https://nahdo.org/sopt|9.2
name
SOP
SOP
package
us.nlm.vsac@0.21.0
us.nlm.vsac@0.21.0
content
complete
complete
status
active
active
date
2021-01-01 05:00:00.0
2021-01-01 05:00:00.0
Source of Payment Typology
| code | display | definition | hierarchy |
|---|---|---|---|
| 1 | MEDICARE | ||
| 11 | Medicare Managed Care (Includes Medicare Advantage Plans) | ||
| 111 | Medicare HMO | ||
| 1111 | Medicare Chronic Condition Special Needs Plan (C-SNP) | ||
| 1112 | Medicare Institutional Special Needs Plan (I-SNP) | ||
| 112 | Medicare PPO | ||
| 113 | Medicare POS | ||
| 119 | Medicare Managed Care Other | ||
| 12 | Medicare (Non-managed Care) | ||
| 121 | Medicare FFS | ||
| 122 | Medicare Drug Benefit | ||
| 123 | Medicare Medical Savings Account (MSA) | ||
| 129 | Medicare Non-managed Care Other | ||
| 13 | Medicare Hospice | ||
| 14 | Dual Eligibility Medicare/Medicaid Organization | ||
| 141 | Dual Eligible Special Needs Plan (D-SNP) | ||
| 142 | Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) | ||
| 19 | Medicare Other | ||
| 191 | Medicare Pharmacy Benefit Manager | ||
| 2 | MEDICAID | ||
| 21 | Medicaid (Managed Care) | ||
| 211 | Medicaid HMO | ||
| 212 | Medicaid PPO | ||
| 213 | Medicaid PCCM (Primary Care Case Management) | ||
| 219 | Medicaid Managed Care Other | ||
| 22 | Medicaid (Non-managed Care Plan) | ||
| 23 | Medicaid/SCHIP | ||
| 25 | Medicaid - Out of State | ||
| 26 | Medicaid - Long Term Care | ||
| 29 | Medicaid Other | ||
| 291 | Medicaid Pharmacy Benefit Manager | ||
| 299 | Medicaid - Dental | ||
| 3 | OTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections) | ||
| 31 | Department of Defense | ||
| 311 | TRICARE (CHAMPUS) | ||
| 3111 | TRICARE Prime--HMO | ||
| 3112 | TRICARE Extra--PPO | ||
| 3113 | TRICARE Standard - Fee For Service | ||
| 3114 | TRICARE For Life--Medicare Supplement | ||
| 3115 | TRICARE Reserve Select | ||
| 3116 | Uniformed Services Family Health Plan (USFHP) -- HMO | ||
| 3119 | Department of Defense - (other) | ||
| 312 | Military Treatment Facility | ||
| 3121 | Enrolled Prime--HMO | ||
| 3122 | Non-enrolled Space Available | ||
| 3123 | TRICARE For Life (TFL) | ||
| 313 | Dental --Stand Alone | ||
| 32 | Department of Veterans Affairs | ||
| 321 | Veteran care-Care provided to Veterans | ||
| 3211 | Direct Care-Care provided in VA facilities | ||
| 3212 | Indirect Care-Care provided outside VA facilities | ||
| 32121 | Fee Basis | ||
| 32122 | Foreign Fee/Foreign Medical Program (FMP) | ||
| 32123 | Contract Nursing Home/Community Nursing Home | ||
| 32124 | State Veterans Home | ||
| 32125 | Sharing Agreements | ||
| 32126 | Other Federal Agency | ||
| 32127 | Dental Care | ||
| 32128 | Vision Care | ||
| 322 | Non-veteran care | ||
| 3221 | Civilian Health and Medical Program for the VA (CHAMPVA) | ||
| 3222 | Spina Bifida Health Care Program (SB) | ||
| 3223 | Children of Women Vietnam Veterans (CWVV) | ||
| 3229 | Other non-veteran care | ||
| 33 | Indian Health Service or Tribe | ||
| 331 | Indian Health Service - Regular | ||
| 332 | Indian Health Service - Contract | ||
| 333 | Indian Health Service - Managed Care | ||
| 334 | Indian Tribe - Sponsored Coverage | ||
| 34 | HRSA Program | ||
| 341 | Title V (MCH Block Grant) | ||
| 342 | Migrant Health Program | ||
| 343 | Ryan White Act | ||
| 344 | Disaster-related (includes Covid-19) | ||
| 349 | Other | ||
| 35 | Black Lung | ||
| 36 | State Government | ||
| 361 | State SCHIP program (codes for individual states) | ||
| 362 | Specific state programs (list/ local code) | ||
| 369 | State, not otherwise specified (other state) | ||
| 37 | Local Government | ||
| 371 | Local - Managed care | ||
| 3711 | HMO | ||
| 3712 | PPO | ||
| 3713 | POS | ||
| 372 | FFS/Indemnity | ||
| 379 | Local, not otherwise specified (other local, county) | ||
| 38 | Other Government (Federal, State, Local not specified) | ||
| 381 | Federal, State, Local not specified managed care | ||
| 3811 | Federal, State, Local not specified - HMO | ||
| 3812 | Federal, State, Local not specified - PPO | ||
| 3813 | Federal, State, Local not specified - POS | ||
| 3819 | Federal, State, Local not specified - not specified managed care | ||
| 382 | Federal, State, Local not specified - FFS | ||
| 389 | Federal, State, Local not specified - Other | ||
| 39 | Other Federal | ||
| 391 | Federal Employee Health Plan - Use when known | ||
| 4 | DEPARTMENTS OF CORRECTIONS | ||
| 41 | Corrections Federal | ||
| 42 | Corrections State | ||
| 43 | Corrections Local | ||
| 44 | Corrections Unknown Level | ||
| 5 | PRIVATE HEALTH INSURANCE | ||
| 51 | Managed Care (Private) | ||
| 511 | Commercial Managed Care - HMO | ||
| 512 | Commercial Managed Care - PPO | ||
| 513 | Commercial Managed Care - POS | ||
| 514 | Exclusive Provider Organization | ||
| 515 | Gatekeeper PPO (GPPO) | ||
| 516 | Commercial Managed Care - Pharmacy Benefit Manager | ||
| 517 | Commercial Managed Care - Dental | ||
| 519 | Managed Care, Other (non HMO) | ||
| 52 | Private Health Insurance - Indemnity | ||
| 521 | Commercial Indemnity | ||
| 522 | Self-insured (ERISA) Administrative Services Only (ASO) plan | ||
| 523 | Medicare supplemental policy (as second payer) | ||
| 524 | Indemnity Insurance - Dental | ||
| 529 | Private health insurance--other commercial Indemnity | ||
| 53 | Managed Care (private) or private health insurance (indemnity), not otherwise specified | ||
| 54 | Organized Delivery System | ||
| 55 | Small Employer Purchasing Group | ||
| 56 | Specialized Stand-Alone Plan | ||
| 561 | Dental | ||
| 562 | Vision | ||
| 59 | Other Private Insurance | ||
| 6 | BLUE CROSS/BLUE SHIELD | ||
| 61 | BC Managed Care | ||
| 611 | BC Managed Care - HMO | ||
| 612 | BC Managed Care - PPO | ||
| 613 | BC Managed Care - POS | ||
| 614 | BC Managed Care - Dental | ||
| 619 | BC Managed Care - Other | ||
| 62 | BC Insurance Indemnity | ||
| 621 | BC Indemnity | ||
| 622 | BC Self-insured (ERISA) Administrative Services Only (ASO)Plan | ||
| 623 | BC Medicare Supplemental Plan | ||
| 629 | BC Indemnity - Dental | ||
| 7 | MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private) | ||
| 71 | HMO | ||
| 72 | PPO | ||
| 73 | POS | ||
| 79 | Other Managed Care | ||
| 8 | NO PAYMENT from an Organization/Agency/Program/Private Payer Listed | ||
| 81 | Self-pay (Includes applicants for insurance and Medicaid applicants) | ||
| 82 | No Charge | ||
| 821 | Charity | ||
| 822 | Professional Courtesy | ||
| 823 | Research/Clinical Trial | ||
| 83 | Refusal to Pay/Bad Debt | ||
| 84 | Hill Burton Free Care | ||
| 85 | Research/Donor | ||
| 89 | No Payment, Other | ||
| 9 | MISCELLANEOUS/OTHER | ||
| 91 | Foreign National | ||
| 92 | Other (Non-government) | ||
| 93 | Disability Insurance | ||
| 94 | Long-term Care Insurance | ||
| 95 | Worker's Compensation | ||
| 951 | Worker's Comp HMO | ||
| 953 | Worker's Comp Fee-for-Service | ||
| 954 | Worker's Comp Other Managed Care | ||
| 959 | Worker's Comp, Other unspecified | ||
| 96 | Auto Insurance (includes no fault) | ||
| 97 | Legal Liability / Liability Insurance | ||
| 98 | Other specified but not otherwise classifiable (includes Hospice - Unspecified plan) | ||
| 99 | No Typology Code available for payment source | ||
| 9999 | Unavailable / No Payer Specified / Blank |