Method that identifies providers and follows all contacts made to correct problems (e.g., provider’s eligibility, medical necessity issue, repeat billing abusers).
Insurance Encyclopedia
provider transaction access number (PTAN)
Formerly known as provider identification number (PIN). It is a carrier-assigned number that every facility, physician, clinic, or organization uses that renders services to patients when submitting insurance claims. It is issued to a provider by the insurance carrier or Medicare fiscal intermediary and allows the physician or patient to receive reimbursement for claims filed to the contractor. Also referred to as a legacy number. PINs have been replaced with the national provider identifiers (NPIs). See national provider identifier (NPI).
provider-sponsored network (PSN)
See: provider-sponsored organization (PSO).
provider-sponsored organization (PSO)
Group of doctors, hospitals, and other health care providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. This type of managed care plan is run by the doctors and providers themselves and not by an insurance company. Also called provider health plan or provider-sponsored network (PSN).
Provider-supplied information
Manual claim information inserted in the bottom half of the CMS-1500 (08-05) claim form.
Provision
UK: 1. An amount retained as reasonably necessary to provide for asset depreciation, or any liability or loss which is likely to be incurred. 2. In a pensions context, the unfunded obligation to provide employees’ pensions and shortfall of funding payments over the amount calculated by the actuary as being his estimate of the costs of providing pensions. Pensions costs in employers’ accounts should be actuarially assessed and included in the employer’s balance sheet under ‘provisions for liabilities’ as ‘pensions and other similar obligations. 3. Term in a policy, contract or statute.
***
MEDICAL,USA: Section of an insurance contract describing in detail a benefit, condition, feature, or requirement of the policy. Also called clause , insurance clause, or insurance provision.
***
UK,REFERENCE: See: reserve.
Provision and Use of Work Equipment Regulations 1998
See: PUWER 1998.
Provision for unearned premium
See: UNEARNED PREMIUM.
Provision for unexpired risks
Amount set aside on the balance sheet in addition to unearned premiums with respect to risks to be borne by the insurance undertaking after the end of the financial year, in order to provide for all claims and expanses in connection with insurance contracts in force in excess of the related unearned premiums and any premiums receivable on those contracts.
Provisional Advice
An early advice to a Reinsurer which is to be followed by a definite advice when accurate details are available.