In workers’ compensation cases, an identification number that is given to each medical provider that submits bills for services provided to the injured or ill worker.

1. Organization or entity that pays for the patient’s health care services and medical treatments (e.g., self-insured employer, managed care plan, federal government, commercial insurance company). Sometimes called payer, indirect payer, insurance company, or insurer. 2. Individual responsible for payment of the amount as shown on the face of a check.

Acronym that translates as payer identification number. The current acronym is NPLANID (national plan identifier). Medicare patients that have a Medigap supplemental insurance plan must show the PAYERID number (often called the OCNA [Other Carrier Name and Address] key ) in Block 9d of the CMS-1500 insurance claim form. The Medicare fiscal intermediary transmits a Medigap claim electronically to the Medigap carrier after processing it for participating physicians. This is called a crossover claim. See NPLANID.

1. Costs incurred for processing of data. 2. See reimbursement. 3. In Medicare fraud, deliberately applying for duplicate payment (e.g., to bill both Medicare and the beneficiary for the same service or to bill both Medicare and another insurance company to attempt to get paid twice). 4. Under the Health Insurance Portability and Accountability Act (HIPAA), use and disclosure of protected health information (PHI) is permissible for treatment, payment, and health care operations (TPO).

Collecting the amount or balance due directly from the patient at the conclusion of the patient’s office visit.