A payer (or payor) is a company that manages a patient’s eligibility to enroll and submit claims for administrated medical services. Typically, these companies include insurance carriers and Third-Party Administrators (TPAs).
Payers depend on complete and accurate data from their network providers. This information verifies that a provider is entered and updated into a payer’s healthcare system correctly. Correct information ensures that claims can be processed and accurate directories are published.
Payers require systems that:
Enter Fourleaf: a unified CRM that eliminates dual data entry, organizes a wide range of documents and data elements, and automates data collection leading to accurate contracts and credentials.
Expected Payer Outcomes
Payers require processes and systems that improve profitability, grow networks, and ensure validated credentials. Some payers and providers devote more than 20% of their back office operations toward processing manual updates and materials.