Central Distributor SID: Description of Data Elements

PAYER1_X - Expected primary payer identifier, plan specific

Documentation Sections:

General Notes

Uniform Values

State Specific Notes

General Notes

PAYER1_X retains the expanded, detailed expected primary payer plan codes provided by the data source. PAY1_X contains payer categories (e.g., commercial insurance); more detailed, plan-specific codes are reported in PAYER1_X (e.g., AETNA and United Healthcare). The original values have not been recoded into uniform HCUP values and are source-specific.

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Uniform Values

Variable Description Value Value Description PAYER1_X Expected primary payer identifier, plan specific n(a) State specific coding - See the "State Specific Notes" section for details

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State Specific Notes

California The 4-digit plan code numbers provided by California represent the name of the Knox-Keene licensed plan or Medi-Cal County Organized Health System. In California, HMOs are regulated under the Knox-Keene Health Care Service Plan Act of 1975. If the plan code numbers are the same and the plan names are different, it means they belong to the same "parent" plan. Knox-Keene Licensed Plans and Plan Code Numbers Plan Code Numbers Plan Code Names 0000 Plan Code not applicable 0176 Aetna Health Plans of California, Inc. 0328 Alameda Alliance for Health 0322 American Family Care 0303 Blue Cross of California 0043 Blue Shield of California 0314 BPS HMO 0352 Brown and Toland Medical Group 0365 Calaveras Provider Network 0326 Care 1st Health Plan 0234 Careamerca-Southern California, Inc. 0278 Chinese Community Health Plan 0152 Cigna Healthcare of California, Inc. 0200 Community Health Group 0248 Community Health Plan (County of Los Angeles) 0360 Concentrated Care, Inc. 0054 Contra Costa Health Plan 0350 FPA Medical Management of California, Inc. 0327 Great American Health Plan 0317 Greater Pacific HMO, Inc. 0292 HAI 0277 Healthmax America 0300 Health Net 0126 Health Plan of America (HPA) 0159 Health Plan of the Redwoods 0357 Heritage Provider Network, Inc. 0346 Inland Empire Health Plan 0151 Inter Valley Health Plan 0289 Kaiser Foundation Added Choice Health Plan 0055 Kaiser Foundation Health Plan, Inc. 0335 Kern Health Systems, Inc. 0343 Key Health Plan of California 0142 Lifeguard, Inc. 0355 LA Care Health Plan 0196 Managed Health Network 0002 Maxicare 0298 MCC Behavioral Care of California, Inc. 0345 MedPartners Provider Network, Inc. 0266 Metrahealth Care Plan 0288 Merit Behavioral Care of California, Inc. 0270 Monarch Plan, Inc. 0222 National Health Plans 0222 National HMO 0235 Occupational Health Services (OHS) 0238 Omni Healthcare, Inc. 0325 One Health Plan of California, Inc. 0301 Pacificare Behavioral Health of California, Inc. 0126 Pacificare of California 0237 Priorityplus of California 0296 Prucare Plus 0300 Qualmed Plans for Health 0354 Regents of the University of California 0349 San Francisco Health Plan 0351 Santa Clara County Family Health Plan 0126 Secure Horizons 0310 Sharp Health Plan 0212 Smartcare Health Plan 0338 The Health Plan of San Joaquin 0324 Tower Health Service 0266 UHC Healthcare 0008 UHP Healthcare 0209 Universal Care 0236 Valley Health Plan 0293 Value Behavioral Health of California, Inc. 0344 Ventura County Health Care Plan 0102 Vista Behavioral Health Plan 0348 Western Health Advantage 8000 Other Medi-Cal County Organized Health Systems and Plan Code Numbers Plan Code Numbers Plan Code Names 0000 Plan Code not applicable 9030 Cal Optima (Orange County) 9041 Health Plan of San Mateo (San Mateo County) 9042 Santa Barbara Health Authority (Santa Barbara County) 9044 Santa Cruz County Health Options (Santa Cruz County) 9048 Solano Partnership Health Plan (Solano County) Maryland Beginning with 2021 data, MD supplies a 3-digit expected payer code. *In addition, coding was transitioned to new FY values begin with 2021 Q3 data - however, the old coding system, which began in 2015, remains in effect through 2021 Q2. However, in in the 2021 Q1/Q2 a 0 is appended to the beginning of each value: for example, value 30, still defined as Aetna Health, will appear as 030 for 2021 Q1/Q2 data only. Code Description (Beginning 2021 Q3) Commercial HMO/POS/PPO/PPN/TPA 101 AETNA HEALTHPLANS 102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS) 103 CIGNA 104 GENERIC TPA/COMMERCIAL PLANS 105 GENERIC COMMERCIAL EMPLOYEE HEALTH PLANS 106 HUMANA 107 KAISER PERMANENTE  108 UNITED HEALTHCARE  125 JOHNS HOPKINS EMPLOYEE HEALTH PLANS 126 UNIVERSITY OF MD EMPLOYEE HEALTH PLANS  127 MEDSTAR EMPLOYEE HEALTH PLANS  MD Medicaid MCO 98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW 101 AETNA HEALTHPLANS 102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS) 107 KAISER PERMANENTE 108 UNITED HEALTHCARE 109 AMERIGROUP COMMUNITY CARE 110 JAI MEDICAL SYSTEMS 111 MARYLAND PHYSICIANS CARE  112 MEDSTAR FAMILY CHOICE  113 PRIORITY PARTNERS  118 OPTUM MARYLAND (MD MEDICAID) (previously Beacon Health) Medicare Advantage 98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW 101 AETNA HEALTHPLANS 102 CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS) 103 CIGNA 106 HUMANA 107 KAISER PERMANENTE  108 UNITED HEALTHCARE  109 AMERIGROUP COMMUNITY CARE 115 JOHNS HOPKINS ADVANTAGE MD  116 PROVIDER PARTNERS HEALTH PLAN (NEW) 128 HORIZONS MEDICARE DIRECT Behavioral Health 98 HEALTH PLAN PAYERS NOT SPECIFIED BELOW 107 KAISER PERMANENTE 119 MAGELLAN  120 CIGNA BEHAVIORAL HEALTH  121 COMPSYCH 122 MANAGE HEALTH NETWORK 123 OPTUM BEHAVIORAL HEALTH (Commercial)  124 BEACON HEALTH OPTIONS  Code Description (Effective 2009-2020 Q2*) Commerical HMO/POS: 30 Aetna Health, Inc. 31 CareFirst Bluechoice 32 Cigna Healthcare of Mid-Atlantic (Discontinued 6/30/16) 33 Coventry Health Care of Delaware, Inc.(Discontinued 6/30/20) 34 Kaiser Permanente of the Mid-Atlantic States 35 MAMSI (Discontinued 6/30/16) 36 United Healthcare of the Mid-Atlantic, Inc. (includes Allsavers) 37 Other HMO/POS 38 Evergreen Health Cooperative, Inc. (Discontinued 6/30/20) 39 Optum Maryland (Medicaid behavioral health) (effective 7/1/2020) 40 Beacon Health Option (effective 7/1/2020) MD Medicaid MCO: 42 Amerigroup 43 Coventry Health Plan of Delaware (Diamond Plan) 44 MedStar Family Choice, Inc. 45 JAI Medical Group 46 Value Options / Beacon (Discontinued 6/30/20) 47 Maryland Physicians Care 48 Priority Partners 49 United Healthcare Community Plan 50 Other Medicaid MCO/HMO 51 2009-6/30/2019: Riverside Health. 7/1/2019-6/30/2020: CAREFIRST BLUECROSS BLUESHIELD COMMUNITY HEALTH PLAN MARYLAND (formerly called UNIVERISTY OF MARYLAND HEALTH PARTNERS BEFORE) 52 Kaiser MCO (Effective 7/1/16) 53 PROVIDER PARTNERS HEALTH PLAN (Effective 7/1/2020) Medicare MA: 55 Aetna Medicare Advantage 58 Other Medicare HMO 59 InforMed (discontinued 6/30/2020) 60 Cigna Healthspring (Bravo) 61 Kaiser Foundation Health Plan 62 CAREFIRST BLUECROSS BLUESHIELD MEDICARE ADVANTAGE (formerly known as UNIVERSITY OF MARYLAND HEALTH ADVANTAGE HMO before 02/01/2020 (Effective 7/1/16) 63 Medstar Medicare Choice (includes choice Dual Advantage & Care Advantage) (Effective 7/1/16 - discontinued 6/30/2020) 64 Johns Hopkins Medicine Medicare Plan (Advantage MD) (Effective 7/1/16) Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs): 65 Aetna Life and Health Insurance Company 66 CareFirst of MD Inc. (CFMI) 67 Carefirst Group Hospitalization and Medical Services Inc. (GHMSI) 68 CCN/First Health (Discontinued 6/30/16) 69 Cigna Life and Health Insurance Company, Inc. (includes connecticut General Life Insurance Companry Inc.) 70 Employer Health Plan (EHP) 71 Fidelity Benefits Administrator (Discontinued 6/30/16) 72 Great West One Plan (Discontinued 6/30/16) 73 Kaiser Permanente Insurance Company (includes Harringon Health and Health Plan Services (TPA to Kaiser) 74 United Healthcare Insurance Company (i.e. One Net PPO, MAMSI Life and Health) Optimum choice, Golden Rule Insurance Companry, MD Individual Practice Association, UMR Inc.) 75 Carefirst Administrators LLC/National Capital Administrative Services (discontinued 6/30/2020) 76 Private Health Care Systems (PHCS) 77 Other Commercial, PPO, PPN, TPA (N/A effective 2020 Q3) 78 Anthem BC/BS (Discontinued 6/30/16) 79 Coresource, Inc. (Effective 7/1/16) 80 Group Benefit Services, Inc. (Effective 7/1/16) 81 Coventry Health and Life Insurance Company / Coventry Nnational Network 82 Healthsmart Benefit Solutions, Inc. (Effective 7/1/16) 83 Humana (Effective 7/1/16) Behavioral Health: 84 Carefirst PPO Behavioral Health (discontinued 6/30/2020) 85 American Psychiatric Systems (APS) (Discontinued 6/30/16) 86 Cigna Behavioral Health 87 ComPsych 88 Magellan 89 Managed Health Network 90 United Optum Behavioral Health (includes Optum Behavioral Solutions effective 7/1/2020) 91 Value Options (discontinued 6/30/2020) 92 Other Behavioral Health Other Government Programs (Including Out-of-State Medicaid Programs): 54 Out-of-State (Non-MD) Medicaid 93 MD Health Insurance Plan (MHIP) EPO (discontinued 6/30/2020) 94 MD Health Insurance Plan (MHIP) PPO (discontinued 6/30/2020) 95 Tricare - example: Health Net 96 Uniformed Services Family Health Plan (USFHP) 97 Other miscellaneous government programs (includes non-MD Medicaid) Other: 00 Not applicable 01 Other Health Plan Payers [including Qualified Dental Plans (QDPs) and Pharmacy Benefit Managers (PBMs)] (Effective 7/1/16) 99 Unknown Code Description (Effective 2009-2014) Primary Adult Care (PAC) MCO: 01 Amerigroup 02 Jai Medical Group 03 Maryland Physicians Care 04 Priority Partners 05 United HealthCare HMO/POS: 30 Aetna Health Plans 31 CareFirst Blue Choice 32 Cigna Healthcare of Mid-Atlantic 33 Coventry Health Plan of Delaware 34 Kaiser Permanente 35 MAMSI 36 United Healthcare 37 Other HMO/POS Medicaid MCO/HMO: 42 Amerigroup 43 Coventry Health Plan of Delaware (Diamond Plan) 44 MedStar Family Choice, Inc. 45 JAI Medical Group 46 Value Options 47 Maryland Physicians Care 48 Priority Partners 49 United Healthcare (Americhoice) 50 Other Medicaid MCO/HMO 51 Riverside Health Medicare HMO: 55 Aetna (Golden Choice) 56 ElderHealth 57 United Healthcare (Evercare) 58 Other Medicare HMO 59 InforMed 60 Bravo Health 61 Kaiser Foundation Health Plan Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs): 65 Aetna 66 CareFirst- CareFirst of Maryland, Inc (CFMI (Maryland)) (PPO, POS, Blue Preferred, REP) 67 CareFirst- Group Hospitalization and Medical Services Inc (DC) (PPO, POS, Blue Preferred) Federal Employee Program (FEP) 68 CCN/First Health 69 Cigna 70 Employer Health Plan (EHP) 71 Fidelity Benefits Administrator 72 Great West One Plan 73 Kaiser Permanente 74 MAMSI (Alliance PPO and MAMSI Life and Health) 75 National Capital PPO (NCPPO) 76 Private Health Care Systems (PHCS) 77 Other Commercial, PPO, PPN, TPA 78 Anthem BC/BS Behavioral Health: 85 American Psychiatric Systems (APS) 86 Cigna Behavioral Health 87 ComPsych 88 Magellan 89 Managed Health Network 90 United Behavioral Health 91 Value Options 92 Other Behavioral Health Other Government Programs: 93 MD Health Insurance Plan (MHIP) EPO 94 MD Health Insurance Plan (MHIP) PPO 95 Tricare - example: Health Net 96 Uniformed Services Family Health Plan (USFHP) 97 Other miscellaneous government programs (includes non-MD Medicaid) Other 0 Not applicable 99 Unknown Beginning in 2006, PAYER values 01-29 are eliminated. Please see the new values below. Code Description (Beginning in 2006) Primary Health Plan Payer HMO/POS: 30 Aetna Health Plans 31 CareFirst Blue Choice 32 Cigna Healthcare of Mid-Atlantic 33 Coventry Health Plan of Delaware 34 Kaiser Permanente 35 MAMSI 36 United Healthcare 37 Other HMO/POS Medicaid MCO/HMO: 42 Amerigroup 43 Coventry Health Plan of Delaware (Diamond Plan) 44 Helix Family Choice, Inc. 45 JAI Medical Group 46 Medicaid/Uninsured APS – Maryland (psychiatric payer) 47 Maryland Physicians Care 48 Priority Partners 49 United Healthcare (Americhoice) 50 Other Medicaid MCO/HMO Medicare HMO: 55 Aetna (Golden Choice) 55 Aetna (Golden Choice) 56 ElderHealth 57 United Healthcare (Evercare) 58 Other Medicare HMO Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs): 65 Aetna 66 CareFirst- CareFirst of Maryland, Inc (BC/BS Plan #190/690) 67 CareFirst- Group Hospitalization and Medical Services Inc (Non HMO) (BC/BS Plan #080/580) Federal Employee Program 68 CCN/First Health 69 Cigna 70 Employer Health Plan (EHP) 71 Fidelity Benefits Administrator 72 Great West One Plan 73 Kaiser Permanente 74 MAMSI (that is, Alliance PPO and MAMSI Life and Health) 75 National Capital PPO (NCPPO) 74 MAMSI (that is, Alliance PPO and MAMSI Life and Health) 76 Private Health Care Systems (PHCS) 77 Other Commercial, PPO, PPN, TPA Behavioral Health: 85 American Psychiatric Systems (APS) 86 Cigna Behavioral Health 87 ComPsych 88 Magellan 89 Managed Health Network 90 United Behavioral Health 91 Value Options 92 Other Behavioral Health Other Government Programs: 93 MD Health Insurance Plan (MHIP) EPO 94 MD Health Insurance Plan (MHIP) PPO 95 Tricare - example: Health Net 96 Uniformed Services Family Health Plan (USFHP) 97 Other miscellaneous government programs 00 Not applicable 99 Unknown Beginning in 2003, HCUP retained the managed care payer information on the AS/ED files. PAYER1_X includes the plan name of the managed care payer. This includes the health maintenance organizations (HMO), managed care organizations (MCO), and provider sponsored organizations (PSO). Source definitions are Code Description (Prior to 2006) 01 AETNA Health Plan Atlantic 02 CapitalCare (Blue Cross National Capital Area) 03 CFS Health Group (Carefirst, Freestate, Potomac Health) 04 Chesapeake Health Plan 05 CIGNA Healthcare MidAtlantic Inc. 06 Columbia Medical Plan 07 Delmarva Health Plan 08 Humana Group Health Plan 09 GWU Health Plans 10 NYL Care (HealthPlus, Inc., Sanus, New York Life Care, New York Life) 11 Kaiser Permanente 12 MAMSI (MDIPA, Optimum Choice, Alliance) 13 Total Health Care 14 U.S. Healthcare 15 Prudential Healthcare Plan - Mid Atlantic 16 Principal Health Care of Mid Atlantic 17 Preferred Health Network of MD 18 Physicians Health Plan Inc. 19 Principal Health\Care of Delaware, Inc. 20 Maryland Physicians Care 21 Helix Family Health 22 JAI Medical 23 Priority Partners 24 United HealthCare 25 New American Health 26 Prime Health 29 Other HMO/MCO/PSO Source values for "Not Applicable" and "Unknown" are recoded to missing (PAYER1_X = " "). Massachusetts PAYER1_X includes specific payment plan identifiers. Valid 10/01/2020 Payer Source Code Health Plan 4 Fallon Community Health Plan 7 Tufts Associated Health Plan 23 Guardian Life Insurance Company 24 Health New England 26 CHAMPUS/TriCare 30 CIGNA 40 Kaiser Foundation 42 ConnectiCare Of Massachusetts 46 Blue CHiP (BCBS Rhode Island) 47 Neighborhood Health Plan 51 Aetna 57 John Hancock Life Insurance 74 United Healthcare Insurance Company 84 Private Healthcare Systems 85 Liberty Mutual 97 UniCare 102 Wausau Insurance Company 103 Medicaid (MassHealth) 118 Mass Behavioral Health Partnership 120 Out-of-State Medicaid 121 Medicare 134 Medicare HMO - Other (not listed elsewhere) 137 AARP/Medigap Supplement 143 Free Care 145 Self-Pay 146 Worker's Compensation 147 Other Commercial (not listed elsewhere) 151 CHAMPUS 154 BCBS Other (Not listed elsewhere) 156 Out of state BCBS 159 None (Valid only for Secondary Source of Payment) 162 Great West Life 178 Children's Medical Security Plan (CMSP) 179 First Health Life and Health Insurance Company 185 Connecticut General Life 207 Network Health 209 Mid-West National Life Insurance Company of Tennessee 226 United Health Care of New England, Inc. 228 Oxford Health Plans 247 Humana Insurance Company 249 MEGA Life and Health Insurance Company 272 Auto Insurance 288 Boston Medical Center HealthNet 295 Meritain 296 Commonwealth Care Alliance 311 Other ACO 320 Community Care Cooperative (ACO) 322 Partners Healthcare Choice (ACO) 323 Steward Health Choice (ACO) 328 Wellforce Care Plan (ACO) 400 Cambridge Network Health Forward 807 Blue Cross Blue Shield of MA 808 Blue Cross Blue Shield of RI 822 Harvard Pilgrim Health Care 826 United Concordia 903 Unlisted International Source 910 Allways Health Partners 911 Anthem 912 Beacon Health Partners 913 Health Plans Inc. 914 Insurance Programmers 915 Key Benefit 916 Lifetime Benefit Solutions 917 Nationwide 918 QCC Insurance Company 919 State Farm 920 UMR Inc. 921 Zenith 922 Senior Whole Health 930 VA Benefits (not listed elsewhere) 931 Other Government Program (not listed elsewhere) 932 Other Third Party Programs (not listed elsewhere) (ex. Vision TPA, Hospice, Transplant programs) 995 Health Safety Net Office 996 Charity Care PAYER1_X includes specific payment plan identifiers. Valid 10/01/10-9/31/20 Pay Code Source of Payment 1 Harvard Community Health Plan 3 Network Blue (PPO) 4 Fallon Community Health Plan 7 Tufts Associated Health Plan 8 Pilgrim Health Care 9 United Health Plan of New England (Ocean State) 11 Blue Care Elect 19 Matthew Thornton 22 Aetna Open Choice PPO 23 Guardian Life Insurance Company PPO 24 Health New England Inc. 28 Great West Life PPO 30 CIGNA (Indemnity) 31 One Health Plan HMO (Great West Life) 35 United Healthcare Insurance Company - HMO 36 United Healthcare Insurance Company - PPO (new for 1997) 37 HCHP - Pilgrim HMO (integrated product) 38 Health New England Select (self-funded) 40 Kaiser Foundation 42 ConnectiCare of Massachusetts 46 Blue ChiP (BCBS Rhode Island) 47 Neighborhood Health Plan 48 US Healthcare 51 Aetna Life Insurance 55 Guardian Life Insurance 57 John Hancock Life Insurance 62 Mutual of Omaha Insurance 74 United Healthcare Insurance Company 77 Options for Healthcare PPO 79 Pioneer Health Care PPO 80 Tufts Total Health Plan PPO 81 HMO Blue 82 John Hancock Preferred 84 Private Healthcare Systems PPO 85 Liberty Mutual 87 CIGNA PPO 89 Great West/NE Care 93 Psychological Health Plan 95 Pilgrim Select - PPO 96 Metrahealth (United Health Care of NE) 97 Unicare 98 Healthy Start 99 Other POS (not listed elsewhere) *** 102 Wausau Insurance Company 103 Medicaid (includes MassHealth) 104 Medicaid Managed Care-Primary Care Clinician (PCC) 108 Medicaid Managed Care-Fallon Community Health Plan 110 Medicaid Managed Care - Health New England 113 Medicaid Managed Care-Fallon Community Health Plan 114 Medicaid Managed Care - United Health Plans of NE 116 Medicaid Managed Care -Tufts Associated Health Plan 118 Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership 119 Medicaid Managed Care Other (not listed elsewhere) *** 120 Out-Of-State Medicaid 121 Medicare 125 Medicare HMO - Fallon Senior Plan**** 128 Medicare HMO - HMO Blue for Seniors**** 131 Medicare HMO - Pilgrim Enhance 65 133 Medicare HMO -Tufts Medicare Supplement (TMS) 134 Medicare HMO - Other (not listed elsewhere)*** 207 Network Health (Cambridge Health Alliance MCD Program) 208 HealthNet (Boston Medical Center MCD Program) 209 Mid-West National Life Insurance Company of Tennessee 210 Medicare HMO - Pilgrim Preferred 65 213 Medicare HMO - Medicare Complete Plans offered by SecureHorizons 214 Medicare HMO - Harvard Pilgrim Health Plan - Medicare Enhance 215 Tufts Medicare HMO - Medicare Preferred 216 Medicare Special Needs Plan - Commonwealth Care Alliance 217 Medicare Special Needs Plan - Fallon Community Health Plan 218 Medicare Special Needs Plan - Senior Whole Health 219 Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IP 220 Medicare HMO - Blue Care 65 221 Medicare HMO - Harvard Community Health Plan 65 223 Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus 224 Medicare HMO - Tufts Secure Horizons 225 Medicare HMO - US Healthcare 226 United Health Care of New England, Inc. 260-269 Reserved 270 UniCare Preferred Plus PPO 272 Auto Insurance 273 MassHealth Senior Care Options**** 274 Medicaid Managed Care - Network Health 275 Medicare SCO - NaviCare (HMO) 276 Medicare SCO - Tufts Senior Care Options 277 Medicare SCO - United Health Care 278 Medicare SCO - Commonwealth Care Alliance 279 Medicare One Care - Fallon Total Care 280 Medicare One Care - Network Health 281 Medicare One Care - Commonwealth Care Alliance 300 CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan can be identified) 301 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I 302 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II 303 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III 311 Medicaid: Other ACO 312 Medicaid: Fallon 365 Care (ACO) 313 Medicaid: Be Healthy Partnership with Health New England (ACO) 314 Medicaid: Berkshire Fallon Health Collaborative (ACO) 315 Medicaid: BMC HealthNet Plan Community Alliance (ACO) 316 Medicaid: BMC HealthNet Plan Mercy Alliance (ACO) 317 Medicaid: BMC HealthNet Plan Signature Alliance (ACO) 318 Medicaid: BMC HealthNet Plan Southcoast Alliance (ACO) 320 Medicaid: Community Care Cooperative (ACO) 321 Medicaid: My Care Family with AllWays Health Partners (ACO) - formerly named My Care Family with Neighborhood Health Plan 322 Medicaid: Partners Healthcare Choice (ACO) 323 Medicaid: Steward Health Choice (ACO) 324 Medicaid: Tufts Health Together with Atrius Health (ACO) 325 Medicaid: Tufts Health Together with BIDCO (ACO) (Beginning in 2019) 326 Medicaid: Tufts Health Together with Boston Children’s ACO (Beginning in 2019) 327 Medicaid: Tufts Health Together with CHA (ACO) 328 Medicaid: Wellforce Care Plan (ACO) 400 CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan can 401 CommCare: Cambridge Network Health Forward - Plan Type I 402 CommCare: Cambridge Network Health Forward - Plan Type II 403 CommCare: Cambridge Network Health Forward - Plan Type III 500 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - General Classification (For use only when no specific level for this plan can be identified) 501 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077) 502 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220) 503 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221) 600 CommCare: Neighborhood Health Plan - General Classification (For use only when no specific level for this plan can be identified) 601 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type I (9CC1) 602 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type II (9CC2) 603 CommCare: Neighborhood Health Plan - NHP Commonwealth Care Plan - Plan Type III (9CC3) 700 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification 701 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 1 702 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 2 703 CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 3 704 CommCare: Celticare Health Plan of Massachusetts / Comonwealth Care Bridge Program 800 Aetna Dental (Beginning in 2010) 801 Aflac (Beginning in 2010) 802 AllState (Beginning in 2010) 803 Altus Dental (Beginning in 2010) 804 Ameritas Life Insurance Corp (Beginning in 2010) 805 Anthem Blue Cross Blue Shield (Beginning in 2010) 806 Assurant (Beginning in 2010) 807 Blue Cross Blue Shield of MA (Beginning in 2010) 808 Blue Cross Blue Shield of RI (Beginning in 2010) 809 Children's Medical Society (Beginning in 2010) 810 Cigna Dental (Beginning in 2010) 811 Creative Plan Dental Administrators (Beginning in 2010) 812 Delta Dental of MA (Beginning in 2010) 813 Delta Dental of Michigan (Beginning in 2010) 814 Delta Dental of New York (Beginning in 2010) 815 DentaQuest Commonwealth Care (Beginning in 2010) 816 DentaQuest MassHealth (Beginning in 2010) 817 DentaQuest Senior Whole Health (Beginning in 2010) 818 EverCare Dental (Beginning in 2010) 819 Fallon Health Plan (Beginning in 2010) 820 Great West Dental (Beginning in 2010) 821 Guardian Dental (Beginning in 2010) 822 Harvard Pilgrim Health Care (Beginning in 2010) 823 MetLife Dental (Beginning in 2010) 824 Principal Plan Dental (Beginning in 2010) 825 Unicare Dental (Beginning in 2010) 826 United Concordia (Beginning in 2010) 827 United HealthCare: Dental (Beginning in 2010) 828 Alicare 829 Adventist Risk Management INC 830 Blue Cross Blue Shield of Texas 831 Brokers National Life insurance 832 Cba Blue Dental 833 Chesterfield Resources 834 Companion Life insurance 835 Dental Health Alliance 836 EBS Benefit Solutions 837 Empire Blue Cross 838 Excellus Blue cross 839 Fortis 840 GEHA Connection Dental 841 GHI 842 Lincoln Financial Group 843 London Health Administrators 844 Midwest Life Insurance 845 Premier Access Dental Plans 846 Sentry Life Insurance 847 Sonoco 848 Sun Life Dental Benefits 849 Symetra Life Insurance Company 850 Tricare Dental 851 Dentemax Insurance 901 Other Commercial Managed Care (not listed elsewhere) 902 Other Dental (not listed elsewhere) 903 Unlisted International Source 904 Unlisted Military Source 905 Other Connector Care Plan (not listed elsewhere) 990 Free Care - co-pay deductible, or co-insurance (when billing for free care service use #143) 995 Health Safety Net 996 Charity Care Prior to 10/1/10, Massachusetts used the source definitions below. Pay Code Source of Payment 1 Harvard Community Health Plan 2 Bay State - a product of HMO Blue 3 Network Blue (PPO) 4 Fallon Community Health Plan (includes Fallon Plus, Fallon Affiliates, Fallon UMass) 5 Invalid (replaced by #9) 6 Invalid (replaced by #251) 7 Tufts Associated Health Plan 8 Pilgrim Health Care 9 United Health Plan of New England (Ocean State) 10 Pilgrim Advantage - PPO 11 Blue Care Elect 12 Invalid (replaced by #49) 13 Community Health Plan Options (New York) 14 Health New England Advantage POS 15 Invalid (replaced by #158) 16 Invalid (replaced by #172) 17 Prudential Healthcare POS 18 Prudential Healthcare PPO 19 Matthew Thornton 20 HCHP of New England (formerly RIGHA) 21 Commonwealth PPO 22 Aetna Open Choice PPO 23 Guardian Life Insurance Company PPO 24 Health New England, Inc. 25 Pioneer Plan 26 Invalid (replaced by #75) 27 First Allmerica Financial Life Insurance PPO 28 Great West Life PPO 29 Invalid (replaced by #171 and 250) 30 CIGNA (Indemnity) 31 One Health Plan HMO (Great West Life) 32 Invalid (replaced by #157 and 158) 33 Mutual of Omaha PPO 34 New York Life Care PPO 35 United Healthcare Insurance Company - HMO (New for 1997) 36 United Healthcare Insurance Company - PPO (New for 1997) 37 HCHP-Pilgrim HMO (integrated product) 38 Health New England Select (self-funded) 39 Pilgrim Direct 40 Kaiser Foundation 41 Invalid (replaced by #157) 42 ConnectiCare of Massachusetts 43 MEDTAC 44 Community Health Plan 45 Health Source New Hampshire 46 Blue CHiP (BCBS Rhode Island) 47 Neighborhood Health Plan 48 US Healthcare 49 Healthsource CMHC Plus PPO 50 Blue Health Plan for Kids 51 Aetna Life Insurance 52 Boston Mutual Insurance 53 Invalid (no replacement) 54 Continental Assurance Insurance 55 Guardian Life Insurance 56 Hartford L&A Insurance 57 John Hancock Life Insurance 58 Liberty Life Insurance 59 Lincoln National Insurance 60 Invalid (replaced by #97) 61 Invalid (replaced by #96) 62 Mutual of Omaha Insurance 63 New England Mutual Insurance 64 New York Life Care Indemnity (New York Life Insurance) 65 Paul Revere Life Insurance 66 Prudential Insurance 67 First Allmercia Financial Life Insurance 68 Invalid (replaced by #96) 69 Corporate Health Insurance Liberty Plan 70 Union Labor Life Insurance 71 ADMAR 72 Healthsource New Hampshire 73 United Health and Life (subsidiary of United Health Plans of NE) 74 United Healthcare Insurance Company (New for 1997) 75 Prudential HMO 76 Invalid (replaced by #270) 77 Options for Healthcare PPO 78 Phoenix Preferred PPO 79 Pioneer Health Care PPO 80 Tufts Total Health Plan PPO 81 HMO Blue 82 John Hancock Preferred 83 US Healthcare Quality Network Choice-PPO 84 Private Healthcare Systems PPO 85 Liberty Mutual 86 United Health & Life PPO (Subsidiary of United Health Plans of NE) 87 CIGNA PPO 88 Freedom Care 89 Great West/NE Care 90 Healthsource Preferred (self-funded) 91 New England Benefits 92 Invalid (replaced by #84, 166, 184) 93 Psychological Health Plan 94 Time Insurance Co. 95 Pilgrim Select - PPO 96 Metrahealth (United Health Care of NE) 97 UniCare 98 Healthy Start 99 Other POS (not listed elsewhere) 100 Transport Life Insurance 101 Quarto Claims 102 Wausau Insurance Company 103 Medicaid 104 Medicaid Managed Care-Primary Care Clinician (PCC) 105 Invalid (replaced by #111) 106 Medicaid Managed Care-Central Mass Health Care 107 Medicaid Managed Care-Community Health Plan 108 Medicaid Managed Care-Fallon Community Health Plan 109 Medicaid Managed Care-Harvard Community Health Plan 110 Medicaid Managed Care-Health New England 111 Medicaid Managed Care-HMO Blue 112 Medicaid Managed Care-Kaiser Foundation Plan 113 Medicaid Managed Care-Neighborhood Health Plan 114 Medicaid Managed Care-United Health Plans of NE (Ocean State Physician's Plan) 115 Medicaid Managed Care-Pilgrim Health Care 116 Medicaid Managed Care-Tufts Associated Health Plan 117 Invalid (no replacement) 118 Medicaid Mental Health & Substance Abuse Plan - Mass Behavioral Health Partnership 119 Medicaid Managed Care Other (not listed elsewhere) *** 120 Out-of-State Medicaid 121 Medicare 122 Invalid (replaced by #235) 123 Invalid (no replacement) 124 Invalid (replaced by #230) 125 Medicare HMO - Fallon Senior Plan 126 Invalid (replaced by #230) 127 Medicare HMO - Health New England Medicare Wrap ** 128 Medicare HMO - HMO Blue for Seniors ** 129 Medicare HMO - Kaiser Medicare Plus Plan ** 130 Invalid (replaced by #232 and 233) 131 Medicare HMO - Pilgrim Enhance 65 ** 132 Medicare HMO - Matthew Thornton Senior Plan 133 Medicare HMO - Tufts Medicare Supplement (TMS) 134 Medicare HMO - Other (not listed elsewhere) *** 135 Out-of-State Medicare 136 BCBS Medex ** 137 AARP/Medigap supplement ** 138 Banker's Life and Casualty Insurance ** 139 Bankers Multiple Line ** 140 Combined Insurance Company of America ** 141 Other Medigapy (not listed elsewhere) *** 142 Blue Cross Indemnity 143 Free Care 144 Other Government 145 Self-Pay 146 Worker's Compensation 147 Other Commercial (not listed elsewhere) *** 148 Other HMO (not listed elsewhere) *** 149 PPO and Other Managed Care (not listed elsewhere) *** 150 Other Non-Managed care (not listed elsewhere) *** 151 CHAMPUS 152 Foundation 153 Grant 154 BCBS Other (not listed elsewhere) *** 155 Blue Cross Managed Care Other (not listed elsewhere) *** 156 Out of state BCBS 157 Metrahealth - PPO (United Health Care of NE) 158 Metrahealth - HMO (United Health Care of NE) 159 None (valid only for secondary source of payment) 160 Blue Choice (includes Healthflex Blue) - POS 161 Aetna Managed Choice POS 162 Great West Life POS 163 United Healthcare Insurance Company - POS (New for 1997) 164 Healthsource CMHC Plus POS 165 Healthsource New Hampshire POS (self-funded) 166 Private Healthcare Systems POS 167 Fallon POS 168 Reserved 169 Kaiser Added Choice 170 US Healthcare Quality POS 171 CIGNA POS 172 Metrahealth - POS (United Health Care of NE) 173-180 Reserved 181 First Allmercia Financial Life Insurance EPO 182 UniCare Preferred Plus Managed Access EPO 183 Pioneer Health Care EPO 184 Private Healthcare Systems EPO 185-198 Reserved 199 Other EPO (not listed elsewhere) *** 200 Hartford Life Insurance Co. 201 Mutual of Omaha ** 202 New York Life Insurance ** 203 Principal Financial Group (Principal Mutual Life) 204 Christian Brothers Employee 207 Network Health (Cambridge Health Alliance MCD Program) 208 HealthNet (Boston Medical Center MCD Program) 205-209 Reserved 210 Medicare HMO - Pilgrim Preferred 65 ** 211 Medicare HMO - Neighborhood Health Plan Senior Health Plus ** 212 Medicare HMO - Healthsource CMHC Central Care Supplement ** 213-219 Reserved 220 Medicare HMO - Blue Care 65 221 Medicare HMO - Harvard Community Health Plan 65 222 Medicare HMO - Healthsource CMHC 223 Medicare HMO - Harvard Pilgrim Health Care of New England Care Plus 224 Medicare HMO - Tufts Secure Horizons 225 Medicare HMO - US Healthcare 226-229 Reserved 230 Medicare HMO - HCHP First Seniority 231 Medicare HMO - Pilgrim Prime 232 Medicare HMO - Seniorcare Direct 233 Medicare HMO - Seniorcare Plus 234 Medicare HMO - Managed Blue for Seniors 235-249 Reserved 250 CIGNA HMO 251 Healthsource CMHC HMO 252-269 Reserved 270 UniCare Preferred Plus PPO 271 Hillcrest HMO 272 Auto Insurance 300 CommCare: BMC HealthNet Plan/Commonwealth Care - General Classification (For use only when no specific level for this plan cal be identified) 301 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type I 302 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type II 303 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type III 304 CommCare: BMC HealthNet Plan/Commonwealth Care - Plan Type IV 400 CommCare: Cambridge Network Health Forward - General Classification (For use only when no specific level for this plan cal be identified) 401 CommCare: Cambridge Network Health Forward - Plan Type I 402 CommCare: Cambridge Network Health Forward - Plan Type II 403 CommCare: Cambridge Network Health Forward - Plan Type III 404 CommCare: Cambridge Network Health Forward - Plan Type IV 500 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – General Classification (For use only when no specific level for this plan cal be identified) 501 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 1 (Group No. 4445077) 502 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 2 (Group No. 4455220) 503 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 3 (Group No. 4455221) 504 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care - Plan 4 (Group No. 4455222) 600 CommCare: Neighborhood Health Plan - General Classification (For use only when no specific level for this plan cal be identified) 601 CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type I (9CC1) 602 CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type II (9CC2) 603 CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type III (9CC3) 604 CommCare: Neighborhood Health Plan - NHP Commnwealth Care Plan - Plan Type IV (9CC4) 990 Free Care - co-pay deductible, or co-insurance (when billing for free care service use #143) New York New York provides information on payer using the Public Health Data Standards Consortium Source of Payment Typology, Version 3.0. Details on the payer typology are available at https://www.health.ny.gov/statistics/sparcs/sysdoc/appp.htm. Vermont Detailed payer information is available in the 5-character alphanumeric payer variable PAYER1_X. The first character indicates the type of payer: 1st character - Type of Payer Description B Blue Cross/Blue Shield C Champus D Medicaid E Other Government Plans G MVP (effective 1/1/20) H HMO I Commercial M Medicare P Self Pay W Workers Comp X Charity (effective 1/1/20) Z Medically Indigent/Free U Unknown The second through fifth characters indicate the payer sub ID: 2nd -5th character - Payer Sub ID Description 1001 Maine 1002 Massachusetts 1003 National 1004 New Hampshire 1005 New York 1006 Vermont 1111 ACO (effective 1/1/20) 1919 Covid 19 HRSA (effective 1/1/20) 2001 BC 2002 CHP Kaiser 2003 VHAP 3001 Healthsource/Cigna 3002 TVHP 3003 Mathew Thronton 3004 MVHP (Discontinued 12/31/19) 4001 Standard Managed Care 4002 Managed Care 8888 No Sub ID 9009 Other West Virginia Detailed payer information is available in the 4-digit payer variable PAYER1_X. The first digit indicates the type of payer: 1st Digit - Type of Payer Description 1 Federal Government 2 West Virginia State Government 3 Other States' Government 4 Commercial 5 Non-profit 6 Employer/ERISA/Union 7 Uninsured 8 Unknown 9 NEC The payment program is indicated by the second digit. 1st Digit - Type of Payer 2nd Digit - Payment Program Description 1 1 Medicare 1 2 DOL - Black Lung 1 3 Railroad Workers 1 4 UMWA Trusts 1 5 Veterans Administration 1 6 Federal Bureau Corrections 1 7 CHAMPUS 1 8 (Reserved) 1 9 Federal NEC 2 1 West Virginia Medicaid 2 2 West Virginia Workers' Compensation 2 3 West Vocational Rehabilitation 2 4 West Virginia PEIA 2 5 West Virginia Maternal & Child Health 2 6 West Virginia Department of Corrections 2 7 West Virginia County/Local Corrections 2 8 WV Children's Health Insurance Program (CHIP) 2 9 West Virginia Government NEC 3 1 Other States' Medicaid 3 2 Other States' Workers' Compensation 3 3-7 (Unassigned) 3 8 (Reserved) 3 9 Other States' Government NEC 4 1 Acordia 4 2 Advantage 4 3 Aetna 4 4 Health Plan of the Upper Ohio Valley 4 5 Prudential 4 6-7 (Unassigned) 4 8 (Reserved) 4 9 Commercial NEC 5 1 AARP 5 2 Blue Cross of Virginia 5 3 Mountain State Blue Cross 5 4 Other Blues 5 5 AccessWV 5 6 West Virginia Small Business Plan 5 7 Unassigned 5 8 (Reserved) 5 9 Non-Profit NEC 6 1 Camcare 6 2 National Association Letter Carriers 6 3 Teamsters 6 4 UMWA 6 5-7 (Unassigned) 6 8 (Reserved) 6 9 Employer/ERISA/Union NEC 7 1 Self-pay 7 2 Charity 7 3-9 (Reserved) 8 8 Unknown 9 9 NEC The payment modality is indicated by the third digit. 3rd Digit - Payment Modality Description 1 Fee for Service/Indemnity (FFS) 2 DRG Prospective Payment System (PPS) 3 Point of Service (POS) 4 HMO 5 Other Managed Care 6 (Unassigned) 7 (Unassigned) 8 Unknown 9 NEC The HMO information is indicated by the fourth digit 4th Digit - HMO Description 0 None 1 Primeone 2 Advantage - Healthguard 3 Carelink 4 Coventry Health Plan (OH) 5 Health Plan of the Upper Ohio Valley (OH) 6 Optimum Choice - (MD) 7 (Unassigned) 8 Unknown 9 NEC

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