Central Distributor SEDD: Description of Data Elements

PAYER1_X - Expected primary payer identifier, plan specific

Documentation Sections:

PAYER1_X retains the expanded, detailed expected primary payer plan codes provided by the data source. PAY1_X contains payer categories (e.g., commercial insurance); more detailed, plan-specific codes are reported in PAYER1_X (e.g., AETNA and United Healthcare). The original values have not been recoded into uniform HCUP values and are source-specific.

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Uniform Values

Variable	Description	Value	Value Description
PAYER1_X	Expected primary payer identifier, plan specific	n(a)	State specific coding - See the "State Specific Notes" section for details

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State Specific Notes

Maryland

Beginning with 2021 data, MD supplies a 3-digit expected payer code. *In addition, coding was transitioned to new FY values begin with 2021 Q3 data - however, the old coding system, which began in 2015, remains in effect through 2021 Q2. However, in in the 2021 Q1/Q2 a 0 is appended to the beginning of each value: for example, value 30, still defined as Aetna Health, will appear as 030 for 2021 Q1/Q2 data only.

Code	Description
(Beginning 2021 Q3)
Commercial HMO/POS/PPO/PPN/TPA
101	AETNA HEALTHPLANS
102	CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
103	CIGNA
104	GENERIC TPA/COMMERCIAL PLANS
105	GENERIC COMMERCIAL EMPLOYEE HEALTH PLANS
106	HUMANA
107	KAISER PERMANENTEÂ
108	UNITED HEALTHCAREÂ
125	JOHNS HOPKINS EMPLOYEE HEALTH PLANS
126	UNIVERSITY OF MD EMPLOYEE HEALTH PLANSÂ
127	MEDSTAR EMPLOYEE HEALTH PLANSÂ
MD Medicaid MCO
98	HEALTH PLAN PAYERS NOT SPECIFIED BELOW
101	AETNA HEALTHPLANS
102	CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
107	KAISER PERMANENTE
108	UNITED HEALTHCARE
109	AMERIGROUP COMMUNITY CARE
110	JAI MEDICAL SYSTEMS
111	MARYLAND PHYSICIANS CAREÂ
112	MEDSTAR FAMILY CHOICEÂ
113	PRIORITY PARTNERSÂ
118	OPTUM MARYLAND (MD MEDICAID) (previously Beacon Health)
Medicare Advantage
98	HEALTH PLAN PAYERS NOT SPECIFIED BELOW
101	AETNA HEALTHPLANS
102	CAREFIRST BLUECROSS BLUESHIELD (INCLUSIVE OF ALL COMMUNITY, COMMERCIAL, AND FEP PRODUCTS, includes formerly UNIVERSITY OF MD HEALTH PARTNERS)
103	CIGNA
106	HUMANA
107	KAISER PERMANENTEÂ
108	UNITED HEALTHCAREÂ
109	AMERIGROUP COMMUNITY CARE
115	JOHNS HOPKINS ADVANTAGE MDÂ
116	PROVIDER PARTNERS HEALTH PLAN (NEW)
128	HORIZONS MEDICARE DIRECT
Behavioral Health
98	HEALTH PLAN PAYERS NOT SPECIFIED BELOW
107	KAISER PERMANENTE
119	MAGELLANÂ
120	CIGNA BEHAVIORAL HEALTHÂ
121	COMPSYCH
122	MANAGE HEALTH NETWORK
123	OPTUM BEHAVIORAL HEALTH (Commercial)Â
124	BEACON HEALTH OPTIONSÂ

Code	Description
*(Effective 2009-2020 Q2)**
Commerical HMO/POS:
30	Aetna Health, Inc.
31	CareFirst Bluechoice
32	Cigna Healthcare of Mid-Atlantic (Discontinued 6/30/16)
33	Coventry Health Care of Delaware, Inc.(Discontinued 6/30/20)
34	Kaiser Permanente of the Mid-Atlantic States
35	MAMSI (Discontinued 6/30/16)
36	United Healthcare of the Mid-Atlantic, Inc. (includes Allsavers)
37	Other HMO/POS
38	Evergreen Health Cooperative, Inc. (Discontinued 6/30/20)
39	Optum Maryland (Medicaid behavioral health) (effective 7/1/2020)
40	Beacon Health Option (effective 7/1/2020)
MD Medicaid MCO:
42	Amerigroup
43	Coventry Health Plan of Delaware (Diamond Plan)
44	MedStar Family Choice, Inc.
45	JAI Medical Group
46	Value Options / Beacon (Discontinued 6/30/20)
47	Maryland Physicians Care
48	Priority Partners
49	United Healthcare Community Plan
50	Other Medicaid MCO/HMO
51	2009-6/30/2019: Riverside Health. 7/1/2019-6/30/2020: CAREFIRST BLUECROSS BLUESHIELD COMMUNITY HEALTH PLAN MARYLAND (formerly called UNIVERISTY OF MARYLAND HEALTH PARTNERS BEFORE)
52	Kaiser MCO (Effective 7/1/16)
53	PROVIDER PARTNERS HEALTH PLAN (Effective 7/1/2020)
Medicare MA:
55	Aetna Medicare Advantage
58	Other Medicare HMO
59	InforMed (discontinued 6/30/2020)
60	Cigna Healthspring (Bravo)
61	Kaiser Foundation Health Plan
62	CAREFIRST BLUECROSS BLUESHIELD MEDICARE ADVANTAGE (formerly known as UNIVERSITY OF MARYLAND HEALTH ADVANTAGE HMO before 02/01/2020 (Effective 7/1/16)
63	Medstar Medicare Choice (includes choice Dual Advantage & Care Advantage) (Effective 7/1/16 - discontinued 6/30/2020)
64	Johns Hopkins Medicine Medicare Plan (Advantage MD) (Effective 7/1/16)
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65	Aetna Life and Health Insurance Company
66	CareFirst of MD Inc. (CFMI)
67	Carefirst Group Hospitalization and Medical Services Inc. (GHMSI)
68	CCN/First Health (Discontinued 6/30/16)
69	Cigna Life and Health Insurance Company, Inc. (includes connecticut General Life Insurance Companry Inc.)
70	Employer Health Plan (EHP)
71	Fidelity Benefits Administrator (Discontinued 6/30/16)
72	Great West One Plan (Discontinued 6/30/16)
73	Kaiser Permanente Insurance Company (includes Harringon Health and Health Plan Services (TPA to Kaiser)
74	United Healthcare Insurance Company (i.e. One Net PPO, MAMSI Life and Health) Optimum choice, Golden Rule Insurance Companry, MD Individual Practice Association, UMR Inc.)
75	Carefirst Administrators LLC/National Capital Administrative Services (discontinued 6/30/2020)
76	Private Health Care Systems (PHCS)
77	Other Commercial, PPO, PPN, TPA (N/A effective 2020 Q3)
78	Anthem BC/BS (Discontinued 6/30/16)
79	Coresource, Inc. (Effective 7/1/16)
80	Group Benefit Services, Inc. (Effective 7/1/16)
81	Coventry Health and Life Insurance Company / Coventry Nnational Network
82	Healthsmart Benefit Solutions, Inc. (Effective 7/1/16)
83	Humana (Effective 7/1/16)
Behavioral Health:
84	Carefirst PPO Behavioral Health (discontinued 6/30/2020)
85	American Psychiatric Systems (APS) (Discontinued 6/30/16)
86	Cigna Behavioral Health
87	ComPsych
88	Magellan
89	Managed Health Network
90	United Optum Behavioral Health (includes Optum Behavioral Solutions effective 7/1/2020)
91	Value Options (discontinued 6/30/2020)
92	Other Behavioral Health
Other Government Programs (Including Out-of-State Medicaid Programs):
54	Out-of-State (Non-MD) Medicaid
93	MD Health Insurance Plan (MHIP) EPO (discontinued 6/30/2020)
94	MD Health Insurance Plan (MHIP) PPO (discontinued 6/30/2020)
95	Tricare - example: Health Net
96	Uniformed Services Family Health Plan (USFHP)
97	Other miscellaneous government programs (includes non-MD Medicaid)
Other:
00	Not applicable
01	Other Health Plan Payers [including Qualified Dental Plans (QDPs) and Pharmacy Benefit Managers (PBMs)] (Effective 7/1/16)
99	Unknown

Code	Description
(Effective 2009-2014)
Primary Adult Care (PAC) MCO:
01	Amerigroup
02	Jai Medical Group
03	Maryland Physicians Care
04	Priority Partners
05	United HealthCare
HMO/POS:
30	Aetna Health Plans
31	CareFirst Blue Choice
32	Cigna Healthcare of Mid-Atlantic
33	Coventry Health Plan of Delaware
34	Kaiser Permanente
35	MAMSI
36	United Healthcare
37	Other HMO/POS
Medicaid MCO/HMO:
42	Amerigroup
43	Coventry Health Plan of Delaware (Diamond Plan)
44	MedStar Family Choice, Inc.
45	JAI Medical Group
46	Value Options
47	Maryland Physicians Care
48	Priority Partners
49	United Healthcare (Americhoice)
50	Other Medicaid MCO/HMO
51	Riverside Health
Medicare HMO:
55	Aetna (Golden Choice)
56	ElderHealth
57	United Healthcare (Evercare)
58	Other Medicare HMO
59	InforMed
60	Bravo Health
61	Kaiser Foundation Health Plan
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65	Aetna
66	CareFirst- CareFirst of Maryland, Inc (CFMI (Maryland)) (PPO, POS, Blue Preferred, REP)
67	CareFirst- Group Hospitalization and Medical Services Inc (DC) (PPO, POS, Blue Preferred) Federal Employee Program (FEP)
68	CCN/First Health
69	Cigna
70	Employer Health Plan (EHP)
71	Fidelity Benefits Administrator
72	Great West One Plan
73	Kaiser Permanente
74	MAMSI (Alliance PPO and MAMSI Life and Health)
75	National Capital PPO (NCPPO)
76	Private Health Care Systems (PHCS)
77	Other Commercial, PPO, PPN, TPA
78	Anthem BC/BS
Behavioral Health:
85	American Psychiatric Systems (APS)
86	Cigna Behavioral Health
87	ComPsych
88	Magellan
89	Managed Health Network
90	United Behavioral Health
91	Value Options
92	Other Behavioral Health
Other Government Programs:
93	MD Health Insurance Plan (MHIP) EPO
94	MD Health Insurance Plan (MHIP) PPO
95	Tricare - example: Health Net
96	Uniformed Services Family Health Plan (USFHP)
97	Other miscellaneous government programs (includes non-MD Medicaid)
Other
0	Not applicable
99	Unknown

Beginning in 2006, PAYER values 01-29 are eliminated. Please see the new values below.

Code	Description
(Beginning in 2006)
Primary Health Plan Payer HMO/POS:
30	Aetna Health Plans
31	CareFirst Blue Choice
32	Cigna Healthcare of Mid-Atlantic
33	Coventry Health Plan of Delaware
34	Kaiser Permanente
35	MAMSI
36	United Healthcare
37	Other HMO/POS
Medicaid MCO/HMO:
42	Amerigroup
43	Coventry Health Plan of Delaware (Diamond Plan)
44	Helix Family Choice, Inc.
45	JAI Medical Group
46	Medicaid/Uninsured APS â€“ Maryland (psychiatric payer)
47	Maryland Physicians Care
48	Priority Partners
49	United Healthcare (Americhoice)
50	Other Medicaid MCO/HMO
Medicare HMO:
55	Aetna (Golden Choice)
55	Aetna (Golden Choice)
56	ElderHealth
57	United Healthcare (Evercare)
58	Other Medicare HMO
Commercial (Indemnity), PPO/PPN/Third Party Administrators (TPAs):
65	Aetna
66	CareFirst- CareFirst of Maryland, Inc (BC/BS Plan #190/690)
67	CareFirst- Group Hospitalization and Medical Services Inc (Non HMO) (BC/BS Plan #080/580) Federal Employee Program
68	CCN/First Health
69	Cigna
70	Employer Health Plan (EHP)
71	Fidelity Benefits Administrator
72	Great West One Plan
73	Kaiser Permanente
74	MAMSI (that is, Alliance PPO and MAMSI Life and Health)
75	National Capital PPO (NCPPO)
74	MAMSI (that is, Alliance PPO and MAMSI Life and Health)
76	Private Health Care Systems (PHCS)
77	Other Commercial, PPO, PPN, TPA
Behavioral Health:
85	American Psychiatric Systems (APS)
86	Cigna Behavioral Health
87	ComPsych
88	Magellan
89	Managed Health Network
90	United Behavioral Health
91	Value Options
92	Other Behavioral Health
Other Government Programs:
93	MD Health Insurance Plan (MHIP) EPO
94	MD Health Insurance Plan (MHIP) PPO
95	Tricare - example: Health Net
96	Uniformed Services Family Health Plan (USFHP)
97	Other miscellaneous government programs
00	Not applicable
99	Unknown

Beginning in 2003, HCUP retained the managed care payer information on the AS/ED files. PAYER1_X includes the plan name of the managed care payer. This includes the health maintenance organizations (HMO), managed care organizations (MCO), and provider sponsored organizations (PSO). Source definitions are

Code	Description
(Prior to 2006)
01	AETNA Health Plan Atlantic
02	CapitalCare (Blue Cross National Capital Area)
03	CFS Health Group (Carefirst, Freestate, Potomac Health)
04	Chesapeake Health Plan
05	CIGNA Healthcare MidAtlantic Inc.
06	Columbia Medical Plan
07	Delmarva Health Plan
08	Humana Group Health Plan
09	GWU Health Plans
10	NYL Care (HealthPlus, Inc., Sanus, New York Life Care, New York Life)
11	Kaiser Permanente
12	MAMSI (MDIPA, Optimum Choice, Alliance)
13	Total Health Care
14	U.S. Healthcare
15	Prudential Healthcare Plan - Mid Atlantic
16	Principal Health Care of Mid Atlantic
17	Preferred Health Network of MD
18	Physicians Health Plan Inc.
19	Principal Health\Care of Delaware, Inc.
20	Maryland Physicians Care
21	Helix Family Health
22	JAI Medical
23	Priority Partners
24	United HealthCare
25	New American Health
26	Prime Health
29	Other HMO/MCO/PSO

Source values for "Not Applicable" and "Unknown" are recoded to missing (PAYER1_X = " ").

New York

New York provides information on payer using the Public Health Data Standards Consortium Source of Payment Typology, Version 3.0. Details on the payer typology are available at https://www.health.ny.gov/statistics/sparcs/sysdoc/appp.htm.

Vermont

Detailed payer information is available in the 5-character alphanumeric payer variable PAYER1_X.

The first character indicates the type of payer:

1st character - Type of Payer	Description
B	Blue Cross/Blue Shield
C	Champus
D	Medicaid
E	Other Government Plans
G	MVP (effective 1/1/20)
H	HMO
I	Commercial
M	Medicare
P	Self Pay
W	Workers Comp
X	Charity (effective 1/1/20)
Z	Medically Indigent/Free
U	Unknown

The second through fifth characters indicate the payer sub ID:

2nd -5th character - Payer Sub ID	Description
1001	Maine
1002	Massachusetts
1003	National
1004	New Hampshire
1005	New York
1006	Vermont
1111	ACO (effective 1/1/20)
1919	Covid 19 HRSA (effective 1/1/20)
2001	BC
2002	CHP Kaiser
2003	VHAP
3001	Healthsource/Cigna
3002	TVHP
3003	Mathew Thronton
3004	MVHP (Discontinued 12/31/19)
4001	Standard Managed Care
4002	Managed Care
8888	No Sub ID
9009	Other

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Central Distributor SEDD: Description of Data Elements