Organization | Field Name | ID | Required |
---|---|---|---|
KCR | Primary Payer (PrimaryPayor) | 30220 | yes |
NAACCR | Primary Payer at DX | 630 | yes |
Field Length: 2
Code the patient's primary payer or insurance carrier at the time of initial admission.
Code |
Label |
Description |
01 |
Not insured |
Patient has no insurance and is declared a charity write-off |
02 |
Not insured, self pay |
Patient has no insurance and is declared responsible for charges |
10 |
Insurance, NOS |
Type of insurance unknown or other than the types listed in codes 20, 31, 35, 50-56 |
20 |
Managed Care, HMO, PPO |
An organized system of prepaid care for a group of enrollees usually within a defined geographic area |
21 |
Private Insurance: Fee-for-service |
An insurance plan that does not have a negotiated fee structure with the participating hospital |
31 |
Medicaid |
State government administered insurance for persons who are uninsured, below the poverty level, or covered under entitlement programs |
35 |
Medicaid administered through a Managed Care Plan |
State government administered insurance which is administered through a commercial Managed Care plan |
60 |
Medicare without supplement, Medicare, NOS |
Federal government funded insurance for persons who are retired or disabled, or over 65 years old |
61 |
Medicare with supplement |
Patient has Medicare and another insurance to pay costs not covered by Medicare |
62 |
Medicare administered through a Managed Care Plan |
Patient enrolled in Medicare through a Managed Care Plan (e.g. HMO, PPO). The plan pays for all incurred costs |
63 |
Medicare with private supplement |
Patient has Medicare and private insurance to pay costs not covered by Medicare |
64 |
Medicare with Medicaid eligibility |
Federal government Medicare insurance with State Medicaid administered supplement |
65 |
TRICARE (Formerly CHAMPUS) |
Department of Defense program providing supplementary civilian-sector hospital and medical services to military dependents, retirees, and their dependents |
66 |
Military |
Military personnel or their dependents who are treated at a military facility |
67 |
Veterans Affairs |
Veterans who are treated in Veterans Affairs facilities |
68 |
Indian/Public Health Service |
Patient who receives care at an Indian Health Service facility and costs are reimbursed by the Indian Health Service. |
99 |
Insurance status unknown |
It is unknown from the patient’s medical record whether or not the patient is insured |