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Appendix D-Expected Reimbursement Codes
It is important that pay source information be as accurate as possible. Regular and frequent communication between the Medical Records Office and the Patient Accounts Department is essential to achieve accuracy in the Expected Reimbursement Code field.
| NYS Expected Reimbursement Code |
Definition |
| 01 | Self-Pay |
| 02 | Workers' Compensation |
| 03 | Medicare |
| 04 | Medicaid |
| 06 | Blue Cross |
| 07 | Other Government |
| 08 | Commercial Insurance Company |
| 09 | No Charge |
| 10 | Other |
| 11 | HMO - Other |
| 12 | CHAMPUS/VA |
| 13 | No-Fault |
| 14 | Corrections - Federal, State, or Local (Obsolete 1/1/1996) |
| 15 | Self-Insured, Self-Administered Plan |
| 16 | Medicare HMO (Effective 1/1/1993) |
| 17 | Medicaid HMO (Effective 1/1/1993) |
| 18 | Corrections - Federal (Effective 1/1/1996) |
| 19 | Corrections - State (Effective 1/1/1996) |
| 20 | Corrections - Local (Effective 1/1/1996) |
Below are some enhancements to the Expected Reimbursement definitions.
| Corrections | Patient is from a state, local, or federal correctional facility. It should be noted that effective 1/1/1996 there are separate codes for state, local, and federal correctional facilities. |
Self Insured, Self Administered |
Plan is administered by employer or third-party on behalf of the employer. Employee Retirement Income and Security Act (ERISA) plans are typically considered this type of plan. |
Medicare HMO |
HMO is engaged in a Federal Risk Contract or an HMO is taking Medicare aged patients with Medicare benefits. |
Medicaid HMO |
HMO is contracted with Department of Social Services to provide benefits to Medicaid patients. |