Which statement about payer-plan relationships is true?

• A. A payer can have multiple plans.
• B. A plan can have multiple payers.
• C. Payers and plans are unrelated.
• D. Payers must be linked to a single plan.

Answer: (A)

Payers offer a range of plan options to cover different groups and needs. A single payer can administer multiple plans—different benefit designs, deductibles, networks, and premium levels—so they can serve individuals, employers, and various market segments. This flexibility is essential for accurate claims processing, because each plan has its own rules and pricing that determine how a claim is adjudicated and what the patient pays. The statement that a plan can have multiple payers isn’t how this relationship is typically viewed, since plans are generally tied to a specific payer. Likewise, claims processing isn’t about unrelated payer and plan entities, and payers aren’t required to be linked to only one plan.