Process of obtaining insurance claim information to decide if a claim should be paid by the insurance company.

1. Time period between the patient’s encounter (incurred) date of the insurance claim and its submission to the third-party payer. 2. Time period between the incurred date of the insurance claim and its payment by the third-party payer.

Data evidence of claims paid under an insurance plan or coverage for a specific time period. Such lists include identification of the insured, cause of the insurance claim, description of service, and amount paid.

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.