Two-digit numeric code inserted in Fields 18 through 28 on the Uniform Bill (UB-04) insurance claim form to show that a condition applies and affects payment of the claim. Condition codes denote if coverage exists under another insurance, the illness or injury is employment related, the bill is an outlier, or medical necessity affects room assignment.

Insurance agreement in which the insured’s acceptance is considered uncertain during a specific time period and during which time the individual may cancel the agreement and receive a refund of the premium payments.
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Although only the Insurer can be forced to perform after the contract after the contract is effective, the Insurer can refuse to perform if the insured does not satisfy certain conditions contained in the contract. As such, Insurance contracts are conditional contracts.

Reimbursement made by Medicare for services for which a third-party (primary payer) is responsible. The provider (physician) requests payment from the Medicare Secondary Payer because a lengthy processing delay (more than 120 days) by the third-party payer is expected. The provider must agree to send a refund or request for reconsideration from Medicare within 60 days of the third-party payer’s payment.

Type of premium receipt given to the applicant on payment of the initial premium. The life insurance policy becomes effective before it is actually issued only on acceptance or approval of the application (i.e., the proposed insured is found to be insurable). Also called conditional receipt.

Circumstance in which Medicare is billed as the primary payer for a temporary period of time.

Insurance policy renewal provision that grants the insurer a limited right to refuse to renew a health insurance policy either to a stated date, at the end of a premium payment period, or at an advanced age.
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A continuation provision in health insurance under which the insurer may not cancel the policy during its term but can refuse to renew under specified circumstances.

MEDICAL,USA: 1. Illnesses, diseases, injuries, pregnancies, bodily defects or abnormalities, mental illnesses, alcoholism, or drug or chemical dependencies. 2. Part of an insurance policy that states the insured’s obligations and those of the insurance company in order for the policy to be in effect.
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UK: Parts of a policy that must be complied with by one party or the other. Conditions may be implied by law or expressed, i.e. set out in the policy. The effect of a breach by the insured depends upon whether it relates to a condition precedent (things to be done before the contract is concluded, e.g. utmost good faith); a condition subsequent (things to be done during the policy certain stanterm, e.g. maintainin dards); a condition precedent to liability (things to be done before the insurer is liable for a particular loss, e.g. proper notification). See WARRANTY.
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US: Provisions inserted in an insurance contract that qualify or place limitations on the insurer’s promise to perform.
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See: policy conditions.
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These are provisions of an insurance policy which state either the rights and duties of the insured or the rights and duties of the insurer. Typical condition have to do with such things as the insured’s duties in the event of loss, cancellation provisions, and the right of the insurer to inspect the property.

Federal requirements that health care facilities must meet to be eligible to participate in the Medicare program and receive payments for medical services rendered to beneficiaries. These conditions include meeting a statutory definition of the particular institution or facility, conforming to state and local laws and having an acceptable utilization review plan. Surveys to determine whether facilities meet conditions of participation are made by the appropriate state health agency.