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A medical biller then takes the coded information, combined with the patient's insurance details, and forms a claim that is submitted to the payors. [2] Payors evaluate claims by verifying the patient's insurance details, medical necessity of the recommended medical management plan, and adherence to insurance policy guidelines. [4]
In addition to medical expense insurance, "health insurance" may also refer to insurance covering disability or long-term nursing or custodial care needs. Different health insurance provides different levels of financial protection and the scope of coverage can vary widely, with more than 40% of insured individuals reporting that their plans do ...
Professional liability insurance (PLI), also called professional indemnity insurance (PII) but more commonly known as errors & omissions (E&O) in the US, is a form of liability insurance which helps protect professional advising, consulting, and service-providing individuals and companies from bearing the full cost of defending against a ...
A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization).
This is an accepted version of this page This is the latest accepted revision, reviewed on 12 January 2025. Equitable transfer of the risk of a loss, from one entity to another in exchange for payment "Insure" redirects here. Not to be confused with Ensure. For other uses, see Insurance (disambiguation). An advertisement for a fire insurance company Norwich Union, showing the amount of assets ...
Insurance industry group America's Health Insurance Plans estimates that administrative costs have averaged approximately 12% of premiums over the last 40 years, with costs shifting away from adjudicating claims and towards medical management, nurse help lines, and negotiating discounted fees with healthcare providers.
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Line of business (LOB) is a general term which refers to a product or a set of related products that serve a particular customer transaction or business need. In some industry sectors , like insurance , "line of business" also has a regulatory and accounting definition to meet a statutory set of insurance policies.
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related to: service lines medical definition insurance