Within the healthcare industry, a payer (or payor) matrix is a data repository that provides information on healthcare payers. It’s used by healthcare providers, revenue cycle departments and medical billing and coding staff to store and organize information related to insurance verification, reimbursement rates, authorization requirements, claims submission guidelines, payment policies, coverage data, and information related to denials and appeals processes.
Payer Matrix is also the name of a specialty drug cost containment company, often referred to as an alternative funding company in healthcare.
After identifying the payers to be included in the matrix and gathering the relevant details, organizing the data is critical. This can be done via a spreadsheet or various software tools. Once your tool has been customized with your data, be sure to double-check the inputs for accuracy.
Once the matrix has been finalized and shared with stakeholders, it’s important to put a process in place to keep the information up-to-date and relevant to your organization.
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