What is a payer?

What is a payer?

The definition of a payer (or payor) is an organization, entity, or person, that negotiates or sets rates for healthcare services supplied by providers, collects premiums and other payments from individuals and plan sponsors, processes claims, and pays providers using premiums.

Examples of payers include individuals; employers, unions and other entities that sponsor health plans; and state and federal governments that operate healthcare entitlement programs.

What’s the difference between “payor” v. “payer”?

Payor is used interchangeably with “payer”. This is the entity that makes the payment, satisfying the claim, and/or settling any financial obligation.

What is a payor benefit rider?

Payor benefit riders appear in life insurance policies. Also known as a juvenile premium provision, the rider allows premiums for a juvenile’s life insurance policy to be waived in the event that the person who pays the premium dies or becomes totally disabled.

What is “single payer” in healthcare?

A single payer in healthcare is one who collects funds and pays for healthcare on behalf on an entire population. In the United States, many leaders have proposed moving to a single payer system on the state or federal level, but it has never been enacted.

What is payer matrix?

A healthcare payer matrix is a team of dedicated healthcare professionals who partner with your employer to reduce the cost of your high dollar prescription drugs. Payers in healthcare work directly with you to obtain alternative funding though the manufacturer, foundations, and grants.

What are payer solutions in healthcare?

MMIT payer solutions help health plans and pharmacy benefit managers establish reimbursement policies and formulary positioning that make therapies affordable for patients.