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Line item

Medical service or other item listed as a line entry on an insurance claim form or other computer-generated document. Usual data are date of the service, procedural code, service fee amount, and so on.

Line item denial

Insurance carrier or fiscal intermediary’s refusal to pay one or more of the line items on an insurance claim due to a technical error or because of insurance policy benefit issues. Denied line items must be appealed by the provider except for emergency department visits in which the patient died during a procedure categorized as an inpatient procedure. In that situation, the claim is resubmitted as an inpatient claim.

Line item rejection

Insurance carrier or fiscal intermediary’s elimination of one or more of the line items on an insurance claim due to a technical error such as omission or erroneous information, or because it does not follow Medicare guidelines. In these situations the claim may be corrected and resubmitted by the provider, but they cannot be appealed.

Line Limit

Underwriting guidelines specifying the maximum amount of a particular type of Insurance that an Insurer judges it can safely write on a particular exposure without purchasing Reinsurance.

Line of business

A general category applied to insurers; for example, Homeowners, Health or Life.
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A general classification of insurance industry business—for example, fire, life, health, liability.
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REINSURANCE: The general classification of business designated by the National Association of Insurance Commissioners (NAIC) utilized in the insurance industry to identify the major segments of policies that are sold to the general public, i.e., fire, allied lines, homeowners, other liability, products liability, auto liability, etc. These are often referenced in the “Business Covered” article of reinsurance treaty contracts to designate the classes of business covered by the treaty. Many of these general classifications have one or more sub-classifications.
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The general classifications of business as utilized in the insurance industry, e.g., Fire, Allied Lines and Householders.

line of business (LOB)

1. Private indemnity insurance plan or managed care plan that is set up as a separate business unit within another larger organization (e.g., life insurance company, fidelity line, HMO, PPO). The LOB makes a distinction between the managed care plans from the free-standing company or one set up as a subsidiary. 2. Refers to a distinctive type of program within a health plan such as Medicaid. 3. Different types of health plans offered by a large insurance company or insurance broker as a product line.