In a managed care plan, membership established in the name of a member, who was not previously the subscriber, who is given a new identification number.
Insurance Encyclopedia
Reversed Onus of Proof
The law normally places on a party to a lawsuit the burden of proving certain facts. This onus of proof if sometimes shifted to another party either by statute or by contract.
Reversion
(1) A right to succeed to property or a position. (2) The repossession of property after a lapse of tie or the happening of an event.
Reversionary annuity
Annuity payable to one person (e.g. surviving spouse) upon the death of another (other spouse). If the former dies first, the premiums are forfeited.
Reversionary annuity (Annuity)
A contract, called an annuity, which is really more a type of life insurance contract on an insured. This contract only pays annuity benefits if the annuitant is still alive when the insured dies; for example, if one spouse, the annuitant, is alive as of the death of the other spouse, who is the insured.
Reversionary bonus
the share of surplus allocated to holders of with-profits policies at the insurer’s year-end; sometimes called annual or guaranteed bonus, and payable in the same circumstances as the sum assured. Once declared it cannot be taken away and is added to the sum assured; but see Market value reduction.
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A sum added periodically during the currency of a with profits life insurance which becomes payable at the same time and in the same circumstances as the sum insured.
Review
1. Independent, critical examination of an insurance claim made by the insurance carrier personnel not involved in the initial claim determination. 2. Request for a redetermination to the local Medicare carrier by telephone or in writing. 3. Brief note or a provider’s initials appended to a test report is considered a review; when billing, it is included in evaluation and management services.
Review committee
Group of individuals who evaluate insurance claims that have been denied payment by the insurance carrier and appealed by the provider of the medical services. In the Medicare program, this process is called redetermination and was formerly known as review .
Review of claims
Evaluation of information on an insurance claim or other information requested to support the medical services billed and to make a determination regarding payment to the provider.
review of systems (ROS)
Inventory of body systems obtained through a series of questions that is used to identify signs and/or symptoms that the patient might be experiencing or has experienced. ROS may clarify the differential diagnosis or identify needed tests. A documented report of the body system directly related to the problem must be identified in the history of present illness (HPI) plus all additional body systems (at least 10) for comprehensive assessments. Also called system review .