Administrative guidelines documented in a book used by insurance claims adjusters to settle (adjudicate) claims for payment according to the insurance company’s policies and procedures.

Social Security number of the wage earner, which appears on the Medicare identification card.

Number assigned to a Medicare insurance claim for processing by the fiscal intermediary.

In insurance, an estimate of the amount of money to set aside that will be needed to pay insurance claims. The claim department gathers information during the course of handling the claim to obtain this estimate. These data may include the extent to which the claim is covered by the policy, the effect of previously paid claims on the amount of coverage available to pay a current claim, and the effect of any applicable reinsurance coverage on the claim.

Type of contract in which the insurance company provides claims processing and bases its fee on the number of processed claims.

National administrative code set that indicates the general category of the status of health care claims. This code set is used in the X12 277 claim status notification transaction and is maintained by the Health Care Code Maintenance Committee.

National administrative code set that identifies the status of health care claims. This code set is used in the X12 277 claim status notification transaction and is maintained by the Health Care Code Maintenance Committee.

MEDICAL,USA: Insured individual or beneficiary who makes a formal request for payment of insurance benefits because of illness or injury that meets the terms of an insurance contract. This individual could be a provider or legal representative of the insured who makes a claim to an insurance plan.
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The first or third party. That is any person who asserts right of recovery.
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The individual requesting payment of a claim.
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The person making a claim.
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US: The person making a claim. Use of the word “claimant” usually denotes that the person has not yet filed a lawsuit. Upon filing a lawsuit, claimant becomes a plaintiff, but the terms are often used interchangeably.
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The person making a claim. Use of the word &#8220claimant&#8221 usually denotes that the person has not yet filed a lawsuit. Upon filing a lawsuit, claimant becomes a plaintiff, but the terms are often used interchangeably.