Resource Evaluation

A public payer is a public insurance option that allows the government to create health insurance agencies that would compete with other insurance agencies.

An example is the Medicare which is a federal health insurance program for individuals who are above  65 years of age, younger individuals with disabilities and individuals with end-stage renal disease.Some of the services covered by Medicare are laboratory tests,  radiology, inpatient and outpatient services only to mention a few.Private payer, on the other hand, is the insurance companies.They can be purchased from one’s employer, a government marketplace as well as a private market place.

An example is the Blue Cross and Blue Shield plans.These plans cover about 90 million individuals.People benefiting from it can easily access a good doctor, medical services and hospitals across the world.

Workers compensation is structured as an insurance scheme in the U.S.The medical benefits of workers who are injured or ill are financed through insurance premiums paid by employers to insurers.Tricare health program is an excellent example of a health insurance system that compensates workers, i.e., militants. It is a health care program that has almost 9.4 million beneficiaries.It offers 11 options depending on the sponsors’ status and geographic location.The Tricare program, unlike other military benefits, gives the beneficiaries the right to choose the plans that suit their health needs.In most instances, the Tricare provider files the medical claims for the beneficiary then the beneficiary receives an explanation of the benefits that details what was paid.The Tricare is regulated While submitting the claim, information such as the charge for each service, date, and place of each service, Sponsor’s Social Security Number,  Providers name and address, description of each service, the diagnosis required, modifier placement online items and the appeals process for denied claims.


Resource 1

From this resource, I will be able to come up with the third party payer regulations and claim submission requirements. The information provided in this source is useful in assessing the current trends in Healthcare.There is no evidence of bias on the side of the author, he open-mindedly addresses all the issues related to healthcare.

Resource 2

From this source, I will be able to come up with the specific reporting requirement for the payers’.I will then be able to assess the needs and explain how they will be beneficial in the billing department

Staff, P. (2018). Millennial Mindset Changing Health Care. Sat, 1(2), 3.

Resource 3

From this source, I will be able to get more information about private and public payer.I will also be able to identify the types of each of the payer and the services they offer.Moreover, I will be able to know the population it covers and the individuals who are eligible to benefit from it.The information I n it is useful in exploring more on the current insurance forms.

Glazer, J., & McGuire, T. G. (2002). Multiple payers, commonality and free-riding in health care: Medicare and private payers. Journal of Health Economics, 21(6), 1049-1069.

Resource 4

From this source, I will be able to explore more on the worker’s compensation plan and the medical costs for the care of patients’.The available information is relevant enough in the assessing of the worker’s compensation plans .the author was not biased in any way while writing the article.The source w3ent through peer review before being published.

Williams, J. A., Sorensen, G., Hashimoto, D., Hopcia, K., Wagner, G. R., & Boden, L. I. (2017). Impact of Occupational Injuries on Non-Workers’ Compensation Medical Costs of Patient-Care Workers. Journal of occupational and environmental medicine, 59(6), e119.



Work cited

Green, Michelle A. Understanding health insurance: A guide to billing and reimbursement. Cengage Learning, 2018.