Skip Navigation
Healthcare Cost and Utilization Project logo
KID Description of Data Elements
The KID is set of longitudinal hospital inpatient databases included in the HCUP family. These databases are created by AHRQ through a Federal-State-Industry partnership.
 search icon
 
  Home      Databases      Tools & Software      Reports      News & Events      Technical Assistance   
 
PAY1 - Expected primary payer, uniform
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

PAY1 indicates the expected primary payer (Medicare, Medicaid, private insurance, etc.). To ensure uniformity of coding across data sources, PAY1 combines detailed categories in the more general groups. For example,

  • Medicare includes both fee-for-service and managed care Medicare patients.
  • Medicaid includes both fee-for-service and managed care Medicaid patients.
  • Private insurance (PAY1 = 3) includes Blue Cross, commercial carriers, and private HMOs and PPOs.
  • Other (PAY1 = 6) includes Worker's Compensation, CHAMPUS, CHAMPVA, Title V, and other government programs.

In the 1988-1997 data, the data element PAY1_N provides more detailed categories for private insurance and other payers. This data element is discontinued beginning in the 1998 data because of the difficulty of coding the information uniformly across States.

The HCUP data element PAY1_X retains the expected primary payer as provided by the data source. The State Specific Notes for PAY1 include information on how the source values contained in the PAY1_X are recoded into the HCUP uniform values of PAY1.

If information on secondary or tertiary payers is provided by the data source, the coding of the associated HCUP variables (PAY2, PAY2_X, and PAY3_X) is included under the State Specific Notes for PAY1.
 
Top
 
Uniform Values
VariableDescriptionValueValue Description
PAY1Expected primary payer, uniform1Medicare
2Medicaid
3Private insurance
4Self-pay
5No charge
6Other
.Missing
.AInvalid
.BUnavailable from source (coded in 1988-1997 data only)
 
Top
 
 
State Specific Notes

Arizona
Arizona
(Valid beginning 2003)
PAY1_X PAY1
Value Description Value Description
05, 5 Medicare 1 Medicare
11 Medicare Risk
06 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group/ Medicaid 2 Medicaid
01 Commercial (Indemnity) 3 Private Insurance
02 HMO
03, 3 PPO
04 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group (for the self employed, small businesses (under 50 employees), and the uninsured employees of political subdivisions)
00 Self pay 4 Self pay
12 Charity 5 No charge
07 CHAMPUS/MEDEXCEL 6 Other
08 Children's Rehab Services
09 Worker's Compensation
10 Indian Health Services
13 Foreign National
14 Other
15 Tobacco Tax (beginning in 1998)(discontinued 2007)
Blank, 99 Missing . Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid July 2002 through December 2002)
PAY1_X PAY1
Value Description Value Description
F Medicare 1 Medicare
L Medicare Risk
G AHCCCS/Medicaid 2 Medicaid
B Commercial (Indemnity) 3 Private Insurance
C HMO
D PPO
E Arizona Health Care Cost Containment System (AHCCCS) Health Care Group (for the self employed, small businesses (under 50 employees), and the uninsured employees of political subdivisions)
A Self pay 4 Self pay
M Charity 5 No charge
H CHAMPUS/MEDEXCEL 6 Other
I Children's Rehab Services
J Worker's Compensation
K Indian Health Services
N Foreign National
O Other
?, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid 1995 to June 2002)
PAY1_X PAY1
Value Description Value Description
05, 5 Medicare 1 Medicare
11 Medicare Risk
04 Arizona Health Care Cost Containment System (AHCCCS) Health Care Group 2 Medicaid
06 AHCCCS/Medicaid
01 Commercial (Indemnity) 3 Private Insurance
02 HMO
03, 3 PPO
00 Self pay 4 Self pay
12 Charity 5 No charge
07 CHAMPUS/MEDEXCEL 6 Other
08 Children's Rehab Services
09 Worker's Compensation
10 Indian Health Services
13 Foreign National
14 Other
15 Tobacco Tax (Beginning in 1998)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Arizona
(Valid from 1989-1994)
PAY1_X PAY1
Value Description Value Description
3 Medicare 1 Medicare
4 AHCCCS/Medicaid 2 Medicaid
1 Commercial 3 Private Insurance
2 HMO/PHP/Blue Cross
--   4 Self-pay
--   5 No charge
5 Other (self-pay, unknown, charity, etc.) 6 Other
Blank   . Missing
Other Values   .A Invalid


California
California
(Valid beginning in 1999)
PAY1_X PAY1
Value Description Value Description
010 Medicare 1 Medicare
011 Medicare (HMO) 1 Medicare
012 Medicare (Managed care - Other) 1 Medicare
013 Medicare (fee for service) 1 Medicare
020 Medi-Cal 2 Medi-Cal
021 Medi-Cal (HMO) 2 Medi-Cal
022 Medi-Cal (Managed care - Other) 2 Medi-Cal
023 Medi-Cal (fee for service) 2 Medi-Cal
030 Private Coverage 3 Private insurance
031 Private Coverage (HMO) 3 Private insurance
032 Private Coverage (Managed care - Other) 3 Private insurance
033 Private Coverage (fee for service) 3 Private insurance
08n, where n=0-3 Self-pay 4 Self-pay
--   5 No charge
04n, where n=0-3 Worker's Compensation 6 Other
05n, where n=0-3 County Indigent Programs
06n, where n=0-3 Other Government
07n, where n=0-3 Other Indigent (includes charity care)
09n, where n=0-3 Other
0, 000 Type of coverage not considered applicable to the payer category . Missing
Any values not documented by the data source .A Invalid

The first two digits of PAY1_X describes the payer category (e.g., Medicare (01), Medi-Cal (02), Private coverage (03), Workers' Compensation (04), County Indigent Programs (05), Other Government (06), Other Indigent (07), Self Pay (08), and Other Payer (09)).

The third digit of PAY1_X describes the type of coverage (e.g., Knox-Keene (HMO)* or Medi-Cal County Organized Health Systems (MCOHS) plan (1), Managed Care Other (PPO, IPO, POS, etc.) (2), traditional coverage (fee for service) (3), and type of coverage not considered applicable to the payer category (0).

* HMOs are regulated in California under the Knox-Keene Health Care Service Plan Act of 1975.



California
(Valid from 1995-1998)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Even if HMO or PPO) 1 Medicare
02 Medi-Cal (even if HMO or PPO) 2 Medicaid
07 HMO 3 Private insurance
08 PPO
09 Private Insurance Company (not HMO, not PPO)
10 Blue Cross/Blue Shield (not HMO, not PPO)
11 Self-pay 4 Self-pay
12 Charity 5 No charge
13 No Charge
03 Worker's Compensation 6 Other
04 County Indigent Programs
05 CHAMPUS/CHAMPVA/VA
06 Other Governmental
14 Other Non-Governmental
00, Blank Missing . Missing
Any values not documented by the data source .A Invalid



California
(Valid from 1988-1994)
PAY1_X PAY1
Value Description Value Description
01 Medicare 1 Medicare
02 Medi-Cal 2 Medicaid
06 Blue Cross/Blue Shield 3 Private insurance
07 Insurance Company
08 HMO/PHP
09 Self-pay 4 Self-pay
10 No-charge (free charity, special research, or teaching) 5 No charge
04 Title V 6 Other
03 Workers' Compensation
05, 12 Other government; Medically indigent services under Section 17000
11 Other non-government
Blank Valid before 1994 . Missing
00 Valid in 1994 . Missing
Other Values   .A Invalid


Colorado
Colorado
(Valid beginning in 1998)
PAY1_X PAY1
Value Description Value Description
04 Medicare 1 Medicare
05 Medicaid 2 Medicaid
01 Blue Cross/Blue Shield 3 Private insurance
02 Commercial Ins/Indemnity Plans/Self Insured 3 Private Insurance
03 Other Liability Ins/No Fault/Casualty 3 Private Insurance
08 HMO-PPO/Managed Care/Discounted 3 Private Insurance
12 Self-Pay 4 Self-pay
13 No Charge/Charity Research 5 No charge
06 Worker's Comp 6 Other
09 CHAMPUS
11 Other Government
14 Other
15 Colorado Medically Indigent
00, Blank Missing . Missing
Any other values .A Invalid



Colorado
(Valid from 1993-1997)
PAY1_X PAY1
Value Description Value Description
04 Medicare 1 Medicare
05 Medicaid 2 Medicaid
01 Blue Cross/Blue Shield 3 Private insurance
02, 03 Commercial insurance/Indemnity plans/Self-insured; Other liability insurance/No fault/ Casualty
08 HMO-PPO/Managed Care/Discounted
12 Self-Pay 4 Self-pay
13 No Charge/Charity/Research 5 No charge
06 Workers' Comp 6 Other
09 CHAMPUS
11, 15 Other government; Colorado Medically Indigent
14 1993-1996: Other
Blank Unknown . Missing
00 Starting in 1996: Missing . Missing
Other Values   .A Invalid



Colorado
(Valid from 1988-1992)
PAY1_X PAY1
Value Description Value Description
3 Medicare 1 Medicare
4 Medicaid 2 Medicaid
7 Blue Cross/Blue Shield 3 Private insurance
8 Commercial insurance
B HMO-PPO
1 Self-Pay 4 Self-pay
9 No Charge 5 No charge
5 Title V 6 Other
2 Workers' Compensation
6 Other government
A, C Other; Other non-gov
"00", blank Unknown . Missing
Other Values   .A Invalid


Connecticut
Connecticut
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
C Medicare 1 Medicare
M Medicare managed care 1 Medicare
D Medicaid 2 Medicaid
J Medicaid managed care (beginning in 1998) 2 Medicaid
F Commercial Insurance 3 Private insurance
G Blue Cross (Blue Cross PPOs are coded as PPOs, value "T") 3 Private insurance
S HMO 3 Private insurance
T PPO 3 Private insurance
A Self-pay 4 Self-pay
R No charge 5 No charge
B Worker's Comp 6 Other
E Other Federal Program
H Champus
I Other
Q Title V
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Connecticut
(Valid from 1993-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
C, M (1997 only) Medicare 1 Medicare
D Medicaid 2 Medicaid
G Blue Cross 3 Private Insurance
F, T Commercial Insurance: PPO
S HMO
A Self-pay 4 Self-pay
R No charge 5 No charge
Q Title V 6 Other
B Workers' Compensation
H CHAMPUS
E Other federal programs
I Other
Blank   . Missing
Other Values   .A Invalid


Florida
Florida
(Valid beginning in 2006)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
B Medicare HMO
C Medicaid 2 Medicaid
D Medicaid HMO
E Commercial Insurance 3 Private Insurance
F Commercial HMO
G Commercial PPO
L Self pay/Under-insured (No third party coverage or less than 30% estimated insurance coverage) 4 Self-pay
N Charity 5 No charge
H Worker's Compensation 6 Other
I Champus
J VA
K Other State/Local Government
M Other
O KidCare (Healthy Kids, MediKids, and Children's Medical Services - beginning 2003)
P Unknown. Reported only if information is not available, and type of service is 7QUOT;2" and patient status is "7" . Missing
Blank Missing
Any values not documented by the data source .A Invalid


Florida
Florida
(Valid beginning in 1998)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
B Medicare HMO or Medicare PPO
C Medicaid 2 Medicaid
D Medicaid HMO
E Commercial Insurance 3 Private Insurance
F Commercial HMO
G Commercial PPO
L Self pay/Under-insured (No third party coverage or less than 30% estimated insurance coverage) 4 Self-pay
N Charity 5 No charge
H Worker's Compensation 6 Other
I Champus
J VA
K Other State/Local Government
M Other
O KidCare (Healthy Kids, MediKids, and Children's Medical Services - beginning 2003)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Florida
(Valid for 1997)
PAY1_X PAY1
Value Description Value Description
A, B Medicare, Medicare HMO 1 Medicare
C, D Medicaid, Medicaid HMO 2 Medicaid
E, G Commercial insurance (includes self-insured and Blue Cross/Blue Shield); Commercial PPO 3 Private Insurance
F Commercial HMO
L Self-pay, charity, underinsured 4 Self-pay
N Charity 5 No charge
H Workers' Compensation 6 Other
I, J CHAMPUS; VA
K Other state/local government
M Other
Blank   . Missing
Other values   .A Missing



Florida
(Valid from 1992-1996)
PAY1_X PAY1
Value Description Value Description
A, B Medicare, Medicare HMO 1 Medicare
C, D Medicaid, Medicaid HMO 2 Medicaid
E, G Commercial insurance (includes self-insured and Blue Cross/Blue Shield); Commercial PPO 3 Private Insurance
F Commercial HMO
L Self-pay, charity, underinsured 4 Self-pay
--   5 No charge
H Workers' Compensation 6 Other
I, J CHAMPUS; VA
K Other state/local government
M Other
Blank   . Missing
Other values   .A Invalid



Florida
(Valid from 1988-1991)
PAY1_X PAY1
Value Description Value Description
A Medicare 1 Medicare
C Medicaid 2 Medicaid
E Commercial insurance (includes self-insured and Blue Cross/Blue Shield) 3 Private Insurance
--   4 Self-pay
--   5 No charge
M Other 6 Other
Blank   . Missing
Other values   .A Invalid


Georgia
Georgia
(Valid beginning in 1998)
PAY1_X, PAY2_X, PAY3_X PAY1, PAY2, PAY3
Value Description Value Description
M Medicare 1 Medicare
U Medicare Managed Care 1 Medicare
D Medicaid 2 Medicaid
A Medicaid Managed Care 2 Medicaid
F Medicaid Applicants 2 Medicaid
G Georgia Better Health 2 Medicaid
B Blue Cross/Blue Shield 3 Private Insurance
H HMO/Managed Care
I Commercial Insurance
K Other Non-Specific Managed Care
X PPO
6 POS (Point of Service)
7 State Health Benefit Plan
P Self-pay 4 Self-pay
--   5 No charge
C TriCare/Champus 6 Other
E Peachcare for Kids (Beginning in 2002 data)
N Other Government Assistance
W Workers Compensation
Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Georgia
(Valid for 1997)
PAY1_X PAY1
Value Description Value Description
M Medicare 1 Medicare
D Medicaid 2 Medicaid
B Blue Cross and Blue Shield 3 Private Insurance
I, S Other Insurance Companies; Self Insured
H HMO-PPO
P Self-pay 4 Self-pay
Z Free 5 No charge
W Workers' Comp 6 Other
C CHAMPUS
E, N Other Government
L, O Other
3, 5, A, F, G, J, K, Y Unknown . Missing
Other values   .A Invalid


Hawaii
Hawaii
(Valid beginning in 2003)
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
18 HMSA 65C+
19 Kaiser 65C+
2 Medicaid 2 Medicaid
13 Hawaii QUEST (managed care) Beginning in 2006, the general QUEST category was discontinued and split into plan-specific categories
15 AlohaCare (plan participating in QUEST) beginning in 2003
22 HMSA QUEST - beginning 2006
23 Kaiser QUEST - beginning 2006
24 QUEST (Any QUEST Plan except AlohaCare, HMSA Quest, Kaiser Quest) - beginning 2006
14 HMSA's Health Plan Hawaii beginning in 2003 3 Private Insurance
16 Hawaii Management Alliance Association (HMAA) beginning in 2003
17 University Health Alliance (UHA) beginning in 2003
4 HMSA (any other HMSA plan)
5 Kaiser
6 Other Insurance
8 No Fault
7 Self pay 4 Self pay
--   5 No charge
9 Worker's Compensation 6 Other
10 Tricare/CHAMPUS/VA/Other Government - Discontinued in 2006
12 Department of Defense
20 Veterans Administration (VA) - Beginning 2006
21 Tricare/CHAMPUS/Other Government - Beginning 2006
11, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Hawaii
(Valid 1998-2002)
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
13 QUEST 2 Medicaid
4 HMSA (Blue Cross/Blue Shield affiliate that provides HMO, PPO and Fee for Service plans) 3 Private Insurance
5 Kaiser 3 Private Insurance
6 Other Insurance 3 Private Insurance
8 No Fault 3 Private Insurance
7 Self pay 4 Self pay
--   5 No charge
9 Worker's Compensation 6 Other
10 CHAMPUS/VA/Other Government
12 Department of Defense
11, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid



Hawaii
(Valid from 1996-1997)
PAY1_X PAY1
Value Description Value Description
"Medicare" Medicare 1 Medicare
"Medicaid", "SHIP", "Quest" Medicaid; SHIP; Quest 2 Medicaid
"Other Insurance", "HMSA", "No Fault" Other Insurance, HMSA, No Fault 3 Private Insurance
"Kaiser" Kaiser
"Self Pay" Self-pay 4 Self-pay
--   5 No charge
"Workers Comp" Worker's Comp 6 Other
"Champus", "DOD" CHAMPUS/VA/Other Government; Department of Defense
"Unknown", Blank Unknown . Missing
Other values   .A Invalid


Iowa
Iowa
(Valid beginning in 2003)
PAY1_X PAY1
Value Description Value Description
1 Medicare (Title 18) 1 Medicare
2 Medicaid (Title 19) 2 Medicaid
6 Blue Cross 3 Private Insurance
7 Commercial (private or group plans including HMO, PPO, ODS)
8 Self-pay (the patient has no insurance, is ineligible for governmental assistance and is not a "no charge" patient) 4 Self-pay
10 No charge 5 No charge
3 Other State (including State Papers) 6 Other
4 County
5 CHAMPUS
9 Workers Compensation
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Iowa
(Valid 1998-2002)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
11 Medicare Managed Care (Presently no predominant plans in Iowa) 1 Medicare
02 Medicaid (Title 19) 2 Medicaid
12 Medicaid Managed Care (e.g., Medipass, Heritage National, Care Choices, Principal Health Care) 2 Medicaid
06 Blue Cross (e.g., Blue Cross Alliance Select should be recorded as PPO; Blue Cross Unity Choice should be recorded as HMO) 3 Private Insurance
07 Commercial (private or group plans other than HMO, PPO, ODS) 3 Private Insurance
13 HMO (e.g., Care Choices, Medical Associates Health Plan, Inc., Principal Health Care of Iowa, Heritage National Healthplan, Inc., John Deere Family Health Plan, Principal Health Care of Nebraska, United Healthcare of the Midlands, Unity Choice) 3 Private Insurance
14 PPO (e.g., Alliance Select, Healthcare Preferred, Plaines Health Network) 3 Private Insurance
15 Organized Delivery Systems (ODS) (e.g., SecureCare of Iowa) 3 Private Insurance
08 Self-pay (the patient has no insurance, is ineligible for governmental assistance and is not a "no charge" patient) 4 Self-pay
10 No charge 5 No charge
03 Other State (including State Papers) 6 Other
04 County
05 CHAMPUS
09 Workers Compensation
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Iowa
(Valid from 1991-1997)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
02 Medicaid (Title 19) 2 Medicaid
06 Blue Cross (of Iowa, Western Iowa, or other state Blue Cross plans) 3 Private Insurance
08 Self-pay or relative 4 Self-pay
--   5 No charge
09 Workers' Compensation 6 Other
03, 04, 05 Other state; county (including state papers); Other federal government (including CHAMPUS, Veterans, Title V, Railroad, Hill-Burton, Crippled Children, etc.)
Blank   . Missing
Other Values   .A Invalid



Iowa
(Valid from 1988-1990)
PAY1_X PAY1
Value Description Value Description
01 Medicare (Title 18) 1 Medicare
02 Medicaid (Title 19) 2 Medicaid
06 Blue Cross (of Iowa, Western Iowa, or other state Blue Cross plans) 3 Private Insurance
07 Commercial (private or group)
08 Self-pay or relative 4 Self-pay
--   5 No charge
09 Workers' Compensation 6 Other
03, 04, 05 Other state government; Other county government; Other federal government
10 Other non-government
Blank   . Missing
Other Values   .A Invalid


Kansas
Kansas
(Valid beginning in 2003)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
001 Medicare 1 Medicare
101 Medicare Managed Care
002 Medicaid 2 Medicaid
102 Medicaid Managed Care
004 Blue Cross/Blue Shield 3 Private Insurance
007 Commercial/Private
104 Blue Cross/Blue Shield Managed Care
107 All Commercial Payers Managed Care
006 Self-pay 4 Self-pay
008 Charity/No Charge 5 No charge
005 Workers Compensation 6 Other
009 Other Government
010 Champus
011 Other
103 HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP)
105 Workers Compensation Managed Care
109 Other Government Managed Care (not Champus)
110 Champus Managed Care
111 Other Managed Care
Blank, 00, 000 Missing . Missing
Any values not documented by the data source .A Invalid



Kansas
(Valid 1993-2002)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
3 Blue Cross 3 Private Insurance
4 Commercial
5 Self-pay 4 Self-pay
--   5 No charge
6 Other 6 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid

Separate information on HMO and PPO providers is not provided.


Kentucky
Kentucky
PAY1_X, PAY2_X, PAY3_X PAY1 and PAY2
Value Description Value Description
C Medicare 1 Medicare
D Medicaid 2 Medicaid
P Passport Medicaid Managed Care (beginning with 2003 data)
F Commercial - Insurance Company 3 Private insurance
G Commercial - Blue Cross/Blue Shield 3 Private insurance
J Commercial - Indemnity 3 Private insurance
K Commercial - Preferred Provider 3 Private insurance
L Commercial - HMO 3 Private insurance
M Commercial - Managed Care 3 Private insurance
A Self Pay 4 Self-pay
--   5 No charge
B Workers' Compensation 6 Other
E Other Federal programs
H Champus<