMO - Healthsource CMHC
223	Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus
224	Medicare HMO - Tufts Secure Horizons
225	Medicare HMO - US Healthcare
226-229	Reserved
230	Medicare HMO - HCHP First Seniority
231	Medicare HMO - Pilgrim Prime
232	Medicare HMO - Seniorcare Direct
233	Medicare HMO - Seniorcare Plus
234	Medicare HMO - Managed Blue for Seniors
235-249	Reserved
250	CIGNA HMO
251	Healthsource CMHC HMO
252-269	Reserved
270	UniCare Preferred Plus PPO
271	Hillcrest HMO
272	Auto Insurance
300	CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan cal be identified)
301	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I
302	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II
303	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III
304	CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type IV
400	CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan cal be identified)
401	CommCare: Cambridge Network Health Forward - Plan Type I
402	CommCare: Cambridge Network Health Forward - Plan Type II
403	CommCare: Cambridge Network Health Forward - Plan Type III
404	CommCare: Cambridge Network Health Forward - Plan Type IV
500	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care â€“ General Classification (For use only when no specific level for this plan cal be identified)
501	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077)
502	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220)
503	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221)
504	CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 4 (Group No. 4455222)
600	CommCare: Neighborhood Health Plan - General Classification (For use only when no specific level for this plan cal be identified)
601	CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type I (9CC1)
602	CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type II (9CC2)
603	CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type III (9CC3)
604	CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type IV (9CC4)
990	Free Care - co-pay deductible, or co-insurance (when billing for free care service use #143)

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

West Virginia

As of May 22, 2024, year-specific skinny files containing data elements on expected payer as provided by the data source are available for data years 2009 through 2021: PAY1_X, PAY2_X, PAY3_X, PAYER1_X, PAYER2_X, and PAYER3_X. ï¿½In data years 2009-2016, data for PAYER3_X is unavailable, and the field is blank. Users can link the year-specific skinny files to the Core file in the same data year by using data elements YEAR and KEY. Although the 2015 West Virginia SID data files are split by coding system (January-September [Q1-Q3] for ICD-9-CM and October-December [Q4] for ICD-10-CM/PCS), there is only one skinny file for 2015 that includes the records for the full year. Starting in data year 2022, these data elements will be included in the Core file.

Detailed payer information is available in the 4-digit payer variable PAYER1_X.

The first digit indicates the type of payer:

1st Digit - Type of Payer	Description
1	Federal Government
2	West Virginia State Government
3	Other States' Government
4	Commercial
5	Non-profit
6	Employer/ERISA/Union
7	Uninsured
8	Unknown
9	NEC

The payment program is indicated by the second digit.

1st Digit - Type of Payer	2nd Digit - Payment Program	Description
1	1	Medicare
1	2	DOL - Black Lung
1	3	Railroad Workers
1	4	UMWA Trusts
1	5	Veterans Administration
1	6	Federal Bureau Corrections
1	7	CHAMPUS
1	8	(Reserved)
1	9	Federal NEC
2	1	West Virginia Medicaid
2	2	West Virginia Workers' Compensation
2	3	West Vocational Rehabilitation
2	4	West Virginia PEIA
2	5	West Virginia Maternal & Child Health
2	6	West Virginia Department of Corrections
2	7	West Virginia County/Local Corrections
2	8	WV Children's Health Insurance Program (CHIP)
2	9	West Virginia Government NEC
3	1	Other States' Medicaid
3	2	Other States' Workers' Compensation
3	3-7	(Unassigned)
3	8	(Reserved)
3	9	Other States' Government NEC
4	1	Acordia
4	2	Advantage
4	3	Aetna
4	4	Health Plan of the Upper Ohio Valley
4	5	Prudential
4	6-7	(Unassigned)
4	8	(Reserved)
4	9	Commercial NEC
5	1	AARP
5	2	Blue Cross of Virginia
5	3	Mountain State Blue Cross
5	4	Other Blues
5	5	AccessWV
5	6	West Virginia Small Business Plan
5	7	Unassigned
5	8	(Reserved)
5	9	Non-Profit NEC
6	1	Camcare
6	2	National Association Letter Carriers
6	3	Teamsters
6	4	UMWA
6	5-7	(Unassigned)
6	8	(Reserved)
6	9	Employer/ERISA/Union NEC
7	1	Self-pay
7	2	Charity
7	3-9	(Reserved)
8	8	Unknown
9	9	NEC

The payment modality is indicated by the third digit.

3rd Digit - Payment Modality	Description
1	Fee for Service/Indemnity (FFS)
2	DRG Prospective Payment System (PPS)
3	Point of Service (POS)
4	HMO
5	Other Managed Care
6	(Unassigned)
7	(Unassigned)
8	Unknown
9	NEC

The HMO information is indicated by the fourth digit

4th Digit - HMO	Description
0	None
1	Primeone
2	Advantage - Healthguard
3	Carelink
4	Coventry Health Plan (OH)
5	Health Plan of the Upper Ohio Valley (OH)
6	Optimum Choice - (MD)
7	(Unassigned)
8	Unknown
9	NEC

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Central Distributor SID: Description of Data Elements