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Source of Payment Typology (Version 3.0)

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The Source of Payment Typology was developed and is maintained by the Public Health Data Standards Consortium's Payer Type Subcommittee. The purpose of the Payer Typology Subcommittee is to create and refine a payer type standard to allow consistent reporting of payer data to public health agencies for health care services and research. The Source of Payment Typology has been incorporated into the ANSI ASC X12 standard. The October 2007 version (5050) of the ANSI ASC X12 837 Health Care Service Data Reporting Guide will support reporting payer type information using the Source of Payment Typology. The ANSI X12 837 standard is flexible enough to provide an interim method of reporting for those states interested in implementing the Source of Payment Typology prior to the publication of the 5050 version of the Health Care Service Data Reporting Guide.

Additional information about the Source of Payment Typology is available on the PHDSC Payer Type Subcommittee Home Page including: a downloadable file of the Source of Payment Typology, a Users Guide, a Fact Sheet, and information about existing pilots that have plans or have already implemented the Source of Payment Typology.

Source of Payment Typology (Version 3.0)

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1 MEDICARE
   
11          Medicare (Managed Care)
111                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)
129                Medicare Non-managed Care Other
   
19           Medicare Other
   
2 MEDICAID
   
21             Medicaid (Managed Care)
211                Medicaid HMO
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
   
3 OTHER GOVERNMENT (Federal/State/Local)
           (excluding Department of Corrections)
   
31      Department of Defense  
311               TRICARE (CHAMPUS)  
3111                       TRICARE  Prime--HMO
3112                       TRICARE  Extra--PPO
3113                      TRICARE Standard - Fee For Service
3114                       TRICARE For Life--Medicare Supplement
3115                   TRICARE Reserve Select
3116                    Uniformed Services Family Health Plan (USFHP) -- HMO
3119                   Department of Defense -  (other) 
312           Military Treatment Facility
3121                   Enrolled Prime--HMO
3122                   Nonenrolled Space Available
3123                  TRICARE For Life (TFL)
313           Dental --Stand Alone
   
32           Department of Veterans Affairs
321          Veteran care--Care provided to Veterans
3211                  Direct Care--Care provided in VA facilities
3212                  Indirect Care--Care provided outside VA facilities
32121                          Fee Basis
32122                          Foreign Fee/Foreign Medical Program(FMP)
32123                          Contract Nursing Home/Community Nursing Home
32124                          State Veterans Home
32125                          Sharing Agreements
32126                          Other Federal Agency
   
322          Non-veteran care
3221                  Civilian Health and Medical Program for the VA (CHAMPVA)
3222                  Spina Bifida Health Care Program (SB)
3223                  Children of Women Vietnam Veterans (CWVV)
3229                   Other non-veteran care
   
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 (codes for individual states)
362              Specific state programs (list/ local code)
369               State, not otherwise specified (other state)
           
37          Local Government
371                Local - Managed care
3711                  HMO
3712                     PPO
3713                    POS
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 managed care
3811                       Federal, State, Local not specified - HMO
3812                       Federal, State, Local not specified - PPO
3813                   Federal, State, Local not specified - POS
3819                   Federal, State, Local not specified - not specified managed care
382           Federal, State, Local not specified - FFS
389           Federal, State, Local not specified - Other
           
39       Other Federal
   
4 DEPARTMENTS OF CORRECTIONS
   
41       Corrections Federal
42       Corrections State
43       Corrections Local
44       Corrections Unknown Level
   
5 PRIVATE HEALTH INSURANCE
   
51       Managed Care (Private)
511             Commercial Managed Care - HMO
512             Commercial Managed Care - PPO
513             Commercial Managed Care - POS
514             Exclusive  Provider Organization
515             Gatekeeper PPO (GPPO)
519             Managed Care, Other (non HMO)
             
52       Private Health Insurance - Indemnity
521            Commercial Indemnity
522            Self-insured (ERISA) Administrative Services Only (ASO) plan
523            Medicare supplemental policy (as second payor)
529         Private health insurance—other commercial Indemnity
   
53         Managed care (private) or private health insurance (indemnity),
        not otherwise specified
54       Organized Delivery System
55       Small Employer Purchasing Group
59       Other Private Insurance
   
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   (to be used only if one can't distinguish public from private)
   
71       HMO
72       PPO
73       POS
79       Other Managed Care, Unknown if public or private
   
8 NO PAYMENT from an  Organization/Agency/Program/Private Payer Listed
   
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
   
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 HMO
953             Worker's Comp Fee-for-Service
954             Worker’s Comp Other Managed Care
959             Worker's Comp, Other unspecified
               
96       Auto Insurance (no fault)
98       Other specified (includes Hospice - Unspecified plan)
99       No Typology Code available for payment source
   
ZZZ Unavailable / Unknown

 

 

 
 

 
  
 

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