FISS UB-04 Data Entry Payer Codes

The following payer codes may be reported in the CD field on CLAIM PAGE 03 of the online UB-04 claim entry record.

Payer Code	Description
1	Medicaid
2	Blue Cross
3	Other
A	Working Aged
B	ESRD beneficiary in coordination with an EGHP
D	Automobile, no-fault or any liability insurance
E	Workers’ Compensation (WC)
F	Public Health Service (PHS) or other federal agency
G	Disabled
H	Federal Black Lung program
I	Veterans Administration
L	Liability
W	WC set aside
Z	Medicare Part A (and Part B of A)

Revised 5/16/2017