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 .

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.

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) .

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.

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.

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.

System of calculating insurance policy dividends and distributing excess funds above the amount needed for legal reserves. Excess funds come from mortality savings, interest earned on investments, and expense savings.