Contract between a self-funded insurance plan and an insurance company or third-party administrator (TPA) whereby the insurance company provides administrative services only and assumes no risk. Usually, this is an employer’s group health insurance program and it retains financial responsibility for payment of the insurance claims. Services include actuarial activities, benefit plan design, claim processing, data recovery and analysis, employee benefits communication, financial advice, medical care conversions, preparation of data for federal reports, and stop-loss coverage. Also known as ACS contract.
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Contract between an insurer (or its subsidiary) and a group employer, eligible group, trustee, or other party, in which the insurer provides certain administrative services. These services may include actuarial support, plan design, claims processing, data recovery and analysis, benefits communications, financial advice, medical care conversions, data preparation for governmental reports, and stop-loss coverage.
Insurance Encyclopedia
Administrative services organization (ASO)
Association that provides only administrative services for a self-funded insurance company or entity such as billing, practice management, and marketing.
Administrative simplification (AS)
Title II, Subtitle F, of HIPAA, which gives Health and Human Services (HHS) the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. This is also the name of Title II, Subtitle F, Part C of HIPAA.
Administrative Simplification Compliance Act
Statute that was signed into law on December 27, 2001, as Public Law 107-105. It provides a 1-year extension to Health Insurance Portability and Accountability Act (HIPAA)–covered entities to meet electronic and code set transaction requirements. It allows the Secretary of the Department of Health and Human Services (HHS) to exclude providers from Medicare if they are not compliant with the HIPAA electronic and code set transaction requirements and to prohibit Medicare payment of paper claims received after October 16, 2003, except under certain situations.
Administrative subpoenas
Subpoenas issued in the course of administrative proceedings or investigations seeking the disclosure of medical records or other patient health information such as hearings before disciplinary boards to revoke professional licenses, proceedings before state agencies to determine the propriety of facility license citations, and disputes before administrative law judges about proper Medicare or Medicaid reimbursement.
Administrator
A person legally vested with the right of administration of an estate.
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MEDICAL, US:
1. Individual appointed by a court to manage and settle a deceased person’s estate. 2. Third-party entity or individual responsible for the management of a group insurance program. Responsibilities include accounting, certificate issuance, and insurance claim reimbursement. 3. In a 401(k) defined-contribution pension plan, a company that processes employees’ contributions, mails statements, ensures compliance with federal tax law, and handles other bureaucratic chores. 4. In the Medicare and Medicaid programs, the title of the director of the Centers for Medicare and Medicaid Services (CMS).
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An individual or professional organization (such as a Bank’s Trust Department) authorized to administer the estate of a deceased person by the court; his or her duties are to collect assets of the estate, pay its debts, and distribute the residue to those entitled. He or she resembles an executor who is appointed by the will of the deceased. The administrator is appointed by the court and not by the deceased and therefore must give security for the administration of the estate, called an administration bond.
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1. A person appointed by the court to administer the estate of another who died intestate or without an executor. Section 167 of the Judicature Act 1925 obliges the administrator to enter into an administration bond. 2. The person or persons regarded by the Inland Revenue and, where relevant the Occupational Pensions Board, as responsible for the management of a pension scheme. 3. An insolvency practitioner managing the affairs of a company when it into administragoes tion.
Admiralty
Involving maritime law, concerning the high seas or navigable waters.
Admiralty Court
Admiralty Court is a court having jurisdiction over maritime questions pertaining to ocean transport, including contacts, charters, collisions and cargo damages.
Admiralty courts
Courts of law that deal with matters pertaining to the sea.
Admiralty Law
Admiralty law (also known as “Maritime Law”) includes all areas of law relating to maritime activity. Navigation, commerce, the shipment of goods, the transportation of passengers, and matters dealing with maritime employees are all covered. Admiralty law governs much of the insuring language in Ocean Marine Insurance. (See Ocean Marine Insurance).