HCUP Methods Series Supplements 1–3: An Examination of Expected Payer Coding in HCUP Databases (Updated for 2019 HCUP Data)

HCUP Methods Series
Supplements 1–3: An Examination of Expected Payer Coding in HCUP Databases (Updated for 2019 HCUP Data)

Report #2021-01

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Recommended Citation: Barrett ML, Welch J, Jiang J. An Examination of Expected Payer Coding in HCUP Databases (Updated for 2019 HCUP Data), Supplements 1-3. 2021. HCUP Methods Series Report #2021-01 ONLINE. November 30, 2021. U.S. Agency for Healthcare Research and Quality. Available: www.hcup-us.ahrq.gov/reports/methods/methods.jsp.

The Healthcare Cost and Utilization Project (HCUP) Methods Series Report An Examination of Expected Payer Coding in HCUP Databases was produced in order to inform HCUP data users about expected payer codes by (1) presenting detailed information about the expected payer codes collected by HCUP States, (2) suggesting how these payer codes can be used for research purposes, and (3) examining the extent to which HCUP data capture discharges covered by these payers in comparison with other national data sources. Although the report provides information on all types of payers, the focus is on payers for low-income populations (especially expected payers that may cover patients who are uninsured) and managed care. These are two areas of coding that tend to be the least standardized, and they are of increasing interest for researchers.

The Methods Series report includes a main descriptive report and four separate supplements. Supplements 1–3 include coding information for the HCUP State databases specific to expected payers that may cover patients who are uninsured, are managed care programs, and are specific to Medicaid. Supplements 1–3 are updated annually; however, to ensure users refer to the most up-to-date version, only the current year is available for reference. This report (#2021-01) includes information for all years 2008–2019. Supplement 4 has detailed data tables supporting the comparative figures in the main report and is only included with the original report, Methods Series Report #2014-03.

This document includes the three supplements with information on the expected payer coding in the 2008–2019 HCUP State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD).

Table of Contents

Supplement 1. HCUP State-Specific Recodes for Expected Payers That May Cover Patients Who are Uninsured

Table 1A. State-Specific Recodes for the Expected Payers that May Cover Patients Who are Uninsured to Align HCUP Payer Codes with the American Community Survey (ACS)

Supplement 2. HCUP State-Specific Coding for Managed Care

Table 2A. State-Specific Coding for Medicare Managed Care

Table 2B. State-Specific Coding for Medicaid Managed Care

Table 2C. State-Specific Coding for Private Managed Care

Supplement 3. HCUP State-Specific Recodes for Medicaid to Align HCUP with the American Community Survey

Table 3A. State-Specific Recodes for Medicaid to Align HCUP Payer Codes with the American Community Survey (ACS)

SUPPLEMENT 1. HCUP STATE-SPECIFIC RECODES FOR EXPECTED PAYERS THAT MAY COVER PATIENTS WHO ARE UNINSURED

The following table includes State-specific recodes for the programs that cover the uninsured. Recoding these payers to uninsured better aligns the HCUP expected payer codes with the American Community Survey (ACS) definition of the uninsured. The information can be reported in either the expected primary payer as received from the State (HCUP data element PAY1_X) or the expected primary payer plan identifier as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it does not identify other Federal, State, and local programs that serve the uninsured.

Table 1A. State-Specific Recodes for the Expected Payers that May Cover Patients Who are Uninsured to Align HCUP Payer Codes with the American Community Survey (ACS)

State	PAY1_X Source Value (Unless Noted)	SID Years	SASD Years	SEDD Years	Source Description
Alaska^a	06	2010–2012, 2015–2019	2019	2019	Indian Health Service
Arizona	10	2008–2019	N/A	2008–2019	Indian Health Services
California	05n, where n=0–3	2008–2019	N/A	N/A	County Indigent Programs
California^b	07n, where n=0–3	2008–2016	N/A	N/A	Other Indigent (includes charity care)
Colorado	15	2008–2016	2008–2016	N/A	Colorado Medically Indigent
Georgia	33	2008–2019	2008–2019	2008–2019	Indian Health Service or Tribe
Georgia	331	2008–2019	2008–2019	2008–2019	Indian Health Service (Regular)
Georgia	332	2008–2019	2008–2019	2008–2019	Indian Health Service (Contract)
Georgia	333	2008–2019	2008–2019	2008–2019	Indian Health Service (Managed Care)
Georgia	334	2008–2019	2008–2019	2008–2019	Indian Tribe (Sponsored Coverage)
Georgia	342	2008–2019	2008–2019	2008–2019	Migrant Health Program
Georgia	343	2008–2019	2008–2019	2008–2019	Ryan White Act
Maryland	PAYERn_X = 93 and 94	2009–2019	2009–2019	2009–2019	Maryland Health Insurance Plan (MHIP)
Massachusetts	H	2009–2019	N/A	Jan 2009–Sept 2009	Health Safety Net
Massachusetts	PAYERn_X = 995	Oct 2010-2019	N/A	N/A	Health Safety Net
Massachusetts	PAYERn_X = 178	Oct 2010-2019	N/A	N/A	Children's Medical Security Plan (CMSP)
Massachusetts	PAYERn_X=809	Oct 2010-2019	N/A	N/A	Children's Medical Society
Massachusetts	995	N/A	N/A	Oct 2009–2019	Health Safety Net
Massachusetts	178	N/A	N/A	Oct 2009–2019	Children's Medical Security Plan (CMSP)
Massachusetts	809	N/A	N/A	2012–2019	Children’s Medical Security
Montana	98940	2009–2019	N/A	2014–2019	Indian Health Services
Nevada^c	13	2008–2011	2011	2010–2011	Hill-Burton Free Care (HBFC)
Nevada	23	2008–2019	2011–2019	2010–2019	County Indigent Referral (Patient has already been approved for County Coverage)
Nevada	29	2008–2019	2011–2019	2010–2019	Section 1011 undocumented Aliens/unknown
New Jersey^d	095	2017-2019	2017-2019	2017-2019	Indigent: New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance)
New Mexico	04, 4	2009–2019	N/A	N/A	IHS/PHS
New Mexico	09, 9	2009–2019	N/A	N/A	County Indigent Funds (CIF)
New York	33	2017-2019	2017-2019	2017-2019	Indian Health Service or Tribe
New York	331	2017-2019	2017-2019	2017-2019	Indian Health Service (Regular)
New York	332	2017-2019	2017-2019	2017-2019	Indian Health Service (Contract)
New York	333	2017-2019	2017-2019	2017-2019	Indian Health Service (Managed Care)
New York	334	2017-2019	2017-2019	2017-2019	Indian Tribe (Sponsored Coverage)
New York	342	2017-2019	2017-2019	2017-2019	Migrant Health Program
New York	343	2017-2019	2017-2019	2017-2019	Ryan White Act
Ohio	R	2008–2019	2008–2019	2008–2019	Hospital Care Assurance Program (HCAP)
Oregon	33	2008–2019	2010–2019	2015–2019	Indian Health Service or Tribe
South Carolina	12	2008–2019	2008–2019	2008–2019	Other Agency, Charity (i.e. Medical Indigent Assistance Program (MAIP), Hill Burton, County Government, etc.)
Utah	Indian Health Service	2015–2019	2015–2019	2015–2019	Indian Health Service
Virginia^e	10	2008–2012	N/A	N/A	Indigent/Charity
Wisconsin^f	OTH71, oth71	2008-2018	2008-2018	2008-2018	Research Grant

^a Alaska 2013-2014 SID were not available at the time of publication.
^b California payer code 07n was mapped to No Charge starting in data year 2017.
^c Nevada payer code 13 was mapped to No Charge starting in data year 2012.
^d Prior to 2017, New Jersey payer code 095 was mapped to No Charge.
^e Virginia payer code 10 was mapped to No Charge starting in data year 2013.
^f Wisconsin payer code OTH71 was mapped to No Charge starting in data year 2019.

SUPPLEMENT 2. HCUP STATE-SPECIFIC CODING FOR MANAGED CARE

The following tables include State-specific coding that can be used to identify patients in which the expected payer is a managed care plan.

Table 2A includes information on the coding of Medicare managed care plans.
Table 2B includes information on the coding of Medicaid managed care plans.
Table 2B includes information on the coding of managed care plans for the privately insured.

The information can be reported in either the expected primary payer, as received from the State (HCUP data element PAY1_X), or the expected primary payer plan identifier, as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it did not have detailed payer codes that identified managed care plans.

Table 2A. State-Specific Coding for Medicare Managed Care

Medicare Advantage is sometimes viewed as managed care; however, because Medicare Advantage also can include private fee-for-service plans, payer codes specific to Medicare Advantage were not included in the table below.

State	PAY1_XSource Value (Unless Noted)	SID Years	SASD Years	SEDD Years	Source Description
Arizona	11	2008–2019	N/A	2008–2019	Medicare Risk
California	011	2008–2019	N/A	N/A	Medicare (HMO)
California	012	2008–2019	N/A	N/A	Medicare (Managed care - Other)
California	16	N/A	2008–2019	2008–2019	Health Maintenance Organization (HMO) Medicare Risk
Connecticut	M	2008–2019	2008–2019	2008–2019	Medicare managed care
District of Columbia	MHMO	2014–2019	2014–2019	2014–2019	Medicare HMO
District of Columbia	MPPO	2014–2019	2014–2019	2014–2019	Medicare PPO
District of Columbia	MPOS	2014–2019	2014–2019	2014–2019	Medicare point of service
District of Columbia	QHMO	2014–2019	2014–2019	2014–2019	Medicare psychiatric HMO
District of Columbia	QPPO	2014–2019	2014–2019	2014–2019	Medicare psychiatric PPO
District of Columbia	QPOS	2014–2019	2014–2019	2014–2019	Medicare psychiatric point of service
District of Columbia	RHMO	2014–2019	2014–2019	2014–2019	Medicare rehabilitation HMO
District of Columbia	RPPO	2014–2019	2014–2019	2014–2019	Medicare rehabilitation PPO
District of Columbia	RPOS	2014–2019	2014–2019	2014–2019	Medicare rehabilitation point of service
Florida	B	2008–2009	2008–2009	2008–2009	Medicare HMO or Medicare PPO
Florida	B	2010–2019	2010–2019	2010–2019	Medicare Managed Care
Georgia	11	2008–2019	2008–2019	2008–2019	Medicare Managed Care
Georgia	111	2008–2019	2008–2019	2008–2019	Medicare HMO
Georgia	1111	2008–2019	2008–2019	2008–2019	Medicare HMO, Aetna Inc.
Georgia	1112	2008–2019	2008–2019	2008–2019	Medicare HMO, Coventry Health Care, Inc.
Georgia	1113	2008–2019	2008–2019	2008–2019	Medicare HMO, Humana Inc.
Georgia	1114	2008–2019	2008–2019	2008–2019	Medicare HMO, Kaiser Foundation Health Plan, Inc.
Georgia	1115	2008–2019	2008–2019	2008–2019	Medicare HMO, United HealthCare of Georgia, Inc.
Georgia	1116	2008–2019	2008–2019	2008–2019	Medicare HMO, Wellcare of Georgia
Georgia	1117	2008–2019	2008–2019	2008–2019	Medicare HMO, WellPoint, Inc.
Georgia	1118	2008–2019	2008–2019	2008–2019	Other Medicare HMO
Georgia	112	2008–2019	2008–2019	2008–2019	Medicare Managed Care (PPO)
Georgia	113	2008–2019	2008–2019	2008–2019	Medicare Managed Care (POS)
Georgia	119	2008–2019	2008–2019	2008–2019	Medicare Managed Care (Other)
Hawaii^a	18	2008-2019	2008-2016, 2019	2008-2016, 2019	HMSA 65C+
Hawaii	19	2008–2019	2008–2016, 2019	2008–2016, 2019	Kaiser 65C+
Hawaii	26	2008–2019	2008–2016, 2019	2008–2016, 2019	AlohaCare Advantage/Advantage Plus (confirmed as including only managed care plans)^b
Illinois	A98945	2011–2019	N/A	N/A	Medicare Managed Care
Iowa	11	2008– 2019	2008–2019	2008–2019	Medicare Managed Care
Kansas	101	2008–2019	2008–2019	2008–2019	Medicare Managed Care
Kentucky	98945	2009; 2015–2019	2009; 2015–2019	2009; 2015–2019	Medicare Managed Care
Kentucky	R	2008; 2010–2014	2008; 2010–2014	2008; 2010–2014	Medicare Managed Care
Louisiana	L	2013-2019	N/A	N/A	HMO Medicare Risk
Maryland	15	2008–2019	2008–2019	2008–2019	Medicare Managed Care
Massachusetts	F	2008–2019	N/A	N/A	Medicare Managed Care
Massachusetts	125	N/A	N/A	2008-2019	Medicare HMO – Fallon Senior Plan
Massachusetts	127	N/A	N/A	2008-2019	Medicare HMO – Health New England Medicare Wrap
Massachusetts	128	N/A	N/A	2008-2019	Medicare HMO – HMO Blue for Seniors
Massachusetts	131	N/A	N/A	2008-2019	Medicare HMO – Pilgrim Enhance 65
Massachusetts	133	N/A	N/A	2008-2019	Medicare HMO – Tufts Medicare Supplement (TMS)
Massachusetts	134	N/A	N/A	2008-2019	Medicare HMO – Other (not listed elsewhere)
Massachusetts	210	N/A	N/A	2008-2019	Medicare HMO –Pilgrim Preferred 65
Massachusetts	213	N/A	N/A	2008-2019	Medicare HMO – Medicare Complete Plans offered by SecureHorizons
Massachusetts	214	N/A	N/A	2008-2019	Medicare HMO – Harvard Pilgrim Health Plan - Medicare Enhance
Massachusetts	215	N/A	N/A	2008-2019	Tufts Medicare HMO – Medicare Preferred
Massachusetts	216	N/A	N/A	2008-2019	Medicare Special Needs Plan – Commonwealth Care Alliance
Massachusetts	217	N/A	N/A	2008-2019	Medicare Special Needs Plan – Fallon Community Health Plan
Massachusetts	218	N/A	N/A	2008-2019	Medicare Special Needs Plan – Senior Whole Health
Massachusetts	219	N/A	N/A	2008-2019	Medicare Special Needs Plan – United Health Group Evercare Mass. SCO and Evercare Plan IP
Massachusetts	220	N/A	N/A	2008-2019	Medicare HMO – Blue Care 65
Massachusetts	224	N/A	N/A	2008-2019	Medicare HMO – Tufts Secure Horizons
Massachusetts	230	N/A	N/A	2008-2019	Medicare HMO – HCHP First Seniority Freedom
Massachusetts	231	N/A	N/A	2008-2019	Medicare HMO – Pilgrim Prime
Massachusetts	232	N/A	N/A	2008-2019	Medicare HMO – Senior Care Direct
Massachusetts	233	N/A	N/A	2008-2019	Medicare HMO – Senior Care Plus
Massachusetts	234	N/A	N/A	2008-2019	Medicare HMO – Managed Blue for Seniors
Michigan	30	2008–2019	2008–2019	2018-2019	Medicare Managed Care Plans
Minnesota	6000103	2008–2019	2008–2019	2008–2019	Blue Cross, MN, Medicare
Minnesota	7000102	2008–2019	2008–2019	2008–2019	Medica - Choice, Medicare
Minnesota	7000202	2008–2019	2008–2019	2008–2019	Group Health, Medicare
Minnesota	7000402	2008–2019	2008–2019	2008–2019	Medica - Primary, Medicare
Minnesota	7000602	2008–2019	2008–2019	2008–2019	UCare, Medicare
Minnesota	7000702	2008–2019	2008–2019	2008–2019	Blue Plus, Medicare
Minnesota	7000802	2008–2019	2008–2019	2008–2019	Metro. Health Plan, Medicare
Minnesota	7001002	2008–2019	2008–2019	2008–2019	Health Partners, Medicare
Minnesota	7001302	2008–2019	2008–2019	2008–2019	First Plan HMO, Medicare
Minnesota	7000902	2008–2019	2008–2019	2008–2019	Blue Cross HMO, Medicare
Minnesota	7009902	2008–2019	2008–2019	2008–2019	Other HMO, Medicare
Minnesota	8000502	2008–2019	2008–2019	2008–2019	America's PPO, Medicare
Minnesota	8000602	2008–2019	2008–2019	2008–2019	Aetna PPO, Medicare
Minnesota	8009902	2008–2019	2008–2019	2008–2019	Other PPO, Medicare
Montana	98945	2009–2019	N/A	2014–2019	Medicare Managed Care
Nevada	27	2008–2019	2011–2019	2010–2019	Medicare HMO
New Hampshire^c	10	2008–2009	2008–2009	2008–2009	Medicare Managed Care
New Jersey	082	2008–2019	2008–2019	2008–2019	Medicare HMO
New York	16	2008–2016	2008–2016	2008–2016	Medicare HMO
New York	11	2017-2019	2017-2019	2017-2019	Medicare Managed Care
New York	111	2017-2019	2017-2019	2017-2019	Medicare HMO
New York	112	2017-2019	2017-2019	2017-2019	Medicare PPO
New York	113	2017-2019	2017-2019	2017-2019	Medicare point of service
New York	119	2017-2019	2017-2019	2017-2019	Medicare Managed Care (Other)
North Dakota	6000103	2011–2019	2013-2019	2011–2019	Blue Cross, MN, Medicare
North Dakota	7000102	2011–2019	2013-2019	2011–2019	Medica - Choice, Medicare
North Dakota	7000202	2011–2019	2013-2019	2011–2019	Group Health, Medicare
North Dakota	7000402	2011–2019	2013-2019	2011–2019	Medica - Primary, Medicare
North Dakota	7000602	2011–2019	2013-2019	2011–2019	UCare, Medicare
North Dakota	7000702	2011–2019	2013-2019	2011–2019	Blue Plus, Medicare
North Dakota	7000802	2011–2019	2013-2019	2011–2019	Metro. Health Plan, Medicare
North Dakota	7001002	2011–2019	2013-2019	2011–2019	Health Partners, Medicare
North Dakota	7001302	2011–2019	2013-2019	2011–2019	First Plan HMO, Medicare
North Dakota	7000902	2011–2019	2013-2019	2011–2019	Blue Cross HMO, Medicare
North Dakota	7009902	2011–2019	2013-2019	2011–2019	Other HMO, Medicare
North Dakota	8000502	2011–2019	2013-2019	2011–2019	America's PPO, Medicare
North Dakota	8000602	2011–2019	2013-2019	2011–2019	Aetna PPO, Medicare
North Dakota	8009902	2011–2019	2013-2019	2011–2019	Other PPO, Medicare
Ohio	O	2008–2019	2008–2019	2008–2019	Medicare Managed Care
Oregon	11	2008–2019	2010–2019	2015–2019	Medicare (Managed Care)
Pennsylvania	12	2008–2019	2013-2019	N/A	Medicare - PPO
Pennsylvania	13	2008–2019	2013-2019	N/A	Medicare - POS
Pennsylvania	15	2008–2019	2013-2019	N/A	Medicare - HMO
Rhode Island	B 4000	2008–2019	N/A	2008–2019	Out of State Blue Cross, Medicare (managed care)
Rhode Island	H 4000	2008–2019	N/A	2008–2019	Coordinated Health Partners, Medicare (managed care)
Rhode Island	O 4000	2008–2019	N/A	2008–2019	Other, Medicare (managed care)
Rhode Island	U 4000	2008–2019	N/A	2008–2019	UHC, Medicare (managed care)
Rhode Island	M 4000	2013–2016	N/A	2013–2016	Medicare, managed care
Rhode Island	R 4000	2015–2019	N/A	2015–2019	Medicare managed care by Rhode Island Blue Cross
South Dakota	11	2008–2019	2008–2019	2008–2019	Medicare - Managed Care (e.g., HMO, PPO, PCCM)
Tennessee	K	2008–2019	2008–2019	2008–2019	Medicare HMO/PSO
Texas	16	2008–2019	2011–2019	2015–2019	Health Maintenance Organization (HMO) Medicare Risk
Vermont	PAYER1_X = M4002	2008–2019	2008–2019	2008–2019	Medicare - Managed Care
West Virginia	PAYER1_X = 113n, 114n or 115n, where n can have the values 0-9	2008–2019	N/A	N/A	WV reports a four-digit payer code in PAYERn_X. The first digit indicates the types of payer with 1 indicating the federal government. The second digit indicates the payment program with the value 1 indicating Medicare. The third digit indicates the payment modality with the values: (3) point of service, (4) HMO, and (5) other managed care. The fourth digit includes information on the HMO using the following values: (0) none, (1) Acordia - Primeone, (2) Advantage-Healthguard, (3) Carelink, (4) Coventry Health plan (OH), (5) Health Plan of Upper Ohio Valley (OH), (6) Optimum Choice – (MD), (8) unknown, and (9) not elsewhere classified
Wisconsin	MED02	2008–2019	2008–2019	2008–2019	Medicare - Alternative health care insurance plans (e.g., HMO, PPO, PPA)
Wisconsin	T1802	2008–2019	2008–2019	2008–2019	Medicare - Alternative health care insurance plans (e.g., HMO, PPO, PPA)

^a Hawaii 2016-2018 SEDD and SASD were not available at the time of publication.
^b Hawaii reports two other Medicare Advantage payers that would have to be confirmed as including only managed care plans: Secure Horizons Medicare Advantage (value 25) and Other Medicare Advantage Plan (value 31).
^c New Hampshire 2010-2018 SID, SASD, and SEDD were not available at the time of publication. Beginning in 2019, New Hampshire resumed providing SID and SEDD, but did not provide Medicare managed care information.

Table 2B. State-Specific Coding for Medicaid Managed Care

State	PAY1_X Source Value (Unless Noted)	SID Years	SASD Years	SEDD Years	Source Description
California	021	2008–2019	N/A	N/A	Medi-Cal (HMO)
California	022	2008–2019	N/A	N/A	Medi-Cal (Managed care - Other)
Connecticut	J	2008–2019	2008–2019	2008–2019	Medicaid managed care
District of Columbia	FHMO	2014–2019	2014–2019	2014–2019	D.C. Medicaid HMO
District of Columbia	FPPO	2014–2019	2014–2019	2014–2019	D.C. Medicaid PPO
District of Columbia	FPOS	2014–2019	2014–2019	2014–2019	D.C. Medicaid point of service
District of Columbia	GHMO	2014–2019	2014–2019	2014–2019	Maryland Medicaid HMO
District of Columbia	GPPO	2014–2019	2014–2019	2014–2019	Maryland Medicaid PPO
District of Columbia	GPOS	2014–2019	2014–2019	2014–2019	Maryland Medicaid point of service
District of Columbia	JHMO	2014–2019	2014–2019	2014–2019	Virginia Medicaid HMO
District of Columbia	JPPO	2014–2019	2014–2019	2014–2019	Virginia Medicaid PPO
District of Columbia	JPOS	2014–2019	2014–2019	2014–2019	Virginia Medicaid point of service
District of Columbia	DHMO	2014–2019	2014–2019	2014–2019	Medicaid out of region HMO
District of Columbia	DPPO	2014–2019	2014–2019	2014–2019	Medicaid out of region PPO
District of Columbia	DPOS	2014–2019	2014–2019	2014–2019	Medicaid out of region point of service
District of Columbia	5HMO	2014–2019	2014–2019	2014–2019	Medicaid pending HMO
District of Columbia	5PPO	2014–2019	2014–2019	2014–2019	Medicaid pending PPO
District of Columbia	5POS	2014–2019	2014–2019	2014–2019	Medicaid pending point of service
Florida	D	2008–2009	2008–2009	2008–2009	Medicaid HMO
Florida	D	2010–2019	2010–2019	2010–2019	Medicaid Managed Care
Georgia	21	2014–2019	2014–2019	2014–2019	Medicaid Managed Care
Georgia	211	2014–2019	2014–2019	2014–2019	Medicaid HMO
Georgia	2111	2014–2019	2014–2019	2014–2019	Medicaid HMO, Amerigroup CMO
Georgia	2112	2014–2019	2014–2019	2014–2019	Medicaid HMO, PeachState CMO
Georgia	2113	2014–2019	2014–2019	2014–2019	Medicaid HMO, WellCare CMO
Georgia	2114	2017-2019	2017-2019	2017-2019	Medicaid Caresource HMO
Georgia	212	2014–2019	2014–2019	2014–2019	Medicaid Managed Care (PPO)
Georgia	219	2014–2019	2014–2019	2014–2019	Medicaid Managed Care (Other)
Hawaii^a	15	2008–2019	2008–2016, 2019	2008–2016, 2019	AlohaCare (plan participating in QUEST)
Hawaii	22	2008–2019	2008–2016, 2019	2008–2016, 2019	HMSA QUEST
Hawaii	23	2008–2019	2008–2016, 2019	2008–2016, 2019	Kaiser QUEST
Hawaii	24	2008–2019	2008–2016, 2019	2008–2016, 2019	QUEST (Any QUEST Plan except AlohaCare, HMSA Quest, Kaiser Quest)
Hawaii	29	2008–2019	2008–2016, 2019	2008–2016, 2019	Ohana Health Plan QUEST
Hawaii	30	2008–2019	2008–2016, 2019	2008–2016, 2019	United Healthcare Community Plan QUEST
Illinois	B98935	2011-2019	N/A	N/A	Medicaid Managed Care
Iowa	12	2008–March 2016	2008–March 2016	2008–March 2016	Medicaid Managed Care
Iowa	21	April 2016–2019	April 2016–2019	April 2016–2019	Amerigroup Iowa, Inc.
Iowa	22	April 2016-2019	April 2016-2019	April 2016-2019	AmeriHealth Caritas Iowa, Inc.
Iowa	23	April 2016-2019	April 2016-2019	April 2016-2019	UnitedHealthcare Plan of the River Valley, Inc.
Kansas	102	2008–2019	2008–2019	2008–2019	Medicaid Managed Care
Kansas^b	103	2017-2019	2017-2019	2017-2019	HealthWave/Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)
Kentucky	98940	2009; 2015–2019	2009; 2015–2019	2009; 2015–2019	Passport Medicaid Managed Care
Kentucky	98929	2015–2019	2015–2019	2015–2019	Humana Medicaid Managed Care
Kentucky	98990	2015–2019	2015–2019	2015–2019	Kentucky Spirit Medicaid Managed Care
Kentucky	98970	2015–Sept 2018	2015–Sept 2018	2015–Sept 2018	Coventry Cares of KY Medicaid Managed Care
Kentucky	98970	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Aetna Better Health of KY Medicaid Managed Care
Kentucky	98980	2015–2019	2015–2019	2015–2019	WellCare of Kentucky Medicaid Managed Care
Kentucky	98991	2015–Sept 2018	2015–Sept 2018	2015–Sept 2018	BCBS Medicaid Managed Care
Kentucky	98991	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Anthem Medicaid Managed Care
Kentucky	P	2008; 2010–2014	2008; 2010–2014	2008; 2010–2014	Passport Medicaid Managed Care
Kentucky	Q	2010–2014	2010–2014	2010–2014	Kentucky Spirit Medicaid Managed Care
Kentucky	T	2010–2014	2010–2014	2010–2014	Coventry Cares of KY Medicaid Managed Care
Kentucky	U	2010–2014	2010–2014	2010–2014	WellCare of Kentucky Medicaid Managed Care
Kentucky	X	2014	2014	2014	BCBS Medicaid managed care
Kentucky	Z	2010–2014	2010–2014	2010–2014	Humana Medicaid Managed Care
Louisiana	J	2013-2019	N/A	N/A	Medicaid HMO - Prepaid
Louisiana	K	2013-2019	N/A	N/A	Managed HMO - Shared
Maryland	14	2008–2019	2008–2019	2008–2019	Maryland Medicaid HMO
Massachusetts	B	2008–2019	N/A	N/A	Medicaid Managed Care
Massachusetts	104	N/A	N/A	2008–2019	Medicaid Managed Care - Primary Care Clinician (PCC)
Massachusetts	107	N/A	N/A	2008–2019	Medicaid Managed Care - Community Health Plan
Massachusetts	108	N/A	N/A	2008–2019	Medicaid Managed Care - Fallon Community Health Plan
Massachusetts	110	N/A	N/A	2008–2019	Medicaid Managed Care - Health New England
Massachusetts	111	N/A	N/A	2008–2019	Medicaid Managed Care - HMO Blue
Massachusetts	113	N/A	N/A	2008–2019	Medicaid Managed Care - Neighborhood Health Plan
Massachusetts	114	N/A	N/A	2008–2019	Medicaid Managed Care - United Health Plans of NE
Massachusetts	116	N/A	N/A	2008–2019	Medicaid Managed Care Tufts Associated Health Plan
Massachusetts	119	N/A	N/A	2008–2019	Medicaid Managed Care Other (not listed elsewhere)
Massachusetts	274	N/A	N/A	2012–2019	Medicaid Managed Care – Network Health
Michigan	40	2008–2019	2008–2019	2018-2019	Medicaid Managed Care Plans
Minnesota	4000800	2010–2019	2010–2019	2010–2019	PrimeWest, Cty Based Purchased
Minnesota	4000900	2010–2019	2010–2019	2010–2019	Itasca Medical Care, CBP
Minnesota	4001000	2010–2019	2010–2019	2010–2019	So. Country Hlth Alliance, CBP
Minnesota	7000101	2008–2019	2008–2019	2010–2019	Medica - Choice, Medicaid
Minnesota	7000201	2008–2019	2008–2019	2010–2019	Group Health, Medicaid
Minnesota	7000401	2008–2019	2008–2019	2010–2019	Medica - Primary, Medicaid
Minnesota	7000601	2008–2019	2008–2019	2010–2019	Ucare, Medicaid
Minnesota	7000701	2008–2019	2008–2019	2010–2019	Blue Plus, Medicaid
Minnesota	7000801	2008–2019	2008–2019	2010–2019	Metro. Health Plan, Medicaid
Minnesota	7000901	2008–2019	2008–2019	2010–2019	Blue Cross HMO, Medicaid
Minnesota	7001001	2008–2019	2008–2019	2010–2019	Health Partners, Medicaid
Minnesota	7001301	2008–2019	2008–2019	2010–2019	First Plan HMO, Medicaid
Minnesota	7009901	2008–2019	2008–2019	2010–2019	Other HMO, Medicaid
Minnesota	8000901	2008–2019	2008–2019	2010–2019	Blue Cross PPO, Medicaid
Minnesota	8001001	2008–2019	2008–2019	2010–2019	Medica Choice PPO, Medicaid
Minnesota	8001501	2008–2019	2008–2019	2010–2019	LaborCare PPO, Medicaid
Minnesota	8009901	2008–2019	2008–2019	2010–2019	Other PPO, Medicaid
Mississippi	98921	2019	N/A	2019	United Healthcare, Medicaid
Mississippi	98922	2019	N/A	2019	Magnolia Health, Medicaid
Mississippi	98923	2019	N/A	2019	Molina Healthcare, Medicaid
Montana	98935	2009-2019	N/A	2014–2019	Medicaid Managed Care
Nevada	28	2008–2019	2011–2019	2010–2019	Nevada Medicaid HMO
New Hampshire^c	11	2008-2009	2008-2009	2008-2009	Medicaid Managed Care
New Jersey	083	2008–2019	2008–2019	2008–2019	Medicaid HMO
New York	21	2017-2019	2017-2019	2017-2019	Medicaid (Managed Care)
New York	211	2017-2019	2017-2019	2017-2019	Medicaid HMO
New York	2111	2017-2019	2017-2019	2017-2019	Family Health Plus (NYS Addition)
New York	2112	2017-2019	2017-2019	2017-2019	Healthy New York (NYS Addition)
New York	212	2017-2019	2017-2019	2017-2019	Medicaid PPO
New York	219	2017-2019	2017-2019	2017-2019	Medicaid Managed Care (Other)
New York	17	2008–2016	2008–2016	2011–2016	Medicaid HMO
North Dakota	4000800	2014-2019	2014-2019	2014–2019	PrimeWest, Cty Based Purchased
North Dakota	4000900	2014-2019	2014-2019	2014–2019	Itasca Medical Care, CBP
North Dakota	4001000	2014-2019	2014-2019	2014–2019	So. Country Hlth Alliance, CBP
North Dakota	7000101	2011-2019	2013-2019	2011–2019	Medica - Choice, Medicaid
North Dakota	7000201	2011-2019	2013-2019	2011–2019	Group Health, Medicaid
North Dakota	7000401	2011-2019	2013-2019	2011–2019	Medica - Primary, Medicaid
North Dakota	7000601	2011-2019	2013-2019	2011–2019	Ucare, Medicaid
North Dakota	7000701	2011-2019	2013-2019	2011–2019	Blue Plus, Medicaid
North Dakota	7000801	2011-2019	2013-2019	2011–2019	Metro. Health Plan, Medicaid
North Dakota	7000901	2011-2019	2013-2019	2011–2019	Blue Cross HMO, Medicaid
North Dakota	7001001	2011-2019	2013-2019	2011–2019	Health Partners, Medicaid
North Dakota	7001301	2011-2019	2013-2019	2011–2019	First Plan HMO, Medicaid
North Dakota	7009901	2011-2019	2013-2019	2011–2019	Other HMO, Medicaid
North Dakota	8000901	2011-2019	2013-2019	2011–2019	Blue Cross PPO, Medicaid
North Dakota	8001001	2011-2019	2013-2019	2011–2019	Medica Choice PPO, Medicaid
North Dakota	8001501	2011-2019	2013-2019	2011–2019	LaborCare PPO, Medicaid
North Dakota	8009901	2011-2019	2013-2019	2011–2019	Other PPO, Medicaid
Ohio	M	2008–2019	2008–2019	2008–2019	Medicaid Managed Care
Oregon	21	2008–2019	2010–2019	2015–2019	Medicaid (Managed Care)
Pennsylvania	22	2008–2019	2013–2019	N/A	Medicaid - PPO
Pennsylvania	25	2008–2019	2013–2019	N/A	Medicaid - HMO
Rhode Island	B 3000	2008–2019	N/A	2008–2019	Out of State Blue Cross, Medicaid (managed care)
Rhode Island	D 3000	2013–2019	N/A	2013–2019	Medicaid managed care
Rhode Island	H 3000	2008–2019	N/A	2008–2019	Coordinated Health Partners, Medicaid (managed care)
Rhode Island	N 3000	2008–2019	N/A	2008–2019	Neighborhood Health Plan, Medicaid (managed care)
Rhode Island	O 3000	2008–2019	N/A	2008–2019	Other, Medicaid (managed care)
Rhode Island	R 3000	2017-2019	N/A	2017-2019	Rhode Island Blue Cross, Medicaid
Rhode Island	U 3000	2008–2019	N/A	2008–2019	UHC, Medicaid (managed care)
South Dakota	12	2008–2019	2008–2019	2008–2019	Medicaid - Managed Care (e.g. HMO, PPI, PCCM)
Tennessee	T	2008–2019	2008–2019	2008–2019	TennCare Plan: Unspecified
Tennessee	5	2008–2011	2008–2011	2008–2011	TennCare Plan: UAHC (discontinued in 2012)
Tennessee	7	2008–2011	2008–2011	2008–2011	TennCare Plan: Windsor Health Plan of TN, Inc. (discontinued in 2012)
Tennessee	8	2008–2019	2008–2019	2008–2019	United Healthcare Community Plan (previously TennCare Plan: AmeriChoice/John Deere/Heritage)
Tennessee	9	2008–2011	2008–2011	2008–2011	TennCare Plan: Preferred Health Partnership (discontinued in 2012)
Tennessee	10	2008–2019	2008–2019	2008–2019	TennCare Plan: AmeriChoice (previously John Deere/Heritage)
Tennessee	F	2008–2016	2008–2016	2008–2016	TennCare Plan: TLC Family Care Healthplan
Tennessee	J	2008–2019	2008–2019	2008–2019	TennCare Plan: Blue Care
Tennessee	Q	2008–2019	2008–2019	2008–2019	TennCare Plan: TennCare Select
Tennessee	R	2008-2011	2008-2011	2008-2011	TennCare Plan: Unison Health Plan (discontinued in 2012)
Tennessee	U	2008-2011	2008-2011	2008-2011	TennCare Behavioral: Tennessee Behavioral Health, Inc. (discontinued in 2012)
Tennessee	X	2008–2016	2008–2016	2008–2016	TennCare Behavioral: Premier Behavioral Systems of TN
Vermont	PAYER1_X = D2002	2008–2019	2008–2019	2008–2019	Medicaid – CHP Kaiser
West Virginia	PAYER1_X = 213n, 214n, 215n, 313n, 314n, 315n, where n can have the values 0-9	2008–2019	N/A	N/A	WV reports a four-digit payer code in PAYERn_X. The first two digits of 21 indicate West Virginia Medicaid and the first two digits of 31 indicate other States’ Medicaid. The third digit indicates the payment modality with the values: (3) point of service, (4) HMO, and (5) other managed care. The fourth digit includes information on the HMO using the following values: (0) none, (1) Acordia - Primeone, (2) Advantage, (3) Carelink, (4) Coventry Health plan, (5) Health Plan of Upper Ohio Valley, (6) Optimum Choice, (8) unknown, and (9) not elsewhere classified
Wisconsin^d	BGR02	2008-2019	2008-2019	2008-2019	Badger Care (family coverage) - Alternative health care insurance plans (HMO, PPO)
Wisconsin	MAX02	2008-June 2014	2008-June 2014	2008-June 2014	Badger Care Plus - Alternative health care insurance plans (HMO, PPO, PPA, etc.) Became Badger Care Expansion for childless adults in 2010.
Wisconsin	T1902	2008–2019	2008–2019	2008–2019	T19nn means Wisconsin Medicaid and 02 means Alternative Health Care Insurance Plans (HMO, PPO)
Wisconsin^e	OTH54, oth54	2008-2019	2008-2019	2008-2019	Wisconsin Family Care Program (WI – DHS Program)

^a Hawaii 2016-2018 SEDD and SASD were not available at the time of publication.
^b Prior to 2017, Kansas payer code 103 was mapped to Other.
^c New Hampshire 2010-2018 SID, SASD, and SEDD were not available at the time of publication. Beginning in 2019, New Hampshire resumed providing SID and SEDD, but did not provide Medicaid managed care information.
^d From 2008-2010, Wisconsin payer code BGR02 was mapped to Other.
^e From 2008-2018, Wisconsin payer code OTH54 was mapped to Other.

Table 2C. State-Specific Coding for Private Managed Care

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

State	PAY1_X Source Value (Unless Noted)	SID Years	SASD Years	SEDD Years	Source Description
Arizona	02	2008–2019	N/A	2008–2019	HMO
Arizona	03, 3	2008–2019	N/A	2008–2019	PPO
Arkansas	H	2008–2014	N/A	2013–2014	HMO/Managed Care
Arkansas	7	2015–2019	N/A	2015–2019	Managed care, unspecified
California	031	2008–2019	N/A	N/A	Private Coverage (HMO)
California	032	2008–2019	N/A	N/A	Private Coverage (Managed care - Other)
California	12	N/A	2008–2019	2008–2019	Preferred Provider Organization (PPO)
California	13	N/A	2008–2019	2008–2019	Point of Service (POS)
California	HM	N/A	2008–2019	2008–2019	Health Maintenance Organization
Colorado	08	2008–2016	2008–2016	N/A	HMO-PPO / Managed Care / Discounted
Connecticut	S	2008–2019	2008–2019	2008–2019	HMO
Connecticut	T	2008–2019	2008–2019	2008–2019	PPO
Delaware	6	2016-2019	N/A	N/A	HMO
Delaware	7	2016-2019	N/A	N/A	PPO
District of Columbia	BHMO	2014–2019	2014–2019	2014–2019	Blue Cross Blue Shield HMO
District of Columbia	BPPO	2014–2019	2014–2019	2014–2019	Blue Cross Blue Shield PPO
District of Columbia	BPOS	2014–2019	2014–2019	2014–2019	Blue Cross Blue Shield point of service
District of Columbia	IHMO	2014–2019	2014–2019	2014–2019	Indemnity HMO
District of Columbia	IPPO	2014–2019	2014–2019	2014–2019	Indemnity PPO
District of Columbia	IPOS	2014–2019	2014–2019	2014–2019	Indemnity point of service
District of Columbia	SHMO	2014–2019	2014–2019	2014–2019	Self-insured HMO
District of Columbia	SPPO	2014–2019	2014–2019	2014–2019	Self-insured PPO
District of Columbia	SPOS	2014–2019	2014–2019	2014–2019	Self-insured point of service
Florida	F	2008-2009	2008-2009	2008-2009	Commercial HMO (discontinued in 2010)
Florida	G	2008-2009	2008-2009	2008-2009	Commercial PPO (discontinued in 2010)
Georgia	51	2008–2019	2008–2019	2008–2019	Managed Care (Private)
Georgia	511	2008–2019	2008–2019	2008–2019	Commercial Managed Care (HMO)
Georgia	512	2008–2019	2008–2019	2008–2019	Commercial Managed Care (PPO)
Georgia	513	2008–2019	2008–2019	2008–2019	Commercial Managed Care (POS)
Georgia	519	2008–2019	2008–2019	2008–2019	Managed Care, Other (non-HMO)
Georgia	61	2008–2019	2008–2019	2008–2019	BC Managed Care
Georgia	611	2008–2019	2008–2019	2008–2019	BC Managed Care (HMO)
Georgia	612	2008–2019	2008–2019	2008–2019	BC Managed Care (PPO)
Georgia	613	2008–2019	2008–2019	2008–2019	BC Managed Care (POS)
Georgia	619	2008–2019	2008–2019	2008–2019	BC Managed Care (Other)
Hawaii^a	5	2008–2019	2008–2016, 2019	2008–2016, 2019	Kaiser
Illinois	Dnnnnnnnnn, where nnnnnnnnn is a 9-digit number	2008–2018	N/A	N/A	Commercial HMO
Illinois	D40015	2016–2019	N/A	N/A	Blue Cross Blue Shield Commercial HMO
Illinois	D40025	2016–2019	N/A	N/A	United Healthcare Commercial HMO
Illinois	D40035	2016–2019	N/A	N/A	Aetna Commercial HMO
Illinois	D40155	2016–2019	N/A	N/A	Humana Commercial HMO
Illinois	D40165	2016–2019	N/A	N/A	Health Alliance Commercial HMO
Illinois	D98925	2008–2019	N/A	N/A	Commercial HMO other than 400 series
Illinois	D	N/A	2009–2019	2009–2019	HMO
Kansas	104	2008–2019	2008–2019	2008–2019	Blue Cross/Blue Shield Managed Care
Kansas	107	2008–2019	2008–2019	2008–2019	All Commercial Payers Managed Care
Kentucky	K	2008; 2010–2014	2008; 2010–2014	2008; 2010–2014	Commercial – Preferred Provider
Kentucky	L	2008; 2010–2014	2008; 2010–2014	2008; 2010–2014	Commercial – HMO
Kentucky	M	2008	2008	2008	Commercial - Other Managed Care
Kentucky	98923	2009; 2015–2019	2009; 2015–2019	2009; 2015–2019	Commercial – PPO
Kentucky	98922	2009; 2015–2019	2009; 2015–2019	2009; 2015–2019	Commercial – HMO
Kentucky	98901	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Aetna Health HMO Plan
Kentucky	98902	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Aetna Health PPO Plan
Kentucky	98903	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Humana POS Plan
Kentucky	98904	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Humana HMO Plan
Kentucky	98905	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Humana PPO Plan
Kentucky	98906	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Anthem Health Plans of KY POS Plan
Kentucky	98908	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Anthem Health Plans of KY HMO Plan
Kentucky	98931	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – United Healthcare POS Plan
Kentucky	98933	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – United Healthcare PPO Plan
Kentucky	98934	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – United Healthcare of KY POS Plan
Kentucky	98935	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – United Healthcare of KY HMO Plan
Kentucky	98936	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – United Healthcare of Ohio POS Plan
Kentucky	98938	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Cigna Health & Life PPO Plan
Kentucky	98941	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Caresource Kentucky HMO Plan
Kentucky	98942	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Wellcare Health Plans of KY HMO Plan
Kentucky	98960	Oct 2018-2019	Oct 2018-2019	Oct 2018-2019	Commercial – Anthem Health Plans of KY PPO Plan
Louisiana	H	2008–2019	N/A	N/A	HMO/Managed Care
Maine	10	2008–2010	2008–2010	2008-2010	HMO/PPO
Maryland	16	2008–2019	2008–2019	2008–2019	Blue Cross of the National Capital Area (HMO)
Maryland	12	2008–2019	2008–2019	2008–2019	HMO
Massachusetts	C	2008–2019	N/A	N/A	Blue Cross Managed Care
Massachusetts	D	2008–2019	N/A	N/A	Commercial Managed Care
Massachusetts	8	2008–2019	N/A	N/A	HMO
Massachusetts	E	2008–2019	N/A	N/A	PPO and Other Managed Care not listed elsewhere
Massachusetts	J	2008–2019	N/A	N/A	Point of service plan
Massachusetts	175	N/A	N/A	2010-2019	Aetna Health Inc - HMO
Massachusetts	174	N/A	N/A	2010-2019	Aetna Health Inc. – Quality POS
Massachusetts	161	N/A	N/A	2008-2019	Aetna Managed Choice PPO
Massachusetts	22	N/A	N/A	2008-2019	Aetna Open Choice PPO
Massachusetts	2	N/A	N/A	2008-2009, 2012-2019	Bay State – a product of HMO Blue
Massachusetts	136	N/A	N/A	2008-2019	BCBS Medex
Massachusetts	155	N/A	N/A	2008-2019	Blue Cross Managed Care Other (not listed elsewhere)
Massachusetts	259	N/A	N/A	2010-2019	Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX)
Massachusetts	250	N/A	N/A	2008-2019	CIGNA HMO
Massachusetts	171	N/A	N/A	2008-2019	CIGNA POS
Massachusetts	87	N/A	N/A	2008-2019	CIGNA PPO
Massachusetts	21	N/A	N/A	2008-2009, 2012-2019	Commonwealth PPO
Massachusetts	186	N/A	N/A	2010-2019	Connecticut General Life - POS
Massachusetts	187	N/A	N/A	2010-2019	Connecticut General Life - PPO
Massachusetts	167	N/A	N/A	2008-2009, 2012-2019	Fallon POS
Massachusetts	188	N/A	N/A	2010-2019	Fallon Flex POS
Massachusetts	190	N/A	N/A	2010-2019	Fallon Preferred Care - PPO
Massachusetts	191	N/A	N/A	2010-2019	Genworth Preferred PPO
Massachusetts	162	N/A	N/A	2008-2019	Great West Life POS
Massachusetts	28	N/A	N/A	2008-2019	Great West Life PPO
Massachusetts	192	N/A	N/A	2010-2019	Guarantee Trust Life Insurance Company PPO
Massachusetts	23	N/A	N/A	2008-2019	Guardian Life Insurance Company PPO
Massachusetts	194	N/A	N/A	2010-2019	Harvard Pilgrim - POS
Massachusetts	195	N/A	N/A	2010-2019	Harvard Pilgrim - PPO
Massachusetts	196	N/A	N/A	2010-2019	Harvard Pilgrim Health Care, Inc. (HMO)
Massachusetts	37	N/A	N/A	2008-2009, 2012-2019	HCHP – Pilgrim HMO (integrated product)
Massachusetts	205	N/A	N/A	2010-2019	Health New England Select Premier PPO
Massachusetts	251	N/A	N/A	2008-2009, 2012-2019	Healthsource CMHC HMO
Massachusetts	49	N/A	N/A	2008-2009, 2012-2019	Healthsource CMHC Plus PPO
Massachusetts	81	N/A	N/A	2008-2019	HMO Blue
Massachusetts	40	N/A	N/A	2008-2009, 2012-2019	Kaiser Foundation
Massachusetts	158	N/A	N/A	2008-2009-, 2012-2019	Metrahealth – HMO (United Health Care of NE)
Massachusetts	157	N/A	N/A	2008-2009, 2012-2019	Metrahealth – PPO (United Health Care of NE)
Massachusetts	3	N/A	N/A	2008-2009, 2012-2019	Network Blue (PPO)
Massachusetts	227	N/A	N/A	2010-2019	Northeast Health Direct - PPO
Massachusetts	31	N/A	N/A	2008-2019	One Health Plan HMO (Great West Life)
Massachusetts	77	N/A	N/A	2008-2009, 2012-2019	Options for Healthcare PPO
Massachusetts	148	N/A	N/A	2008-2019	Other HMO (not listed elsewhere)
Massachusetts	99, 099	N/A	N/A	2008-2019	Other POS (not listed elsewhere)
Massachusetts	10	N/A	N/A	2008-2009, 2012-2019	Pilgrim Advantage - PPO
Massachusetts	95	N/A	N/A	2008-2009, 2012-2019	Pilgrim Select - PPO
Massachusetts	79	N/A	N/A	2008-2019	Pioneer Health Care PPO
Massachusetts	149	N/A	N/A	2008-2019	PPO and Other Managed Care (not listed elsewhere)
Massachusetts	246	N/A	N/A	2010-2019	Preferred Blue PPO
Massachusetts	166	N/A	N/A	2008-2019	Private Healthcare Systems POS
Massachusetts	84	N/A	N/A	2008-2019	Private Healthcare Systems PPO
Massachusetts	75	N/A	N/A	2008-2009, 2012-2019	Prudential Healthcare HMO
Massachusetts	239	N/A	N/A	2010-2019	Tufts Associated Health Maintenance Organization, Inc. POS Plan
Massachusetts	238	N/A	N/A	2010-2019	Tufts Associated Health Maintenance Organization, Inc. PPO
Massachusetts	236	N/A	N/A	2010-2019	Tufts Associated Health Maintenance Organization, Inc. (TAHMO)
Massachusetts	237	N/A	N/A	2010-2019	Tufts Insurance Company PPO
Massachusetts	80	N/A	N/A	2008-2009, 2012-2019	Tufts Total Health Plan PPO
Massachusetts	240	N/A	N/A	2010-2019	UniCare PPO
Massachusetts	270	N/A	N/A	2008-2009, 2012-2019	UniCare Preferred Plus PPO
Massachusetts	35	N/A	N/A	2008-2009, 2012-2019	United Healthcare Insurance Company – HMO (new for 1997)
Massachusetts	163	N/A	N/A	2008-2009, 2012-2019	United Healthcare Insurance Company – POS (new for 1997)
Massachusetts	36	N/A	N/A	2008-2019	United Healthcare Insurance Company – PPO (new for 1997)
Michigan	09	2008–2019	2008–2019	2018-2019	Managed care or other
Michigan	11	2008–2019	2008–2019	2018-2019	Blue Cross/Blue Shield HMO
Michigan	12	2008–2019	2008–2019	2018-2019	Other HMO
Michigan	17	2008–2019	2008–2019	2018-2019	Blue Cross/Blue Shield PPO/PPA
Michigan	18	2008–2019	2008–2019	2018-2019	Other PPO/PPA
Minnesota	6000100	2008–2019	2008–2019	2008–2019	Blue Cross, MN
Minnesota	7000000	2008–2019	2008–2019	2008–2019	Other HMO
Minnesota	7000100	2008–2019	2008–2019	2008–2019	Medica - Choice
Minnesota	7000200	2008–2019	2008–2019	2008–2019	Group Health
Minnesota	7000400	2008–2019	2008–2019	2008–2019	Medica - Primary
Minnesota	7000600	2008–2019	2008–2019	2008–2019	Ucare
Minnesota	7000700	2008–2019	2008–2019	2008–2019	Blue Plus
Minnesota	7000800	2008–2019	2008–2019	2008–2019	Metro. Health Plan
Minnesota	7000900	2008–2019	2008–2019	2008–2019	Blue Cross HMO
Minnesota	7001000	2008–2019	2008–2019	2008–2019	Health Partners
Minnesota	7001300	2008–2019	2008–2019	2008–2019	First Plan HMO
Minnesota	7009900	2008–2019	2008–2019	2008–2019	Other HMO
Minnesota	8000000	2008–2019	2008–2019	2008–2019	Other PPO
Minnesota	8000500	2008–2019	2008–2019	2008–2019	ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO)
Minnesota	8000520	2008–2019	2008–2019	2008–2019	ARAZ (formerly Ethix Midwest; also known as America's PPO)
Minnesota	8000600	2008–2019	2008–2019	2008–2019	Aetna PPO
Minnesota	8000620	2008-2019	2008-2019	2008-2019	Aetna PPO, Union
Minnesota	8000700	2008–2019	2008–2019	2008–2019	Group Health PPO
Minnesota	8000900	2008–2019	2008–2019	2008–2019	Blue Cross PPO
Minnesota	8001000	2008–2019	2008–2019	2008–2019	Medica Choice PPO
Minnesota	8001500	2008–2019	2008–2019	2008–2019	LaborCare PPO
Minnesota	8001520	2008–2019	2008–2019	2008–2019	LaborCare PPO, Union
Minnesota	8009900	2008–2019	2008–2019	2008–2019	Other PPO
Minnesota	8009920	2008–2019	2008–2019	2008–2019	Other PPO, union
Mississippi^b	11	2010–2012	N/A	N/A	PPO
Mississippi^b	6	2010–2012	N/A	N/A	HMO
Montana	00005	2009–2019	N/A	2014–2019	Montana HMO - Blue Cross/Blue Shield
Montana	98925	2014–2019	N/A	2014–2019	Commercial HMO
Montana	40010	2009- 2019	N/A	2014- 2019	Blue Cross Blue Shield (POS, PPO)
Montana	40015	2009- 2019	N/A	2014- 2019	Blue Cross Blue Shield HMO
Montana	40020	2009- 2019	N/A	2014- 2019	United Healthcare (POS, PPO)
Montana	40025	2009- 2019	N/A	2014- 2019	United Healthcare HMO
Montana	40030	2009- 2019	N/A	2014- 2019	Aetna (POS, PPO)
Montana	40035	2009- 2019	N/A	2014- 2019	Aetna HMO
Montana	40150	2009- 2019	N/A	2014- 2019	Humana (POS, PPO)
Montana	40155	2009- 2019	N/A	2014- 2019	Humana HMO
Montana	40160	2009- 2019	N/A	2014- 2019	Health Alliance (POS, PPO)
Montana	40165	2009- 2019	N/A	2014- 2019	Health Alliance HMO
Montana	40170	2009- 2019	N/A	2014- 2019	Allegiance (POS, PPO)
Montana	40175	2009- 2019	N/A	2014- 2019	Allegiance HMO
Montana	40180	2009- 2019	N/A	2014- 2019	Montana Health COOP (POS, PPO)
Montana	40185	2009- 2019	N/A	2014- 2019	Montana Health COOP HMO
Nevada	21	2008–2019	2011–2019	2008–2019	Negotiated Discounts e.g. Preferred Provider Organization (PPO)
Nevada	22	2008–2019	2011–2019	2008–2019	Health Maintenance Organization (HMO)
New Hampshire^c	5	2008-2009	2008-2009	2008-2009	HMO
New Jersey	032	2008–2019	2008–2019	2008–2019	HMO
New Jersey	033	2008–2019	2008–2019	2008–2019	HMO
New Jersey	034	2008–2019	2008–2019	2008–2019	HMO
New Jersey	035	2008–2019	2008–2019	2008–2019	HMO
New Jersey	036	2008–2019	2008–2019	2008–2019	HMO
New Jersey	037	2008–2019	2008–2019	2008–2019	HMO
New Jersey	045	2008–2019	2008–2019	2008–2019	HMO
New Jersey	047	2008–2019	2008–2019	2008–2019	HMO
New Jersey	048	2008–2019	2008–2019	2008–2019	HMO
New Jersey	056	2008–2019	2008–2019	2008–2019	HMO
New Jersey	058	2008–2019	2008–2019	2008–2019	HMO
New Jersey	059	2008–2019	2008–2019	2008–2019	HMO
New Jersey	072	2008–2019	2008–2019	2008–2019	HMO
New Jersey	073	2008–2019	2008–2019	2008–2019	HMO
New Jersey	074	2008–2019	2008–2019	2008–2019	HMO
New Jersey	077	2008–2019	2008–2019	2008–2019	HMO
New Jersey	078	2008–2019	2008–2019	2008–2019	HMO
New Jersey	081	2008–2019	2008–2019	2008–2019	HMO
New Jersey	084	2008–2019	2008–2019	2008–2019	HMO
New Jersey	087	2008–2019	2008–2019	2008–2019	HMO
New Jersey	088	2008–2019	2008–2019	2008–2019	HMO
New Jersey	094	2008–2019	2008–2019	2008–2019	HMO
New Jersey	097	2008–2019	2008–2019	2008–2019	HMO
New York	11	2008–2016	2008–2016	2008–2016	HMO (Other)
New York	51	2017-2019	2017-2019	2017-2019	Managed Care (Private)
New York	511	2017-2019	2017-2019	2017-2019	Commercial Managed Care (HMO)
New York	512	2017-2019	2017-2019	2017-2019	Commercial Managed Care (PPO)
New York	513	2017-2019	2017-2019	2017-2019	Commercial Managed Care (POS)
New York	515	2017-2019	2017-2019	2017-2019	Gatekeeper PPO (GPPO)
New York	519	2017-2019	2017-2019	2017-2019	Managed Care, Other (non-HMO)
New York	61	2017-2019	2017-2019	2017-2019	BC Managed Care
New York	611	2017-2019	2017-2019	2017-2019	BC Managed Care (HMO)
New York	612	2017-2019	2017-2019	2017-2019	BC Managed Care (PPO)
New York	613	2017-2019	2017-2019	2017-2019	BC Managed Care (POS)
New York	619	2017-2019	2017-2019	2017-2019	BC Managed Care (Other)
North Carolina	H	2008–2009, 2012–2015	2008–2009, 2012–2015	2008–2009, 2012–2015	HMO - PPO
North Carolina	HM	2010-2019	2010-2019	2010-2019	HMO - PPO
North Carolina	16	2010–2019	2010–2019	2010–2019	Health Maintenance Organization
North Carolina	13	2010–2019	2010–2019	2010–2019	Point of Service
North Carolina	12	2010-2019	2010-2019	2010-2019	Preferred Provider Organization
North Carolina	Y	2008–2009, 2012–2015	2008–2009, 2012–2015	2008–2009, 2012–2015	Point of Service
North Carolina	K	2008-2009	2008-2009	2008-2009	Health Maintenance Organization
North Carolina	Z	2008-2009	2008-2009	2008-2009	Preferred Provider Organization
North Dakota	6000100	2011–2019	2013–2019	2011–2019	Blue Cross, MN
North Dakota	7000000	2011–2019	2013–2019	2011–2019	Other HMO
North Dakota	7000100	2011–2019	2013–2019	2011–2019	Medica - Choice
North Dakota	7000200	2011–2019	2013–2019	2011–2019	Group Health
North Dakota	7000400	2011–2019	2013–2019	2011–2019	Medica - Primary
North Dakota	7000600	2011–2019	2013–2019	2011–2019	Ucare
North Dakota	7000700	2011–2019	2013–2019	2011–2019	Blue Plus
North Dakota	7000800	2011–2019	2013–2019	2011–2019	Metro. Health Plan
North Dakota	7000900	2011–2019	2013–2019	2011–2019	Blue Cross HMO
North Dakota	7001000	2011–2019	2013–2019	2011–2019	Health Partners
North Dakota	7001300	2011–2019	2013–2019	2011–2019	First Plan HMO
North Dakota	7009900	2011–2019	2013–2019	2011–2019	Other HMO
North Dakota	8000000	2011–2019	2013–2019	2011–2019	Other PPO
North Dakota	8000500	2011–2019	2013–2019	2011–2019	ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO)
North Dakota	8000520	2011–2019	2013–2019	2011–2019	ARAZ (formerly Ethix Midwest; also known as America's PPO)
North Dakota	8000600	2011–2019	2013–2019	2011–2019	Aetna PPO
North Dakota	8000620	2011-2019	2013–2019	2011–2019	Aetna PPO, Union
North Dakota	8000700	2011–2019	2013–2019	2011–2019	Group Health PPO
North Dakota	8000900	2011–2019	2013–2019	2011–2019	Blue Cross PPO
North Dakota	8001000	2011–2019	2013–2019	2011–2019	Medica Choice PPO
North Dakota	8001200	2011–2019	2013–2019	2011–2019	Northwest National Life (NWNL) PPO
North Dakota	8001500	2011–2019	2013–2019	2011–2019	LaborCare PPO
North Dakota	8001520	2011–2019	2013–2019	2011–2019	LaborCare PPO, Union
North Dakota	8009900	2011–2019	2013–2019	2011–2019	Other PPO
North Dakota	8009920	2011–2019	2013–2019	2011–2019	Other PPO, union
Ohio	K	2008–2019	2008–2019	2008–2019	HMO
Ohio	L	2008–2019	2008–2019	2008–2019	PPO
Ohio	N	2008–2019	2008–2019	2008–2019	Blue Cross HMO
Oregon	51	2008–2019	2010–2019	2015–2019	HMO/Managed Care
Oregon	511	2008–2019	2010–2019	2015–2019	Kaiser Permanente
Oregon	61	2008–2019	2010–2019	2015–2019	Regence Blue Cross Managed Care
Pennsylvania	32	2008–2019	2013–2019	N/A	Blue Cross - PPO
Pennsylvania	33	2008–2019	2013–2019	N/A	Blue Cross - POS
Pennsylvania	35	2008–2019	2013–2019	N/A	Blue Cross - HMO
Pennsylvania	42	2008–2019	2013–2019	N/A	Commercial - PPO
Pennsylvania	43	2008–2019	2013–2019	N/A	Commercial - POS
Pennsylvania	45	2008–2019	2013–2019	N/A	Commercial - HMO
South Carolina	5	2008–2019	2008–2019	2008–2019	HMO
Tennessee	H	2008–2016	2008–2016	2008–2016	Blue Cross - Managed Care - HMO/PPO/Other Managed Care
Tennessee	L	2008–2019	2008–2019	2008–2019	Commercial Managed Care - HMO/PPO/Other Managed Care
Texas	12	2008–2019	2011–2019	2015–2019	Preferred Provider Organization (PPO)
Texas	13	2008–2019	2011–2019	2015–2019	Point of Service (POS)
Texas	HM	2008–2019	2011–2019	2015–2019	Health Maintenance Organization
Utah	06	2008–2014	2008–2014	2008–2014	Managed care (HMO and PPO)
Vermont	H	2008–2019	2008–2019	2008–2019	HMO
Vermont	PAYER1_X = Hnnnn	2008–2019	2008–2019	2008–2019	HMO – 2^nd to 5^th character provides detail on the payer (e.g., Blue Cross, Kaiser, etc.)
Virginia	29	2008–2019	N/A	N/A	HMO/PPO – Unspecified
Virginia	34	2008–2019	N/A	N/A	Kaiser Permanente
Washington	004	2008–2019	N/A	N/A	Health Maintenance Organization (HMO) (e.g., Group Health, Kaiser Foundation, Good Health)
West Virginia	PAYER1_X = First digit of 4, 5, or 6 and third digit of 3, 4, or 5	2008–2019	N/A	N/A	WV reports a four-digit payer code in PAYERn_X. The first digit indicates the types of payer with the following values: (4) commercial, (5) nonprofit, and (6) employer, ERISA, or union. The second digit indicates the payment program. The third digit indicates the payment modality with the values: (3) point of service (POS), (4) HMO, and (5) other managed care. The fourth digit includes information on the HMO using the following values: (0) none, (1) Acordia - Primeone, (2) Advantage - Healthguard, (3) Carelink, (4) Coventry Health plan (OH), (5) Health Plan of Upper Ohio Valley (OH), (6) Optimum Choice – (MD), (7) (unassigned), (8) unknown, and (9) NEC not elsewhere classified Choice
Wisconsin	WPS02	2008-June 2014	2008-June 2014	2008-June 2014	Wisconsin Physicians Service - Alternative health care insurance plans
Wisconsin	OTH12	2008-2017	2008-2017	2008-2017	Commercial or private insurance - Alternative health care insurance plans (HMO or PPO)
Wisconsin	OTH22	2008-2017	2008-2017	2008-2017	Employer self-funded - Alternative health care insurance plans (HMO or PPO)
Wisconsin	OTH32	2008-2017	2008-2017	2008-2017	Other organization self-funded - Alternative health care insurance plans (HMO or PPO)
Wisconsin	nnn02, where nnn is a 3-digit numerical code	2008-2017	2008-2017	2008-2017	Blue Cross/Blue Shield - Alternative health care insurance plans (HMO or PPO)
Wisconsin	BCS02	2008-2017	2008-2017	2008-2017	Blue Cross - Alternative health care insurance plans (HMO or PPO)
Wyoming	H	2008–2019	N/A	2014-2019	Managed Care (HMO/PPO)

^a Hawaii 2016-2018 SEDD and SASD were not available at the time of publication.
^b Mississippi 2012 SID was not available at the time of publication.
^c New Hampshire 2010-2018 SID, SASD, and SEDD were not available at the time of publication. Beginning in 2019, New Hampshire resumed providing SID and SEDD, but did not provide private managed care information.

SUPPLEMENT 3. HCUP STATE-SPECIFIC RECODES FOR MEDICAID TO ALIGN HCUP WITH THE AMERICAN COMMUNITY SURVEY

The following table includes State-specific recodes for Medicaid to align HCUP payer codes with the American Community Survey (ACS) category. The information can be reported in either the expected primary payer as received from the State (HCUP data element PAY1_X) or the expected primary payer plan identifier as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it does not separately report Medicaid programs like the Children’s Health Insurance Program (CHIP).

Table 3A. State-Specific Recodes for Medicaid to Align HCUP Payer Codes with the American Community Survey (ACS)

State	PAY1_X Source Value (Unless Noted)	SID Years	SASD Years	SEDD Years	Source Description	Recode to
Arizona^a	08	2008–2012	N/A	2008–2012	Children's Rehab Services	Medicaid
Florida^b	O	2010–2016	2010–2016	2010–2016	KidCare	CHIP program to Medicaid
Florida	O	2008-2009	2008-2009	2008-2009	KidCare (Healthy Kids, MediKids, and Children's Medical Services	CHIP program to Medicaid
Georgia^c	361	2008–2016	2008–2016	2008–2016	State SCHIP Program	CHIP program to Medicaid (CHIP code not used in 2011 data)
Kansas^d	103	2008–2016	2008–2016	2008–2016	HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)	CHIP program to Medicaid
Minnesota^e	4000500	2008–2009	2008–2009	2008–2009	General Assistance Medical Care (GAMC)/GA/Welfare	Medicaid
Minnesota^e	4000800	2008–2009	2008–2009	2008–2009	PrimeWest, Cty Based Purchased	Medicaid managed care
Minnesota^e	4000900	2008–2009	2008–2009	2008–2009	Itasca Medical Care, CBP	Medicaid managed care
Minnesota^e	4001000	2008–2009	2008–2009	2008–2009	So. Country Hlth Alliance, CBP	Medicaid managed care
Minnesota^e	7000103	2008–2009	2008–2009	2008–2009	Medica - Choice, GAMC	Medicaid
Minnesota^e	7000303	2008–2009	2008–2009	2008–2009	Ramsey Care, GAMC, etc.	Medicaid
Minnesota^e	7000603	2008–2009	2008–2009	2008–2009	Ucare, GAMC, etc.	Medicaid
Minnesota^e	7000703	2008–2009	2008–2009	2008–2009	Blue Plus, GAMC, etc.	Medicaid
Minnesota^e	7000803	2008–2009	2008–2009	2008–2009	Metro. Health Plan, GAMC, etc.	Medicaid
Minnesota^e	7001003	2008–2009	2008–2009	2008–2009	Health Partners, GAMC, etc.	Medicaid
Minnesota^e	7009903	2008–2009	2008–2009	2008–2009	Other HMO, GAMC/GA/Welfare	Medicaid
North Dakota^f	4000500	2011-2013	2013	2011-2013	General Assistance Medical Care (GAMC)/GA/Welfare	Medicaid
North Dakota^f	4000800	2011-2013	2013	2011-2013	PrimeWest, Cty Based Purchased	Medicaid managed care
North Dakota^f	4000900	2011-2013	2013	2011-2013	Itasca Medical Care, CBP	Medicaid managed care
North Dakota^f	4001000	2011-2013	2013	2011-2013	So. Country Hlth Alliance, CBP	Medicaid managed care
North Dakota^f	7000103	2011-2013	2013	2011-2013	Medica - Choice, GAMC	Medicaid
North Dakota^f	7000303	2011-2013	2013	2011-2013	Ramsey Care, GAMC, etc.	Medicaid
North Dakota^f	7000603	2011-2013	2013	2011-2013	Ucare, GAMC, etc.	Medicaid
North Dakota^f	7000703	2011-2013	2013	2011-2013	Blue Plus, GAMC, etc.	Medicaid
North Dakota^f	7000803	2011-2013	2013	2011-2013	Metro. Health Plan, GAMC, etc.	Medicaid
North Dakota^f	7001003	2011-2013	2013	2011-2013	Health Partners, GAMC, etc.	Medicaid
North Dakota^f	7009903	2011-2013	2013	2011-2013	Other HMO, GAMC/GA/Welfare	Medicaid
Tennessee^g	12	2008–2016	2008–2016	2008–2016	Cover Kids	CHIP program to Medicaid
Utah	13	2008–2014	2008–2014	2008–2014	Children's Health Insurance Plan (CHIP)	CHIP program to Medicaid
Utah^h	CHIP	2015–2016	2015–2016	2016	Children's Health Insurance Plan (CHIP)	CHIP program to Medicaid
West Virginiaⁱ	28	2008–2017	N/A	N/A	WV Children's Health Insurance Program (CHIP)	CHIP program to Medicaid
Wisconsin^j	BGR01	2008–2010	2008-2010	2008-2010	Badger Care - Fee for service	Medicaid
Wisconsin^j	BGR02	2008–2010	2008-2010	2008-2010	Badger Care - Alternative health care insurance plans (HMO, PPO, PPA, etc.)	Medicaid
Wisconsin^j	BGR09	2008–2010	2008-2010	2008-2010	Badger Care - type unknown	Medicaid

^a Arizona payer code 08 was mapped to Medicaid starting in 2013.
^b Florida payer code O was mapped to Medicaid starting in 2017.
^c Georgia payer code 361 was mapped to Medicaid starting in 2017.
^d Kansas payer code 103 was mapped to Medicaid starting in 2017.
^e These Minnesota payer codes were mapped to Medicaid starting in 2010.
^f These North Dakota payer codes were mapped to Medicaid starting in 2014.
^g Tennessee payer code 12 was mapped to Medicaid starting in 2017.
^h Utah payer code CHIP was mapped to Medicaid starting in 2017.
ⁱ West Virginia payer code 28 was mapped to Medicaid starting in 2018.
^j These Wisconsin payer codes were mapped to Medicaid starting in 2011.

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