Search results
Results From The WOW.Com Content Network
Claims that are denied or underpaid may require follow-up, appeals, or adjustments by the medical billing department. [ 5 ] Accurate medical billing demands proficiency in coding and billing standards, a thorough understanding of insurance policies, and attention to detail to ensure timely and accurate reimbursement.
This term is also now commonly used in commercial general liability (CGL) policies or so called "casualty" business. In these instances, the liability policies are written with a large (in excess of $50,000) self-insured retention (SIR) that operates somewhat like a deductible, but rather than being paid at the end of a claim (when a loss payment is made to a claimant), the money is paid up ...
The United States Court of Federal Claims (in case citations, Fed. Cl. or C.F.C.) is a United States federal court that hears monetary claims against the U.S. government.It was established by statute in 1982 as the United States Claims Court, and took its current name in 1992.
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans.
Claims and loss handling is the materialized utility of insurance; it is the actual "product" paid for. Claims may be filed by insureds directly with the insurer or through brokers or agents. The insurer may require that the claim be filed on its own proprietary forms, or may accept claims on a standard industry form, such as those produced by ...
The United States Department of Veterans Affairs, formerly titled the Veterans Administration, was the only federal administrative agency that operated without independent judicial oversight. [7] The Board of Veterans' Appeals, which is a part of the Department of Veterans Affairs, provided the final decision in a veteran's claim for benefits.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Before the Court of Claims was established, monetary claims against the federal government were normally submitted through petitions to Congress. By the time of the Court's creation, the workload had become unwieldy so Congress gave the Court jurisdiction to hear all monetary claims based upon a law, a regulation, or a federal government ...