PAYER TYPE LIST PAYER TYPE CODE TYPE DEFINITION PAYER TYPE ABBREVIATION 1 Self Pay SP 2 Worker's Compensation WC 3 Medicare MCR F Medicare Managed Care MCR-MC 4 Medicaid 4 B Medicaid Managed Care MCD-MC 5 Other Government Payment GOV 6 Blue BCBS C Blue Cross Managed Care BCBS-MC 7 Commercial Insurance COM D Commercial Managed Care COM-MC 8 HMO HMO 9 Other Free Care (Charity Care) FC 0 Other Non-Managed Care Plans OTH E PPO and Other Managed Care Plans Not Elsewhere Classified PPO H Health Safety Net HSN J Plan POS K Exclusive Provider Organization EPO T Auto Insurance AI N None (Valid only for Secondary Payer) N Q Commonwealth Care CommCare Z Dental Plans DEN SOURCE LIST SOURCE PAY CODE SOURCE OF PAYMENT DEFINITIONS MATCHING PAYER TYPE CODE PAYER TYPE ABBREVIATION 1 Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously Harvard Community Health Plan)
178 Children's Medical Security Plan (CMSP) 5 GOV 179 First Health Life and Health Insurance Company 7 COM 180 Fresenius Medical Care Health Plan (Medicare Advantage Plan) F MCR-MC 181 Invalid (no replacement) 182 Unicare Preferred Plus Managed Access EPO D COM-MC 183 Invalid (no replacement) 184 Private Healthcare Systems EPO K EPO 185 Connecticut General Life - Indemnity 7 COM 186 Connecticut General Life - POS J POS 187 Connecticut General Life - PPO E PPO 188 Fallon Flex POS J POS 189 Fallon Major Medical - Indemnity 7 COM 190 Fallon Preferred Care - PPO D COM-MC 191 Genworth Preferred PPO D COM-MC 192 Guarantee Life Insurance Company - PPO D COM-MC 193 Harvard Pilgrim - Indemnity 7 COM 194 Harvard Pilgrim - POS 8 HMO 195 Harvard Pilgrim - PPO 8 HMO
196 Harvard Pilgrim Health Care, Inc. (HMO) 8 HMO 197 Health Insurance Plan of (HIP) 7 COM 198 John Alden Life Insurance Company 7 COM 199 Other EPO (not listed elsewhere) *** K EPO 200 Invalid (no replacement) 201 Invalid (no replacement) 202 Invalid (no replacement) 203 Invalid (no replacement) 204 Invalid (no replacement) 205 Health New Select Premier PPO E PPO 206 Health Guaranteed Issue - Individual Plans 7 COM 207 Network Health ( Health MCD Program) B MCD-MC 208 HealthNet ( MCD Program) B MCD-MC 209 Mid-West National Life Insurance Company of 7 COM 210 Invalid (no replacement) 211 Invalid (no replacement) 212 Invalid (no replacement) 213 Medicare HMO - Medicare Complete Plans offered by SecureHorizons F MCR-MC
226 United Health Care of New England, Inc. D COM-MC 227 Northeast Health Direct - PPO E PPO 228 Health Plans 7 COM 229 Professional Insurance Company (Indemnity) 7 COM 230 Medicare HMO – HCHP Seniority Freedom F MCR-MC 231 Invalid (no replacement) 232 Medicare HMO - Senior Care Direct F MCR-MC 233 Medicare HMO - Senior Care Plus F MCR-MC 234 Medicare HMO – Managed Blue for Seniors F MCR-MC 235 Trustmark Life Insurance Company 7 COM 236 Tufts Health Maintenance Organization, Inc. (TAHMO) 8 HMO 237 Tufts Insurance Company PPO E PPO 238 Associated Health Maintenance Organization, Inc. PPO 8 HMO 239 Tufts Associated Health Maintenance Organization, Inc. POS Plan 8 HMO 240 Unicare PPO E PPO 241 Union Security Insurance Company 7 COM 242 Wellcare Health Plans, Inc. 7 COM 243 Pioneer Health Network 8 HMO
244 Tufts Medicare Complement (TMC) 7 COM 245 Blazer Health Enterprises, LLC F MCR-MC 246 Preferred Blue PPO C BCBS-MC 247 Humana Insurance Company ** 7 COM 248 Mail Handlers Benefit Plan 7 COM 249 MEGA Life and Health Insurance Company 7 COM 250 CIGNA HMO D COM-MC 251 Invalid (replaced by #250) 252 Health (HNE) Medicare Advantage Plan F MCR-MC 253 Blue Medicare PFFS F MCR-MC 254 Cigna Medicare Access Plans F MCR-MC 255 Health Net F MCR-MC 256 Humana Gold PFFS F MCR-MC 257 Today's Options Premier from Universal American F MCR-MC 258 Unicare Security Choice F MCR-MC 259 Celticare Health Plan of / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX) 8 HMO 260-269 Reserved 270 Invalid (replaced by #240) 271 Invalid (no replacement) 272 Auto Insurance T AI
273 MassHealth Senior Care Options**** F MCR-MC 274-299 Reserved 300 CommCare: BMC HealthNet Care – General Classification (For use only when no specific level for this plan can be identified) Q CommCare 301 CommCare: BMC HealthNet Care – Plan Type I Q CommCare 302 CommCare: BMC HealthNet Care – Plan Type II Q CommCare 303 CommCare: BMC HealthNet Care – Plan Type III Q CommCare 304 Invalid (no replacement) 400 CommCare: Network Health Forward – General Classification (For use only when no specific for this plan can be identified) Q CommCare 401 CommCare: Network Health Forward – Plan Type I Q CommCare 402 CommCare: Network Health Forward – Plan Type II Q CommCare 403 CommCare: Network Health Q CommCare
Forward – Plan Type III 404 Invalid (no replacement) 500 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – General Classification (For use only when no specific level for this plan can be identified) Q CommCare 501 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 1 (Group No. 4445077) Q CommCare 502 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 2 (Group No. 4455220) Q CommCare 503 CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 3 (Group No. 4455221) Q CommCare 504 Invalid (no replacement) 600 CommCare: Neighborhood Health Plan– General Q CommCare
Classification (For use only when no specific level for this plan can be identified) 601 CommCare: Neighborhood Health Plan – Care Plan – Plan Type I (9CC1) Q CommCare 602 CommCare: Neighborhood Health Plan – Care Plan – Plan Type II (9CC2) Q CommCare 603 CommCare: Neighborhood Health Plan – Care Plan – Plan Type III (9CC3) Q CommCare 604 Invalid (no replacement) 700 CommCare: Celticare Health Plan of / Commonwealth Care - General Classification Q CommCare 701 CommCare: Celticare Health Plan of / Commonwealth Care - Plan 1 Q CommCare 702 CommCare: Celticare Health Plan of / Commonwealth Care - Plan 2 Q CommCare 703 CommCare: Celticare Health Plan of / Commonwealth Care - Plan 3 Q CommCare 704 CommCare: Celticare Health Plan of / Commonwealth Program Q CommCare 800 Dental Z DEN