||The Payers section contains data on the patient’s payers, whether a ‘third party’
insurance, self-pay, other payer or guarantor, or some combination of payers, and
is used to define which entity is the responsible fiduciary for the financial aspects
of a patient’s care.
Each unique instance of a payer and all the pertinent data needed to
contact, bill to, and collect from that payer should be included. Authorization information
that can be used to define pertinent referral, authorization tracking number, procedure,
therapy, intervention, device, or similar authorizations for the patient or provider,
or both should be included. At a minimum, the patient’s pertinent current payment
The sources of payment are represented as a Coverage Activity, which identifies all
of the insurance policies or government or other programs that cover some or all of
the patient's healthcare expenses. The policies or programs are sequenced by preference.
The Coverage Activity has a sequence number that represents the preference order.
or program identifies the covered party with respect to the payer, so that the identifiers
can be recorded.