PHDSC Payer Type Work Group 2005 PHDSC Annual Business Meeting Washington D.C. May 24, 2005

PHDSC Payer Type Work Group PHDSC Payer Type Work Group Organized July 20, 2000 Co-Chairs: Co-Chairs: Amy Bernstein, Sc.D. Acting Chief Analytic Studies Branch/Office of Analysis and Epidemiology Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Judy Parlato, M.B.A., B.S.N., R.N. Clinical Advisor Massachusetts Division of Health Care Finance & Policy

PHDSC Payer Type Work Group Payer Type WG Committee Members Roxanne Andrews, Ph.D. Center for Delivery, Organization and Markets Agency for Healthcare Research and Quality Starla Ledbetter, MHSA, RHIA, PMP MIRCal Project Manager/OSHPD HIPAA Coordinator California Office of Statewide Planning &Development Ginger Cox Research Analyst II California Office of Statewide Planning &Development Denise Love, M.B.A. Executive Director National Assoc of Health Data Organizations (NAHDO) Bob Davis Consultant National Center for Health Statistics (NCHS) Claudia Steiner, M.D., M.P.H. Senior Research Physician Agency for Healthcare Research and Quality (AHRQ) Marjorie Greenberg, M.A. Chief, Classifications and Public Health Data Standards Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Charles Wentzel Statistician Pennsylvania Health Care Cost Containment Council H. Joanna Jiang, Ph.D. Center for Delivery, Organization and Markets Agency for Healthcare Research and Quality Michelle Williamson, B.S., B.S.N., R.N. Health Informatics Specialist Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) Hetty Khan, M.S., B.S.N., R.N. Health Informatics Specialist Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS)

PHDSC Payer Type Work Group Goals of the Committee To create a payer type standard for reporting payer data for health care services. To create a payer type standard for reporting payer data for health care services. The payer standard will allow for consistent comparison of the payment category from various data sets and across different types of providers. The payer standard will allow for consistent comparison of the payment category from various data sets and across different types of providers. The payer type standard will be flexible, expandable and allow for different levels of detail. The payer type standard will be flexible, expandable and allow for different levels of detail. The payer standard will be one that all providers can use. The payer standard will be one that all providers can use.

PHDSC Payer Type Work Group Need for Payer Typology There is currently no national standard for reporting and classifying source of payment data. There is currently no national standard for reporting and classifying source of payment data. Existing ASC X12N 837 categories in the subscriber section are currently neither mutually exclusive nor comprehensive. Existing ASC X12N 837 categories in the subscriber section are currently neither mutually exclusive nor comprehensive. Ability to compare source of payment data across databases is critical to policymakers and researchers examining effects of payment policy. Ability to compare source of payment data across databases is critical to policymakers and researchers examining effects of payment policy. PlanID is not expected to meet the Committee’s goals. PlanID is not expected to meet the Committee’s goals.

PHDSC Payer Type Work Group Accomplishments to Date Developed a flexible and expandable Payer Typology for reporting and analyzing payer data called “Possible Source of Payment Typology” Developed a flexible and expandable Payer Typology for reporting and analyzing payer data called “Possible Source of Payment Typology”  main category with sub-categories containing finer detail, allowing sub-categories to be rolled up if necessary. Refinement of the PHDSC Payer Typology. Refinement of the PHDSC Payer Typology.

PHDSC Payer Type Work Group PHDSC Payer Typology Refinement Collaboration with The Agency for Healthcare Research and Quality (AHRQ), Hospital Cost and Utilization Project (HCUP) Collaboration with The Agency for Healthcare Research and Quality (AHRQ), Hospital Cost and Utilization Project (HCUP) AHRQ/HCUP review of current state Payer reporting practices for 33 states using the PHDSC Payer Typology as the framework. AHRQ/HCUP review of current state Payer reporting practices for 33 states using the PHDSC Payer Typology as the framework. Modifications from review made to the PHDSC Typology. Modifications from review made to the PHDSC Typology. Further revisions from Bob Davis, Technical Consultant for NAHDO & AHRQ. Further revisions from Bob Davis, Technical Consultant for NAHDO & AHRQ.

PHDSC Payer Type Work Group Future Directions  Review additional feedback on the updated Typology.  Develop list of possible organizations for maintenance of the Typology.  Develop case to support Work Group’s Payer Typology as an external code source for X12 standards.  Respond to NPRM PlanID when released for comment:  incorporate PHDSC’s Typology into mechanics of PlanID system  leveraging support from Consortium members in this effort.

PHDSC Payer Type Work Group Updated Payer Typology  Updated Payer Typology is available on the PHDSC website at:  Additional comments on the Payer Typology can be sent to:  Additional comments on the Payer Typology can be sent to: