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Payer Typology Implementation Pilot Projects

The development of the Payer Typology underscored the deficiencies in the current code sets used to identify the category of payer. Most state reporting systems collect a payer data for a variety of purposes. Many state systems use “home grown” payer codes sets for their purposes. Some other states use the ANSI X12 maintained code set, which is mandated for institutional claims by the HIPAA rules. Both the “home grown” and HIPAA mandated code sets share common problems. Each has categories that are not adequately defined. Each has gaps or overlapping categories. The Payer Typology developed and maintained by the Public Health Data Standards Consortium was created to address these short comings with a hierarchical code list. 

A hierarchical code list has the capabilities to accommodate different state requirements with one standard that can be applied with different levels of granularity.

Now that the Payer Typology has been developed and the work is well underway to get the ANSI X12 standards to support the reporting of the Payer Typology as an external code list, there is an effort to recruit states to pilot the use of this code set.

Payer Typology Implementation Pilot Projects