A multiyear rating device found in some reinsurance agreements that provides that a loss to reinsurers in a given time period may be applied to the results of a previous period (loss carryback) or may be applied to a future period (loss carryforward).
Insurance Encyclopedia
Cartel
Cartel is an association of several independent national or international business organizations that regulates competition by controlling the prices, the production or the marketing of a product or an industry.
Carve out
1. Medical service not included within the capitation rate as a benefit of a managed care contract and may be contracted for separately. For example, carve-out services might include vision and dental, sometimes called a single-service plan (SSP) . 2. Integrated plan of providing medical coverage to Medicare-eligible employees. See Medicare carve-out.
Carve-out plan
Insurance coverage for specific health care services available for purchase separately from the basic managed care plan. Also called single-service plan (SSP). Also see Medicare/employer supplemental insurance.
Case
1. A particular instance of injury or disease, as a case of leukemia; sometimes used incorrectly to designate the patient with the disease. 2. Entire plan of a group insurance policyholder.
Case by Case Estimation
A method of determining the reserve for outstanding reported claims. Each outstanding claim is individually assessed to arrive at an estimate of the total payment to be made.
Case history
Past and current clinical information that the physician wants to know about the patient. The case history becomes part of the patient’s health record.
Case Law
The part of the law which is found in the decision of the judge as reported to the various series of law reports.
Case managed
See: case management.
Case management
1. Ongoing review of cases by clinical professionals to ensure the necessity of the clinical services given and most appropriate use of services to a patient. Typically, case managers are nurses or social workers. They may operate privately or may be employed by social service agencies or public programs. 2. Process that integrates and coordinates patient care in complex and high-cost cases. Sometimes a patient is referred to as case managed. 3. Process of developing a defined health care plan for a patient for better communication and to improve quality of care and reduce costs. Case management is sometimes a “carve out.” See carve out. 4. In the Medicare program, an arrangement of services needed to give proper health care to a beneficiary; tracking of beneficiary’s use of facilities and resources. Also known as catastrophic case management, catastrophic claim management, large claim management, or medical case management.
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Case management is used to manage healthcare costs in workers compensation. The case manager works with the insured, the physician, and the employer to design the most cost-efficient treatment plan. Case managers also monitor the injured worker’s progress and keep the employer and insurance company informed about the worker’s ability to return to work.