Medical or surgical procedure that may be obsolete or of doubtful value. Such procedures or tests are usually marked to be manually reviewed by a managed care plan’s utilization review committee for appropriateness of care.
Insurance Encyclopedia
Suspended claim
Insurance claim held by the insurance carrier as pending either due to an error or the need for additional information.
Suspense
1. Processed insurance claim held as pending either due to an error or the need for additional information. 2. Reminder method used to track pending or resubmitted insurance claims and to telephone or send inquiries about nonpayment. Also called a follow-up file, tickler file , or tracing file . Also see tracing file or tickler file .
Suspense period
Time span or hold period following discharge of a hospitalized patient in which the patient’s financial account remains available for charges and services before it drops into the claim-submission queue. Once this period passes, the account is deemed “unbilled.” This hold period is established by the hospital’s finance department.
Suspension
Preparation of a liquid drug in which the particles are undissolved and must be mixed by stirring or shaking before administration.
Suspension of payments
Withholding of payment by a fiscal intermediary or insurance carrier from a provider or supplier of an approved Medicare payment amount before a determination of the amount of the overpayment exists. Also called managed care payment suspension .
Suspension order
Opra suspension of a named person from continuing to act as a trustee of any occupational pension covered by the order (PA95, s.4). The trustee will be able to resume if the order is removed.
Suspension Provision
Insurance Policy clause which temporarily suspends coverage if some specified condition occurs. Coverage is restored if the condition is corrected, for example, some property Insurance policies contain a provision that coverage is suspended “during any substantial increase in hazard which is within the knowledge and control of the insured.
Suspicious
A term used to identify conditions found during the investigation of a fire incident. Used to indicate that the fire’s cause has not been determined, and that conditions present indicate that the fire cause is suspect of the fact of intentional burning. All accidental fire causes should be eliminated before this designation is given.
Sustainable growth rate
System for establishing goals for the rate of growth in expenditures for physicians’ services.