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ValueSet: US Core Source of Payment Value Set

Official URL: http://hl7.org/fhir/us/core/ValueSet/us-core-source-of-payment Version: 0.1.0
Standards status: Trial-use Maturity Level: 2 Computable Name: USCoreSourceofPaymentValueSet

Copyright/Legal: The Source of Payment Typology is freely available for use and modification.

US Public Health Data Consortium Source of Payment Codes excluding specific payer organizations such as “BLUE CROSS/BLUE SHIELD” and limited to main categories for classification, type of plan and additional subcategories.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

This value set includes codes based on the following rules:

  • Import all the codes that are contained in Payer

This value set excludes codes based on the following rules:

  • Exclude these codes as defined in https://nahdo.org/sopt
    CodeDisplay
    1111Medicare Chronic Condition Special Needs Plan (C-SNP)
    1112Medicare Institutional Special Needs Plan (I-SNP)
    3111TRICARE Prime--HMO
    3112TRICARE Extra--PPO
    3113TRICARE Standard - Fee For Service
    3114TRICARE For Life--Medicare Supplement
    3115TRICARE Reserve Select
    3116Uniformed Services Family Health Plan (USFHP) -- HMO
    3119Department of Defense - (other)
    3121Enrolled Prime--HMO
    3122Non-enrolled Space Available
    3123TRICARE For Life (TFL)
    3211Direct Care-Care provided in VA facilities
    3212Indirect Care-Care provided outside VA facilities
    32121Fee Basis
    32122Foreign Fee/Foreign Medical Program (FMP)
    32123Contract Nursing Home/Community Nursing Home
    32124State Veterans Home
    32125Sharing Agreements
    32126Other Federal Agency
    32127Dental Care
    32128Vision Care
    3221Civilian Health and Medical Program for the VA (CHAMPVA)
    3222Spina Bifida Health Care Program (SB)
    3223Children of Women Vietnam Veterans (CWVV)
    3229Other non-veteran care
    3711HMO
    3712PPO
    3713POS
    3811Federal, State, Local not specified - HMO
    3812Federal, State, Local not specified - PPO
    3813Federal, State, Local not specified - POS
    3819Federal, State, Local not specified - not specified managed care
    6BLUE CROSS/BLUE SHIELD
    61BC Managed Care
    611BC Managed Care - HMO
    612BC Managed Care - PPO
    613BC Managed Care - POS
    614BC Managed Care - Dental
    619BC Managed Care - Other
    62BC Insurance Indemnity
    621BC Indemnity
    622BC Self-insured (ERISA) Administrative Services Only (ASO)Plan
    623BC Medicare Supplemental Plan
    629BC Indemnity - Dental

 

Expansion

Expansion based on:

This value set has 162 codes in it. In order to keep the publication size manageable, only a selection (119 codes) of the whole set of codes is shown.

CodeSystemDisplay
  1https://nahdo.org/soptMEDICARE
  11https://nahdo.org/soptMedicare Managed Care (Includes Medicare Advantage Plans)
  111https://nahdo.org/soptMedicare HMO
  112https://nahdo.org/soptMedicare PPO
  113https://nahdo.org/soptMedicare POS
  119https://nahdo.org/soptMedicare Managed Care Other
  12https://nahdo.org/soptMedicare (Non-managed Care)
  121https://nahdo.org/soptMedicare FFS
  122https://nahdo.org/soptMedicare Drug Benefit
  123https://nahdo.org/soptMedicare Medical Savings Account (MSA)
  129https://nahdo.org/soptMedicare Non-managed Care Other
  13https://nahdo.org/soptMedicare Hospice
  14https://nahdo.org/soptDual Eligibility Medicare/Medicaid Organization
  19https://nahdo.org/soptMedicare Other
  191https://nahdo.org/soptMedicare Pharmacy Benefit Manager
  2https://nahdo.org/soptMEDICAID
  21https://nahdo.org/soptMedicaid (Managed Care)
  211https://nahdo.org/soptMedicaid HMO
  212https://nahdo.org/soptMedicaid PPO
  213https://nahdo.org/soptMedicaid PCCM (Primary Care Case Management)
  219https://nahdo.org/soptMedicaid Managed Care Other
  22https://nahdo.org/soptMedicaid (Non-managed Care Plan)
  23https://nahdo.org/soptMedicaid/SCHIP
  25https://nahdo.org/soptMedicaid - Out of State
  26https://nahdo.org/soptMedicaid - Long Term Care
  29https://nahdo.org/soptMedicaid Other
  291https://nahdo.org/soptMedicaid Pharmacy Benefit Manager
  299https://nahdo.org/soptMedicaid - Dental
  3https://nahdo.org/soptOTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections)
  31https://nahdo.org/soptDepartment of Defense
  311https://nahdo.org/soptTRICARE (CHAMPUS)
  312https://nahdo.org/soptMilitary Treatment Facility
  313https://nahdo.org/soptDental --Stand Alone
  32https://nahdo.org/soptDepartment of Veterans Affairs
  321https://nahdo.org/soptVeteran care-Care provided to Veterans
  322https://nahdo.org/soptNon-veteran care
  33https://nahdo.org/soptIndian Health Service or Tribe
  331https://nahdo.org/soptIndian Health Service - Regular
  332https://nahdo.org/soptIndian Health Service - Contract
  333https://nahdo.org/soptIndian Health Service - Managed Care
  334https://nahdo.org/soptIndian Tribe - Sponsored Coverage
  34https://nahdo.org/soptHRSA Program
  341https://nahdo.org/soptTitle V (MCH Block Grant)
  342https://nahdo.org/soptMigrant Health Program
  343https://nahdo.org/soptRyan White Act
  349https://nahdo.org/soptOther
  35https://nahdo.org/soptBlack Lung
  36https://nahdo.org/soptState Government
  361https://nahdo.org/soptState SCHIP program (codes for individual states)
  362https://nahdo.org/soptSpecific state programs (list/ local code)
  369https://nahdo.org/soptState, not otherwise specified (other state)
  37https://nahdo.org/soptLocal Government
  371https://nahdo.org/soptLocal - Managed care
  372https://nahdo.org/soptFFS/Indemnity
  379https://nahdo.org/soptLocal, not otherwise specified (other local, county)
  38https://nahdo.org/soptOther Government (Federal, State, Local not specified)
  381https://nahdo.org/soptFederal, State, Local not specified managed care
  382https://nahdo.org/soptFederal, State, Local not specified - FFS
  389https://nahdo.org/soptFederal, State, Local not specified - Other
  39https://nahdo.org/soptOther Federal
  391https://nahdo.org/soptFederal Employee Health Plan - Use when known
  4https://nahdo.org/soptDEPARTMENTS OF CORRECTIONS
  41https://nahdo.org/soptCorrections Federal
  42https://nahdo.org/soptCorrections State
  43https://nahdo.org/soptCorrections Local
  44https://nahdo.org/soptCorrections Unknown Level
  5https://nahdo.org/soptPRIVATE HEALTH INSURANCE
  51https://nahdo.org/soptManaged Care (Private)
  511https://nahdo.org/soptCommercial Managed Care - HMO
  512https://nahdo.org/soptCommercial Managed Care - PPO
  513https://nahdo.org/soptCommercial Managed Care - POS
  514https://nahdo.org/soptExclusive Provider Organization
  515https://nahdo.org/soptGatekeeper PPO (GPPO)
  516https://nahdo.org/soptCommercial Managed Care - Pharmacy Benefit Manager
  517https://nahdo.org/soptCommercial Managed Care - Dental
  519https://nahdo.org/soptManaged Care, Other (non HMO)
  52https://nahdo.org/soptPrivate Health Insurance - Indemnity
  521https://nahdo.org/soptCommercial Indemnity
  522https://nahdo.org/soptSelf-insured (ERISA) Administrative Services Only (ASO) plan
  523https://nahdo.org/soptMedicare supplemental policy (as second payer)
  524https://nahdo.org/soptIndemnity Insurance - Dental
  529https://nahdo.org/soptPrivate health insurance--other commercial Indemnity
  53https://nahdo.org/soptManaged Care (private) or private health insurance (indemnity), not otherwise specified
  54https://nahdo.org/soptOrganized Delivery System
  55https://nahdo.org/soptSmall Employer Purchasing Group
  56https://nahdo.org/soptSpecialized Stand-Alone Plan
  561https://nahdo.org/soptDental
  562https://nahdo.org/soptVision
  59https://nahdo.org/soptOther Private Insurance
  7https://nahdo.org/soptMANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private)
  71https://nahdo.org/soptHMO
  72https://nahdo.org/soptPPO
  73https://nahdo.org/soptPOS
  79https://nahdo.org/soptOther Managed Care
  8https://nahdo.org/soptNO PAYMENT from an Organization/Agency/Program/Private Payer Listed
  81https://nahdo.org/soptSelf-pay (Includes applicants for insurance and Medicaid applicants)
  82https://nahdo.org/soptNo Charge
  821https://nahdo.org/soptCharity
  822https://nahdo.org/soptProfessional Courtesy
  823https://nahdo.org/soptResearch/Clinical Trial
  83https://nahdo.org/soptRefusal to Pay/Bad Debt
  84https://nahdo.org/soptHill Burton Free Care
  85https://nahdo.org/soptResearch/Donor
  89https://nahdo.org/soptNo Payment, Other
  9https://nahdo.org/soptMISCELLANEOUS/OTHER
  91https://nahdo.org/soptForeign National
  92https://nahdo.org/soptOther (Non-government)
  93https://nahdo.org/soptDisability Insurance
  94https://nahdo.org/soptLong-term Care Insurance
  95https://nahdo.org/soptWorker's Compensation
  951https://nahdo.org/soptWorker's Comp HMO
  953https://nahdo.org/soptWorker's Comp Fee-for-Service
  954https://nahdo.org/soptWorker's Comp Other Managed Care
  959https://nahdo.org/soptWorker's Comp, Other unspecified
  96https://nahdo.org/soptAuto Insurance (includes no fault)
  97https://nahdo.org/soptLegal Liability / Liability Insurance
  98https://nahdo.org/soptOther specified but not otherwise classifiable (includes Hospice - Unspecified plan)
  99https://nahdo.org/soptNo Typology Code available for payment source
  9999https://nahdo.org/soptUnavailable / No Payer Specified / Blank

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code