Who are the top payors by provider specialty?

Payors, or insurance companies, provide financial protection and support for individuals seeking healthcare services. Healthcare providers, on the other hand, are the professionals who offer medical care to patients. Understanding the relationship between the two is critical for both individuals seeking healthcare services and providers looking to work with payors.

In the U.S., health insurance is necessary for individuals seeking healthcare services due to the high cost of medical care. The Health Insurance Marketplace was established to provide affordable health insurance options for individuals who may not be able to afford traditional healthcare plans. It offers various plans, including relatively less expensive health insurance options, which are designed for individuals on a tight budget.

No-cost health insurance options are also available for individuals who meet certain criteria. These options include Medicaid and Medicare, which are government-funded programs that provide healthcare coverage for certain people, including low-income individuals and senior citizens.

What is a claim?

A claim is a bill containing medical codes related to the specifics of treatment that healthcare providers submit to payors for payment. A claim offers insight into all of the medical services provided, including pharmaceuticals, medical devices and medical supplies.

It’s worth noting that the number of claims filed by a healthcare provider can be heavily influenced by their specialty. For example, family practice physicians and nurse practitioners often serve as the first point of contact for patients seeking medical care. They may provide a wide range of services and treatments, including preventive care, routine check-ups, and chronic disease management. Additionally, family practice physicians and nurse practitioners may see a higher volume of patients overall, which could also contribute to a higher number of claims.

Below we’ve highlighted the top three payors for the 10 largest provider specialties based on the volume of claims filed in 2022.