Payer

Is a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicare, TRICARE, etc.) or an entity such as a third party administrator (TPA), repricer, or third party organization (TPO) that may be contracted by one of those groups. The term ”payer” is defined as the intended entity that is responsible for one or more of the following: final processing of the claim in order to return the remittance advice. final processing of the inquiry (eligibility, services review or claim status) in order to return the response (eligibility, services review or claim status). final processing of the (member) enrollment or premium payment.