or modifications to the Payer Typology via the PHDSC website
Modeled loosely after the ICD classification for medical conditions, the Payer Typology identifies broad payer classifications with related sub-classifications that are more specific.
The Payer Typology was designed to address the “payer” (
Centers for Medicare and Medicaid Services (CMS), Blue Cross,
etc.) and the “mechanism for payment” (HMO, private insurance, etc.).
This type of format provides analysts with the flexibility to
either use payer codes at a highly detailed level or to roll up
codes to broader hierarchical categories for comparative analyses across payer types and mechanisms for payment.
Other health plan codes, such as those created by the National Association of Insurance Commissioners (NAIC), are
state-based codes. These codes are used primarily for regulatory actions. X12N also has a claim filing indicator (payer
list); it is not hierarchical in structure and is less comprehensive than the Payer Typology in terms of payer types and it
does not provide definitions for each classification.
The Payer Typology is referenced as an external code list in
the American National Standards Institute (ANSI) X12 stan-
dards and as a data element in the Subscriber Information
Segment (SBR) in the Subscriber and the Patient loops. Exter-
nal code lists are not maintained by ANSI X12, but are integral
to the ANSI X12 standards. Health Level Seven International
(HL7) recognizes the Source of Payment Typology with an Ob-
ject Identifier Definition (OID) for use in HL7 messaging stan-
dards. The Office of the National Coordinator for Health IT
(ONC) includes the Payer Typology in electronic health record
(EHR) standards and the Payer Typology is designated as the
value set for the required supplemental data element “payer”
for the CMS 2014 “meaningful use” EHR Incentive Program
clinical quality measures.
State Users of the Payer Typology in Administrative
State public health administrative data reporting systems are
using the Payer Typology as the best solution for categorizing
the types of payers in the healthcare transaction data that are
collected and analyzed.
Georgia was the first state to take the leap to voluntarily
replace their existing proprietary payment codes with the
Payer Typology. Georgia decided that as part of its state migration from the UB-92 to the UB-04 they would address the
issue of poor data quality in the reporting of payer type information. Their solution was to be an early implementer of the
The state of Oregon also incorporated the Payer Typology
during the migration of their state discharge reporting system
from the UB-92 to the UB-04. Adoption of the Payer Typology
was included as part of that migration. This replaced a propri-
The Payer Typology provides a critical data point for the linkage of
patients, care delivery, payers, and payments.
SOFTWARE SPEED UP YOUR TEXT INPUT • Create customized glossaries in an instant.
• Type a few letters and Instant Text suggests.
• Continue phrases without typing.
Call 1 800 355 5251 Instant Text 7 Pro www.instanttext.com
Make your clinical documentation and data entry
TIMELY - ACCURATE - RELIABLE
and give doctors more time for patient care.