Source of Payment Typology (Version 3.0)

Source of Payment Typology (Version 3.0) View/Download PDF Version (28 KB) View/Download Excel Version View/Download Word Version
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 -- Payment directly by the patient, personal guarantor, relatives, or friends.

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