Changes in Payer Codes – Effective with January 2016 Discharges – December 22, 2015
On June 29, 2015, we sent an email regarding changes in payer codes effective with January 1, 2016 discharge data. This notification serves as a reminder as the New Year is quickly approaching! More specifically, the changes are as follows:
- Current payer codes “B-Blue Cross/Blue Shield (not managed care)” and “H-Blue Cross Managed Care – HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “B-Blue Cross/Blue Shield.”
- There are two additions added to payer code B: (1) Blue Network E and (2) Blue Network M.
- Current payer codes “I-Commercial Insurance (not managed care)” and “L-Commercial Managed Care-HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “L” and renamed to “Commercial – Other.”
- The following payers have been removed from being grouped into payer code “L-Commercial-Other” and have been assigned new payer codes:
- United Healthcare – payer code 14
- Cigna – payer code 15
- Aetna – payer code 16
- A new payer code has been created for the Community Health Alliance (CHA). The payer code assigned is 17.
- Payer code K has been renamed to Medicare Advantage and has three additions: (1) Windsor, (2) CrestPoint and (3) Sterling.
- Payer code “13-Access TN” has been removed.
A few other minor changes were made which reflect updated health plan names, etc. Again, the changes outlined above are effective beginning with January 1, 2016 discharges. A reference document is available for download. The changes listed above and reflected in the Excel document should be applied to all three payer code fields (primary, secondary and tertiary payer codes).
Please share this information with each person in your facility who is involved in state required hospital discharge data reporting activities.