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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.
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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.
 
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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)
 
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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
PAY1_X, PAY2_X, PAY3_X PAY1, PAY2, PAY3
Value Description Value Description
1 Medicare 1 Medicare
11 Medicare (Managed Care)
111 Medicare HMO
1111 Aetna Inc.
1112 Coventry Health Care, Inc.
1113 Humana Inc.
1114 Kaiser Foundation Health Plan, Inc.
1115 United HealthCare of Georgia, Inc.
1116 Wellcare of Georgia
1117 WellPoint, Inc.
1118 Other Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care (Other)
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
124 Medicare Drug Benefit (Part D)
129 Medicare Non-managed Care (Other)
19 Medicare (Other)
2 Medicaid 2 Medicaid
21 Medicaid (Managed Care)
211 Medicaid HMO
2111 Amerigroup CMO
2112 PeachState CMO
2113 WellCare CMO
212 Medicaid PPO
213 Medicaid PCCM (Primary Care Case Management)
219 Medicaid Managed Care (Other)
22 Medicaid (Non-managed Care Plan)
23 Medicaid/SCHIP
24 Medicaid Applicant
25 Medicaid (Out of State)
29 Medicaid (Other)
5 Private Health Insurance (other than Blue Cross/Blue Shield) 3 Private Insurance
51 Managed Care (Private)
511 Commercial Managed Care (HMO)
512 Commercial Managed Care (PPO)
513 Commercial Managed Care (POS)
514 Exclusive Provider Organization
519 Managed Care, Other (non-HMO)
52 Private Health Insurance (Indemnity)
521 Indemnity (e.g. high option/low option)
522 ERISA ASO Plan
523 Commercial Indemnity
524 Self-insured (ERISA) ASO Plan
525 Medicare Supplemental Policy (as secondary payor)
53 Commercial (Indemnity or Managed Care, unspecified)
54 Organized Delivery System
55 Small Employer Purchasing Group
59 Other Private Insurance, not BC or Kaiser
6 Blue Cross/Blue Shield
61 BC Managed Care
611 BC Managed Care (HMO)
612 BC Managed Care (PPO)
613 BC Managed Care (POS)
619 BC Managed Care (Other)
62 BC Indemnity
63 BC Indemnity or Managed Care (Out of State)
64 BC Indemnity or Managed Care (Unspecified)
69 BC Indemnity or Managed Care (Other)
7 Managed Care (Unspecified)
71 HMO
72 PPO
73 POS
79 Other Managed Care (Unknown if public or private)
8 NOPAYMENT from an Organization/Agency/Program/Private Payor Listed 4 Self-pay
81 Self-pay
82 No Charge
821 Charity
822 Professional Courtesy
823 Research/Clinical Trial
83 Refusal to Pay/Bad Debt
84 Hill Burton Free Care
85 Research/Donor
89 No Payment (Other)
--   5 No charge
3 Other Government (Federal/State/Government) 6 Other
31 Department of Defense
311 CHAMPUS
3111 Indemnity
3112 TriCare
312 CHAMPVA
319 Department of Defense (not CHAMPUS)
32 VA
321 VA (Priority Veteran)
322 VA (Enrolled Veteran with Copay)
329 VA (Other)
33 Indian Health Service or Tribe
331 Indian Health Service (Regular)
332 Indian Health Service (Contract)
333 Indian Health Service (Managed Care)
334 Indian Tribe (Sponsored Coverage)
34 HRSA Program
341 Title V (MCH Block Grant)
342 Migrant Health Program
343 Ryan White Act
349 Other
35 Black Lung
36 State Government
361 State SCHIP Program
362 Specific State Programs
369 State, not otherwise specified (other state)
37 Local Government
371 Local (Managed Care)
3711 HMO
3712 POS
3713 PPO
372 FFS/Indemnity
379 Local, not otherwise specified (other local, county)
38 Other Government (Federal, State, Local not specified)
381 Federal, State, Local not specified (FFS)
382 Federal, State, Local not specified (HMO)
383 Federal, State, Local not specified (PPO)
384 Federal, State, Local not specified (POS)
389 Federal, State, Local not specified (Other)
39 Other Federal
4 Department of Corrections
41 Corrections Federal
42 Corrections State
43 Corrections Local
44 Corrections (Unknown Level)
9 Miscellaneous/Other
91 Foreign National
92 Other (Non-government)
93 Disability Insurance
94 Long-term Care Insurance
95 Worker's Compensation
951 Worker's Comp (Fee-for-Service)
952 Worker's Comp (HMO)
953 Worker's Comp (Other Managed Care)
96 Auto Insurance (no fault)
97 Other (not specified)
98 Other specified (includes Hospice - Unspecified plan)
99 Other Unspecified
  Not reported . Missing
- Invalid Code Scheme
ZZZ Missing Data
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
I Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid


Maryland
>
Maryland
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
15 Medicare HMO (payer specified in PAYER1_X/PAYER2_X) 1 Medicare
02 Medicaid 2 Medicaid
14 Medicaid HMO (payer specified in PAYER1_X/PAYER2_X) 2 Medicaid
04 Blue Cross of MD 3 Private Insurance
16 Blue Cross of the National Capital Area (HMO) 3 Private Insurance
17 Blue Cross (other state) 3 Private Insurance
05 Commercial/PPO 3 Private Insurance
12 Managed Care (payer specified in PAYER1_X/ PAYER2_X) 3 Private Insurance
08 Self-pay 4 Self-pay
09 Charity - no charge 5 No charge
03 Title V 6 Other
06 Other government program
07 Worker's Compensation
10 Other
11 Donor
99 Unknown . Missing
Blank Missing
13 Do not use .A Invalid
27, 29, 37, 67, 77Unknown/invalid values
Any values not documented by the data source



Maryland
(Valid from 1996-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1, 15 Medicare; Medicare HMO 1 Medicare
2,14 Medicaid; Medicaid HMO 2 Medicaid
4, 16, 17 Blue Cross; Blue Cross NCA; Blue Cross - other State 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Primary Payer Unknown; missing . Missing
99, 77, blank Secondary Payer Unknown; not applicable; missing . Missing
Other Values   .A Invalid



Maryland
(Valid from 1993-1995)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2, 13,14 Medicaid; Medicaid (state only); Medicaid HMO 2 Medicaid
4 Blue Cross 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Primary Payer Unknown; missing . Missing
99, 77, blank Secondary Payer Unknown; not applicable; missing . Missing
Other Values   .A Invalid



Maryland
(Valid from 1990-1992)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2, 13,14 Medicaid; Medicaid (state only); Medicaid HMO 2 Medicaid
4 Blue Cross 3 Private Insurance
5 Commercial Insurance
12 HMO
8 Self-pay 4 Self-pay
9 Charity 5 No charge
3 Title V 6 Other
7 Workers' Compensation
6 Other government program
10, 11 Other; Donor
99, blank Unknown; missing . Missing
Other Values   .A Invalid


Massachusetts
Massachusetts
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3 Medicare 1 Medicare
F Medicare Managed Care 1 Medicare
4 Medicaid 2 Medicaid
B Medicaid Managed Care 2 Medicaid
6 Blue Cross 3 Private Insurance
C Blue Cross Managed Care
7 Commercial Insurance
D Commercial Managed Care
8 HMO
E PPO and Other Managed Care not listed elsewhere
J Point of Service Plan
K Exclusive Provider Plan
T Auto Insurance
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Worker's Compensation 6 Other
5 Other government payment
0 Other non-managed care plans
Q CommCare
N, Blank None, Missing . Missing
Any values not documented by the data source .A Invalid



Massachusetts
(Valid from 1996-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3, F Medicare; Medicare managed care 1 Medicare
4, B Medicaid; Medicaid managed care 2 Medicaid
6, C Blue Cross; Blue Cross managed care 3 Private Insurance
7, D, E Commercial Insurance; Commercial managed care; PPO and other managed care not listed elsewhere
8, J HMO; Point of Service (added 4th Qtr 1997)
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Worker's Compensation 6 Other
5 Other government payment
0 Primary Payer: Other non-managed care
0, A Secondary Payer: Other non-managed care; Other or principal source of payment covered in full
Blank Primary Payer: . Missing
Blank Secondary Payer: . Missing
Other values   .A Invalid



Massachusetts
(Valid from Quarter 4 1993 through 1995)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3, F Medicare; Medicare managed care 1 Medicare
4, B Medicaid; Medicaid managed care 2 Medicaid
6, C Blue Cross; Blue Cross managed care 3 Private Insurance
7, D Commercial Insurance; Commercial managed care
8, J HMO
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Workers' Compensation 6 Other
5 Other government payment
0, E Primary Payer: Other non-managed care; PPO and other managed care not listed elsewhere
0, A, E Secondary Payer: Other non-managed care; Other or principal source of payment covered in full; PPO and other managed care not listed elsewhere
Blank Primary Payer: . Missing
"N",Blank Secondary Payer:None . Missing
Other values   .A Invalid



Massachusetts
(Valid from 1988 through Quarters1-3, 1995)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
3 Medicare 1 Medicare
4 Medicaid 2 Medicaid
6 Blue Cross 3 Private Insurance
7 Commercial Insurance
8 HMO
1 Self-pay 4 Self-pay
9 Free care (no charge) 5 No charge
2 Workers' Compensation 6 Other
5 Other government payment
0 Primary Payer: Other
0, A Secondary Payer: Other; Other or principal source of payment covered in full
Blank Primary Payer: . Missing
"N",Blank Secondary Payer:None . Missing
Other values   .A Invalid


Missouri
Missouri
(Valid beginning in 1995)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
02 Medicaid 2 Medicaid
04 Blue Cross/Blue Shield 3 Private Insurance
07 Commercial/Private Insurance
06 Self-pay 4 Self-pay
08 No charge (charity) 5 No charge
03 Maternal and Child Health 6 Other
05 Worker's Compensation
09 Other government (CHAMPUS)
10 Other
99, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid

Separate information on HMO and PPO providers is not provided.


New Jersey
New Jersey
(Valid beginning in 1998)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
009 Section 1011 Undocumented Aliens 1 Medicare
011 Title XVII (Medicare) Part A
015 Title XVII (Medicare) Part B
017 Title XVII (Medicare) Part B - Physician Charges
082 Medicare HMO (Beginning in 2003)
012 Title XIX (Medicaid) 2 Medicaid
083 Medicaid HMO (Beginning in 2003)
010 Blue Cross Plan: Alabama 3 Private Insurance
018 New Jersey State Health Benefits Plan 3 Private Insurance
020 Blue Cross Plan: Arkansas 3 Private Insurance
022 Blue Cross Plan: New Jersey - FEP 3 Private Insurance
025 Blue Cross Plan: New Jersey - Garden State 3 Private Insurance
026 Blue Cross Plan: New Jersey - Host 3 Private Insurance
029 Blue Cross Plan: Other Blue Cross 3 Private Insurance
030 Blue Cross Plan: Arizona 3 Private Insurance
040 Blue Cross Plan: California - all other groups 3 Private Insurance
041 Blue Cross Plan: Oakland (CA) (1994 only) 3 Private Insurance
042 Blue Cross Plan: San Francisco (CA) (1994 only) 3 Private Insurance
050 Blue Cross Plan: Colorado 3 Private Insurance
060 Blue Cross Plan: Connecticut 3 Private Insurance
070 Blue Cross Plan: Delaware 3 Private Insurance
080 Blue Cross Plan: District of Columbia 3 Private Insurance
090 Blue Cross Plan: Florida 3 Private Insurance
100 Blue Cross Plan: Columbus (GA) (1994 only) 3 Private Insurance
101 Blue Cross Plan: Georgia - all other groups 3 Private Insurance
110 Blue Cross Plan: Idaho 3 Private Insurance
121 Blue Cross Plan: Illinois 3 Private Insurance
130 Blue Cross Plan: Indiana 3 Private Insurance
140 Blue Cross Plan: Iowa - all other groups 3 Private Insurance
141 Blue Cross Plan: Sioux City (IA) (1994 only) 3 Private Insurance
150 Blue Cross Plan: Kansas 3 Private Insurance
160 Blue Cross Plan: Kentucky 3 Private Insurance
170 Blue Cross Plan: Louisiana 3 Private Insurance
180 Blue Cross Plan: Maine 3 Private Insurance
190 Blue Cross Plan: Maryland 3 Private Insurance
200 Blue Cross Plan: Massachusetts 3 Private Insurance
210 Blue Cross Plan: Michigan 3 Private Insurance
220 Blue Cross Plan: Minnesota 3 Private Insurance
230 Blue Cross Plan: Mississippi 3 Private Insurance
240 Blue Cross Plan: Missouri - Kansas City 3 Private Insurance
241 Blue Cross Plan: Missouri - St. Louis 3 Private Insurance
250 Blue Cross Plan: Montana 3 Private Insurance
260 Blue Cross Plan: Nebraska 3 Private Insurance
265 Blue Cross Plan: Nevada 3 Private Insurance
270 Blue Cross Plan: New Hampshire 3 Private Insurance
280 Blue Cross Plan: New Jersey - all other groups 3 Private Insurance
281 Blue Cross Plan: New Jersey - Non-Group Line of Business 3 Private Insurance
290 Blue Cross Plan: New Mexico 3 Private Insurance
300 Blue Cross Plan: Albany (NY) (1994 only) 3 Private Insurance
301 Blue Cross Plan: New York - Buffalo 3 Private Insurance
303 Blue Cross Plan: New York - New York 3 Private Insurance
304 Blue Cross Plan: New York - Rochester 3 Private Insurance
305 Blue Cross Plan: New York - Syracuse 3 Private Insurance
306 Blue Cross Plan: New York - Utica 3 Private Insurance
307 Blue Cross Plan: Watertown (NY) (1994 only) 3 Private Insurance
308 Blue Cross Plan: Part A only (NY) (1994 only) 3 Private Insurance
310 Blue Cross Plan: North Carolina 3 Private Insurance
320 Blue Cross Plan: North Dakota 3 Private Insurance
331 Blue Cross Plan: Canton (OH) (1994 only) 3 Private Insurance
332 Blue Cross Plan: Ohio - Cincinnati 3 Private Insurance
333 Blue Cross Plan: Ohio - Cleveland 3 Private Insurance
334 Blue Cross Plan: Columbus (OH) (1994 only) 3 Private Insurance
335 Blue Cross Plan: Lima (OH) (1994 only) 3 Private Insurance
337 Blue Cross Plan: Toledo (OH) (1994 only) 3 Private Insurance
338 Blue Cross Plan: Youngstown (OH) (1994 only) 3 Private Insurance
340 Blue Cross Plan: Oklahoma 3 Private Insurance
350 Blue Cross Plan: Oregon 3 Private Insurance
351 Blue Cross Plan: Portland 3 Private Insurance
360 Blue Cross Plan: Allentown (PA) (1994 only) 3 Private Insurance
361 Blue Cross plan: Pennsylvania - Harrisburg 3 Private Insurance
362 Blue Cross Plan: Pennsylvania - Philadelphia 3 Private Insurance
363 Blue Cross plan: Pennsylvania - Pittsburgh 3 Private Insurance
364 Blue Cross plan: Pennsylvania - Wilkes-Barre 3 Private Insurance
370 Blue Cross plan: Rhode Island 3 Private Insurance
380 Blue Cross plan: South Carolina 3 Private Insurance
390 Blue Cross Plan: Tennessee - Chattanooga 3 Private Insurance
392 Blue Cross Plan: Tennessee - Memphis 3 Private Insurance
400 Blue Cross plan: Texas 3 Private Insurance
410 Blue Cross plan: Utah 3 Private Insurance
415 Blue Cross plan: Vermont 3 Private Insurance
423 Blue Cross plan: Virginia - all other groups 3 Private Insurance
424 Blue Cross Plan: Roanoke (VA) (1994 only) 3 Private Insurance
430 Blue Cross Plan: Alaska/Washington 3 Private Insurance
441 Blue Cross Plan: Charleston (WV) (1994 only) 3 Private Insurance
443 Blue Cross Plan: West Virginia - all other groups 3 Private Insurance
444 Blue Cross Plan: Wheeling (WV) (1994 only) 3 Private Insurance
450 Blue Cross Plan: Wisconsin 3 Private Insurance
460 Blue Cross Plan: Wyoming 3 Private Insurance
470 Blue Cross Plan: Puerto Rico 3 Private Insurance
471 Blue Cross Plan: Hawaii - all other groups 3 Private Insurance
865 Blue Cross Plan: Pennsylvania - Camp Hill (effective 1/95) 3 Private Insurance
932 Blue Cross Plan: Seattle (WA/AK) (1994 only) 3 Private Insurance
936 Blue Cross Plan: Spokane (WA/AK) (1994 only) 3 Private Insurance
971 Blue Cross Plan: Blue Shield (HI) (1994 only) 3 Private Insurance
105 Commercial: Aetna 3 Private Insurance
106 Commercial: NJ Carpenter's Health Fund 3 Private Insurance
107 Commercial: AARP (effective 4/95) 3 Private Insurance
115 Commercial: Connecticut General 3 Private Insurance
120 Commercial: Continental Assurance 3 Private Insurance
125 Commercial: Equitable 3 Private Insurance
131 Commercial: Guardian Life 3 Private Insurance
135 Commercial: Intercontinental 3 Private Insurance
142 Commercial: John Hancock 3 Private Insurance
145 Commercial: Massachusetts Mutual 3 Private Insurance
151 Commercial: Metropolitan Life 3 Private Insurance
155 Commercial: Mutual of Omaha 3 Private Insurance
161 Commercial: New York Life 3 Private Insurance
165 Commercial: Provident Alliance 3 Private Insurance
171 Commercial: Prudential 3 Private Insurance
175 Commercial: Travelers 3 Private Insurance
181 Commercial: Washington National Insurance 3 Private Insurance
185 Commercial: New Jersey Auto Dealers Association 3 Private Insurance
186 Commercial: Allstate 3 Private Insurance
187 Commercial: Mutual Life of New York 3 Private Insurance
188 Commercial: National Association of Letter Carriers 3 Private Insurance
189 Commercial: Local Union Insurance 3 Private Insurance
191 Commercial: Lincoln National 3 Private Insurance
192 Commercial: New Jersey Turnpike Authority 3 Private Insurance
193 Commercial: Rasmussen 3 Private Insurance
194 Commercial: Inter County Health Plan 3 Private Insurance
195 Commercial: American Postal Workers 3 Private Insurance
196 Commercial: Leader Administrators 3 Private Insurance
197 Commercial: Fred S. James (James Benefit) 3 Private Insurance
198 Commercial: Mail Handlers Benefit Plan 3 Private Insurance
199 Commercial: Other Commercial Insurance 3 Private Insurance
032 HMO: Americaid Inc. (effective 11/96) 3 Private Insurance
033 HMO: American Preferred Provider Plan, Inc. (effective 11/96) 3 Private Insurance
034 HMO: United Health Care (Effective 8/96) 3 Private Insurance
035 HMO: MEDI-Group, Inc. (HMO Blue) (effective 11/95) 3 Private Insurance
036 HMO: Principal HMO (Effective 8/97) 3 Private Insurance
037 HMO: Mission Health Plans (effective 8/97) 3 Private Insurance
043 HMO: Crossroads Health Plan (1994 only) 3 Private Insurance
044 HMO: Cumberland Regional Health Plan (1994 only) 3 Private Insurance
045 HMO: HIP of NJ 3 Private Insurance
046 HMO: HIP of Greater NJ (1994 only) 3 Private Insurance
047 HMO: HMO Blue (Medigroup Central) 3 Private Insurance
048 HMO: HMO of PA-NJ (US Healthcare) & (AETNA Health Plans of NJ, Inc.) 3 Private Insurance
049 HMO: Rutgers Community Health Plan (1994 only) 3 Private Insurance
051 HMO: Southern Inter-County Med Assn (1994 only) 3 Private Insurance
052 HMO: Valley Health Plan (1994 only) 3 Private Insurance
053 HMO: AETNA Health Plans of New Jersey, Inc. (discontinued 6/98) 3 Private Insurance
054 HMO: HMO of NJ (1994 only) 3 Private Insurance
055 HMO: Omni Care (1994 only) 3 Private Insurance
056 HMO: CIGNA HealthCare of Northern NJ, Inc. 3 Private Insurance
057 HMO: Bergen County IPA (1994 only) 3 Private Insurance
058 HMO: PruCare of NJ 3 Private Insurance
059 HMO: Other HMO 3 Private Insurance
061 HMO: MetraHealth Care Plan of Upstate New York (discontinued 6/98) 3 Private Insurance
062 HMO: Garden State Health Plan (discontinued 6/98) 3 Private Insurance
063 HMO: HMO of PA (1994 only) 3 Private Insurance
064 HMO: PruCare (1994 only) 3 Private Insurance
065 HMO: MAXICARE (1994 only) 3 Private Insurance
066 HMO: HMO Blue (Medigroup Metro) (discontinued 6/98) 3 Private Insurance
067 HMO: HMO Blue (Medigroup North) (discontinued 6/98) 3 Private Insurance
068 HMO: HMO Blue (Medigroup South) (discontinued 6/98) 3 Private Insurance
069 HMO: HMO Blue (Medigroup Shoreline) (discontinued 6/98) 3 Private Insurance
071 HMO: MetraHealth Care Plan of NJ (discontinued 6/98) 3 Private Insurance
072 HMO: Oxford Health Plan 3 Private Insurance
073 HMO: NYL Care Health Plans of NJ, Inc. 3 Private Insurance
074 HMO: CIGNA Health Care of NJ., Inc. South 3 Private Insurance
075 HMO: Corporate Health Administrators (1994 only) 3 Private Insurance
077 HMO: QUALMED/Greater Atlantic Health Services 3 Private Insurance
078 HMO: Amerihealth HMO, Inc. 3 Private Insurance
081 HMO: Atlanticare Health Plan (effective 11/96) 3 Private Insurance
082 HMO: ChubbHealth Plan (discontinued 6/98) 3 Private Insurance
083 HMO: Community Health Care and Development Corp (discontinued 6/98) 3 Private Insurance
084 HMO: First Option Health Plan (effective 11/96) 3 Private Insurance
085 HMO: Harmony Health Plan (discontinued 6/98) 3 Private Insurance
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (discontinued 6/98) 3 Private Insurance
087 HMO: Liberty Health Plan (effective 11/96) 3 Private Insurance
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective 11/96) 3 Private Insurance
089 HMO: Physician Health Care Plan of New Jersey (discontinued 6/98) 3 Private Insurance
094 HMO: Physician Health Services of New Jersey, Inc. (effective 11/96) 3 Private Insurance
097 HMO: University Health Plans, Inc. (effective 11/96) 3 Private Insurance
076 Miscellaneous: Premier Preferred Care of New Jersey 3 Private Insurance
091 Miscellaneous: Union Insurance 3 Private Insurance
093 Miscellaneous: MAGNET (Magna Care) (effective 1/95) 3 Private Insurance
096 Miscellaneous: QualCare (effective 1/95) 3 Private Insurance
309 No Fault: Allstate 3 Private Insurance
311 No Fault: New Jersey Manufacturers 3 Private Insurance
315 No Fault: State Farm 3 Private Insurance
399 No Fault: Other 3 Private Insurance
095 Miscellaneous: Indigent 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Miscellaneous: Hospital Responsibility 5 No charge
014 Champus 6 Other
016 Department of Vocational Rehabilitation
092 Miscellaneous: Personnel Health Program
099 Miscellaneous: Other
019 Other Government
013 Title V (Material and Child Health)
205 Worker's Compensation: Aetna
211 Worker's Compensation: Insurance Company of North America
215 Worker's Compensation: Liberty Mutual
221 Worker's Compensation: Employers Mutual
225 Worker's Compensation: New Jersey Manufacturers
231 Worker's Compensation: Travelers
299 Worker's Compensation: Other
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid



New Jersey
(Valid from 1988-1997)
PAY1_X and PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
011 Title XVII (Medicare) Part A 1 Medicare
015 Title XVII (Medicare) Part B 1 Medicare
017 Title XVII (Medicare) Part B - Physician Charges 1 Medicare
012 Title XIX (Medicaid) 2 Medicaid
010 Blue Cross: Alabama 3 Private Insurance
020 Blue Cross: Arkansas 3 Private Insurance
022 Blue Cross: New Jersey, FEP 3 Private Insurance
025 Blue Cross: New Jersey; Garden State 3 Private Insurance
026 Blue Cross: New Jersey, Host 3 Private Insurance
029 Blue Cross: Other Blue Cross 3 Private Insurance
030 Blue Cross: Arizona 3 Private Insurance
040 Blue Cross: California 3 Private Insurance
040 Blue Cross: California, all other groups (1994 only)
040 Blue Cross: California, Woodland Hills (1988-1993 only)
041 Blue Cross: California, Oakland (1994 only) 3 Private Insurance
042 Blue Cross: California, San Francisco (1994 only) 3 Private Insurance
050 Blue Cross: Colorado 3 Private Insurance
060 Blue Cross: Connecticut 3 Private Insurance
070 Blue Cross: Delaware 3 Private Insurance
080 Blue Cross: District of Columbia 3 Private Insurance
090 Blue Cross: Florida 3 Private Insurance
100 Blue Cross: Georgia 3 Private Insurance
100 Blue Cross: Georgia, all other groups (1994 only)
100 Blue Cross: Georgia, Atlanta (1988-1993 only)
101 Blue Cross: Georgia, Columbus (1994 only) 3 Private Insurance
110 Blue Cross: Idaho 3 Private Insurance
121 Blue Cross: Illinois 3 Private Insurance
130 Blue Cross: Indiana 3 Private Insurance
140 Blue Cross: Iowa 3 Private Insurance
140 Blue Cross: Iowa, all other groups (1994 only)
140 Blue Cross: Iowa, not Sioux City (1988-1993 only)
141 Blue Cross: Iowa, Sioux City (1994 only) 3 Private Insurance
141 Blue Cross: Iowa, Sioux city South Dakota (1988-1993 only)
150 Blue Cross: Kansas 3 Private Insurance
160 Blue Cross: Kentucky 3 Private Insurance
170 Blue Cross: Louisiana 3 Private Insurance
180 Blue Cross: Maine 3 Private Insurance
190 Blue Cross: Maryland 3 Private Insurance
200 Blue Cross: Massachusetts 3 Private Insurance
210 Blue Cross: Michigan 3 Private Insurance
220 Blue Cross: Minnesota 3 Private Insurance
230 Blue Cross: Mississippi 3 Private Insurance
240 Blue Cross: Missouri, Kansas City 3 Private Insurance
241 Blue Cross: Missouri, St. Louis 3 Private Insurance
250 Blue Cross: Montana 3 Private Insurance
260 Blue Cross: Nebraska 3 Private Insurance
265 Blue Cross: Nevada 3 Private Insurance
270 Blue Cross: New Hampshire 3 Private Insurance
280 Blue Cross: New Jersey, All Other Groups 3 Private Insurance
281 Blue Cross: New Jersey, Non-Group Line of Business (valid beginning 1/93) 3 Private Insurance
290 Blue Cross: New Mexico 3 Private Insurance
300 Blue Cross: New York, Albany (1994 only) 3 Private Insurance
301 Blue Cross: New York, Buffalo 3 Private Insurance
303 Blue Cross: New York, New York 3 Private Insurance
304 Blue Cross: New York, Rochester 3 Private Insurance
305 Blue Cross: New York, Syracuse 3 Private Insurance
306 Blue Cross: New York, Utica 3 Private Insurance
307 Blue Cross: New York, Watertown (1994 only) 3 Private Insurance
308 Blue Cross: New York, Part A Only (1994 only) 3 Private Insurance
310 Blue Cross: North Carolina 3 Private Insurance
320 Blue Cross: North Dakota 3 Private Insurance
331 Blue Cross: Ohio, Canton (1994 only) 3 Private Insurance
332 Blue Cross: Ohio, Cincinnati 3 Private Insurance
333 Blue Cross: Ohio, Cleveland 3 Private Insurance
334 Blue Cross: Ohio, Columbus (1994 only) 3 Private Insurance
335 Blue Cross: Ohio, Lima (1994 only) 3 Private Insurance
337 Blue Cross: Ohio, Toledo (1994 only) 3 Private Insurance
338 Blue Cross: Ohio, Youngstown (1994 only) 3 Private Insurance
340 Blue Cross: Oklahoma 3 Private Insurance
350 Blue Cross: Oregon 3 Private Insurance
360 Blue Cross: Pennsylvania, Allentown (1994 only) 3 Private Insurance
361 Blue Cross: Pennsylvania, Harrisburg 3 Private Insurance
362 Blue Cross: Pennsylvania, Philadelphia 3 Private Insurance
363 Blue Cross: Pennsylvania, Pittsburgh 3 Private Insurance
364 Blue Cross: Pennsylvania, Wilkes-Barre 3 Private Insurance
370 Blue Cross: Rhode Island 3 Private Insurance
380 Blue Cross: South Carolina 3 Private Insurance
390 Blue Cross: Tennessee, Chattanooga 3 Private Insurance
392 Blue Cross: Tennessee, Memphis 3 Private Insurance
400 Blue Cross: Texas 3 Private Insurance
410 Blue Cross: Utah 3 Private Insurance
415 Blue Cross: Vermont 3 Private Insurance
423 Blue Cross: Virginia, all other groups (formerly Blue Cross: Virginia, Richmond) 3 Private Insurance
424 Blue Cross: Virginia, Roanoke (1994 only) 3 Private Insurance
430 Blue Cross: Alaska/Washington (formerly, Alaska/Washington, all other groups) 3 Private Insurance
441 Blue Cross: West Virginia, Charleston (1994 only) 3 Private Insurance
443 Blue Cross: West Virginia, Parksburg 3 Private Insurance
444 Blue Cross: West Virginia, Wheeling (1994 only) 3 Private Insurance
450 Blue Cross: Wisconsin 3 Private Insurance
460 Blue Cross: Wyoming 3 Private Insurance
470 Blue Cross: Puerto Rico 3 Private Insurance
471 Blue Cross: Hawaii, all other groups (effective beginning 1/93) 3 Private Insurance
865 Blue Cross: Camp Hill (effective beginning 1/95) 3 Private Insurance
932 Blue Cross: Washington, Seattle (1994 only) 3 Private Insurance
936 Blue Cross: Washington, Spokane (1994 only) 3 Private Insurance
971 Blue Shield: Hawaii (1994 only) 3 Private Insurance
105 Commercial: Aetna 3 Private Insurance
106 Commercial: New Jersey Carpenters' Health Fund 3 Private Insurance
107 AARP (effective beginning 4/1/95) 3 Private Insurance
115 Commercial: Connecticut General 3 Private Insurance
120 Commercial: Continental Assurance 3 Private Insurance
125 Commercial: Equitable 3 Private Insurance
131 Commercial: Guardian Life 3 Private Insurance
135 Commercial: Intercontinental 3 Private Insurance
142 Commercial: John Hancock 3 Private Insurance
145 Commercial: Massachusetts Mutual 3 Private Insurance
151 Commercial: Metropolitan Life 3 Private Insurance
155 Commercial: Mutual of Omaha 3 Private Insurance
161 Commercial: New York Life 3 Private Insurance
165 Commercial: Provident Alliance 3 Private Insurance
171 Commercial: Prudential 3 Private Insurance
175 Commercial: Travelers 3 Private Insurance
181 Commercial: Washington National Insurance 3 Private Insurance
185 Commercial: New Jersey Auto Dealers Association 3 Private Insurance
186 Commercial: Allstate (Formerly Companion Life) 3 Private Insurance
187 Commercial: Mutual Life of New York 3 Private Insurance
188 Commercial: National Association of Letter Carriers 3 Private Insurance
189 Commercial: Local Union Insurance 3 Private Insurance
191 Commercial: Lincoln National 3 Private Insurance
192 Commercial: New Jersey Turnpike Authority 3 Private Insurance
193 Commercial: Rasmussen 3 Private Insurance
194 Commercial: InterCounty Health Plan 3 Private Insurance
195 Commercial: American Postal Workers 3 Private Insurance
196 Commercial: Leader Administrators 3 Private Insurance
197 Commercial: Fred S. James (James Benefit) 3 Private Insurance
198 Commercial: Mail Handlers Benefit Plan 3 Private Insurance
199 Commercial: Other Commercial Insurance 3 Private Insurance
032 HMO: Americaid Inc. (effective beginning 11/8/96) 3 Private Insurance
033 HMO: Americaid Preferred Provider Plan, Inc. (effective beginning 11/8/96) 3 Private Insurance
034 HMO: United Healthcare (Effective beginning 1/1/97) 3 Private Insurance
035 HMO: MediGroup, Inc. (effective beginning 1/1/97) 3 Private Insurance
043 HMO: Crossroads Health Plan (1994 only) 3 Private Insurance
044 HMO: Cumberland Regional Health Plan (1994 only) 3 Private Insurance
045 HMO: HIP/RHP of New Jersey (formerly Health Care Plan of New Jersey) 3 Private Insurance
046 HMO: HIP of Greater New Jersey (1994 only) 3 Private Insurance
047 HMO: HMO Blue (Medigroup-Central) (Formerly Mercer Regional Medical Group) 3 Private Insurance
048 HMO: HMO of PA/NJ (US Healthcare) 3 Private Insurance
049 HMO: Rutgers Community Health Plan (1994 only) 3 Private Insurance
051 HMO: Southern Inter-County Med Association (1994 only) 3 Private Insurance
052 HMO: Valley Health Plan (1994 only) 3 Private Insurance
053 HMO: Aetna Health Plans of New Jersey 3 Private Insurance
054 HMO: HMO of New Jersey (1994 only) 3 Private Insurance
055 HMO: OmniCare (1994 only) 3 Private Insurance
056 HMO: CIGNA Health Plan of New Jersey (Formerly Co. Med., Inc.) 3 Private Insurance
057 HMO: Bergen County IPA (1994 only) 3 Private Insurance
058 HMO: South Shore Health Plan 3 Private Insurance
059 HMO: Other HMO 3 Private Insurance
061 HMO: Travelers Health Plan 3 Private Insurance
062 HMO: Garden State Health Plan 3 Private Insurance
063 HMO: HMO of Pennsylvania (1994 only) 3 Private Insurance
064 HMO: PruCare (1994 only) 3 Private Insurance
065 HMO: Maxicare (1994 only) 3 Private Insurance
066 HMO: HMO Blue Medigroup - Metro, Inc. 3 Private Insurance
067 HMO: HMO Blue Medigroup - North, Inc. 3 Private Insurance
068 HMO: HMO Blue Medigroup - South, Inc. 3 Private Insurance
069 HMO: HMO Blue Medigroup - Shoreline, Inc. 3 Private Insurance
071 HMO: Metlife Health Care Network 3 Private Insurance
072 HMO: Oxford Health Plan 3 Private Insurance
073 HMO: Sanus of New Jersey 3 Private Insurance
074 HMO: CIGNA Health Plan of Southern New Jersey (Formerly CIGNA Health Plan) 3 Private Insurance
075 HMO: Corporate Health Administrators (1994 only) 3 Private Insurance
076 HMO: Premier Preferred Care of New Jersey (effective beginning 1/93) 3 Private Insurance
077 HMO: Greater Atlantic Health Services (effective beginning 1/95) 3 Private Insurance
078 HMO: Delaware Valley HMO (effective beginning 1/95) 3 Private Insurance
081 HMO: Atlanticare Health Plan (effective beginning 11/8/96) 3 Private Insurance
082 HMO: ChubbHealth Plan (effective beginning 11/8/96) 3 Private Insurance
083 HMO: Community Health Care and Development Corp (effective beginning 11/8/96) 3 Private Insurance
084 HMO: First Option Health Plan (effective beginning 11/8/96) 3 Private Insurance
085 HMO: Harmony Health Plan (effective beginning 11/8/96) 3 Private Insurance
086 HMO: HMO Blue (Blue Cross/Blue Shield of New Jersey) (effective beginning 11/8/96)) 3 Private Insurance
087 HMO: Liberty Health Plan (effective beginning 11/8/96) 3 Private Insurance
088 HMO: Managed Health Care Systems of New Jersey, Inc. (effective beginning 11/8/96) 3 Private Insurance
089 HMO: Physician Health Care Plan of New Jersey (effective beginning 11/8/96) 3 Private Insurance
093 Misc: Magnet (Magna Care) (effective beginning 1/95) 3 Private Insurance
094 HMO: Physician Health Services of New Jersey, Inc. (effective beginning 11/8/96) 3 Private Insurance
096 Misc: Qual Care (effective beginning 11/8/96) 3 Private Insurance
097 HMO: University Health Plans, Inc. (effective beginning 11/8/96) 3 Private Insurance
091 Misc: Union Insurance 3 Private Insurance
309 No Fault: Allstate 3 Private Insurance
311 No Fault: New Jersey Manufacturers 3 Private Insurance
315 No Fault: State Farm 3 Private Insurance
399 No Fault: Other No Fault 3 Private Insurance
095 Miscellaneous: Indigent (effective beginning 1/93) 4 Self-pay
031 Patient: Direct
039 Patient: Other Source of Patient Pay
098 Misc: Hospital Responsibility 5 No charge
014 CHAMPUS 6 Other
016 Department of Vocational Rehabilitation
092 Misc: Personnel Health Program
099 Misc: Other
018 New Jersey State Health Benefits Plan
019 Other Government
013 Title V (Material and Child Health)
205 Workers' Comp: Aetna
211 Workers' Comp: Insurance Company of North America
215 Workers' Comp: Liberty Mutual
221 Workers' Comp: Employers Mutual
225 Workers' Comp: New Jersey Manufacturers
231 Workers' Comp: Travelers
299 Workers' Comp: Other Workers' Compensation
095 Misc: Indigent (effective from 1988-1992)
000, Blank Not Available, Missing . Missing
Any values not documented by the data source .A Invalid


New York
New York
(Valid beginning in 1993)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
03 Medicare 1 Medicare
16 Medicare HMO
04 Medicaid 2 Medicaid
17 Medicaid HMO
06 Blue Cross 3 Private Insurance
08 Commercial Insurance Company
11 HMO (Other)
13 No-fault
15 Self-insured, Self-administered plans
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Worker's Compensation 6 Other
07 Other Government
10 Other
12 CHAMPUS/VA
14 Corrections (federal, state, or local) (1993-1995 only)
18 Corrections Federal (beginning in 1996)
19 Corrections State (beginning in 1996)
20 Corrections Local (beginning in 1996)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



New York
(Valid for 1992)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
03 Medicare 1 Medicare
04 Medicaid 2 Medicaid
06 Blue Cross 3 Private Insurance
08, 13, 15 Commercial Insurance; no-fault; self-insured, self-administered plan
11 Other HMO
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Workers' Compensation 6 Other
12 CHAMPUS/VA
07, 14 Other government; Corrections (state, county, or city)
10 Other
Blank Primary . Missing
Blank, 00 Secondary . Missing
Other Values   .A Invalid



New York
(Valid from 1988-1991)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
03 Medicare 1 Medicare
04 Medicaid 2 Medicaid
06 Blue Cross 3 Private Insurance
08 Commercial Insurance
11 Other HMO
01 Self-pay 4 Self-pay
09 No charge 5 No charge
02 Workers' Compensation 6 Other
07 Other government; Corrections (state, county, or city)
10 Other
Blank Primary: . Missing
Blank, 00 Secondary: . Missing
Other Values   .A Invalid


North Carolina
North Carolina
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
M Medicare 1 Medicare
T Medicare
D Medicaid 2 Medicaid
B Blue Cross 3 Private insurance
H HMO - PPO
I Other Insurance Companies
A Automobile Medical
J Exclusive Provider Org
K Health Maintenance Org
L Indemnity Insurance
Q Liability
R Liability Medical
Y Point of Service
Z Preferred Provider Org
P Self-pay 4 Self-pay
--   5 No charge
C Champus 6 Other
O Other
G Disability
V Other Federal Program
X Other Non-Federal Program
1 Title V
2 Veteran Administration Plan
W Workers' Compensation
U, Blank Documented by source as unknown values . Missing
Any values not documented by the data source .A Invalid


other

Due to an error in processing, 4,616 (0.89%) Workers Compensation records were coded to missing. These records can be identified by PAY1_X = 5.

Oklahoma
PAY1_X PAY1
Value Description Value Description
2 Medicare, including HMO and insurance managed Medicare 1 Medicare
3 Medicaid, including Medicaid pending 2 Medicaid
1 Commercial (include HMO, PPO, POS, Indemnity) 3 Private Insurance
6 Uninsured / Self Pay 4 Self pay
--   5 No charge
4 Veterans affairs / Military 6 Other
5 Workers Compensation
7 Others - All payers not in any of the above groups and including charity, Indian Health, hospice, auto liability, DOC or correctional institution
Blank Missing . Missing
Any values not documented by the data source .A Invalid


Oregon
Oregon
(Valid beginning in 1998)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
M Medicare 1 Medicare
D Medicaid 2 Medicaid
X HMO/Oregon Health Plan (Medicaid)
B Blue Cross/Blue Shield 3 Private Insurance
I Commercial Insurance
S Self-Insured
H HMO/Managed Care
K Kaiser Permanente
Y PPO
P Self Pay 4 Self-pay
Z Medically Indigent, Free, Research 5 No charge
W Workers Compensation 6 Other
C CHAMPUS
E County or State
L Managed Assistance
N Division of Health Services
O Other
T Title V
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Oregon
(Valid from 1995-1997)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
M Medicare 1 Medicare
D, X Medicaid: HMO/Oregon Health Plan (Medicaid) 2 Medicaid
B Blue Cross/Blue Shield 3 Private Insurance
I, Y, S Commercial Insurance; PPO; Self-insured
H, K HMO/Managed Care; Kaiser Permanente
P Self Pay 4 Self-pay
Z Medically Indigent/Free/Research 5 No charge
T Title V 6 Other
W Workers' Compensation
C CHAMPUS
E, L, N County of State; Managed Assistance; Division of Health Services
O Other
Blank Missing . Missing
Other Values   .A Invalid



Oregon
(Valid from 1993-1994)
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
6 Blue Cross 3 Private Insurance
7 Other commercial insurance
8 Self-pay 4 Self-pay
--   5 No charge
3 Title V 6 Other
5 Workers' Compensation
4 Other government
9 Other
0, blank Missing . Missing
Other Values   .A Invalid


other
Pennsylvania
(Valid beginning in 1998)
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
10 Medicare - Other (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 1 Medicare
12 Medicare - PPO (Beginning in 7/99) 1 Medicare
13 Medicare - POS (Beginning in 1/00) 1 Medicare
14 Medicare Part A or B - Fee for Service (Beginning in 7/99) 1 Medicare
15 Medicare - HMO (Beginning 1/00) 1 Medicare
20 Medicaid - Other (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 2 Medicaid
22 Medicaid - PPO (Beginning in 7/99) 2 Medicaid
24 Medicaid - Fee for Service (Beginning in 7/99) 2 Medicaid
25 Medicaid - HMO (Beginning in 1/00) 2 Medicaid
30 Blue Cross - Other (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
32 Blue Cross - PPO (Beginning in 7/99) 3 Private Insurance
33 Blue Cross - POS (Beginning in 7/99) 3 Private Insurance
34 Blue Cross - Fee for Service (Beginning in 7/99) 3 Private Insurance
35 Blue Cross - HMO (Beginning in 1/00) 3 Private Insurance
38 Blue Cross - United Health & Welfare Fund (Source documentation states that this code was discontinued in 1998, but because it was still used, HCUP allowed the value in the 1999-2000 data) 3 Private Insurance
39 Blue Cross - Association (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
39 Blue Cross - Unknown/Not Listed (beginning in 2002) 3 Private Insurance
40 Commercial - Other (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
42 Commercial - PPO (Beginning in 7/99) 3 Private Insurance
43 Commercial - POS (Beginning in 7/99) 3 Private Insurance
44 Commercial - Fee for Service (Beginning in 7/99) 3 Private Insurance
45 Commercial - HMO (Beginning in 1/00) 3 Private Insurance
46 Commercial - Union Health & Welfare Fund (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
48 Commercial - Automobile 3 Private Insurance
49 Commercial - Unknown (Beginning in 1/00) 3 Private Insurance
50 Employer Funded Plans - Other (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
55 Employer Funded Plans - HMO/PPO (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
56 Employer Funded Plans - Union Health & Welfare Fund (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
59 Employer Funded Plans - Association Group (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data) 3 Private Insurance
00 Patient Direct Bill (Discontinued 12/99) Uninsured - Self Pay or Charity/Indigent Care (Beginning in 7/99) 4 Self-pay
--   5 No charge
47 Commercial - Workers' Compensation 6 Other
57 Employer Funded Plans - Workers' Compensation (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data)
80 Other government - Other/Unknown (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data)
82 Government - PPO (Beginning in 7/99)
84 Government - Fee for Service (Beginning in 7/99)
85 Government - HMO (Beginning in 7/99)
87 Other Government - State Workers Insurance Fund (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data)
88 Other Government - Catastrophic Loss Fund (Source documentation states that this code was discontinued in 1999, but because it was still used, HCUP allowed the value in the 2000 data)
89 Government - Unknown/Not Listed (Beginning in 7/99)
90, 99, Blank Unknown, Not Listed, Missing . Missing
Any values not documented by the data source .A Invalid



Pennsylvania
(Valid from 1994-1997)
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
10 Medicare - Other 1 Medicare
15 Medicare - HMO/PPO
20 Medicaid - Other 2 Medicaid
25 Medicaid - HMO/PPO
30 Blue Cross - Other 3 Private Insurance
35 Blue Cross - HMO/PPO
36 BC - union health & welfare fund (1994-1997 only)
38 Blue Cross - United Health & Welfare Fund
39 Blue Cross - Association
40 Commercial - Other
45 Commercial - HMO/PPO
46 Commercial - Union Health & Welfare Fund
48 Commercial - Automobile
49 Commercial - Association
50 Employer Funded Plans - Other
55 Employer Funded Plans - HMO/PPO
56 Employer Funded Plans - Union Health & Welfare Fund
59 Employer Funded Plans - Association Group
05 Patient direct bill - HMO/PPO (1994-1997 only)
00 Patient Direct Bill; Uninsured - Self Pay or Charity/Indigent Care 4 Self-pay
--   5 No charge
47 Commercial - Workers' Compensation 6 Other
57 Employer Funded Plans - Workers' Compensation
80 Other government - Other/Unknown
87 Other Government - State Workers Insurance Fund
88 Other Government - Catastrophic Loss Fund
90, 99, Blank Unknown, Not Listed, Missing . Missing
Any values not documented by the data source .A Invalid



Pennsylvania
(Valid from 1990-1993)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
02 Medicare 1 Medicare
01 Medicaid 2 Medicaid
03 Blue on Blue 3 Private Insurance
04,10, 11, 12 Commercial; Employers; Associations; Auto Insurance
05 HMO/PPO
00 (not "0") Self-pay 4 Self-pay
--   5 No charge
07 Workers' Compensation 6 Other
06, 08, 09 Health and Welfare; CAT fund; Other government programs
99, blank Unknown . Missing
(includes "0") Other values .A Invalid


South Carolina
South Carolina
(Valid beginning in 2002)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
4 Commercial (including Blue Cross) 3 Private insurance
5 HMO
6 Self-Pay 4 Self-pay
--   5 No charge
9 Workers' Compensation 6 Other
10 Tricare, CHAMPUS, CHAMPVA
12 Other Agency, Charity (i.e. Medical Indigent Assistance Program (MAIP), Hill Burton, County Government, etc.)
13 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid


South Carolina
South Carolina
(Valid 2000-2001)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
1 Medicare 1 Medicare
13 Medicare managed care
2 Medicaid 2 Medicaid
14 Medicaid managed care
4 Commercial, PPO 3 Private insurance
5 HMO
6 Self-Pay 4 Self-pay
--   5 No charge
9 Workers' Compensation 6 Other
10 CHAMPUS, CHAMPVA
12 Other
Blank Missing . Missing
Any values not documented by the data source .A Invalid



South Carolina
(Valid from 1998-1999)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
6 Medicare 1 Medicare
7 Medicaid 2 Medicaid
12 Commercial, unspecified 3 Private insurance
13 Commercial, unspecified 3 Private insurance
14 Commercial, unspecified 3 Private insurance
16 HMO 3 Private Insurance
1 Self-pay 4 Self-pay
--   5 No charge
2 State or county indigent program, unspecified 6 Other
3 State or county indigent program, unspecified
4 State or county indigent program, unspecified
5 Champus
8 State or county indigent program, unspecified
9 Worker's Compensation
10 State or county indigent program, unspecified
11 State or county indigent program, unspecified
15, Blank Not Stated, Missing . Missing
Any values not documented by the data source .A Invalid



South Carolina
(Valid from 1993-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
02 Medicare 1 Medicare
03 Medicaid 2 Medicaid
04, 16 Blue Cross/Commercial; HMO 3 Private insurance
01 Self-pay 4 Self-pay
--   5 No charge
05, 06, 07 Workers' Comp; Indigent/Charity; Other government 6 Other
08, Blank Missing . Missing
-- Other .A Invalid


Tennessee
Tennessee
(Valid beginning in 1998)
PAY1_X, PAY2_X, and PAY3_X PAY1 and PAY2
Value Description Value Description
M Medicare 1 Medicare
1 Medicare Managed Care (discontinued in 2000) 1 Medicare
K Medicare HMO/PSO (beginning in 2000) 1 Medicare
D Medicaid 2 Medicaid
T TennCare Plan: Unspecified 2 Medicaid
2 TennCare Plan: Access-Med Plus
3 TennCare Plan: Blue Cross
4 TennCare Plan: Advantage Care/Phoenix
5 TennCare Plan: Omni Care
6 TennCare Plan: Health Net
7 TennCare Plan: Unspecified
8 TennCare Plan: John Deere/Heritage
9 TennCare Plan: Preferred Health Partnership
A TennCare Plan: Prudential Community Care
F TennCare Plan: TLC Family Care Healthplan
G TennCare Plan: Tennsource
J TennCare Plan: Blue Care
Q TennCare Plan: TennCare Select
R TennCare Plan: Better Health Plans, Inc.
V TennCare Plan: Universal Care of Tennessee
U TennCare Behavioral: Tennessee Behavioral Health, Inc.
E TennCare Behavioral: BHO - plan unspecified (beginning in 2000)
X TennCare Behavioral: Premier Behavioral Systems of TN
B Blue Cross/Blue Shield 3 Private Insurance
H Blue Cross - Managed Care - HMO/PPO/Other Managed Care (beginning in 2000) 3 Private Insurance
I Commerical Insurance (Indemnity Carrier) 3 Private Insurance
L Commerical/Managed Care - HMO/PPO/Other Managed Care (beginning in 2000) 3 Private Insurance
S Self Insured 3 Private Insurance
H HMO/Managed Care (redefined in 2000) 3 Private Insurance
P Self-pay 4 Self-pay
Z Medically Indigent/Free 5 No charge
W Workers/State Compensation 6 Other
C Federal, Champus (Military)
E County or state employee (redefined in 2000)
L Managed Assistance (redefined in 2000)
N Division of Health Services (Voc. Rehab.)
O Other, Unknown . Missing
Blank Missing
Any values not documented by the data source .A Invalid


Texas
Texas
(Beginning in 2004)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
MA Medicare Part A 1 Medicare
MB Medicare Part B
MC Medicaid 2 Medicaid
12 Preferred Provider Organization (PPO) 3 Private insurance
13 Point of Service (POS)
14 Exclusive Provider Organization (EPO)
15 Indemnity Insurance
16 Health Maintenance Organization (HMO) Medicare Risk
AM Automobile Medical
BL Blue Cross/Blue Shield
CI Commercial Insurance
HM Health Maintenance Organization
LI Liability
LM Liability Medical
LM Liability Medical
09 Self-Pay 4 Self-pay
ZZ Charity, Indigent, or Unknown (codes 90 and ZZ combined for 2004) 5 No charge
10 Central Certification (Beginning in 2004) 6 Other
11 Other Non-Federal Programs
CH CHAMPUS
DS Disability Insurance
TV Title V
OF Other Federal Program
VA Veteran Administration Plan
WC Worker's Compensation Health Claim
Blank Missing . Missing
*, Any values not documented by the data source .A Invalid



Texas
(Prior to 2004)
PAY1_X, PAY2_X PAY1 and PAY2
Value Description Value Description
"C", "C$", where $ is not equal to V Medicare 1 Medicare
"CV" Medicare Managed Care 1 Medicare
"D", "D$", where $ is not equal to X Medicaid 2 Medicaid
"DX" Medicaid Managed Care 2 Medicaid
"F", "F$", where $ is not equal to Y or U Commercial 3 Private insurance
"FY" Commercial HMO 3 Private insurance
"FU" Commercial PPO 3 Private insurance
"G", "G$", where $ is not equal to Y or U Blue Cross 3 Private insurance
"GY" Blue Cross - HMO 3 Private insurance
"GU" Blue Cross - PPO 3 Private insurance
"A", "A$" Self-pay 4 Self-pay
"IZ" Charity care 5 No charge
"B", "Ba" Worker's Compensation 6 Other
"E", "E$" Other federal program, - including VA
"H", "H$" CHAMPUS
"I", "I$", where $ is not equal to Z Other
Blank Missing . Missing
" * ", " ** ", "$" (value that is missing the standard source or payment), or any values not documented by the data source .A Invalid

PAY1_X/PAY2_X are created from two data elements provided by the data source:

  • the first digit of PAY1_X/PAY2_X is the reported standard source of payment and
  • the second digit is the reported non-standard source of payment

Documented values for the standard source of payment (the first digit of PAY1_X/PAY2_X) include:

A = Self-pay
B = Workers' Compensation
C = Medicare
D = Medicaid
E = Other federal programs
F = Commercial
G = Blue Cross
H = CHAMPUS
I = Other

Documented values for the non-standard source of payment (the second digit of PAY1_X/PAY2_X) include:

T = State or local government programs
U = Commercial PPO
V = Medicare managed care
X = Medicaid managed care
Y = Commercial HMO
Z = Charity Care

As the table above indicates, the coding PAY1/PAY2 from PAY1_X/PAY2_X is primarily based on the standard source of payment code (first digit of PAY1_X/PAY2_X) because it is from the UB-92 and may be required for payment.


Utah

In Utah, hospitals report plan-specific expected payer codes. The data organization that provides the Utah source files to HCUP (the Office of Health Care Statistics, Utah of Department of Health) maps the plan-specific payer codes into grouped payer categories. The data source reports that self-pay/uninsured are not identified very effectively since the original data are mostly based on billing information and they do not have any way to determine whether the payer declined to pay. There is a field for "patient as payer" on the source file, but it is not reliable coded and is only submitted by a small number of hospitals. HCUP receives only the grouped payer code.

Utah
(Valid beginning in 1998)
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
02 Medicaid 2 Medicaid
04 Blue Cross/Blue Shield 3 Private Insurance
05 Other commercial 3 Private Insurance
06 Managed care (HMO and PPO) 3 Private Insurance
07 Self pay 4 Self-pay
09 Charity/Unclassified 5 No charge
03 Other government 6 Other
08 Industrial and Worker's compensation
09 Unclassified (Valid prior to 2006)
12 Other (Valid prior to 2006)
13 Children's Health Insurance Plan (CHIP)
10, 99, Blank Unknown, Not reported, Missing . Missing
Any values not documented by the data source .A Invalid



Utah
(Valid for 1997)
PAY1_X, PAY2_X and PAY3_X PAY1 and PAY2
Value Description Value Description
01 Medicare 1 Medicare
02 Medicaid 2 Medicaid
04 Blue Cross/Blue Shield 3 Private Insurance
05 Other commercial
06 Managed care (HMO and PPO)
07 Self pay 4 Self-pay
--   5 No charge
03 Other government 6 Other
08 Industrial and Worker's compensation
09 Unclassified
12 Other
10, 99, Blank Unknown, Not reported, Missing . Missing
Any values not documented by the data source .A Invalid


Virginia
Virginia
PAY1_X PAY1
Value Description Value Description
1 Medicare 1 Medicare
2 Medicaid 2 Medicaid
31 Medicaid - Out of State 2 Medicaid
3 Anthem/Trigon/BC/BS 3 Private insurance
6 Aetna/US Healthcare 3 Private insurance
7 United Healthcare 3 Private Insurance
8 Cigna 3 Private Insurance
9 Other Commercial 3 Private Insurance
13 Prudential 3 Private Insurance
14 State Farm 3 Private Insurance
24 All State 3 Private Insurance
28 John Hancock 3 Private Insurance
29 HMO/PPO - Unspecified 3 Private Insurance
32 BC/BS Out of State 3 Private Insurance
33 GWU Health Plan 3 Private Insurance
34 Kaiser Permanente 3 Private Insurance
35 MAMSI 3 Private Insurance
36 NYLcare (New York Life) 3 Private Insurance
37 Qualchoice 3 Private Insurance
38 Sentara 3 Private Insurance
39 Southern Health 3 Private Insurance
5 Self Pay 4 Self-pay
--   5 No charge
4 Tricare/Champus 6 Other
10 Indigent/Charity
11 Worker's Comp
16 Local Government
17 State Government
18 Other Government
19 Government Assistance
20 Jail/Detention
21 Black Lung
25 Research/Donor
26 Foreign
27 Hospice - Unspecified
99, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid


Washington
Washington
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
001 Medicare 1 Medicare
002 Medicaid (DSHS) 2 Medicaid
004 Health Maintenance Organization (HMO) (e.g., Group Health, Kaiser Foundation, Good Health) 3 Private Insurance
006 Commercial insurance (e.g., AETNA, Mutual of Omaha, Safeco) 3 Private Insurance
610 Health Care Service Contractors (e.g., Blue Cross, county medical bureaus, Washington Physicians Service) 3 Private Insurance
009 Self-pay 4 Self-pay
630 Charity Care as defined in WAC 246-453-010 5 No charge
008 Workers Compensation (includes state fund, self insured employers, and Labor and Industries crime victims claims) 6 Other
625 Other Sponsored Patients (e.g., CHAMPUS, Indian Health)
Blank Missing . Missing
Any values not documented by the data source .A Invalid



Washington
(Valid from 1988-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
001 Medicare 1 Medicare
002 Medicaid (DSHS) 2 Medicaid
004 Health Maintenance Organization (HMO) (e.g., Group Health, Kaiser Foundation, Good Health) 3 Private Insurance
006 Commercial insurance (e.g., AETNA, Mutual of Omaha, Safeco)
610 Health Care Service Contractors (e.g., Blue Cross, county medical bureaus, Washington Physicians Service) (Beginning in 1994)
009 Self-pay 4 Self-pay
630 Charity Care as defined in WAC 246-453-010 5 No charge
008 Workers Compensation (includes state fund, self insured employers, and Labor and Industries crime victims claims) 6 Other
610 Health Care Service Contractors (e.g., Blue Cross, county medical bureaus, Washington Physicians Service) (Prior to 1994)
625 Other Sponsored Patients (e.g., CHAMPUS, Indian Health)
Blank Missing . Missing
Any values not documented by the data source .A Invalid


West Virginia

Beginning in 2007, West Virginia used new payer coding scheme.

West Virginia
(Beginning in 2007)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
11 Medicare 1 Medicare
21 WV Medicaid 2 Medicaid
31 Other States Medicaid
41 ACORDIA 3 Private Insurance
42 Advantage
43 Aetna
44 Health Plan of the Upper Ohio Valley
45 Prudential
49 Commercial NEC (Not Elsewhere Classified)
51 AARP
52 Blue Cross of VA
53 Mountain State Blue Cross
54 Other Blues
55 ACCESSWV
56 West Virginia Small Business Plan
59 Non-Profit NEC (Not Elsewhere Classified)
61 CAMCare
62 National Association Letter Carriers
63 Teamsters
64 UMWA
14 UMWA Trusts
24 WV PEIA
69 EMPLOYER/ERISA/UNION NEC (Not Elsewhere Classified)
71 SELF-PA 4 Self-Pay
72 Charity 5 No charge
12 DOL-BLACK LUNG 6 Other
13 Railroad Workers
15 Veterans Administration
16 Federal BUR Corrections
17 CHAMPUS
19 Federal NEC (Not Elsewhere Classified)
22 WV Workers’ Comp
23 WV Vocational Rehabilitation
25 WV Maternal & Child Health
26 WV Department of Corrections
27 WV County/Local Corrections
28 WV Children's Health Insurance Program (CHIP)
29 WV Government NEC (Not Elsewhere Classified)
32 Other States’ Workers’ Comp
39 Other States’ Government NEC (Not Elsewhere Classified)
99 NEC (Not Elsewhere Classified)
88, Blank Unknown, Missing . Missing
Any values not documented by the data source .A Invalid


Wisconsin
Wisconsin
(Valid beginning in 1998)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
MED01 Medicare - Fee for service, non-HMO Medicare, or non-HMO Medicaid 1 Medicare
MED02 Medicare - Alternative health care insurance plans (HMO, PPO, PPA, etc.)
MED09 Medicare - Unable to determine insurance type
T1801 Medicare - Fee for service
T1802 Medicare - Alternative health care insurance plans (HMO, PPO, PPA, etc.)
T1809 Medicare - Unable to determine insurance type
T1901 Wisconsin Medicaid - Fee for service 2 Medicaid
T1902 Wisconsin Medicaid - Alternative health care insurance plans
T1909 Wisconsin Medicaid - type unknown
OTH51 Non-Wisconsin Medicaid
WPS01 Wisconsin Physicians Service - Fee for service 3 Private Insurance
WPS02 Wisconsin Physicians Service - Alternative health care insurance plans
WPS09 Wisconsin Physicians Service - type unknown
OTH11 Commercial or private insurance - Fee for service
OTH12 Commercial or private insurance - Alternative health care insurance plans
OTH19 Commercial or private insurance - type unknown
OTH21 Employer self-funded - Fee for service
OTH22 Employer self-funded - Alternative health care insurance plans
OTH29 Employer self-funded - type unknown
OTH31 Other organization self-funded - Fee for service
OTH32 Other organization self-funded - Alternative health care insurance plans
OTH39 Other organization self-funded - type unknown
nnn01, where nnn is a 3-digit code Blue Cross - Fee for service
nnn02, where nnn is a 3-digit code Blue Cross - Alternative health care insurance plans
nnn09, where nnn is a 3-digit code Blue Cross - type unknown
BCS01 Blue Cross - Fee for service
BCS02 Blue Cross - Alternative health care insurance plans
BCS09 Blue Cross - type unknown
OTH61 Self-pay 4 Self-pay
--   5 No charge
BGR01 Badger Care - Fee for service 6 Other
BGR02 Badger Care - Alternative health care insurance plans (HMO, PPO, PPA, etc.)
BGR09 Badger Care - type unknown
CHA01 CHAMPUS, CHAMPVA (effective beginning in 1994)
CHA02 CHAMPUS, CHAMPVA (effective beginning in 1994)
CHA03 CHAMPUS, CHAMPVA (effective beginning in 1994)
OTH41 Worker's Compensation
OTH52 51.42 / 51.437 / 46.23 Board
OTH53 General Relief
OTH54 WisconsinCare
OTH55 CHAMPUS Supplement
OTH56 HIRSP
OTH59 Other government (Not in the 2004 data but documented)
OTH71 Research Grant
OTH98 Other
bbb01, where b is a blank Other - Fee for service (beginning in 1998)
OTH01 Other - Fee for service (effective from 1989-1997)
OTH99 Unknown . Missing
bbb00, where b is a blank Unknown
Blank Missing
Any values not documented by the data source .A Invalid
Prior to 2006: PAYn_X is created by concatenating the source variables PAYID and PAYCAT (i.e. PAY1_X = PAYID || PAYCAT).

Beginning 2006: PAYn_X is created by concatenating the source variables PAYID and PAYTYPE (i.e. PAY1_X = PAYID || PAYTYPE).



Wisconsin
(Valid from 1989-1997)
PAY1_X and PAY2_X PAY1 and PAY2
Value Description Value Description
MED01 Medicare - Fee for service, non-HMO Medicare, or non-HMO Medicaid 1 Medicare
MED02 Medicare - Alternative health care insurance plans (HMO, PPO, PPA, etc.)
MED09 Medicare - Unable to determine insurance type
T1901 Wisconsin Medicaid - Fee for service 2 Medicaid
T1902 Wisconsin Medicaid - Alternative health care insurance plans
T1909 Wisconsin Medicaid - type unknown
OTH51 Non-Wisconsin Medicaid
WPS01 Wisconsin Physicians Service - Fee for service 3 Private Insurance
WPS02 Wisconsin Physicians Service - Alternative health care insurance plans 3 Private Insurance
WPS09 Wisconsin Physicians Service - type unknown 3 Private Insurance
OTH11 Commercial or private insurance - Fee for service 3 Private Insurance
OTH12 Commercial or private insurance - Alternative health care insurance plans 3 Private Insurance
OTH19 Commercial or private insurance - type unknown 3 Private Insurance
OTH21 Employer self-funded - Fee for service 3 Private Insurance
OTH22 Employer self-funded - Alternative health care insurance plans 3 Private Insurance
OTH29 Employer self-funded - type unknown 3 Private Insurance
OTH31 Other organization self-funded - Fee for service 3 Private Insurance
OTH32 Other organization self-funded - Alternative health care insurance plans 3 Private Insurance
OTH39 Other organization self-funded - type unknown 3 Private Insurance
nnn01, where nnn is a 3-digit code Blue Cross - Fee for service 3 Private Insurance
nnn02, where nnn is a 3-digit code Blue Cross - Alternative health care insurance plans 3 Private Insurance
nnn09, where nnn is a 3-digit code Blue Cross - type unknown 3 Private Insurance
OTH61 Self-pay 4 Self-pay
--   5 No charge
CHA01 CHAMPUS, CHAMPVA (effective beginning in 1994) 6 Other
CHA02 CHAMPUS, CHAMPVA (effective beginning in 1994)
CHA03 CHAMPUS, CHAMPVA (effective beginning in 1994)
OTH41 Worker's Compensation
OTH52 51.42 / 51.437 / 46.23 Board
OTH53 General Relief
OTH54 WisconsinCare
OTH55 CHAMPUS Supplement
OTH56 HIRSP
OTH59 Other government
OTH98 Other
OTH01 Other - Fee for service (effective from 1989-1997)
OTH99 Unknown . Missing
bbb00, where b is a blank Unknown
Blank Missing
Any values not documented by the data source .A Invalid

 
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Internet Citation: HCUP KID Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). September 2008
Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/pay1/kidnote.jsp.
Last modified 9/17/08