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Central Distributor SID: Description of Data Elements
This section describes how HCUP data elements are coded, restrictions on their use, their uniform values, and State-specific coding practices.
 
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

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
Code Description
(Beginning in 2015)
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.
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.
MD 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 Community Plan
50 Other Medicaid MCO/HMO
51 Riverside Health
52 Kaiser MCO (Effective 7/1/16)
Medicare HMO:
55 Aetna Medicare Advantage
58 Other Medicare HMO
59 InforMed
60 Cigna Healthspring (Bravo)
61 Kaiser Foundation Health Plan
62 University of Maryland Health Advantage HMO (Effective 7/1/16)
63 Medstar Medicare Choice (includes choice Dual Advantage & Care Advantage) (Effective 7/1/16)
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
76 Private Health Care Systems (PHCS)
77 Other Commercial, PPO, PPN, TPA
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 (Effective 7/1/16)
82 Healthsmart Benefit Solutions, Inc. (Effective 7/1/16)
83 Humana (Effective 7/1/16)
Behavioral Health:
84 Carefirst PPO Behavioral Health
85 American Psychiatric Systems (APS) (Discontinued 6/30/16)
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 (Including Out-of-State Medicaid Programs):
54 Out-of-State (Non-MD) Medicaid
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:
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 = " ").



Massachusetts

PAYER1_X includes specific payment plan identifiers. Beginning in 10/1/10, Massachusetts uses the new source definitions.

Pay Code Source of Payment
4 Fallon Community Health Plan
11 Blue Care Elect
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)
36 United Healthcare Insurance Company - PPO (new for 1997)
38 Health New England Select (self-funded)
42 ConnectiCare of Massachusetts
46 Blue ChiP (BCBS Rhode Island)
47 Neighborhood Health Plan
51 Aetna Life Insurance
55 Guardian Life Insurance
57 John Hancock Life Insurance
62 Mutual of Omaha Insurance
74 United Healthcare Insurance Company
79 Pioneer Health Care PPO
81 HMO Blue
82 John Hancock Preferred
84 Private Healthcare Systems PPO
87 CIGNA PPO
89 Great West/NE Care
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
113 Medicaid Managed Care-Fallon Community 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****
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 **
141 Other Medigap (not listed elsewhere) ***
142 Blue Cross Indemnity
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
159 None (valid only for secondary source of payment)
160 Blue Choice
161 Aetna Managed Choice POS
162 Great West Life POS
166 Private Healthcare Systems POS
168 Advantra Freedom
171 CIGNA POS
173 Aetna Medicare Open
174 Aetna Health Inc. - Quality POS
175 Aetna Health Inc - HMO
176 Carelink (CIGNA & Tufts)
177 Chesapeake Life Insurance Company
178 Children's Medical Security Plan (CMSP)
179 First Health Life and Health Insurance Company
180 Fresenius Medical Care Health Plan (Medicare Advantage Plan)
182 Unicare Preferred Plus Managed Access EPO
184 Private Healthcare Systems EPO
185 Connecticut General Life - Indemnity
186 Connecticut General Life - POS
187 Connecticut General Life - PPO
188 Fallon Flex POS
189 Fallon Major Medical - Indemnity
190 Fallon Preferred Care - PPO
191 Genworth Preferred PPO
192 Guarantee Trust Life Insurance Company - PPO
193 Harvard Pilgrim - Indemnity
194 Harvard Pilgrim - POS
195 Harvard Pilgrim - PPO
196 Harvard Pilgrim Health Care, Inc. (HMO)
197 Health Insurance Plan of New York (HIP)
198 John Alden Life Insurance Company
199 Other EPO (not listed elsewhere) ***
205 Health New England Select Premier PPO
206 Health New England Guaranteed Issue - Individual Plans
207 Network Health (Cambridge Health Alliance MCD Program)
208 HealthNet (Boston Medical Center MCD Program)
209 Mid-West National Life Insurance Company of Tennessee
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
226 United Health Care of New England, Inc.
227 Northeast Health Direct - PPO
228 Oxford Health Plans
229 Professional Insurance Company (Indemnity)
230 Medicare HMO - HCHP First Seniority Freedom
232 Medicare HMO - Senior Care Direct
233 Medicare HMO - Senior Care Plus
234 Medicare HMO - Managed Blue for Seniors
235 Trustmark Life Insurance Company
236 Tufts Health Maintenance Organization, Inc. (TAHMO)
237 Tufts Insurance Company PPO
238 Tufts Associated Health Maintenance Organization, Inc. PPO
239 Tufts Associated Health Maintenance Organization, Inc. POS Plan
240 Unicare PPO
241 Union Security Insurance Company
242 Wellcare Health Plans, Inc.
243 Pioneer Health Network
244 Tufts Medicare Complement (TMC)
245 Trail Blazer Health Enterprises, LLC
246 Preferred Blue PPO
247 Humana Insurance Company **
248 Mail Handlers Benefit Plan
249 MEGA Life and Health Insurance Company
250 CIGNA HMO
252 Health New England (HNE) Medicare Advantage Plan
253 Blue Medicare PFFS
254 Cigna Medicare Access Plans
255 Health Net Pearl
256 Humana Gold PFFS
257 Today's Options Premier from Universal American
258 Unicare Security Choice
259 Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX)
260-269 Reserved
272 Auto Insurance
273 MassHealth Senior Care Options****
274-299 Reserved
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
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 €“ 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
H HMO
I Commercial
M Medicare
P Self Pay
W Workers Comp
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
2001 BC
2002 CHP Kaiser
2003 VHAP
3001 Healthsource/Cigna
3002 TVHP
3003 Mathew Thronton
3004 MVHP
4001 Standard Managed Care
4002 Managed Care
8888 No Sub ID
9009 Other


West Virginia

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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Internet Citation: HCUP Central Distributor SID Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). August 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/siddistnote.jsp?var=payer1_x.
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