HCUP Methods Series Supplements 1-3 An Examination of Expected Payer Coding in HCUP Databases Report #

Transcription

1 HCUP Methods Series

2 Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD For Technical Assistance with HCUP Products: or Phone: HCUP Recommended Citation: Barrett M, Lopez-Gonzalez L, Hines A, Andrews R, Jiang J. An Examination of Expected Payer Coding in HCUP Databases, Supplements HCUP Methods Series Report # ONLINE. December 17, U.S. Agency for Healthcare Research and Quality. Available:

3 The Healthcare Cost and Utilization Project (HCUP) Methods Series Report An Examination of Expected Payer Coding in HCUP Databases was produced in order to inform HCUP data users about expected payer codes by (1) presenting detailed information about the expected payer codes collected by HCUP States, (2) suggesting how these payer codes can be used for research purposes, and (3) examining the extent to which HCUP data capture discharges covered by these payers in comparison with other national data sources. Although the report provides information on all types of payers, the focus is on payers for low-income populations (especially the uninsured) and managed care. These are two areas of coding that tend to be the least standardized, and they are of increasing interest for researchers. The Methods Series report includes a main descriptive report and four separate supplements. Supplements 1 3 include coding information for the HCUP State databases specific to the uninsured, managed care, and Medicaid. Supplement 4 has detailed data tables supporting the comparative figures in the main report. This document includes the three supplements with information on the expected payer coding in the HCUP State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). Supplement 1. HCUP State-Specific Recodes for the Uninsured... 1 Table 1A. State-Specific Recodes for the Uninsured to Align HCUP Payer Codes with the American Community Survey (ACS)... 1 Supplement 2. HCUP State-Specific Coding for Managed Care... 3 Table 2A. State-Specific Coding for Medicare Managed Care... 3 Table 2B. State-Specific Coding for Medicaid Managed Care... 7 Table 2C. State-Specific Coding for Private Managed Care Supplement 3. HCUP State-Specific Recodes for Medicaid to Align HCUP with the American Community Survey Table 3A. State-Specific Recodes for Medicaid to Align HCUP Payer Codes with the American Community Survey (ACS) HCUP (12/2/14) Methods Series Report: HCUP Payer Coding, Supplements

4 SUPPLEMENT 1. HCUP STATE-SPECIFIC RECODES FOR THE UNINSURED The following table includes State-specific recodes for the programs that cover the uninsured. Recoding these payers to uninsured aligns the HCUP payer codes with the American Community Survey (ACS) definition of the uninsured. The information can be reported in either the expected primary payer as received from the State (HCUP data element ) or the expected primary payer plan identifier as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it does not identify other Federal, State, and local programs that serve the uninsured. Table 1A. State-Specific Recodes for the Uninsured to Align HCUP Payer Codes with the American Community Survey (ACS) State Alaska N/A N/A Indian Health Service Arizona N/A Indian Health Services California 05n, where n= N/A N/A County Indigent Programs California 07n, where n= N/A N/A Other Indigent (includes charity care) Colorado N/A Colorado Medically Indigent Georgia Indian Health Service or Tribe Georgia Indian Health Service (Regular) Georgia Indian Health Service (Contract) Georgia Indian Health Service (Managed Care) Georgia Indian Tribe (Sponsored Coverage) Georgia Migrant Health Program Georgia Ryan White Act Maryland PAYERn_X = Maryland Health Insurance Plan (MHIP) 93 and 94 Massachusetts H N/A 2009 Sept Health Safety Net 2009 Massachusetts 995 N/A N/A Oct Health Safety Net Massachusetts PAYERn_X = N/A N/A Children's Medical Security Plan (CMSP) 178 Montana N/A N/A Indian Health Services Nevada Hill-Burton Free Care (HBFC) HCUP (12/2/14) 1 Methods Series Report: HCUP Payer Coding, Supplement 1

5 Nevada County Indigent Referral (Patient has already been approved for County Coverage) Nevada Section 1011 undocumented Aliens/unknown New Mexico N/A N/A IHS/PHS New Mexico N/A N/A County Indigent Funds (CIF) Ohio R Hospital Care Assurance Program (HCAP) Oregon N/A Indian Health Service or Tribe South Carolina Other Agency, Charity (i.e. Medical Indigent Assistance Program (MAIP), Hill Burton, County Government, etc.) Virginia N/A N/A Indigent/Charity HCUP (12/2/14) 2 Methods Series Report: HCUP Payer Coding, Supplement 1

6 SUPPLEMENT 2. HCUP STATE-SPECIFIC CODING FOR MANAGED CARE The following tables include State-specific coding that can be used to identify patients in which the expected payer is a managed care plan. Table 2A includes information on the coding of Medicare managed care plans. Table 2B includes information on the coding of Medicaid managed care plans. Table 2B includes information on the coding of managed care plans for the privately insured. The information can be reported in either the expected primary payer, as received from the State (HCUP data element ), or the expected primary payer plan identifier, as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it did not have detailed payer codes that identified managed care plans. Table 2A. State-Specific Coding for Medicare Managed Care State (Unless Noted) SID Years SASD Years SEDD Years Source Description Arizona N/A Medicare Risk California N/A N/A Medicare (HMO) California N/A N/A Medicare (Managed care - Other) California 16 N/A Health Maintenance Organization (HMO) Medicare Risk Connecticut M Medicare managed care Florida B Medicare HMO or Medicare PPO Florida B Medicare Managed Care Georgia Medicare Managed Care Georgia Medicare HMO Georgia Medicare HMO, Aetna Inc. Georgia Medicare HMO, Coventry Health Care, Inc. Georgia Medicare HMO, Humana Inc. Georgia Medicare HMO, Kaiser Foundation Health Plan, Inc. Georgia Medicare HMO, United HealthCare of Georgia, Inc. Georgia Medicare HMO, Wellcare of Georgia Georgia Medicare HMO, WellPoint, Inc. Georgia Other Medicare HMO Georgia Medicare Managed Care (PPO) HCUP (12/2/14) 3 Methods Series Report: HCUP Payer Coding, Supplement 2

7 (Unless Noted) SID Years SASD Years SEDD Years Source Description Georgia Medicare Managed Care (POS) Georgia Medicare Managed Care (Other) Hawaii Kaiser 65C+ Hawaii AlohaCare Advantage/Advantage Plus Iowa Medicare Managed Care Kansas Medicare Managed Care Kentucky Medicare Managed Care Kentucky R 2008; 2008; 2008; Medicare Managed Care Maryland Medicare HMO Massachusetts F N/A Medicare Managed Care Michigan N/A Medicare Managed Care Plans Minnesota Blue Cross, MN, Medicare Minnesota Medica - Choice, Medicare Minnesota Group Health, Medicare Minnesota Medica - Primary, Medicare Minnesota UCare, Medicare Minnesota Blue Plus, Medicare Minnesota Metro. Health Plan, Medicare Minnesota Health Partners, Medicare Minnesota First Plan HMO, Medicare Minnesota Blue Cross HMO, Medicare Minnesota Other HMO, Medicare Minnesota America's PPO, Medicare Minnesota Aetna PPO, Medicare Minnesota Other PPO, Medicare Montana N/A N/A Medicare Managed Care New Hampshire Medicare Managed Care New Jersey Medicare HMO Nevada Medicare HMO New York Medicare HMO North Dakota N/A Blue Cross, MN, Medicare North Dakota N/A Medica - Choice, Medicare HCUP (12/2/14) 4 Methods Series Report: HCUP Payer Coding, Supplement 2

8 (Unless Noted) SID Years SASD Years SEDD Years Source Description North Dakota N/A Group Health, Medicare North Dakota N/A Medica - Primary, Medicare North Dakota N/A UCare, Medicare North Dakota N/A Blue Plus, Medicare North Dakota N/A Metro. Health Plan, Medicare North Dakota N/A Health Partners, Medicare North Dakota N/A First Plan HMO, Medicare North Dakota N/A Blue Cross HMO, Medicare North Dakota N/A Other HMO, Medicare North Dakota N/A America's PPO, Medicare North Dakota N/A Aetna PPO, Medicare North Dakota N/A Other PPO, Medicare Ohio O Medicare Managed Care Oregon N/A Medicare (Managed Care) Pennsylvania N/A N/A Medicare - PPO Pennsylvania N/A N/A Medicare - POS Pennsylvania N/A N/A Medicare - HMO Rhode Island B N/A N/A Out of State Blue Cross, Medicare (managed care) Rhode Island H N/A N/A Coordinated Health Partners, Medicare (managed care) Rhode Island O N/A N/A Other, Medicare (managed care) Rhode Island U N/A N/A UHC, Medicare (managed care) South Dakota Medicare - Managed Care (e.g., HMO, PPO, PCCM)) Tennessee K Medicare HMO/PSO Texas N/A Health Maintenance Organization (HMO) Medicare Risk Vermont PAYER1_X = M Medicare - Managed Care Wisconsin MED Medicare - Alternative health care insurance plans (e.g., HMO, PPO, PPA) Wisconsin T Medicare - Alternative health care insurance plans (e.g., HMO, PPO, PPA) HCUP (12/2/14) 5 Methods Series Report: HCUP Payer Coding, Supplement 2

9 West Virginia (Unless Noted) SID Years SASD Years SEDD Years Source Description PAYER1_X = 113n, 114n or 115n, where n can have the values N/A N/A WV reports a four-digit payer code in PAYERn_X. The first digit indicates the types of payer with 1 indicating the federal government. The second digit indicates the payment program with the value 1 indicating Medicare. The third digit indicates the payment modality with the values: (3) point of service, (4) HMO, and (5) other managed care. The fourth digit include information on the HMO using the following values: (0) none, (1) Acordia, (2) Advantage, (3) Carelink, (4) Coventry Health plan, (5) Health Plan of Upper Ohio Valley, (6) Optimum Choice, (8) unknown, and (9) not elsewhere classified HCUP (12/2/14) 6 Methods Series Report: HCUP Payer Coding, Supplement 2

10 Table 2B. State-Specific Coding for Medicaid Managed Care State California N/A N/A Medi-Cal (HMO) California N/A N/A Medi-Cal (Managed care - Other) Connecticut J Medicaid managed care Florida D Medicaid HMO Florida D Medicaid Managed Care Georgia Medicaid Managed Care Georgia Medicaid HMO Georgia Medicaid HMO, Amerigroup CMO Georgia Medicaid HMO, PeachState CMO Georgia Medicaid HMO, WellCare CMO Georgia Medicaid Managed Care (PPO) Georgia Medicaid Managed Care (Other) Hawaii Hawaii QUEST (managed care) Hawaii AlohaCare (plan participating in QUEST) Hawaii HMSA QUEST Hawaii Kaiser QUEST Hawaii QUEST (Any QUEST Plan except AlohaCare, HMSA Quest, Kaiser Quest) Iowa Medicaid Managed Care Kansas Medicaid Managed Care Kentucky Passport Medicaid Managed Care Kentucky P 2008; 2008; 2008; Passport Medicaid Managed Care Kentucky Q Kentucky Spirit Medicaid Managed Care Kentucky T Coventry Cares of KY Medicaid Managed Care Kentucky U WellCare of Kentucky Medicaid Managed Care Massachusetts B N/A Medicaid Managed Care Maryland Medicaid HMO Michigan N/A Medicaid Managed Care Plans Minnesota PrimeWest, Cty Based Purchased Minnesota Itasca Medical Care, CBP Minnesota So. Country Hlth Alliance, CBP HCUP (12/2/14) 7 Methods Series Report: HCUP Payer Coding, Supplement 2

11 Minnesota Medica - Choice, Medicaid Minnesota Group Health, Medicaid Minnesota Medica - Primary, Medicaid Minnesota Ucare, Medicaid Minnesota Blue Plus, Medicaid Minnesota Metro. Health Plan, Medicaid Minnesota Blue Cross HMO, Medicaid Minnesota Health Partners, Medicaid Minnesota First Plan HMO, Medicaid Minnesota Other HMO, Medicaid Minnesota Blue Cross PPO, Medicaid Minnesota Medica Choice PPO, Medicaid Minnesota LaborCare PPO, Medicaid Minnesota Other PPO, Medicaid Montana N/A N/A Medicaid Managed Care New Hampshire Medicaid Managed Care New Jersey Medicaid HMO Nevada Nevada Medicaid HMO New York Medicaid HMO North Dakota N/A Medica - Choice, Medicaid North Dakota N/A Group Health, Medicaid North Dakota N/A Medica - Primary, Medicaid North Dakota N/A Ucare, Medicaid North Dakota N/A Blue Plus, Medicaid North Dakota N/A Metro. Health Plan, Medicaid North Dakota N/A Blue Cross HMO, Medicaid North Dakota N/A Health Partners, Medicaid North Dakota N/A First Plan HMO, Medicaid North Dakota N/A Other HMO, Medicaid North Dakota N/A Blue Cross PPO, Medicaid North Dakota N/A Medica Choice PPO, Medicaid North Dakota N/A LaborCare PPO, Medicaid North Dakota N/A Other PPO, Medicaid HCUP (12/2/14) 8 Methods Series Report: HCUP Payer Coding, Supplement 2

12 Ohio M Medicaid HMO Oregon N/A Medicaid (Managed Care) Pennsylvania N/A N/A Medicaid - PPO Pennsylvania N/A N/A Medicaid - HMO Rhode Island B N/A N/A Out of State Blue Cross, Medicaid (managed care) Rhode Island H N/A N/A Coordinated Health Partners, Medicaid (managed care) Rhode Island N N/A N/A Neighborhood Health Plan, Medicaid (managed care) Rhode Island O N/A N/A Other, Medicaid (managed care) Rhode Island U N/A N/A UHC, Medicaid (managed care) South Dakota Medicaid - Managed Care (e.g. HMO, PPI, PCCM) Tennessee T TennCare Plan: Unspecified Tennessee TennCare Plan: UAHC Tennessee TennCare Plan: Windsor Health Plan of TN, Inc. Tennessee TennCare Plan: AmeriChoice (previously John Deere/Heritage) Tennessee TennCare Plan: Preferred Health Partnership Tennessee TennCare Plan: AmeriChoice (previously John Deere/Heritage) Tennessee F TennCare Plan: TLC Family Care Healthplan Tennessee J TennCare Plan: Blue Care Tennessee Q TennCare Plan: TennCare Select Tennessee R TennCare Plan: Unison Health Plan Tennessee U TennCare Behavioral: Tennessee Behavioral Health, Inc. Tennessee E TennCare Behavioral: BHO - plan unspecified Tennessee X TennCare Behavioral: Premier Behavioral Systems of TN Vermont PAYER1_X = D Medicaid CHP Kaiser Wisconsin MAX Badger Care Plus - Alternative health care insurance plans (HMO, PPO, PPA, etc.) Wisconsin T T19nn means Wisconsin Medicaid and 02 means Alternative Health Care Insurance Plans (HMO, PPO) HCUP (12/2/14) 9 Methods Series Report: HCUP Payer Coding, Supplement 2

13 West Virginia PAYER1_X = 213n, 214n, 215n, 313n, 314n, 315n,where n can have the values N/A N/A WV reports a four-digit payer code in PAYERn_X. The first two digits of 21 indicate West Virginia Medicaid and the first two digits of 31 indicate other States Medicaid. The third digit indicates the payment modality with the values: (3) point of service, (4) HMO, and (5) other managed care. The fourth digit include information on the HMO using the following values: (0) none, (1) Acordia, (2) Advantage, (3) Carelink, (4) Coventry Health plan, (5) Health Plan of Upper Ohio Valley, (6) Optimum Choice, (8) unknown, and (9) not elsewhere classified HCUP (12/2/14) 10 Methods Series Report: HCUP Payer Coding, Supplement 2

14 Table 2C. State-Specific Coding for Private Managed Care State Arkansas H N/A N/A HMO/Managed Care Arizona N/A HMO Arizona 03, N/A PPO California N/A N/A Private Coverage (HMO) California N/A N/A Private Coverage (Managed care - Other) California 12 N/A Preferred Provider Organization (PPO) California 13 N/A Point of Service (POA) California HM N/A Health Maintenance Organization Colorado N/A HMO-PPO / Managed Care / Discounted Connecticut S HMO Connecticut T PPO Florida F Commercial HMO Florida G Commercial PPO Georgia Managed Care (Private) Georgia Commercial Managed Care (HMO) Georgia Commercial Managed Care (PPO) Georgia Commercial Managed Care (POS) Georgia Managed Care, Other (non-hmo) Georgia BC Managed Care Georgia BC Managed Care (HMO) Georgia BC Managed Care (PPO) Georgia BC Managed Care (POS) Georgia BC Managed Care (Other) Georgia Managed Care (Unspecified) Georgia Managed Care (Unspecified) - HMO Georgia Managed Care (Unspecified) - PPO Georgia Managed Care (Unspecified) - POS Georgia Managed Care (Unspecified) - other managed care (unknown if public or private) Hawaii Kaiser HCUP (12/2/14) 11 Methods Series Report: HCUP Payer Coding, Supplement 2

15 Illinois Dnnnnnnnnn, where N/A N/A Commercial HMO nnnnnnnnn is a 9-digit number Kansas Blue Cross/Blue Shield Managed Care Kansas All Commercial Payers Managed Care Kentucky L 2008; 2008; 2008; Commercial - HMO Kentucky M 2008; 2008; 2008; Commercial - Other Managed Care Kentucky Commercial - PPO Kentucky Commercial - HMO Louisiana H N/A N/A HMO Massachusetts C N/A Q Blue Cross Managed Care Massachusetts D N/A Q Commercial Managed Care Massachusetts N/A Q HMO Massachusetts E N/A Q PPO and Other Managed Care not listed elsewhere Maryland Blue Cross of the National Capital Area (HMO) Maryland Commercial/PPO Maryland Managed Care Maine HMO/PPO Michigan N/A Managed care or other Michigan N/A Blue Cross/Blue Shield HMO Michigan N/A Other HMO Michigan N/A Blue Cross/Blue Shield PPO/PPA Michigan N/A Other PPO/PPA Minnesota Blue Cross, MN Minnesota Other HMO Minnesota Medica - Choice Minnesota Group Health Minnesota Medica - Primary Minnesota Ucare Minnesota Blue Plus Minnesota Metro. Health Plan Minnesota Blue Cross HMO HCUP (12/2/14) 12 Methods Series Report: HCUP Payer Coding, Supplement 2

16 Minnesota Health Partners Minnesota First Plan HMO Minnesota Other HMO Minnesota Other PPO Minnesota ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO) Minnesota ARAZ (formerly Ethix Midwest; also known as America's PPO) Minnesota Aetna PPO Minnesota Group Health PPO Minnesota Blue Cross PPO Minnesota Medica Choice PPO Minnesota LaborCare PPO Minnesota LaborCare PPO, Union Minnesota Other PPO Minnesota Other PPO, union Mississippi N/A N/A PPO Mississippi N/A N/A HMO Montana N/A N/A Montana HMO - Blue Cross/Blue Shield North Carolina H HMO - PPO North Carolina K Health Maintenance Org North Carolina Y Point of Service North Carolina HM HMO - PPO North Carolina 16 Oct 2010 Oct 2010 Oct 2010 Health Maintenance Org North Carolina 13 Oct 2010 Oct 2010 Oct 2010 Point of Service New Hampshire HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO HCUP (12/2/14) 13 Methods Series Report: HCUP Payer Coding, Supplement 2

17 New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO New Jersey HMO Nevada Negotiated Discounts e.g. Preferred Provider Organization (PPO) Nevada Health Maintenance Organization (HMO) New York HMO (Other) North Dakota N/A Blue Cross, MN North Dakota N/A Other HMO North Dakota N/A Medica - Choice North Dakota N/A Group Health North Dakota N/A Medica - Primary North Dakota N/A Ucare North Dakota N/A Blue Plus North Dakota N/A Metro. Health Plan North Dakota N/A Blue Cross HMO North Dakota N/A Health Partners North Dakota N/A First Plan HMO HCUP (12/2/14) 14 Methods Series Report: HCUP Payer Coding, Supplement 2

18 North Dakota N/A Other HMO North Dakota N/A Other PPO North Dakota N/A ARAZ, Union (formerly, Ethix Midwest; also known as America's PPO) North Dakota N/A ARAZ (formerly Ethix Midwest; also known as America's PPO) North Dakota N/A Aetna PPO North Dakota N/A Group Health PPO North Dakota N/A Blue Cross PPO North Dakota N/A Medica Choice PPO North Dakota N/A Northwest National LIfe (NWNL) PPO North Dakota N/A LaborCare PPO North Dakota N/A LaborCare PPO, Union North Dakota N/A Other PPO North Dakota N/A Other PPO, union Ohio K HMO Ohio L PPO Ohio N Blue Cross HMO Oregon N/A HMO/Managed Care Oregon N/A Kaiser Permanente Oregon N/A Regence Blue Cross Managed Care Pennsylvania N/A N/A Blue Cross - PPO Pennsylvania N/A N/A Blue Cross - POS Pennsylvania N/A N/A Blue Cross - HMO Pennsylvania N/A N/A Commercial - PPO Pennsylvania N/A N/A Commercial - POS Pennsylvania N/A N/A Commercial - HMO South Carolina HMO Tennessee H Blue Cross - Managed Care - HMO/PPO/Other Managed Care Tennessee L Commerical Managed Care - HMO/PPO/Other Managed Care Tennessee H HMO/Managed Care Texas N/A Preferred Provider Organization (PPO) HCUP (12/2/14) 15 Methods Series Report: HCUP Payer Coding, Supplement 2

19 Texas N/A Point of Service (POS) Texas HM N/A Health Maintenance Organization Utah Managed care (HMO and PPO) Virginia N/A N/A HMO/PPO - Unspecified Virginia N/A N/A Kaiser Permanente Vermont H HMO Vermont PAYER1_X = H HMO CHP Kaiser Vermont PAYERn_X = H Vermont Health Plan (TVHP) - Vermont Managed Care Washington N/A N/A Health Maintenance Organization (HMO) (e.g., Group Health, Kaiser Foundation, Good Health) Wisconsin WPS Wisconsin Physicians Service - Alternative health care insurance plans Wisconsin OTH Commercial or private insurance - Alternative health care insurance plans Wisconsin OTH Employer self-funded - Alternative health care insurance plans Wisconsin OTH Other organization self-funded - Alternative health care insurance plans Wisconsin nnn02, where nnn is a Blue Cross - Alternative health care insurance plans digit code Wisconsin BCS Blue Cross - Alternative health care insurance plans Wisconsin OTH Commercial or private insurance - HMO or PPO Wisconsin OTH Employer self-funded - HMO or PPO Wisconsin OTH Other organization self-funded - HMO or PPO HCUP (12/2/14) 16 Methods Series Report: HCUP Payer Coding, Supplement 2

20 West Virginia PAYER1_X = First digit of 4, 5, or 6 and third digit of 3, 4, or N/A N/A WV reports a four-digit payer code in PAYERn_X. The first digit indicates the types of payer with the following values: (4) commercial, (5) nonprofit, and (6) employer or union. The second digit indicates the payment program. The third digit indicates the payment modality with the values: (3) point of service, (4) HMO, and (5) other managed care. The fourth digit include information on the HMO using the following values: (0) none, (1) Acordia, (2) Advantage, (3) Carelink, (4) Coventry Health plan, (5) Health Plan of Upper Ohio Valley, (6) Optimum Choice, (8) unknown, and (9) not elsewhere classified Choice, (8) unknown, and (9) not elsewhere classified Wyoming H N/A N/A Managed Care (HMO/PPO) HCUP (12/2/14) 17 Methods Series Report: HCUP Payer Coding, Supplement 2

21 SUPPLEMENT 3. HCUP STATE-SPECIFIC RECODES FOR MEDICAID TO ALIGN HCUP WITH THE AMERICAN COMMUNITY SURVEY The following table includes State-specific recodes for Medicaid to align HCUP payer codes with the American Community Survey (ACS) category. The information can be reported in either the expected primary payer as received from the State (HCUP data element ) or the expected primary payer plan identifier as received from the State (HCUP data element PAYER1_X). Effective dates for coding are specified by the HCUP database: State Inpatient Databases (SID), State Ambulatory Surgery and Services Databases (SASD), and State Emergency Department Databases (SEDD). If a State is not listed, then it does not separately report Medicaid programs like the Children s Health Insurance Program (CHIP). Table 3A. State-Specific Recodes for Medicaid to Align HCUP Payer Codes with the American Community Survey (ACS) State Recode to Arizona N/A N/A Children's Rehab Services Medicaid Florida O KidCare CHIP program to Medicaid Florida O KidCare (Healthy Kids, MediKids, and Children's Medical Services CHIP program to Medicaid Georgia State SCHIP Program CHIP program to Medicaid (CHIP code not used in 2011 data) Kansas HealthWave/ Health Connect Managed Care - Kansas' State Children's Health Insurance Program (SCHIP) Minnesota General Assistance Medical Care (GAMC)/GA/Welfare Minnesota PrimeWest, Cty Based Purchased CHIP program to Medicaid Medicaid Medicaid managed care Minnesota Itasca Medical Care, CBP Medicaid managed care Minnesota So. Country Hlth Alliance, CBP Medicaid managed care Minnesota Medica - Choice, GAMC Medicaid HCUP (12/2/14) 18 Methods Series Report: HCUP Payer Coding, Supplement 3

22 Recode to Minnesota Ramsey Care, GAMC, etc. Medicaid Minnesota Ucare, GAMC, etc. Medicaid Minnesota Blue Plus, GAMC, etc. Medicaid Minnesota Metro. Health Plan, GAMC, etc. Medicaid Minnesota Health Partners, GAMC, etc. Medicaid Minnesota Other HMO, Medicaid GAMC/GA/Welfare Tennessee Cover Kids CHIP program to Medicaid Utah Children's Health Insurance Plan (CHIP) CHIP program to Medicaid West Virginia N/A N/A WV Children's Health Insurance Program (CHIP) CHIP program to Medicaid Wisconsin BGR Badger Care - Fee for service Medicaid Wisconsin BGR Badger Care - Alternative Medicaid health care insurance plans (HMO, PPO, PPA, etc.) Wisconsin BGR Badger Care - type unknown Medicaid HCUP (12/2/14) 19 Methods Series Report: HCUP Payer Coding, Supplement 3