Private insurance company or government fiscal intermediary (third party) that insures and/or pays provider (second party) for health care benefits of members or beneficiaries (first parties) (e.g., Blue Cross, Medicare, Medicaid, commercial insurance companies). Also known as indirect payer, insurance company, insurer , or payer .
Insurance Encyclopedia
third-party payer liable (TPL)
Private insurance company or government fiscal intermediary (third party) legally responsible under a contract to pay providers who rendered health care benefits to its members or beneficiaries.
Third-party payment
Reimbursement sent to the provider (second party) of health care services by an insurance carrier or government program (third party) on behalf of the patient (first party). Also called third-party reimbursement (TPR) .
third-party reimbursement (TPR)
See: third-party payment .
Third-party subrogation
The legal process by which an insurance company seeks from a third party, who has caused a loss, recovery of the amount paid to the policyholder.
Third-party use
Situation in which a third party from another organization is given permission to use data originally obtained from the Centers for Medicare and Medicaid Services (CMS) by the original requestor.
Three Trades Rule
Theory that when three trades are likely to be required to repair the damaged property, a general contractor is presumed to be required to coordinate, supervise, and oversee the repairs and, therefore, a 20 percent contractor’s overhead and profit payment should be included in the ACV settlement.
Three-character category
See: category .
Three-day payment window
See: 72-hour rule .
Three-digit diagnostic codes
Diagnostic codes consisting of three numbers with descriptions that appear in ICD-9-CM code books and are used only when no fourth or fifth digits are available. Approximately 100 codes are at the highest level of specificity in the three-digit characters. Third-party payers, as well as Medicare fiscal intermediaries, do not accept three-digit codes if a higher level of specificity is available.