SOURCE PAY CODE



PAYER TYPE LISTPAYER TYPE CODEPAYER TYPE DEFINITIONPAYER TYPE ABBREVIATION1Self PaySP2Worker's CompensationWC3MedicareMCRFMedicare Managed CareMCR-MC4Medicaid4BMedicaid Managed CareMCD-MC5Other Government PaymentGOV6Blue CrossBCBSCBlue Cross Managed CareBCBS-MC7Commercial InsuranceCOMDCommercial Managed CareCOM-MC8HMOHMO9Other Free Care (Charity Care)FC0Other Non-Managed Care PlansOTHEPPO and Other Managed Care Plans Not Elsewhere ClassifiedPPOHHealth Safety NetHSNJPoint-of-Service PlanPOSKExclusive Provider OrganizationEPOTAuto InsuranceAINNone (Valid only for Secondary Payer)NQCommonwealth Care PlansCommCareZDental PlansDENPAYER SOURCE LISTSOURCE PAY CODESOURCE OF PAYMENT DEFINITIONSMATCHING PAYER TYPE CODEPAYER TYPE ABBREVIATION1Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously Harvard Community Health Plan)??2Invalid (no replacement) ??3Invalid (replaced by #246) (Previously Network Blue (PPO)??4Fallon Community Health Plan 8HMO5Invalid (no replacement) ??6Invalid (no replacement) ??7Invalid (replaced by #236 - Tufts Associated Health Maintenance Organization, Inc. (TAHMO) - (Previously Tufts Associated Health Plan)??8Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously Pilgrim Health Care (HMO))??9Invalid (replaced by #226 - United Healthcare of New England, Inc.) (Previously United Health Plan of New England (Ocean State)??10Invalid (replaced by #195 - Harvard Pilgrim PPO) - (Previously Pilgrim Advantage - PPO)??11Blue Care ElectCBCBS-MC12Invalid (no replacement) ??13Invalid (no replacement) ??14Invalid (no replacement) ??15Invalid (no replacement) ??16Invalid (no replacement) ??17Invalid (no replacement) ??18Invalid (no replacement) ??19Invalid (no replacement) ??20Invalid (no replacement) ??21Invalid (replaced by #249) 22Aetna Open Choice PPODCOM-MC23Guardian Life Insurance Company PPODCOM-MC24Health New England Inc.8HMO25Invalid (replaced by #243) (Previously Pioneer Plan)??26Invalid (no replacement) ??27Invalid (no replacement) ??28Great West Life PPODCOM-MC29Invalid (replaced by #171 & 250)??30CIGNA (Indemnity)7COM31One Health Plan HMO (Great West Life)DCOM-MC32Invalid (no replacement) ??33Invalid (no replacement) ??34Invalid (no replacement) ??35Invalid (replaced by #226 (Previously United Healthcare Insurance Company – HMO (new for 1997))??36United Healthcare Insurance Company - PPO (new for 1997)DCOM-MC37Invalid (replaced by #196 - Harvard Pilgrim Health Care, Inc. (HMO) (Previously HCHP-Pilgrim HMO (integrated product))??38Health New England Select (self-funded)8HMO39Invalid (no replacement) ??40Invalid (no replacement) ??41Invalid (no replacement) ??42ConnectiCare of Massachusetts8HMO43Invalid (no replacement) 44Invalid (no replacement) ??45Invalid (no replacement) ??46Blue ChiP (BCBS Rhode Island)8HMO47Neighborhood Health Plan8HMO48Invalid (replaced by #175) (Previously US Healthcare)49Invalid (replaced by #87) (Previously Healthsource CMHC Plus PPO)??50Invalid (no replacement) ??51Aetna Life Insurance7COM52Invalid (no replacement) 53Invalid (no replacement)??54Invalid (no replacement) 55Guardian Life Insurance7COM56Invalid (no replacement) 57John Hancock Life Insurance7COM58Invalid (no replacement) 59Invalid (no replacement) 60Invalid (replaced by #97)??61Invalid (no replacement) ??62Mutual of Omaha Insurance7COM63Invalid (no replacement) ??64Invalid (no replacement) ??65Invalid (no replacement) ??66Invalid (no replacement) ??67Invalid (no replacement) ??68Invalid (no replacement) ??69Invalid (no replacement) ??70Invalid (no replacement) 71Invalid (no replacement) ??72Invalid (no replacement) ??73Invalid (replaced by #226 United Healthcare of New England, Inc.) (Previously United Health and Life (subsidiary of United Health Plans of NE)??74United Healthcare Insurance Company7COM75Invalid (replaced by #175 - Aetna Health, Inc. (HMO)) (Previously Prudential Healthcare HMO)??76Invalid (no replacement) ??77Invalid (no replacement) ??78Invalid - (no replacement) 79Pioneer Health Care PPOEPPO80Invalid (replaced by #237 and #238 - Tufts Insurance Company PPO and Tufts Health Maintenance Organization, Inc. PPO) (Previously Tufts Total Health Plan PPO)??81HMO BlueCBCBS-MC82John Hancock PreferredDCOM-MC83Invalid (no replacement) 84Private Healthcare Systems PPOEPPO85Invalid (no replacement) ??86Invalid (no replacement) ??87CIGNA PPODCOM-MC88Invalid (no replacement) ??89Great West/NE Care7COM90Invalid (no replacement) ??91Invalid (no replacement) ??92Invalid (no replacement) ??93Invalid (no replacement) ??94Invalid (no replacement) ??95Invalid (replaced by #195 - Harvard Pilgrim PPO) (Previously Pilgrim Select PPO)??96Invalid (replaced by #226) (Previously Metrahealth (United Health Care of NE)??97Unicare7COM98Healthy Start9FC99Other POS (not listed elsewhere) ***JPOS100Invalid (no replacement) ??101Invalid (no replacement) ??102Wausau Insurance Company7COM103Medicaid (includes MassHealth)4MCD104Medicaid Managed Care-Primary Care Clinician (PCC)BMCD-MC105Invalid (no replacement) ??106Invalid (no replacement) ??107Invalid (no replacement) ??108Medicaid Managed Care-Fallon Community Health PlanBMCD-MC109Invalid (no replacement) ??110Invalid (no replacement) ??111Invalid (no replacement) ??112Invalid (no replacement) ??113Medicaid Managed Care-Neighborhood Health PlanBMCD-MC114Invalid (no replacement) ??115Invalid (no replacement) ??116Invalid (no replacement) ??117Invalid (no replacement)??118Medicaid Mental Health & Substance Abuse Plan – Mass Behavioral Health PartnershipBMCD-MC119Medicaid Managed Care Other (not listed elsewhere) ***BMCD-MC120Out-Of-State Medicaid5GOV121Medicare3MCR122Invalid (replaced by #234)??123Invalid (no replacement)??124Invalid (no replacement) ??125Medicare HMO – Fallon Senior Plan****FMCR-MC126Invalid (replaced by #230)??127Invalid (no replacement) ??128Medicare HMO – HMO Blue for Seniors****FMCR-MC129Invalid (no replacement) ??130Invalid (no replacement) ??131Invalid (no replacement) ??132Invalid (no replacement) ??133Invalid (replaced by Payor Source #244 - Tufts Medicare Complement) (Previously Medicare HMO - Tufts Medicare Supplement (TMS)??134Medicare HMO – Other (not listed elsewhere)***FMCR-MC135Out-Of-State Medicare3MCR136BCBS Medex **6BCBS137AARP/Medigap Supplement **7COM138Banker’s Life and Casualty Insurance **7COM139Invalid (no replacement) ??140Invalid (no replacement) 141Other Medigap (not listed elsewhere) ***7COM142Blue Cross Indemnity6BCBS143Invalid (no replacement, Use Payer Source #995 Health Safety Net or #996 Charity Care) ??144Other Government5GOV145Self-Pay1SP146Worker’s Compensation2WOR147Other Commercial (not listed elsewhere) ***7COM148Other HMO (not listed elsewhere) ***8HMO149PPO and Other Managed Care (not listed elsewhere) ***EPPO150Other Non-Managed Care (not listed elsewhere) ***0OTH151CHAMPUS5GOV152Foundation0OTH153Grant0OTH154BCBS Other (not listed elsewhere) ***6BCBS155Blue Cross Managed Care Other (not listed elsewhere) ***CBCBS-MC156Out of State BCBS6BCBS157Invalid (replaced by #36) (Previously Metrahealth - PPO (United Health Care of NE)??158Invalid (replaced by #226) (Previously Metrahealth - HMO (United Health Care of NE))??159None (valid only for secondary source of payment)NNONE160Blue ChoiceCBCBS-MC161Aetna Managed Choice POSDCOM-MC162Great West Life POSDCOM-MC163Invalid (no replacement) ??164Invalid (no replacement) ??165Invalid (no replacement) ??166Private Healthcare Systems POSJPOS167Invalid (replaced by #188 - Fallon Flex POS) (Previously Fallon POS)??168Advantra FreedomFMCR-MC169Invalid (no replacement) ??170Invalid - (replaced by #174 - Aetna Health, Inc. - Quality POS) (Previously US Healthcare Quality POS)??171CIGNA POSDCOM-MC172Invalid (no replacement) ??173Aetna Medicare Open FMCR-MC174Aetna Health Inc. - Quality POS8HMO175Aetna Health, Inc. - HMO8HMO176Carelink (CIGNA & Tufts)7COM177Chesapeake Life Insurance Company7COM178Children's Medical Security Plan (CMSP)5GOV179First Health Life and Health Insurance Company7COM180Fresenius Medical Care Health Plan (Medicare Advantage Plan)FMCR-MC181Invalid (no replacement) ??182Unicare Preferred Plus Managed Access EPODCOM-MC183Invalid (no replacement) ??184Private Healthcare Systems EPOKEPO185Connecticut General Life - Indemnity7COM186Connecticut General Life - POSJPOS187Connecticut General Life - PPOEPPO188Fallon Flex POSJPOS189Fallon Major Medical - Indemnity7COM190Fallon Preferred Care - PPODCOM-MC191Genworth Preferred PPODCOM-MC192Guarantee Trust Life Insurance Company - PPODCOM-MC193Harvard Pilgrim - Indemnity7COM194Harvard Pilgrim - POS8HMO195Harvard Pilgrim - PPO8HMO196Harvard Pilgrim Health Care, Inc. (HMO)8HMO197Health Insurance Plan of New York (HIP)7COM198John Alden Life Insurance Company7COM199Other EPO (not listed elsewhere) ***KEPO200Invalid (no replacement) 201Invalid (no replacement) 202Invalid (no replacement) 203Invalid (no replacement) 204Invalid (no replacement) ??205Health New England Select Premier PPOEPPO206Health New England Guaranteed Issue - Individual Plans7COM207Network Health (Cambridge Health Alliance MCD Program)BMCD-MC208HealthNet (Boston Medical Center MCD Program)BMCD-MC209Mid-West National Life Insurance Company of Tennessee7COM210Invalid (no replacement) ??211Invalid (no replacement) ??212Invalid (no replacement) ??213Medicare HMO - Medicare Complete Plans offered by SecureHorizons FMCR-MC214Medicare HMO - Harvard Pilgrim Health Plan - Medicare EnhanceFMCR-MC215Tufts Medicare HMO - Medicare PreferredFMCR-MC216Medicare Special Needs Plan - Commonwealth Care AllianceFMCR-MC217Medicare Special Needs Plan - Fallon Community Health PlanFMCR-MC218Medicare Special Needs Plan - Senior Whole HealthFMCR-MC219Medicare Special Needs Plan - United Health Group Evercare Mass. SCO and Evercare Plan IPFMCR-MC220Invalid (replaced by #128) (Previously Medicare HMO - Blue Care 65)??221Invalid (no replacement) ??222Invalid (no replacement) ??223Invalid (no replacement) ??224Invalid (replaced by #215 - Tufts Medicare HMO - Medicare Preferred) (Previously Medicare HMO - Tufts Secure Horizons)??225Invalid (no replacement) ??226United Health Care of New England, Inc.DCOM-MC227Northeast Health Direct - PPOEPPO228Oxford Health Plans7COM229Professional Insurance Company (Indemnity)7COM230Medicare HMO – HCHP First Seniority FreedomFMCR-MC231Invalid (no replacement) ??232Medicare HMO - Senior Care DirectFMCR-MC233Medicare HMO - Senior Care PlusFMCR-MC234Medicare HMO – Managed Blue for SeniorsFMCR-MC235Trustmark Life Insurance Company7COM236Tufts Health Maintenance Organization, Inc. (TAHMO)8HMO237Tufts Insurance Company PPOEPPO238Tufts Associated Health Maintenance Organization, Inc. PPO8HMO239Tufts Associated Health Maintenance Organization, Inc. POS Plan8HMO240Unicare PPOEPPO241Union Security Insurance Company7COM242Wellcare Health Plans, Inc.7COM243Pioneer Health Network8HMO244Tufts Medicare Complement (TMC)7COM245Trail Blazer Health Enterprises, LLCFMCR-MC246Preferred Blue PPOC?BCBS-MC247Humana Insurance Company **7COM248Mail Handlers Benefit Plan 7COM249MEGA Life and Health Insurance Company7COM250CIGNA HMODCOM-MC251Invalid (replaced by #250) ??252Health New England (HNE) Medicare Advantage PlanFMCR-MC253Blue Medicare PFFSFMCR-MC254Cigna Medicare Access PlansFMCR-MC255Health Net PearlFMCR-MC256Humana Gold PFFSFMCR-MC257Today's Options Premier from Universal AmericanFMCR-MC258Unicare Security Choice FMCR-MC259Celticare Health Plan of Massachusetts / HMO Plans (includes Celticare Premier, Solution, Saver, and Young Adults with or without RX)8HMO260-269Reserved??270Invalid (replaced by #240) ??271Invalid (no replacement) ??272Auto InsuranceTAI273MassHealth Senior Care Options****FMCR-MC274-299Reserved??300CommCare: BMC HealthNet Plan/Commonwealth Care – General Classification (For use only when no specific level for this plan can be identified)QCommCare301CommCare: BMC HealthNet Plan/Commonwealth Care – Plan Type IQCommCare302CommCare: BMC HealthNet Plan/Commonwealth Care – Plan Type IIQCommCare303CommCare: BMC HealthNet Plan/Commonwealth Care – Plan Type IIIQCommCare304Invalid (no replacement) ??400CommCare: Cambridge Network Health Forward – General Classification (For use only when no specific level for this plan can be identified)QCommCare401CommCare: Cambridge Network Health Forward – Plan Type IQCommCare402CommCare: Cambridge Network Health Forward – Plan Type IIQCommCare403CommCare: Cambridge Network Health Forward – Plan Type IIIQCommCare404Invalid (no replacement) ??500CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – General Classification (For use only when no specific level for this plan can be identified)QCommCare501CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 1 (Group No. 4445077)QCommCare502CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 2 (Group No. 4455220)QCommCare503CommCare: Fallon Community Health Care: Commonwealth Care FCHP Direct Care – Plan 3 (Group No. 4455221)QCommCare504Invalid (no replacement) ??600CommCare: Neighborhood Health Plan– General Classification (For use only when no specific level for this plan can be identified)QCommCare601CommCare: Neighborhood Health Plan – NHP Commonwealth Care Plan – Plan Type I (9CC1)QCommCare602CommCare: Neighborhood Health Plan – NHP Commonwealth Care Plan – Plan Type II (9CC2)QCommCare603CommCare: Neighborhood Health Plan – NHP Commonwealth Care Plan – Plan Type III (9CC3)QCommCare604Invalid (no replacement) ??700CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - General Classification QCommCare701CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 1QCommCare702CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 2QCommCare703CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care - Plan 3QCommCare704CommCare: Celticare Health Plan of Massachusetts / Commonwealth Care Bridge ProgramQCommCare800Aetna DentalZDEN801AflacZDEN802AllStateZDEN803Altus DentalZDEN804Ameritas Life Insurance CorpZDEN805Anthem Blue Cross Blue ShieldZDEN806AssurantZDEN807Blue Cross Blue Shield of MAZDEN808Blue Cross Blue Shield of RIZDEN809Children’s Medical SecurityZDEN810Cigna DentalZDEN811Creative Dental Plan AdministratorsZDEN812Delta Dental of MAZDEN813Delta Dental - OtherZDEN814Delta Dental of New YorkZDEN815DentaQuest Commonwealth CareZDEN816DentaQuest MassHealthZDEN817DentaQuest Senior Whole HealthZDEN818EverCare DentalZDEN819Fallon Health PlanZDEN820Great West DentalZDEN821Guardian DentalZDEN822Harvard Pilgrim Health CareZDEN823MetLife DentalZDEN824Principal Plan DentalZDEN825Unicare DentalZDEN826United ConcordiaZDEN827United Health Care ZDEN828AlicareZDEN829Adventist Risk Management INCZDEN830Blue Cross Blue Shield of TexasZDEN831Brokers National Life insuranceZDEN832Cba Blue DentalZDEN833Chesterfield ResourcesZDEN834Companion Life insuranceZDEN835Dental Health AllianceZDEN836EBS Benefit SolutionsZDEN837Empire Blue CrossZDEN838Excellus Blue crossZDEN839FortisZDEN840GEHA Connection DentalZDEN841GHIZDEN842Lincoln Financial GroupZDEN843London Health AdministratorsZDEN844Midwest Life InsuranceZDEN845Premier Access Dental PlansZDEN846Sentry Life InsuranceZDEN847SonocoZDEN848Sun Life Dental BenefitsZDEN849Symetra Life Insurance CompanyZDEN850Tricare DentalZDEN851Dentemax InsuranceZDEN990Invalid (no replacement) ??995Health Safety NetHHSN996Charity Care9FCSUPPLEMENTAL – USE AS SECONDARY PAYER ONLYSOURCE PAY CODESOURCE OF PAYMENT DEFINITIONSMATCHING PAYER TYPE CODEPAYER TYPE ABBREVIATION127Invalid (no replacement) ??129Invalid (no replacement) ??131Invalid (no replacement) ??136BCBS Medex **6BCBS137AARP/Medigap Supplement **7COM138Banker’s Life & Casualty Insurance **7COM139Invalid (no replacement) ??140Invalid (no replacement) ??141Other Medigap (not listed elsewhere) ***7COM200Invalid (no replacement) ??201Invalid (no replacement) ??202Invalid (no replacement) ??210Invalid (no replacement) ??211Invalid (no replacement) ??212Invalid (no replacement) ??247Humana Insurance Company **7COM** Supplemental Payer Source*** List under specific carrier when possible****More comprehensive than original Medicare plan. Doesn't necessitate Medigap policy ................
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