Question

What are the key differences between and among the different types for payer organizations, and what makes these differences important?

Answer 1

1) A payer, or sometimes payor, is a company that pays for an administered medical service. An insurance company is the most common type of payer. A payer is responsible for processing patient eligibility, enrollment, claims, and payment. The Centers for Medicare and Medicaid Services (CMS) is one of the largest healthcare payers in the United States.A provider is a company that administers a healthcare service. A healthcare provider is typically a hospital or clinic that provides an in or outpatient medical service or procedure. In the federal healthcare industry, a payer can also be a provider at times. This can occur if a patient is referred somewhere else by a government hospital or clinic. One of the biggest examples of this arrangement isVeterans Affairs (VA). Veterans can receive care from VA, but the VA can also refer a patient to an outside specialist for care.
2) Payer is organisation which takes care of financial and operational aspects (which include insurance plans, provider network) of providing health care to US citizens.Bill is a citizen of US and he wants him to be insured from any medical emergencies or hospital costs.
The payer and provider healthcare sectors play a crucial role in how our healthcare sys. A provider is a company that administers a healthcare service. A healthcare provider is typically a hospital or clinic that provides an in or outpatient medical service or procedure. In the federal healthcare industry, a payer can also be a provider at times. This can occur if a patient is referred somewhere else by a government hospital or clinic. One of the biggest examples of this arrangement isVeterans Affairs (VA). Veterans can receive care from VA, but the VA can also refer a patient to an outside specialist for care.