what is a thrid party payer?!
Question: Third party payer pertaining to medical billing?
Answers:
Third party payors do have to play by "rules". Physicians
are contracted with all kinds of insurance companies. Some of these companies have a third party payor that reviews the
claims for them. The third party payor decides what should be paid on different charges. This is based on coding guidelines set forth by the AMA (American Medical Association), and is subject to things like multiple surgery guidelines, bundling and "inclusive" procedures. After the third party payor has determined the pricing and payment amounts, the results go backto the insurance company to send out a check to your doctor. And the end result is your doctor gets paid quite poorly.
Other Answers:
An insurance payor that doesn't have to play by the rules. With most insurance like Blue Cross, United Healthcare, Medicare, etc. you file the UB90 or HCFA to the insurance company, they process it and send you a check or an EOB with a denial. With a third party payor, you file the claim to someone who processes it, makes adjustments and decides if & how much should be paid, then they forward the claim to the payor for payment. Then a check/EOB are sent out. With most insurance the law states they have 45 days to process and pay or deny the claim, with third party payors, there is no time limit and you often have to call, argue and re-bill several times in order to get the claim paid.
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