top of page

Understanding the Difference Between Payers and Providers

In the ever-changing world of healthcare, it can be difficult to stay up to date and properly informed on all of the industry-based acronyms, codes and business titles. One of the most important areas of healthcare to understand is the payer and provider sectors. These healthcare sectors play a crucial role in how our healthcare system functions in the United States. Even though these titles are meant to add identification and clarity, it can quickly become overwhelming and hard to differentiate between the two.

Read on to learn more about the difference between the payer and provider sectors and how Signature Performance strives to bridge the gap within the healthcare administrative services industry using our experience-driven vision.

Who is a Payer?

A payer, or sometimes payor, is a company that pays for an administered medical service. An insurance company is the most common type of payer. A payer is responsible for processing patient eligibility, enrollment, claims, and payment. The Centers for Medicare and Medicaid Services (CMS) is one of the largest healthcare payers in the United States.

Who is a Provider?

A provider is a company that administers a healthcare service. A healthcare provider is typically a hospital or clinic that provides an in or outpatient medical service or procedure. In the federal healthcare industry, a payer can also be a provider at times. This can occur if a patient is referred somewhere else by a government hospital or clinic. One of the biggest examples of this arrangement is Veterans Affairs (VA). Veterans can receive care from VA, but the VA can also refer a patient to an outside specialist for care.

How Signature Bridges the Gap Between Sectors

With each sector carrying such significant responsibility, ensuring that their workflow design is structured for success is key to keeping administrative costs low and allowing patients to receive the care they deserve.

At Signature Performance, it’s our mission to improve efficiency within the healthcare administrative services industry. Our unmatched experience on both the payer and provider side of the business allows our team the opportunity to evaluate industry issues from a variety of perspectives, eliminate any static within communication efforts and create custom solutions that get to the core of the problem.

Signature Performance serves some of the largest payers in the country! Our end-to-end claims cycle and payment integrity reviews make it easy to optimize a payer’s existing system and eliminate common administrative errors. Our 15 years of experience provides Signature with the industry insights and knowledge our team needs to effectively navigate communication challenges payers and providers face. At Signature, our team will coordinate with the provider and patients to help payer beneficiaries receive access to the services they need while eliminating unnecessary costs in the process.

When it comes to providers, Signature works with hospitals and clinics of all sizes. Our team is passionate about implementing cost-effective revenue cycle support. As a full-service revenue cycle business administration partner, we offer a wide variety of provider-based services that will get insurance claims processed accurately and in a timely manner. Our custom solutions and state-of-the-art processes will ensure that providers are paid properly for the care that was administered.

To learn more about how Signature Performance can help you or to request a revenue cycle assessment, contact our team today!


bottom of page