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Fiscal intermediary

The agent (e.g., Blue Cross) that has contracted with providers of service to process claims for reimbursement under health care coverage. In addition to handling financial matters, it may perform other functions such as providing consultative services or serving as a centre for communication with providers and making audits of providers' needs. A private organization, usually an insurance company, that serves as an agent for the Health Care Financing Administration (CMS), which is part of HHS, that determines the amount of payment due to hospitals and other providers and paying them for the Medicare services they have provided. A private company that has a contract with Medicare to pay Part A and some Part B bills (for example, bills from hospitals). Intermediaries make initial coverage determinations and handle the early stages of beneficiary appeals. This entity may also be referred to as TPA or third party administrator.

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  • Part of Speech: noun
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  • Blossary:
  • Industry/Domain: Health care
  • Category: General
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