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.

Computer software that allows Medi-Cal providers to electronically verify recipient eligibility, clear share of cost liability, reserve Medi-Services, perform Family PACT (planning, access, care, treatment) client eligibility transactions, and submit pharmacy or CMS-1500 claims using a personal computer.

Practitioner who works for the consumer and helps patients organize, complete, file, and negotiate health insurance claims of all types to obtain maximum benefits, as well as tell patients what checks to write to providers to eliminate overpayment.

1. In industrial cases, a representative of the insurer who investigates, evaluates, and negotiates the patient’s insurance claim and acts for the company in the settlement of claims. 2. Individual employed by an insurance company who assists in settlement of claims by investigating claims, approving claims that are valid, and denying claims that are invalid or fraudulent. Some claims examiners are individuals who operate independently and are hired by insurance companies to adjust a specific loss. Also called adjuster, claims processor, claims representative, claims administrator, or health insurance adjuster.

A Medi-Cal form used for tracing a claim, resubmitting a claim after a denial, or when requesting an adjustment for underpaid or overpaid claims.

Insurance company’s reimbursement director or executive administrator who supervises and oversees employees who process insurance claims for payment.