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

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
Alaskaa 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
Californiab 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
Nevadac 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 Jerseyd 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
Virginiae 10 2008–2012 N/A N/A Indigent/Charity
Wisconsinf 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)
Hawaiia 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 Hampshirec 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)
Hawaiia 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
Kansasb 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 Hampshirec 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
Wisconsind 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)
Wisconsine 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)
Hawaiia 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
Mississippib 11 2010–2012 N/A N/A PPO
Mississippib 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 Hampshirec 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
VermontPAYER1_X = Hnnnn2008–20192008–20192008–2019HMO – 2nd to 5th character provides detail on the payer (e.g., Blue Cross, Kaiser, etc.)
Virginia292008–2019N/AN/AHMO/PPO – Unspecified
Virginia342008–2019N/AN/AKaiser Permanente
Washington0042008–2019N/AN/AHealth Maintenance Organization (HMO) (e.g., Group Health, Kaiser Foundation, Good Health)
West VirginiaPAYER1_X = First digit of 4, 5, or 6 and third digit of 3, 4, or 52008–2019N/AN/AWV 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 WPS022008-June 20142008-June 20142008-June 2014Wisconsin Physicians Service - Alternative health care insurance plans
Wisconsin OTH122008-20172008-20172008-2017Commercial or private insurance - Alternative health care insurance plans (HMO or PPO)
Wisconsin OTH222008-20172008-20172008-2017Employer self-funded - Alternative health care insurance plans (HMO or PPO)
WisconsinOTH322008-20172008-20172008-2017Other organization self-funded - Alternative health care insurance plans (HMO or PPO)
Wisconsin nnn02, where nnn is a 3-digit numerical code2008-20172008-20172008-2017Blue Cross/Blue Shield - Alternative health care insurance plans (HMO or PPO)
Wisconsin BCS022008-20172008-20172008-2017Blue Cross - Alternative health care insurance plans (HMO or PPO)
WyomingH2008–2019N/A2014-2019Managed 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

Arizonaa

08

2008–2012

N/A

2008–2012

Children's Rehab Services

Medicaid

Floridab

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

Georgiac

361

2008–2016

2008–2016

2008–2016

State SCHIP Program

CHIP program to

Medicaid (CHIP code not used in 2011 data)

Kansasd

103

2008–2016

2008–2016

2008–2016

HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)

CHIP program to

Medicaid

Minnesotae

4000500

2008–2009

2008–2009

2008–2009

General Assistance Medical Care (GAMC)/GA/Welfare

Medicaid

Minnesotae

4000800

2008–2009

2008–2009

2008–2009

PrimeWest, Cty Based Purchased

Medicaid

managed care

Minnesotae

4000900

2008–2009

2008–2009

2008–2009

Itasca Medical Care, CBP

Medicaid

managed care

Minnesotae

4001000

2008–2009

2008–2009

2008–2009

So. Country Hlth Alliance, CBP

Medicaid

managed care

Minnesotae

7000103

2008–2009

2008–2009

2008–2009

Medica - Choice, GAMC

Medicaid

Minnesotae

7000303

2008–2009

2008–2009

2008–2009

Ramsey Care, GAMC, etc.

Medicaid

Minnesotae

7000603

2008–2009

2008–2009

2008–2009

Ucare, GAMC, etc.

Medicaid

Minnesotae

7000703

2008–2009

2008–2009

2008–2009

Blue Plus, GAMC, etc.

Medicaid

Minnesotae

7000803

2008–2009

2008–2009

2008–2009

Metro. Health Plan, GAMC, etc.

Medicaid

Minnesotae

7001003

2008–2009

2008–2009

2008–2009

Health Partners, GAMC, etc.

Medicaid

Minnesotae

7009903

2008–2009

2008–2009

2008–2009

Other HMO, GAMC/GA/Welfare

Medicaid

North Dakotaf

4000500

2011-2013

2013

2011-2013

General Assistance Medical Care (GAMC)/GA/Welfare

Medicaid

North Dakotaf

4000800

2011-2013

2013

2011-2013

PrimeWest, Cty Based Purchased

Medicaid

managed care

North Dakotaf

4000900

2011-2013

2013

2011-2013

Itasca Medical Care, CBP

Medicaid

managed care

North Dakotaf

4001000

2011-2013

2013

2011-2013

So. Country Hlth Alliance, CBP

Medicaid

managed care

North Dakotaf

7000103

2011-2013

2013

2011-2013

Medica - Choice, GAMC

Medicaid

North Dakotaf

7000303

2011-2013

2013

2011-2013

Ramsey Care, GAMC, etc.

 

Medicaid

North Dakotaf

7000603

2011-2013

2013

2011-2013

Ucare, GAMC, etc.

Medicaid

North Dakotaf

7000703

2011-2013

2013

2011-2013

Blue Plus, GAMC, etc.

Medicaid

North Dakotaf

7000803

2011-2013

2013

2011-2013

Metro. Health Plan, GAMC, etc.

Medicaid

North Dakotaf

7001003

2011-2013

2013

2011-2013

Health Partners, GAMC, etc.

Medicaid

North Dakotaf

7009903

2011-2013

2013

2011-2013

Other HMO, GAMC/GA/Welfare

Medicaid

Tennesseeg

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

Utahh

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

Wisconsinj

BGR01

2008–2010

2008-2010

2008-2010

Badger Care - Fee for service

Medicaid

Wisconsinj

BGR02

2008–2010

2008-2010

2008-2010

Badger Care - Alternative health care insurance plans (HMO, PPO, PPA, etc.)

Medicaid

Wisconsinj

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.


Internet Citation: HCUP Methods Series Supplements 1–3: An Examination of Expected Payer Coding in HCUP Databases (Updated for 2019 HCUP Data). Healthcare Cost and Utilization Project (HCUP). December 2021. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/methods/MS2021-01-Expected-Payer-Coding-Supplements.jsp.
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Last modified 12/1/21