National administrative code set that identifies the status of health care claims. This code set is used in the X12 277 claim status notification transaction and is maintained by the Health Care Code Maintenance Committee.
Insurance Encyclopedia
Claim-Made basis (Policy attaching basis)
A form of reinsurance under which the date of claim reported is deemed to be the date of the loss event. Claims reported during the term of the reinsurance agreement are therefore covered, regardless of when they occurred. A claims made agreement is said to “cut of the tail” on liability business by not covering claims reported after the term of reinsurance agreement – unless extended by special agreement. See. Occurrence basis.
Claim-Right Insurance
Insurance to the consignor of goods in respect of money withheld by the consignee in accordance with the contract of sale, pending arrival of the goods.
Claimant
MEDICAL,USA: Insured individual or beneficiary who makes a formal request for payment of insurance benefits because of illness or injury that meets the terms of an insurance contract. This individual could be a provider or legal representative of the insured who makes a claim to an insurance plan.
***
The first or third party. That is any person who asserts right of recovery.
***
The individual requesting payment of a claim.
***
The person making a claim.
***
US: The person making a claim. Use of the word “claimant” usually denotes that the person has not yet filed a lawsuit. Upon filing a lawsuit, claimant becomes a plaintiff, but the terms are often used interchangeably.
***
The person making a claim. Use of the word “claimant” usually denotes that the person has not yet filed a lawsuit. Upon filing a lawsuit, claimant becomes a plaintiff, but the terms are often used interchangeably.
Claiming Cash
A Right which insurers may have to ask reinsurers for immediate settlement of a substantial claim rather than wait for the regular periodical settlement.
Claiming Cash, Reinsurance
Refer: “Reinsurance, Claiming Cash.”
Claims Adjustor
Person who settles claims: an agent, company adjustor, independent adjustor, adjustment bureau, or public adjustor.
Claims administrator
See: adjuster or claims processor.
Claims advice clause
See: Claims Cooperation Clause.
Claims Analysis
In a situation of deteriorating claim results, the claim database need to be analyzed as to whether there is a pattern in the losses. The report may indicate (i) unusual frequency viz., more number of claims than were estimated, or (ii)more severity i.e., more amounts to be paid out than was the expected norms.