A group of claims with a common period of origin. The period is usually a month or a quarter or a calendar year. The origin varies but is usually defined by the date of reporting, or by the date of payment of a claim.
Insurance Encyclopedia
Claim Control Clause
A clause in a Reinsurance contract requiring the Reinsured to give immediate advice to the Reinsurance of any claim that will attach to the Reinsurance contract before he settles it on the original Policy. The clause may require that the Reinsurer’s approval be obtained before the original claim is settled. The Reinsured will be expected to cooperate with the Reinsurer in defending the original claim at the Reinsurer’s option.
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Refer: “Reinsurance, Claims Control Clause”
claim control number (CCN)
Unique multidigit number assigned by the Medi-Cal fiscal intermediary on a Treatment Authorization Request and used for reference when processing the request.
Claim cost control
Insurance company’s attempt to streamline operations to contain and direct claim payments so that insurance premium funds are used efficiently.
Claim Cost Inflation
The rate of increase in the cost of claim payments. It is likely to be influenced by many different types of inflationary force, e.g., general or specific salary inflation, general or specific price inflation, court award inflation.
Claim department
The insurance company’s department that assesses whether claims will be paid.
Claim edits
Electronic examination of transmitted insurance claims for errors, conflicting code entries, and a match of diagnosis to medical service(s) provided. Also called edit check. See front-end edits.
Claim expense
The expense of adjusting a claim, such as investigation and attorneys’ fees. It does not include the cost of the claim itself.
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The costs, other than the actual claim cost, that are associated with paying a claim.
Claim Expenses
Fees charged by the Loss Adjuster/Surveyor, Investigator, Attorneys designated by the Insurance Company or by the insured with the company’s written consent and all other reasonable and necessary fees, costs and expenses resulting from the investigation, adjustment, defense and appeal of a claim if incurred by the insurance company or by the insured with the written consent of the insurance company, including, but not limited to, premiums for any appeal bond, attachment bond or similar bond but without any obligation of the insurance company to apply for or furnish any such bond. Claims expenses with respect to a claim may be paid first and may or may not include fees, costs or expenses of employees or officers of the insurance company.
Claim file
Accumulation of information needed for payment or denial of an insurance claim.