Central Distributor SEDD: Description of Data Elements

PAY3 - Expected tertiary payer, uniform

Documentation Sections:

General Notes

Uniform Values

State Specific Notes

General Notes

PAY3 indicates the expected tertiary payer (Medicare, Medicaid, private insurance, etc.). To ensure uniformity of coding across data sources, PAY3 combines detailed categories in the more general groups. For example, Medicare includes both fee-for-service and managed care Medicare patients. Medicaid includes both fee-for-service and managed care Medicaid patients. Private insurance (PAY3 = 3) includes Blue Cross, commercial carriers, and private HMOs and PPOs. Other (PAY3 = 6) includes Worker's Compensation, CHAMPUS, CHAMPVA, Title V, and other government programs. The HCUP data element PAY3_X retains the expected primary payer as provided by the data source. Because the coding of expected primary and tertiary payer is the same, information on the coding of PAY3 is available under the note for expected primary payer (PAY1).

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Uniform Values

Variable Description Value Value Description PAY3 Expected tertiary payer, uniform 1 Medicare 2 Medicaid 3 Private insurance 4 Self-pay 5 No charge 6 Other . Missing .A Invalid .B Unavailable from source (coded in 1988-1997 data only)

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State Specific Notes

Nebraska Prior to data year 2016, some Medicaid managed care patients may have been categorized in the data under private insurance instead of Medicaid because the Medicaid program was managed by a commercial insurance company. Beginning with data year 2016, there are large increases in the number of Medicaid records and proportionate decreases in records categorized as private insurance because the Nebraska Partner organization improved the process for the identification of patients covered by Medicaid managed care programs managed by commercial insurance companies. Nebraska coded some missing payers as other for tertiary payer in the 2013 data.

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