NCH Primary Payer Code (if not Medicare)

SAS Name
NCH_PRMRY_PYR_CD

The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills.

The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.

Comments

Source: NCH

Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer. (values Z and Y were used prior to 12/90. BLANK was supposed to be effective after 12/90, but may have been used prior to that date.)
Code Code value
A Employer group health plan (EGHP) insurance for an aged beneficiary
B EGHP insurance for an end-stage renal disease (ESRD) beneficiary
C Conditional payment by Medicare; future reimbursement from the Public
Health Service (PHS) expected
D No fault automobile insurance
E Workers' compensation (WC)
F Public Health Service (PHS) or other Federal agency (other than VA)
G Working disabled beneficiary under age 65 with a local government health plan
(LGHP)
H Black Lung (BL) program
I Department of Veteran's Affairs
L Any liability insurance
M Override EGHP - Medicare is primary payer
N Override non-EGHP - Medicare is primary payer
Blank / missing No other primary payer