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

  • Federal tax number of the freestanding ambulatory surgery center.2. Patient control number.3. Patient medical record or chart number.4. Date of principal procedure.5. Patient zip code.6. Patient birth date.7. Patient gender.8. Adjusted total charges and components of those charges.9. Primary payer identifier and type.10.

  • Primary payer payments that are credited toward the beneficiary's deductible and coinsurance are not entered on line 4.

  • Patient’s birth date.2. Patient’s gender.3. Patient zip code.4. Patient condition related to employment.5. Patient condition related to auto accident.6. Patient condition related to other accident.7. Date of current illness, injury or pregnancy.8. The first date of illness, if patient has had same or similar illness.9. Primary payer category code.10.

  • Primary payer amounts relating to services paid under PPS are included on this line, which may result in line 12 being negative.

  • Primary payer status affects mortality for major surgical operations.

  • Primary payer payments that are credited toward the beneficiary's deductible and coinsurance are not entered on line 11.

  • The questionnaire helps to determine who the Primary payer is for any dependent that may also be enrolled in another health plan (including Medicare).

  • Primary payer: The third-party payer with first responsibility in a benefit determination.

  • LaPar DJ et al., Primary payer status affects mortality for major surgical operations.

  • Primary payer payment is credited toward the beneficiary's deductible and coinsurance and are not entered on line 11.3216.2 FORM CMS 1728-94 05-13When the primary payment does not satisfy the beneficiary's liability, include the covered visits and charges in program visits and charges, and include the total visits and charges in total visits and charges for cost apportionment purposes.


More Definitions of Primary payer

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 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 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.

  • 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.

  • Health care insurer means a disability insurer, group

  • 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 has the meaning set forth in 42 U.S.C. 1320a-7b(f).

  • Indian Health Care Provider means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in § 4 of the Indian Health Care Improvement Act (25 USC § 1603). Indian Health Care Provider includes a 638 Facility and provision of Indian Health Service Contract Health Services (IHS CHS).

  • 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.

  • Rural health clinic means a rural health clinic as defined under section 1861 of part C of title XVIII of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395x, and certified to participate in medicaid and medicare.

  • XXXXX Administrator means the Bank of England (or any successor administrator of the Sterling Overnight Index Average).

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Non-Administrator Hospital means a Hospital that does not meet the definition of an Administrator Hospital.