Primary payer definition

Primary payer means a healthinsurer (whether a private health insurer or a public payer such as Medicare) that pays first on a claim for medical care (usually after a deductible has been paid by the insured) up to the limits of the policy or program, regardless of other insurance coverage the insured may have. Primary payers are distinguished from secondary payers that pay second on a claim for medical care to the extent payment has not been made by the primary payer.
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Primary payer means the payer responsible for the highest percentage of the charges for a patient's inpatient or outpatient hospital services;
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Primary payer means the payer, other than the patient,
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Examples of Primary payer in a sentence

  • If the complaint reveals a Medicare appealable issue or regards care for which Medicare was the Primary payer and the issue does not involve any actions by a TRICARE contractor, the complaint shall be forwarded to Medicare for resolution.

  • Example: an individual may have Medicare as a Primary payer and Medicaid, BCBS, etc.

  • Centers for Medicare & Medicaid Services, HHS § 411.24 Primary payer means, when used in the context in which Medicare is the secondary payer, any entity that is or was required or responsible to make payment with respect to an item or service (or any portion thereof) under a primary plan.

  • Acceptable date stamps include any of the following: PHC Florida Claims department date stamp, Primary payer claim payment/denial dateInitial Claim SubmissionClaims for services provided to members assigned to PHC Florida must be submitted on the appropriate billing form (CMS1500, UB04, etc.) within ninety (90) calendar days, or as stated in the written service agreement with PHC Florida.

  • Demographic data includes: • HICN, age, original reason for entitlement (e.g., disability), and Medicaid status• Long Term Institutional status• Primary payer information• ESRD status Diagnostic Data is used in risk score calculations and is obtained from both plans and FFS providers.

  • Primary payer and byui health insurance waiver, to send you to require that we refer you do not pick it is the federal programs are there.

  • Primary payer is used solely for stratification; missing values will be displayed as “Missing” in any reports.

  • UnitedHealthcare follows Health Care Claim Encounter – Professional (837p) and Institutional 837I guidelines.Commercial coordination of benefits claim requirements• Primary payer paid amount – Submit the primary paid amount for each service line from the electronic remittance advice (835) or provider remittance advice (PRA).

  • Plan as Primary payer within six (6) months of service or as per the terms of your contract.

  • Page 11HIPAA 837 Professional Claims Companion Guide LOOPSEGMENT IDNAMEVALUESNOTES 2000B SBRSubscriber Information 2000B SBR01 Payer Sequence Code P, S, TP - Primary payer S - Secondary PayerT - Tertiarypayer Use P if only one payer is involved.


More Definitions of Primary payer

Primary payer means, when used in the context in which Medicare is the secondary payer, any entity that is or was required or responsible to make payment with respect to an item or service (or any portion thereof) under a “primary plan”. These entities include, but are not limited to, insurers or self-insurers, third party administrators, and all employers that sponsor or contribute to group health plans or large group health plans. 42 C.F.R. § 411.21. “Primary plan” means, among other items, automobile or liability insurance. 42 U.S.C. § 1395y(b)(2)(A)(ii).
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Primary payer means the payer is obligated to pay the benefit amount without regard to Paid Leave Compensation that the Covered Employee is receiving. For example: a disability income insurance policy that pays benefits that do not offset due to other income or without an offset specifically for paid leave benefits.
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Primary payer means the payer, other than the patient, who is or was legally required or responsible to make payment with respect to an item or service, or any portion thereof, before any other payer, other than the patient.
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Primary payer means a health in- surer (whether a private health insurer or a public payer such as Medicare) that pays first on a claim for medical care (usually after a deductible has been paid by the in- sured) up to the limits of the policy or pro- gram, regardless of other insurance cover- age the insured may have. Primary pay- ers are distinguished from secondary pay- ers that pay second on a claim for medi- cal care to the extent payment has not been made by the primary payer.
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Related to Primary payer

  • Primary care provider (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • primary carer means the person who has responsibility for the care of the Child. Only one person can be the Child’s Primary Carer on a particular day.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Qualified health care provider means a health care provider who:

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

  • Primary care giver means a person who assumes the principal role of providing care and attention to a child.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.

  • Health care insurer means a disability insurer, group

  • Payer means a natural or legal person who holds a payment account and allows a payment order from that payment account, or, where there is no payment account, a natural or legal person who gives a payment order;

  • Family child care provider means a person who: (a) Provides

  • Mental health provider means a health care provider or a health care facility authorized by state law to provide mental health services.

  • Health-care-insurance receivable means an interest in or claim under a policy of insurance which is a right to payment of a monetary obligation for health-care goods or services provided.

  • Property Administrator means an authorized representative of the Contracting Officer appointed in accordance with agency procedures, responsible for administering the contract requirements and obligations relating to Government property in the possession of a Contractor.

  • Group long-term care insurance means a long-term care insurance policy which is delivered or issued for delivery in this State and issued to:

  • Health care provider or "provider" means:

  • Federal Health Care Program means any “federal health care program” as defined in 42 U.S.C. § 1320a-7b(f), including Medicare, state Medicaid programs, state CHIP programs, TRICARE and similar or successor programs with or for the benefit of any Governmental Authority.

  • Indian Health Care Provider means a health care program

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Long-term care insurance means group insurance that is authorized by the retirement system for retirants, retirement allowance beneficiaries, and health insurance dependents, as that term is defined in section 91, to cover the costs of services provided to retirants, retirement allowance beneficiaries, and health insurance dependents, from nursing homes, assisted living facilities, home health care providers, adult day care providers, and other similar service providers.

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Third Party Administrator (TPA means any organization or institution that is licensed by the IRDA as a TPA and is engaged by the Company for a fee or remuneration for providing Policy and claims facilitation services to the Insured / Insured Person as well as to the Company for an insurable event.

  • Third party administrator means an administrator operating under a certificate of authority issued by the commissioner pursuant to the third party administrator act.

  • Non-Administrator Coordinated Home Care Program means a Coordinated Home Care Program which does not have an agreement with the Claim Administrator or a Blue Cross Plan but has been certified as a home health agency in accordance with the guidelines established by Medicare.