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Appendix P-Source of Payment Typology Codes

Source:  Public Health Data Standards Consortium Source of Payment Typology Version 3.0

Effective: October 2007 (NOTE: NYS ADDITIONS September 2008)

CODE DESCRIPTION
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
2111         Family Health Plus (NYS ADDITION)
2112         Healthy New York (NYS ADDITION)
212   Medicaid PPO
213   Medicaid PCCM (Primary Care Case Management)
219   Medicaid Managed Care Other
22 Medicaid (Non-managed Care Plan)        (Fee-For-Service -- NYS ADDITION)
23 Medicaid/SCHIP        (Child Health Plus -- NYS ADDITION)
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 Non-enrolled 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 managed - FFS
389   Federal, State, Local not specified managed - Other
39 Other Federal
 
4 DEPARTMENT 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 payer)
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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