What is considered a third party payer

Third party payer. A third party payer is any entity that provides an insurance, medical service, or health plan by contract or agreement. It includes but is not limited to: (1) State and local governments that provide such plans other than Medicaid. (2) Insurance underwriters or carriers.

What does it mean to be a third party payer?

Organization, public or private, that pays or insures medical expenses on behalf of enrollees. An individual pays a premium, and the payer organization pays providers' actual medical bills on the individual's behalf.

What is the most common third party payer?

A third-party payer is anyone who pays for medical services other than the patient. In the US, the most common third-party payers are commercial insurance, Medicare, and Medicaid. All of these payers have their own sets of conditions that the provider must meet in order to get paid.

What are the major third party payers?

Third-party payers are the insurers that reimburse healthcare organizations and hence are the major source of revenues for most providers. Third-party payers include private insurers, such as Blue Cross and Blue Shield, and public (government) insur- ers, such as Medicare and Medicaid.

Why is it called a third party payer?

Third-party payer means an entity, other than the person who received the medical care or services at issue (first party) and VA who provided the care or services (second party), responsible for the payment of medical expenses on behalf of a person through insurance, agreement or contract.