PAYER TYPE LIST PAYER TYPE CODE PAYER TYPE DEFINITION
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1 PAYER TYPE LIST PAYER TYPE CODE PAYER TYPE DEINITION PAYER TYPE ABBREVIATION 1 Self Pay SP 2 Worker's Compensation WC 3 Medicare MCR Medicare Managed Care 4 Medicaid 4 B Medicaid Managed Care 5 Other Government Payment GOV 6 Blue Cross BCBS C Blue Cross Managed Care BCBS-MC 7 Commercial Insurance COM D Commercial Managed Care COM-MC 8 HMO HMO 9 Other ree Care (Charity Care) C 0 Other Non-Managed Care Plans OTH E PPO and Other Managed Care Plans PPO Not Elsewhere Classified H Health Safety Net HSN J Point-of-Service Plan POS K Exclusive Provider Organization EPO T Auto Insurance AI N None (Valid only for Secondary N Payer) Commonwealth Care Plans 1
2 PAYER SOURCE LIST SOURCE SOURCE O PAYMENT PAY CODE DEINITIONS MATCHING PAYER TYPE CODE PAYER TYPE ABBREVIATION 1 Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously Harvard Community Health Plan) 2 Invalid (no replacement) 3 Invalid (replaced by #246) (Previously Network Blue (PPO) 4 allon Community Health Plan 8 HMO 5 Invalid (no replacement) 6 Invalid (no replacement) 7 Invalid (replaced by #236 - Tufts Associated Health Maintenance Organization, Inc. (TAHMO) - (Previously Tufts Associated Health Plan) 8 Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously Pilgrim Health Care (HMO)) 9 Invalid (replaced by #226 - United Healthcare of New England, Inc.) (Previously United Health Plan of New England (Ocean State) 10 Invalid (replaced by #195 - Harvard Pilgrim PPO) - (Previously Pilgrim Advantage - PPO) 11 Blue Care Elect C BCBS-MC 12 Invalid (no replacement) 13 Invalid (no replacement) 14 Invalid (no replacement) 15 Invalid (no replacement) 16 Invalid (no replacement) 17 Invalid (no replacement) 18 Invalid (no replacement) 19 Invalid (no replacement) 20 Invalid (no replacement) 21 Invalid (replaced by #249) 22 Aetna Open Choice PPO D COM-MC 23 Guardian Life Insurance Company PPO D COM-MC 24 Health New England Inc. 8 HMO 25 Invalid (replaced by #243) (Previously Pioneer Plan) 26 Invalid (no replacement) 27 Invalid (no replacement) 2
3 28 Great West Life PPO D COM-MC 29 Invalid (replaced by #171 & 250) 30 CIGNA (Indemnity) 7 COM 31 One Health Plan HMO (Great West Life) D COM-MC 32 Invalid (no replacement) 33 Invalid (no replacement) 34 Invalid (no replacement) 35 Invalid (replaced by #226 (Previously United Healthcare Insurance Company HMO (new for 1997)) 36 United Healthcare Insurance Company - D COM-MC PPO (new for 1997) 37 Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously HCHP-Pilgrim HMO (integrated product)) 38 Health New England Select (self-funded) 8 HMO 39 Invalid (no replacement) 40 Invalid (no replacement) 41 Invalid (no replacement) 42 ConnectiCare of Massachusetts 8 HMO 43 Invalid (no replacement) 44 Invalid (no replacement) 45 Invalid (no replacement) 46 Blue ChiP (BCBS Rhode Island) 8 HMO 47 Neighborhood Health Plan 8 HMO 48 Invalid (replaced by #175) (Previously US Healthcare) 49 Invalid (replaced by #87) (Previously Healthsource CMHC Plus PPO) 50 Invalid (no replacement) 51 Aetna Life Insurance 7 COM 52 Invalid (no replacement) 53 Invalid (no replacement) 54 Invalid (no replacement) 55 Guardian Life Insurance 7 COM 56 Invalid (no replacement) 57 John Hancock Life Insurance 7 COM 58 Invalid (no replacement) 59 Invalid (no replacement) 60 Invalid (replaced by #97) 61 Invalid (no replacement) 62 Mutual of Omaha Insurance 7 COM 63 Invalid (no replacement) 64 Invalid (no replacement) 65 Invalid (no replacement) 66 Invalid (no replacement) 3
4 67 Invalid (no replacement) 68 Invalid (no replacement) 69 Invalid (no replacement) 70 Invalid (no replacement) 71 Invalid (no replacement) 72 Invalid (no replacement) 73 Invalid (replaced by #226 United Healthcare of New England, Inc.) (Previously United Health and Life (subsidiary of United Health Plans of NE) 74 United Healthcare Insurance Company 7 COM 75 Invalid (replaced by #175 - Aetna Health, Inc. (HMO)) (Previously Prudential Healthcare HMO) 76 Invalid (no replacement) 77 Invalid (no replacement) 78 Invalid - (no replacement) 79 Pioneer Health Care PPO E PPO 80 Invalid (replaced by #237 and #238 - Tufts Insurance Company PPO and Tufts Health Maintenance Organization, Inc. PPO) (Previously Tufts Total Health Plan PPO) 81 HMO Blue C BCBS-MC 82 John Hancock Preferred D COM-MC 83 Invalid (no replacement) 84 Private Healthcare Systems PPO E PPO 85 Invalid (no replacement) 86 Invalid (no replacement) 87 CIGNA PPO D COM-MC 88 Invalid (no replacement) 89 Great West/NE Care 7 COM 90 Invalid (no replacement) 91 Invalid (no replacement) 92 Invalid (no replacement) 93 Invalid (no replacement) 94 Invalid (no replacement) 95 Invalid (replaced by #195 - Harvard Pilgrim PPO) (Previously Pilgrim Select PPO) 96 Invalid (replaced by #226) (Previously Metrahealth (United Health Care of NE) 97 Unicare 7 COM 98 Healthy Start 9 C 99 Other POS (not listed elsewhere) *** J POS 100 Invalid (no replacement) 101 Invalid (no replacement) 102 Wausau Insurance Company 7 COM 4
5 103 Medicaid (includes MassHealth) 4 MCD 104 Medicaid Managed Care-Primary Care B Clinician (PCC) 105 Invalid (no replacement) 106 Invalid (no replacement) 107 Invalid (no replacement) 108 Medicaid Managed Care-allon B Community Health Plan 109 Invalid (no replacement) 110 Invalid (no replacement) 111 Invalid (no replacement) 112 Invalid (no replacement) 113 Medicaid Managed Care-Neighborhood B Health Plan 114 Invalid (no replacement) 115 Invalid (no replacement) 116 Invalid (no replacement) 117 Invalid (no replacement) 118 Medicaid Mental Health & Substance B Abuse Plan Mass Behavioral Health Partnership 119 Medicaid Managed Care Other (not listed B elsewhere) *** 120 Out-Of-State Medicaid 5 GOV 121 Medicare 3 MCR 122 Invalid (replaced by #234) 123 Invalid (no replacement) 124 Invalid (no replacement) 125 Medicare HMO allon Senior Plan**** 126 Invalid (replaced by #230) 127 Invalid (no replacement) 128 Medicare HMO HMO Blue for Seniors**** 129 Invalid (no replacement) 130 Invalid (no replacement) 131 Invalid (no replacement) 132 Invalid (no replacement) 133 Invalid (replaced by Payor Source #244 - Tufts Medicare Complement) (Previously Medicare HMO - Tufts Medicare Supplement (TMS) 134 Medicare HMO Other (not listed elsewhere)*** 135 Out-Of-State Medicare 3 MCR 136 BCBS Medex ** 6 BCBS 137 AARP/Medigap Supplement ** 7 COM 138 Banker s Life and Casualty Insurance ** 7 COM 139 Invalid (no replacement) 5
6 140 Invalid (no replacement) 141 Other Medigap (not listed elsewhere) *** 7 COM 142 Blue Cross Indemnity 6 BCBS 143 Invalid (no replacement, Use Payer Source #995 Health Safety Net or #996 Charity Care) 144 Other Government 5 GOV 145 Self-Pay 1 SP 146 Worker s Compensation 2 WOR 147 Other Commercial (not listed elsewhere) 7 COM *** 148 Other HMO (not listed elsewhere) *** 8 HMO 149 PPO and Other Managed Care (not listed E PPO elsewhere) *** 150 Other Non-Managed Care (not listed 0 OTH elsewhere) *** 151 CHAMPUS 5 GOV 152 oundation 0 OTH 153 Grant 0 OTH 154 BCBS Other (not listed elsewhere) *** 6 BCBS 155 Blue Cross Managed Care Other (not listed C BCBS-MC elsewhere) *** 156 Out of State BCBS 6 BCBS 157 Invalid (replaced by #36) (Previously Metrahealth - PPO (United Health Care of NE) 158 Invalid (replaced by #226) (Previously Metrahealth - HMO (United Health Care of NE)) 159 None (valid only for secondary source of payment) N NONE 160 Blue Choice C BCBS-MC 161 Aetna Managed Choice POS D COM-MC 162 Great West Life POS D COM-MC 163 Invalid (no replacement) 164 Invalid (no replacement) 165 Invalid (no replacement) 166 Private Healthcare Systems POS J POS 167 Invalid (replaced by #188 - allon lex POS) (Previously allon POS) 168 Advantra reedom 169 Invalid (no replacement) 170 Invalid - (replaced by #174 - Aetna Health, Inc. - uality POS) (Previously US Healthcare uality POS) 171 CIGNA POS D COM-MC 172 Invalid (no replacement) 173 Aetna Medicare Open 6
7 174 Aetna Health Inc. - uality POS 8 HMO 175 Aetna Health, Inc. - HMO 8 HMO 176 Carelink (CIGNA & Tufts) 7 COM 177 Chesapeake Life Insurance Company 7 COM 178 Children's Medical Security Plan (CMSP) 5 GOV 179 irst Health Life and Health Insurance 7 COM Company 180 resenius Medical Care Health Plan (Medicare Advantage Plan) 181 Invalid (no replacement) 182 Unicare Preferred Plus Managed Access D COM-MC EPO 183 Invalid (no replacement) 184 Private Healthcare Systems EPO K EPO 185 Connecticut General Life - Indemnity 7 COM 186 Connecticut General Life - POS J POS 187 Connecticut General Life - PPO E PPO 188 allon lex POS J POS 189 allon Major Medical - Indemnity 7 COM 190 allon Preferred Care - PPO D COM-MC 191 Genworth Preferred PPO D COM-MC 192 Guarantee Trust Life Insurance Company - D COM-MC PPO 193 Harvard Pilgrim - Indemnity 7 COM 194 Harvard Pilgrim - POS 8 HMO 195 Harvard Pilgrim - PPO 8 HMO 196 Harvard Pilgrim Health Care, Inc. (HMO) 8 HMO 197 Health Insurance Plan of New York (HIP) 7 COM 198 John Alden Life Insurance Company 7 COM 199 Other EPO (not listed elsewhere) *** K EPO 200 Invalid (no replacement) 201 Invalid (no replacement) 202 Invalid (no replacement) 203 Invalid (no replacement) 204 Invalid (no replacement) 205 Health New England Select Premier PPO E PPO 206 Health New England Guaranteed Issue - 7 COM Individual Plans 207 Network Health (Cambridge Health B Alliance MCD Program) 208 HealthNet (Boston Medical Center MCD B Program) 209 Mid-West National Life Insurance 7 COM Company of Tennessee 210 Invalid (no replacement) 211 Invalid (no replacement) 212 Invalid (no replacement) 213 Medicare HMO - Medicare Complete Plans 7
8 offered by SecureHorizons 214 Medicare HMO - Harvard Pilgrim Health Plan - Medicare Enhance 215 Tufts Medicare HMO - Medicare Preferred 216 Medicare Special Needs Plan - Commonwealth Care Alliance 217 Medicare Special Needs Plan - allon Community Health Plan 218 Medicare Special Needs Plan - Senior Whole Health 219 Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IP 220 Invalid (replaced by #128) (Previously Medicare HMO - Blue Care 65) 221 Invalid (no replacement) 222 Invalid (no replacement) 223 Invalid (no replacement) 224 Invalid (replaced by #215 - Tufts Medicare HMO - Medicare Preferred) (Previously Medicare HMO - Tufts Secure Horizons) 225 Invalid (no replacement) 226 United Health Care of New England, Inc. D COM-MC 227 Northeast Health Direct - PPO E PPO 228 Oxford Health Plans 7 COM 229 Profesional Insurance Company 7 COM (Indemnity) 230 Medicare HMO HCHP irst Seniority reedom 231 Invalid (no replacement) 232 Medicare HMO - Senior Care Direct 233 Medicare HMO - Senior Care Plus 234 Medicare HMO Managed Blue for Seniors 235 Trustmark Life Insurance Company 7 COM 236 Tufts Health Maintenance Organization, 8 HMO Inc. (TAHMO) 237 Tufts Insurance Company PPO E PPO 238 Tufts Associated Health Maintenance 8 HMO Organization, Inc. PPO 239 Tufts Associated Health Maintenance 8 HMO Organization, Inc. POS Plan 240 Unicare PPO E PPO 241 Union Security Insurance Company 7 COM 242 Wellcare Health Plans, Inc. 7 COM 243 Pioneer Health Network 8 HMO 8
9 244 Tufts Medicare Complement (TMC) 7 COM 245 Trail Blazer Health Enterprises, LLC 246 Preferred Blue PPO C BCBS-MC 247 Humana Insurance Company ** 7 COM 248 Mail Handlers Benefit Plan 7 COM 249 MEGA Life and Health Insurance 7 COM Company 250 CIGNA HMO D COM-MC 251 Invalid (replaced by #250) 252 Health New England (HNE) Medicare Advantage Plan 253 Blue Medicare PS 254 Cigna Medicare Access Plans 255 Health Net Pearl 256 Humana Gold PS 257 Today's Options Premier from Universal American 258 Unicare Security Choice 259 Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX) 8 HMO Reserved 270 Invalid (replaced by #240) 271 Invalid (no replacement) 272 Auto Insurance T AI 273 MassHealth Senior Care Options**** Reserved 300 : BMC HealthNet Plan/Commonwealth Care General Classification (or use only when no specific level for this plan can be identified) 301 : BMC HealthNet Plan/Commonwealth Care Plan Type I 302 : BMC HealthNet Plan/Commonwealth Care Plan Type II 303 : BMC HealthNet Plan/Commonwealth Care Plan Type III 304 Invalid (no replacement) 400 : Cambridge Network Health orward General Classification (or use only when no specific level for this plan can be identified) 401 : Cambridge Network Health orward Plan Type I 402 : Cambridge Network Health orward Plan Type II 9
10 403 : Cambridge Network Health orward Plan Type III 404 Invalid (no replacement) 500 : allon Community Health Care: Commonwealth Care CHP Direct Care General Classification (or use only when no specific level for this plan can be identified) 501 : allon Community Health Care: Commonwealth Care CHP Direct Care Plan 1 (Group No ) 502 : allon Community Health Care: Commonwealth Care CHP Direct Care Plan 2 (Group No ) 503 : allon Community Health Care: Commonwealth Care CHP Direct Care Plan 3 (Group No ) 504 Invalid (no replacement) 600 : Neighborhood Health Plan General Classification (or use only when no specific level for this plan can be identified) 601 : Neighborhood Health Plan NHP Commonwealth Care Plan Plan Type I (9CC1) 602 : Neighborhood Health Plan NHP Commonwealth Care Plan Plan Type II (9CC2) 603 : Neighborhood Health Plan NHP Commonwealth Care Plan Plan Type III (9CC3) 604 Invalid (no replacement) 700 : Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification 701 : Celticare Health Plan of Massachusetts / Commonwealth Care - Plan : Celticare Health Plan of Massachusetts / Commonwealth Care - Plan : Celticare Health Plan of Massachusetts / Commonwealth Care - Plan : Celticare Health Plan of Massachusetts / Comonwealth Care Bridge Program 990 Invalid (no replacement) 10
11 995 Health Safety Net H HSN 996 Charity Care 9 C 11
12 SUPPLEMENTAL USE AS SECONDARY PAYER ONLY SOURCE SOURCE O PAYMENT PAY CODE DEINITIONS MATCHING PAYER TYPE CODE PAYER TYPE ABBREVIATION 127 Invalid (no replacement) 129 Invalid (no replacement) 131 Invalid (no replacement) 136 BCBS Medex ** 6 BCBS 137 AARP/Medigap Supplement ** 7 COM 138 Banker s Life & Casualty Insurance ** 7 COM 139 Invalid (no replacement) 140 Invalid (no replacement) 141 Other Medigap (not listed elsewhere) *** 7 COM 200 Invalid (no replacement) 201 Invalid (no replacement) 202 Invalid (no replacement) 210 Invalid (no replacement) 211 Invalid (no replacement) 212 Invalid (no replacement) 247 Humana Insurance Company ** 7 COM ** Supplemental Payer Source *** List under specific carrier when possible ****More comprehensive than original Medicare plan. Doesn't necessitate Medigap policy 12
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Virginia Mason Insurance Grid (2014-2015)
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AK Premera Blue Cross $709,464 Time Insurance Company $227,600 Trustmark Life Insurance Company $645,743 UnitedHealthcare Insurance Company $62,894 AL The MEGA Life and Health Insurance Company $62,541
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