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.
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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 |
