Administrative Healthcare Data

Chapter 3: The Payers

Introduction

Health Insurance

Medicare

Medicaid

Commercial Insurance

Others

TRICARE

CHAMPVA

FECA Black Lung

Conclusion

Introduction

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.

Health Insurance

Many different business models exist in today’s marketplace ...