Claim evaluation and determination made using system logic (edits). Automated claim reviews never require the intervention of a human to make a claim determination.

Computerized claims processing system used in reimbursement of medical, dental, or disability insurance claims.

Third-party administrator (TPA) that receives information from another entity, performs software edits, and redistributes the claims electronically to various insurance carriers in a standard transaction. Also known as clearinghouse .

An interactive voice response system in the Medi-Cal program that allows providers to access recipient eligibility, clear share of cost, and/or reserve a Medi-Service.

Name of an insurance claim reimbursement method that uses computer technology in settling Medicaid claims.

Bank service that permits payment by one check to a number of creditors or direct payment by the bank for specified recurring bills by monthly transfer of funds (e.g., payment of insurance premiums). See also electronic funds transfer system (EFTS) and preauthorized payment. Also called bank check plan, check deposit billing, electronic funds transfer system (EFTS), check-o-matic, preauthorized checking, or preauthorized payment.

Insurance plan choice that automatically pays any premium that is in default at the end of a grace period (usually 31 days). This payment is charged against the insurance policy as a loan, provided the premium is not in excess of the policy’s cash surrender value on the due date of the premium.

Clause in an insurance policy that provides for automatic restoration of the full face value of the policy after payment for a loss. Also called reinstatement.
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UK: Also called a self-renewing clause. A clause under which the sum insured or limit of indemnity is automatically restored to its original level following a claim.
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A clause in an Insurance Policy which provide for automatic reinstatement of the full face value of the Policy, after payment for a partial loss. Refer “Reinstatement.”

Type of formal agreement between a reinsurer and a ceding insurer that automatically transfers the risks and their acceptance by the reinsurer. Also called treaty.
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Refer: “Reinsurance, Automatic Treaty.”

Clause in a contract that automatically reestablishes the contract with the same terms for another stated period of time. See also reinstatement.