The Family Planning Annual Report (FPAR) Implementation Guide


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    <div xmlns="http://www.w3.org/1999/xhtml"><h2>FPAR Pirmary Insurance Classification value set</h2><div><p>Select SOP (Source Of Payment Typology) codes.  A set of codes that describe how the primary insurance is classified.</p>
</div><p><b>Copyright Statement:</b> TBD</p><p>This value set includes codes from the following code systems:</p><ul><li>Include these codes as defined in <code>SOP (Source of Payment Typology)</code><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td></tr><tr><td>1</td><td>MEDICARE</td><td/></tr><tr><td>11</td><td>Medicare (Managed Care)</td><td/></tr><tr><td>111</td><td>Medicare HMO</td><td/></tr><tr><td>112</td><td>Medicare PPO</td><td/></tr><tr><td>113</td><td>Medicare POS</td><td/></tr><tr><td>119</td><td>Medicare Managed Care Other</td><td/></tr><tr><td>12</td><td>Medicare (Non-managed Care)</td><td/></tr><tr><td>121</td><td>Medicare FFS</td><td/></tr><tr><td>122</td><td>Medicare Drug Benefit</td><td/></tr><tr><td>123</td><td>Medicare Medical Savings Account (MSA)</td><td/></tr><tr><td>129</td><td>Medicare Non-managed Care Other</td><td/></tr><tr><td>13</td><td>Medicare Hospice</td><td/></tr><tr><td>14</td><td>Dual Eligibility Medicare/Medicaid Organization</td><td/></tr><tr><td>19</td><td>Medicare Other</td><td/></tr><tr><td>191</td><td>Medicare Pharmacy Benefit Manager</td><td/></tr><tr><td>2</td><td>MEDICAID</td><td/></tr><tr><td>21</td><td>Medicaid (Managed Care)</td><td/></tr><tr><td>211</td><td>Medicaid HMO</td><td/></tr><tr><td>212</td><td>Medicaid PPO</td><td/></tr><tr><td>213</td><td>Medicaid PCCM (Primary Care Case Management)</td><td/></tr><tr><td>219</td><td>Medicaid Managed Care Other</td><td/></tr><tr><td>22</td><td>Medicaid (Non-managed Care Plan)</td><td/></tr><tr><td>23</td><td>Medicaid/SCHIP</td><td/></tr><tr><td>25</td><td>Medicaid - Out of State</td><td/></tr><tr><td>26</td><td>Medicaid -- Long Term Care</td><td/></tr><tr><td>29</td><td>Medicaid Other</td><td/></tr><tr><td>291</td><td>Medicaid Pharmacy Benefit Manager</td><td/></tr><tr><td>299</td><td>Medicaid - Dental</td><td/></tr><tr><td>3</td><td>OTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections)</td><td/></tr><tr><td>31</td><td>Department of Defense</td><td/></tr><tr><td>311</td><td>TRICARE (CHAMPUS)</td><td/></tr><tr><td>3111</td><td>TRICARE Prime--HMO</td><td/></tr><tr><td>3112</td><td>TRICARE Extra--PPO</td><td/></tr><tr><td>3113</td><td>TRICARE Standard - Fee For Service</td><td/></tr><tr><td>3114</td><td>TRICARE For Life--Medicare Supplement</td><td/></tr><tr><td>3115</td><td>TRICARE Reserve Select</td><td/></tr><tr><td>3116</td><td>Uniformed Services Family Health Plan (USFHP) -- HMO</td><td/></tr><tr><td>3119</td><td>Department of Defense - (other)</td><td/></tr><tr><td>312</td><td>Military Treatment Facility</td><td/></tr><tr><td>3121</td><td>Enrolled Prime--HMO</td><td/></tr><tr><td>3122</td><td>Non-enrolled Space Available</td><td/></tr><tr><td>3123</td><td>TRICARE For Life (TFL)</td><td/></tr><tr><td>313</td><td>Dental --Stand Alone</td><td/></tr><tr><td>32</td><td>Department of Veterans Affairs</td><td/></tr><tr><td>321</td><td>Veteran care--Care provided to Veterans</td><td/></tr><tr><td>3211</td><td>Direct Care--Care provided in VA facilities</td><td/></tr><tr><td>3212</td><td>Indirect Care--Care provided outside VA facilities</td><td/></tr><tr><td>32121</td><td>Fee Basis</td><td/></tr><tr><td>32122</td><td>Foreign Fee/Foreign Medical Program (FMP)</td><td/></tr><tr><td>32123</td><td>Contract Nursing Home/Community Nursing Home</td><td/></tr><tr><td>32124</td><td>State Veterans Home</td><td/></tr><tr><td>32125</td><td>Sharing Agreements</td><td/></tr><tr><td>32126</td><td>Other Federal Agency</td><td/></tr><tr><td>32127</td><td>Dental Care</td><td/></tr><tr><td>32128</td><td>Vision Care</td><td/></tr><tr><td>322</td><td>Non-veteran care</td><td/></tr><tr><td>3221</td><td>Civilian Health and Medical Program for the VA (CHAMPVA)</td><td/></tr><tr><td>3222</td><td>Spina Bifida Health Care Program (SB)</td><td/></tr><tr><td>3223</td><td>Children of Women Vietnam Veterans (CWVV)</td><td/></tr><tr><td>3229</td><td>Other non-veteran care</td><td/></tr><tr><td>33</td><td>Indian Health Service or Tribe</td><td/></tr><tr><td>331</td><td>Indian Health Service -- Regular</td><td/></tr><tr><td>332</td><td>Indian Health Service -- Contract</td><td/></tr><tr><td>333</td><td>Indian Health Service - Managed Care</td><td/></tr><tr><td>334</td><td>Indian Tribe - Sponsored Coverage</td><td/></tr><tr><td>34</td><td>HRSA Program</td><td/></tr><tr><td>341</td><td>Title V (MCH Block Grant)</td><td/></tr><tr><td>342</td><td>Migrant Health Program</td><td/></tr><tr><td>343</td><td>Ryan White Act</td><td/></tr><tr><td>349</td><td>Other</td><td/></tr><tr><td>35</td><td>Black Lung</td><td/></tr><tr><td>36</td><td>State Government</td><td/></tr><tr><td>361</td><td>State SCHIP program (codes for individual states)</td><td/></tr><tr><td>362</td><td>Specific state programs (list/ local code)</td><td/></tr><tr><td>369</td><td>State, not otherwise specified (other state)</td><td/></tr><tr><td>37</td><td>Local Government</td><td/></tr><tr><td>371</td><td>Local - Managed care</td><td/></tr><tr><td>3711</td><td>HMO</td><td/></tr><tr><td>3712</td><td>PPO</td><td/></tr><tr><td>3713</td><td>POS</td><td/></tr><tr><td>372</td><td>FFS/Indemnity</td><td/></tr><tr><td>379</td><td>Local, not otherwise specified (other local, county)</td><td/></tr><tr><td>38</td><td>Other Government (Federal, State, Local not specified)</td><td/></tr><tr><td>381</td><td>Federal, State, Local not specified managed care</td><td/></tr><tr><td>3811</td><td>Federal, State, Local not specified - HMO</td><td/></tr><tr><td>3812</td><td>Federal, State, Local not specified - PPO</td><td/></tr><tr><td>3813</td><td>Federal, State, Local not specified - POS</td><td/></tr><tr><td>3819</td><td>Federal, State, Local not specified - not specified managed care</td><td/></tr><tr><td>382</td><td>Federal, State, Local not specified - FFS</td><td/></tr><tr><td>389</td><td>Federal, State, Local not specified - Other</td><td/></tr><tr><td>39</td><td>Other Federal</td><td/></tr><tr><td>391</td><td>Federal Employee Health Plan - Use when known</td><td/></tr><tr><td>4</td><td>DEPARTMENTS OF CORRECTIONS</td><td/></tr><tr><td>41</td><td>Corrections Federal</td><td/></tr><tr><td>42</td><td>Corrections State</td><td/></tr><tr><td>43</td><td>Corrections Local</td><td/></tr><tr><td>44</td><td>Corrections Unknown Level</td><td/></tr><tr><td>5</td><td>PRIVATE HEALTH INSURANCE</td><td/></tr><tr><td>51</td><td>Managed Care (Private)</td><td/></tr><tr><td>511</td><td>Commercial Managed Care - HMO</td><td/></tr><tr><td>512</td><td>Commercial Managed Care - PPO</td><td/></tr><tr><td>513</td><td>Commercial Managed Care - POS</td><td/></tr><tr><td>514</td><td>Exclusive Provider Organization</td><td/></tr><tr><td>515</td><td>Gatekeeper PPO (GPPO)</td><td/></tr><tr><td>516</td><td>Commercial Managed Care - Pharmacy Benefit Manager</td><td/></tr><tr><td>517</td><td>Commercial Managed Care - Dental</td><td/></tr><tr><td>519</td><td>Managed Care, Other (non HMO)</td><td/></tr><tr><td>52</td><td>Private Health Insurance - Indemnity</td><td/></tr><tr><td>521</td><td>Commercial Indemnity</td><td/></tr><tr><td>522</td><td>Self-insured (ERISA) Administrative Services Only (ASO) plan</td><td/></tr><tr><td>523</td><td>Medicare supplemental policy (as second payer)</td><td/></tr><tr><td>524</td><td>Indemnity Insurance - Dental</td><td/></tr><tr><td>529</td><td>Private health insurance--other commercial Indemnity</td><td/></tr><tr><td>53</td><td>Managed Care (private) or private health insurance (indemnity), not otherwise specified</td><td/></tr><tr><td>54</td><td>Organized Delivery System</td><td/></tr><tr><td>55</td><td>Small Employer Purchasing Group</td><td/></tr><tr><td>56</td><td>Specialized Stand Alone Plan</td><td/></tr><tr><td>561</td><td>Dental</td><td/></tr><tr><td>562</td><td>Vision</td><td/></tr><tr><td>59</td><td>Other Private Insurance</td><td/></tr><tr><td>6</td><td>BLUE CROSS/BLUE SHIELD</td><td/></tr><tr><td>61</td><td>BC Managed Care</td><td/></tr><tr><td>611</td><td>BC Managed Care -- HMO</td><td/></tr><tr><td>612</td><td>BC Managed Care -- PPO</td><td/></tr><tr><td>613</td><td>BC Managed Care -- POS</td><td/></tr><tr><td>614</td><td>BC Managed Care - Dental</td><td/></tr><tr><td>619</td><td>BC Managed Care -- Other</td><td/></tr><tr><td>62</td><td>BC Insurance Indemnity</td><td/></tr><tr><td>621</td><td>BC Indemnity</td><td/></tr><tr><td>622</td><td>BC Self-insured (ERISA) Administrative Services Only (ASO)Plan</td><td/></tr><tr><td>623</td><td>BC Medicare Supplemental Plan</td><td/></tr><tr><td>629</td><td>BC Indemnity - Dental</td><td/></tr><tr><td>7</td><td>MANAGED CARE, UNSPECIFIED (to be used only if one can't distinguish public from private)</td><td/></tr><tr><td>71</td><td>HMO</td><td/></tr><tr><td>72</td><td>PPO</td><td/></tr><tr><td>73</td><td>POS</td><td/></tr><tr><td>79</td><td>Other Managed Care</td><td/></tr><tr><td>8</td><td>NO PAYMENT from an Organization/Agency/Program/Private Payer Listed</td><td/></tr><tr><td>81</td><td>Self-pay (Includes applicants for insurance and Medicaid applicants)</td><td/></tr><tr><td>82</td><td>No Charge</td><td/></tr><tr><td>821</td><td>Charity</td><td/></tr><tr><td>822</td><td>Professional Courtesy</td><td/></tr><tr><td>823</td><td>Research/Clinical Trial</td><td/></tr><tr><td>83</td><td>Refusal to Pay/Bad Debt</td><td/></tr><tr><td>84</td><td>Hill Burton Free Care</td><td/></tr><tr><td>85</td><td>Research/Donor</td><td/></tr><tr><td>89</td><td>No Payment, Other</td><td/></tr><tr><td>9</td><td>MISCELLANEOUS/OTHER</td><td/></tr><tr><td>91</td><td>Foreign National</td><td/></tr><tr><td>92</td><td>Other (Non-government)</td><td/></tr><tr><td>93</td><td>Disability Insurance</td><td/></tr><tr><td>94</td><td>Long-term Care Insurance</td><td/></tr><tr><td>95</td><td>Worker's Compensation</td><td/></tr><tr><td>951</td><td>Worker's Comp HMO</td><td/></tr><tr><td>953</td><td>Worker's Comp Fee-for-Service</td><td/></tr><tr><td>954</td><td>Worker's Comp Other Managed Care</td><td/></tr><tr><td>959</td><td>Worker's Comp, Other unspecified</td><td/></tr><tr><td>96</td><td>Auto Insurance (includes no fault)</td><td/></tr><tr><td>97</td><td>Legal Liability / Liability Insurance</td><td/></tr><tr><td>98</td><td>Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)</td><td/></tr><tr><td>99</td><td>No Typology Code available for payment source</td><td/></tr><tr><td>9999</td><td>Unavailable / No Payer Specified / Blank</td><td/></tr></table></li></ul></div>
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  <description
               value="Select SOP (Source Of Payment Typology) codes.  A set of codes that describe how the primary insurance is classified."/>
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  <copyright value="TBD"/>
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      <concept>
        <code value="1"/>
        <display value="MEDICARE"/>
      </concept>
      <concept>
        <code value="11"/>
        <display value="Medicare (Managed Care)"/>
      </concept>
      <concept>
        <code value="111"/>
        <display value="Medicare HMO"/>
      </concept>
      <concept>
        <code value="112"/>
        <display value="Medicare PPO"/>
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      <concept>
        <code value="113"/>
        <display value="Medicare POS"/>
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      <concept>
        <code value="119"/>
        <display value="Medicare Managed Care Other"/>
      </concept>
      <concept>
        <code value="12"/>
        <display value="Medicare (Non-managed Care)"/>
      </concept>
      <concept>
        <code value="121"/>
        <display value="Medicare FFS"/>
      </concept>
      <concept>
        <code value="122"/>
        <display value="Medicare Drug Benefit"/>
      </concept>
      <concept>
        <code value="123"/>
        <display value="Medicare Medical Savings Account (MSA)"/>
      </concept>
      <concept>
        <code value="129"/>
        <display value="Medicare Non-managed Care Other"/>
      </concept>
      <concept>
        <code value="13"/>
        <display value="Medicare Hospice"/>
      </concept>
      <concept>
        <code value="14"/>
        <display value="Dual Eligibility Medicare/Medicaid Organization"/>
      </concept>
      <concept>
        <code value="19"/>
        <display value="Medicare Other"/>
      </concept>
      <concept>
        <code value="191"/>
        <display value="Medicare Pharmacy Benefit Manager"/>
      </concept>
      <concept>
        <code value="2"/>
        <display value="MEDICAID"/>
      </concept>
      <concept>
        <code value="21"/>
        <display value="Medicaid (Managed Care)"/>
      </concept>
      <concept>
        <code value="211"/>
        <display value="Medicaid HMO"/>
      </concept>
      <concept>
        <code value="212"/>
        <display value="Medicaid PPO"/>
      </concept>
      <concept>
        <code value="213"/>
        <display value="Medicaid PCCM (Primary Care Case Management)"/>
      </concept>
      <concept>
        <code value="219"/>
        <display value="Medicaid Managed Care Other"/>
      </concept>
      <concept>
        <code value="22"/>
        <display value="Medicaid (Non-managed Care Plan)"/>
      </concept>
      <concept>
        <code value="23"/>
        <display value="Medicaid/SCHIP"/>
      </concept>
      <concept>
        <code value="25"/>
        <display value="Medicaid - Out of State"/>
      </concept>
      <concept>
        <code value="26"/>
        <display value="Medicaid -- Long Term Care"/>
      </concept>
      <concept>
        <code value="29"/>
        <display value="Medicaid Other"/>
      </concept>
      <concept>
        <code value="291"/>
        <display value="Medicaid Pharmacy Benefit Manager"/>
      </concept>
      <concept>
        <code value="299"/>
        <display value="Medicaid - Dental"/>
      </concept>
      <concept>
        <code value="3"/>
        <display
                 value="OTHER GOVERNMENT (Federal/State/Local) (excluding Department of Corrections)"/>
      </concept>
      <concept>
        <code value="31"/>
        <display value="Department of Defense"/>
      </concept>
      <concept>
        <code value="311"/>
        <display value="TRICARE (CHAMPUS)"/>
      </concept>
      <concept>
        <code value="3111"/>
        <display value="TRICARE Prime--HMO"/>
      </concept>
      <concept>
        <code value="3112"/>
        <display value="TRICARE Extra--PPO"/>
      </concept>
      <concept>
        <code value="3113"/>
        <display value="TRICARE Standard - Fee For Service"/>
      </concept>
      <concept>
        <code value="3114"/>
        <display value="TRICARE For Life--Medicare Supplement"/>
      </concept>
      <concept>
        <code value="3115"/>
        <display value="TRICARE Reserve Select"/>
      </concept>
      <concept>
        <code value="3116"/>
        <display value="Uniformed Services Family Health Plan (USFHP) -- HMO"/>
      </concept>
      <concept>
        <code value="3119"/>
        <display value="Department of Defense - (other)"/>
      </concept>
      <concept>
        <code value="312"/>
        <display value="Military Treatment Facility"/>
      </concept>
      <concept>
        <code value="3121"/>
        <display value="Enrolled Prime--HMO"/>
      </concept>
      <concept>
        <code value="3122"/>
        <display value="Non-enrolled Space Available"/>
      </concept>
      <concept>
        <code value="3123"/>
        <display value="TRICARE For Life (TFL)"/>
      </concept>
      <concept>
        <code value="313"/>
        <display value="Dental --Stand Alone"/>
      </concept>
      <concept>
        <code value="32"/>
        <display value="Department of Veterans Affairs"/>
      </concept>
      <concept>
        <code value="321"/>
        <display value="Veteran care--Care provided to Veterans"/>
      </concept>
      <concept>
        <code value="3211"/>
        <display value="Direct Care--Care provided in VA facilities"/>
      </concept>
      <concept>
        <code value="3212"/>
        <display value="Indirect Care--Care provided outside VA facilities"/>
      </concept>
      <concept>
        <code value="32121"/>
        <display value="Fee Basis"/>
      </concept>
      <concept>
        <code value="32122"/>
        <display value="Foreign Fee/Foreign Medical Program (FMP)"/>
      </concept>
      <concept>
        <code value="32123"/>
        <display value="Contract Nursing Home/Community Nursing Home"/>
      </concept>
      <concept>
        <code value="32124"/>
        <display value="State Veterans Home"/>
      </concept>
      <concept>
        <code value="32125"/>
        <display value="Sharing Agreements"/>
      </concept>
      <concept>
        <code value="32126"/>
        <display value="Other Federal Agency"/>
      </concept>
      <concept>
        <code value="32127"/>
        <display value="Dental Care"/>
      </concept>
      <concept>
        <code value="32128"/>
        <display value="Vision Care"/>
      </concept>
      <concept>
        <code value="322"/>
        <display value="Non-veteran care"/>
      </concept>
      <concept>
        <code value="3221"/>
        <display
                 value="Civilian Health and Medical Program for the VA (CHAMPVA)"/>
      </concept>
      <concept>
        <code value="3222"/>
        <display value="Spina Bifida Health Care Program (SB)"/>
      </concept>
      <concept>
        <code value="3223"/>
        <display value="Children of Women Vietnam Veterans (CWVV)"/>
      </concept>
      <concept>
        <code value="3229"/>
        <display value="Other non-veteran care"/>
      </concept>
      <concept>
        <code value="33"/>
        <display value="Indian Health Service or Tribe"/>
      </concept>
      <concept>
        <code value="331"/>
        <display value="Indian Health Service -- Regular"/>
      </concept>
      <concept>
        <code value="332"/>
        <display value="Indian Health Service -- Contract"/>
      </concept>
      <concept>
        <code value="333"/>
        <display value="Indian Health Service - Managed Care"/>
      </concept>
      <concept>
        <code value="334"/>
        <display value="Indian Tribe - Sponsored Coverage"/>
      </concept>
      <concept>
        <code value="34"/>
        <display value="HRSA Program"/>
      </concept>
      <concept>
        <code value="341"/>
        <display value="Title V (MCH Block Grant)"/>
      </concept>
      <concept>
        <code value="342"/>
        <display value="Migrant Health Program"/>
      </concept>
      <concept>
        <code value="343"/>
        <display value="Ryan White Act"/>
      </concept>
      <concept>
        <code value="349"/>
        <display value="Other"/>
      </concept>
      <concept>
        <code value="35"/>
        <display value="Black Lung"/>
      </concept>
      <concept>
        <code value="36"/>
        <display value="State Government"/>
      </concept>
      <concept>
        <code value="361"/>
        <display value="State SCHIP program (codes for individual states)"/>
      </concept>
      <concept>
        <code value="362"/>
        <display value="Specific state programs (list/ local code)"/>
      </concept>
      <concept>
        <code value="369"/>
        <display value="State, not otherwise specified (other state)"/>
      </concept>
      <concept>
        <code value="37"/>
        <display value="Local Government"/>
      </concept>
      <concept>
        <code value="371"/>
        <display value="Local - Managed care"/>
      </concept>
      <concept>
        <code value="3711"/>
        <display value="HMO"/>
      </concept>
      <concept>
        <code value="3712"/>
        <display value="PPO"/>
      </concept>
      <concept>
        <code value="3713"/>
        <display value="POS"/>
      </concept>
      <concept>
        <code value="372"/>
        <display value="FFS/Indemnity"/>
      </concept>
      <concept>
        <code value="379"/>
        <display value="Local, not otherwise specified (other local, county)"/>
      </concept>
      <concept>
        <code value="38"/>
        <display value="Other Government (Federal, State, Local not specified)"/>
      </concept>
      <concept>
        <code value="381"/>
        <display value="Federal, State, Local not specified managed care"/>
      </concept>
      <concept>
        <code value="3811"/>
        <display value="Federal, State, Local not specified - HMO"/>
      </concept>
      <concept>
        <code value="3812"/>
        <display value="Federal, State, Local not specified - PPO"/>
      </concept>
      <concept>
        <code value="3813"/>
        <display value="Federal, State, Local not specified - POS"/>
      </concept>
      <concept>
        <code value="3819"/>
        <display
                 value="Federal, State, Local not specified - not specified managed care"/>
      </concept>
      <concept>
        <code value="382"/>
        <display value="Federal, State, Local not specified - FFS"/>
      </concept>
      <concept>
        <code value="389"/>
        <display value="Federal, State, Local not specified - Other"/>
      </concept>
      <concept>
        <code value="39"/>
        <display value="Other Federal"/>
      </concept>
      <concept>
        <code value="391"/>
        <display value="Federal Employee Health Plan - Use when known"/>
      </concept>
      <concept>
        <code value="4"/>
        <display value="DEPARTMENTS OF CORRECTIONS"/>
      </concept>
      <concept>
        <code value="41"/>
        <display value="Corrections Federal"/>
      </concept>
      <concept>
        <code value="42"/>
        <display value="Corrections State"/>
      </concept>
      <concept>
        <code value="43"/>
        <display value="Corrections Local"/>
      </concept>
      <concept>
        <code value="44"/>
        <display value="Corrections Unknown Level"/>
      </concept>
      <concept>
        <code value="5"/>
        <display value="PRIVATE HEALTH INSURANCE"/>
      </concept>
      <concept>
        <code value="51"/>
        <display value="Managed Care (Private)"/>
      </concept>
      <concept>
        <code value="511"/>
        <display value="Commercial Managed Care - HMO"/>
      </concept>
      <concept>
        <code value="512"/>
        <display value="Commercial Managed Care - PPO"/>
      </concept>
      <concept>
        <code value="513"/>
        <display value="Commercial Managed Care - POS"/>
      </concept>
      <concept>
        <code value="514"/>
        <display value="Exclusive Provider Organization"/>
      </concept>
      <concept>
        <code value="515"/>
        <display value="Gatekeeper PPO (GPPO)"/>
      </concept>
      <concept>
        <code value="516"/>
        <display value="Commercial Managed Care - Pharmacy Benefit Manager"/>
      </concept>
      <concept>
        <code value="517"/>
        <display value="Commercial Managed Care - Dental"/>
      </concept>
      <concept>
        <code value="519"/>
        <display value="Managed Care, Other (non HMO)"/>
      </concept>
      <concept>
        <code value="52"/>
        <display value="Private Health Insurance - Indemnity"/>
      </concept>
      <concept>
        <code value="521"/>
        <display value="Commercial Indemnity"/>
      </concept>
      <concept>
        <code value="522"/>
        <display
                 value="Self-insured (ERISA) Administrative Services Only (ASO) plan"/>
      </concept>
      <concept>
        <code value="523"/>
        <display value="Medicare supplemental policy (as second payer)"/>
      </concept>
      <concept>
        <code value="524"/>
        <display value="Indemnity Insurance - Dental"/>
      </concept>
      <concept>
        <code value="529"/>
        <display value="Private health insurance--other commercial Indemnity"/>
      </concept>
      <concept>
        <code value="53"/>
        <display
                 value="Managed Care (private) or private health insurance (indemnity), not otherwise specified"/>
      </concept>
      <concept>
        <code value="54"/>
        <display value="Organized Delivery System"/>
      </concept>
      <concept>
        <code value="55"/>
        <display value="Small Employer Purchasing Group"/>
      </concept>
      <concept>
        <code value="56"/>
        <display value="Specialized Stand Alone Plan"/>
      </concept>
      <concept>
        <code value="561"/>
        <display value="Dental"/>
      </concept>
      <concept>
        <code value="562"/>
        <display value="Vision"/>
      </concept>
      <concept>
        <code value="59"/>
        <display value="Other Private Insurance"/>
      </concept>
      <concept>
        <code value="6"/>
        <display value="BLUE CROSS/BLUE SHIELD"/>
      </concept>
      <concept>
        <code value="61"/>
        <display value="BC Managed Care"/>
      </concept>
      <concept>
        <code value="611"/>
        <display value="BC Managed Care -- HMO"/>
      </concept>
      <concept>
        <code value="612"/>
        <display value="BC Managed Care -- PPO"/>
      </concept>
      <concept>
        <code value="613"/>
        <display value="BC Managed Care -- POS"/>
      </concept>
      <concept>
        <code value="614"/>
        <display value="BC Managed Care - Dental"/>
      </concept>
      <concept>
        <code value="619"/>
        <display value="BC Managed Care -- Other"/>
      </concept>
      <concept>
        <code value="62"/>
        <display value="BC Insurance Indemnity"/>
      </concept>
      <concept>
        <code value="621"/>
        <display value="BC Indemnity"/>
      </concept>
      <concept>
        <code value="622"/>
        <display
                 value="BC Self-insured (ERISA) Administrative Services Only (ASO)Plan"/>
      </concept>
      <concept>
        <code value="623"/>
        <display value="BC Medicare Supplemental Plan"/>
      </concept>
      <concept>
        <code value="629"/>
        <display value="BC Indemnity - Dental"/>
      </concept>
      <concept>
        <code value="7"/>
        <display
                 value="MANAGED CARE, UNSPECIFIED (to be used only if one can&#39;t distinguish public from private)"/>
      </concept>
      <concept>
        <code value="71"/>
        <display value="HMO"/>
      </concept>
      <concept>
        <code value="72"/>
        <display value="PPO"/>
      </concept>
      <concept>
        <code value="73"/>
        <display value="POS"/>
      </concept>
      <concept>
        <code value="79"/>
        <display value="Other Managed Care"/>
      </concept>
      <concept>
        <code value="8"/>
        <display
                 value="NO PAYMENT from an Organization/Agency/Program/Private Payer Listed"/>
      </concept>
      <concept>
        <code value="81"/>
        <display
                 value="Self-pay (Includes applicants for insurance and Medicaid applicants)"/>
      </concept>
      <concept>
        <code value="82"/>
        <display value="No Charge"/>
      </concept>
      <concept>
        <code value="821"/>
        <display value="Charity"/>
      </concept>
      <concept>
        <code value="822"/>
        <display value="Professional Courtesy"/>
      </concept>
      <concept>
        <code value="823"/>
        <display value="Research/Clinical Trial"/>
      </concept>
      <concept>
        <code value="83"/>
        <display value="Refusal to Pay/Bad Debt"/>
      </concept>
      <concept>
        <code value="84"/>
        <display value="Hill Burton Free Care"/>
      </concept>
      <concept>
        <code value="85"/>
        <display value="Research/Donor"/>
      </concept>
      <concept>
        <code value="89"/>
        <display value="No Payment, Other"/>
      </concept>
      <concept>
        <code value="9"/>
        <display value="MISCELLANEOUS/OTHER"/>
      </concept>
      <concept>
        <code value="91"/>
        <display value="Foreign National"/>
      </concept>
      <concept>
        <code value="92"/>
        <display value="Other (Non-government)"/>
      </concept>
      <concept>
        <code value="93"/>
        <display value="Disability Insurance"/>
      </concept>
      <concept>
        <code value="94"/>
        <display value="Long-term Care Insurance"/>
      </concept>
      <concept>
        <code value="95"/>
        <display value="Worker&#39;s Compensation"/>
      </concept>
      <concept>
        <code value="951"/>
        <display value="Worker&#39;s Comp HMO"/>
      </concept>
      <concept>
        <code value="953"/>
        <display value="Worker&#39;s Comp Fee-for-Service"/>
      </concept>
      <concept>
        <code value="954"/>
        <display value="Worker&#39;s Comp Other Managed Care"/>
      </concept>
      <concept>
        <code value="959"/>
        <display value="Worker&#39;s Comp, Other unspecified"/>
      </concept>
      <concept>
        <code value="96"/>
        <display value="Auto Insurance (includes no fault)"/>
      </concept>
      <concept>
        <code value="97"/>
        <display value="Legal Liability / Liability Insurance"/>
      </concept>
      <concept>
        <code value="98"/>
        <display
                 value="Other specified but not otherwise classifiable (includes Hospice - Unspecified plan)"/>
      </concept>
      <concept>
        <code value="99"/>
        <display value="No Typology Code available for payment source"/>
      </concept>
      <concept>
        <code value="9999"/>
        <display value="Unavailable / No Payer Specified / Blank"/>
      </concept>
    </include>
  </compose>
</ValueSet>