The “payer” of healthcare claims is an important player in the U.S. healthcare system. Also known as an insurer or managed care organization, the payer plays a key role in the financial interaction between providers and recipients of healthcare services. An insured recipient of service is also known as a “member” of a payer organization.
In this chapter you will:
• Learn about models of health insurance, including the rudiments of various reimbursement mechanisms.
• Identify and differentiate between major payers.
Many different business models exist in today’s marketplace ...