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Appendix D-Expected Reimbursement Codes

It is important that pay source information be as accurate as possible. Regular and frequent communication between the Medical Records Office and the Patient Accounts Department is essential to achieve accuracy in the Expected Reimbursement Code field.

NYS Expected
Reimbursement Code
    

Definition
01 Self-Pay
02 Workers' Compensation
03 Medicare
04 Medicaid
06 Blue Cross
07 Other Government
08 Commercial Insurance Company
09 No Charge
10 Other
11 HMO - Other
12 CHAMPUS/VA
13 No-Fault
14 Corrections - Federal, State, or Local (Obsolete 1/1/1996)
15 Self-Insured, Self-Administered Plan
16 Medicare HMO (Effective 1/1/1993)
17 Medicaid HMO (Effective 1/1/1993)
18 Corrections - Federal (Effective 1/1/1996)
19 Corrections - State (Effective 1/1/1996)
20 Corrections - Local (Effective 1/1/1996)

Below are some enhancements to the Expected Reimbursement definitions.

Corrections Patient is from a state, local, or federal correctional facility. It should be noted that effective 1/1/1996 there are separate codes for state, local, and federal correctional facilities.

Self Insured, Self Administered

Plan is administered by employer or third-party on behalf of the employer. Employee Retirement Income and Security Act (ERISA) plans are typically considered this type of plan.

Medicare HMO

HMO is engaged in a Federal Risk Contract or an HMO is taking Medicare aged patients with Medicare benefits.

Medicaid HMO

HMO is contracted with Department of Social Services to provide benefits to Medicaid patients.