Health insurance company that pays on a claim as the first carrier before the second insurer pays when a patient has two policies and they are coordinating benefits.
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An original insurer as distinct from a reinsurer.

Program in which the state contracts directly with primary care providers who agree to be responsible for the provision and/or coordination of medical services to Medicaid recipients under their care. Most primary care case management (PCCM) programs pay the primary care physician a monthly case management fee in addition to reimbursing services on a fee-for-service basis. Also called primary care case management (PCCM).

Provision in an insurance policy under the coordination of benefits clause in which the health plan pays without taking into account any other plans.

1. Initial identification of the condition, illness, injury, or chief complaint for which the patient is treated for medical care in a physician’s office or as a hospital outpatient. Insurance claim forms must show the diagnostic code reflecting the primary diagnosis. 2. Underlying cause for the office visit or treatment.

Insurance company that covers the initial payments for medical services when a person has more than one health insurance plan. The patient must pay the deductible and any copayment fee.
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Insurer that provides primary Insurance. See Also: “Primary Insurance.”

1. Insurer obligated to pay losses first when two or more insurers may be responsible for paying the claim. 2. Medicare is a primary payer with respect to Medicaid; for a person eligible under both programs, Medicaid pays only for benefits not covered under Medicare or after Medicare benefits are exhausted. 3. An employer’s health plan if a Medicare patient is covered by that plan, and then Medicare is the secondary payer. 4. Insurance carrier or managed care plan that has the first responsibility under the coordination of benefits clause between two or more insurers.

When coordinating benefits of two insurance plans, the medical expense plan pays benefits first before any benefits are paid by another medical expense plan.

Site where the tumor began or originated.

Patient’s condition established after study that is chiefly responsible for the admission of the patient to the hospital. The principal diagnosis may or may not be the same as the primary diagnosis. Also see admitting diagnosis and major diagnosis .

1. Diagnostic code for a condition established after study that is responsible for the admission of the patient to the hospital. 2. When completing the Uniform Bill (UB-04) paper or electronic claim form, the principal diagnosis code including fourth and fifth digits should appear in Field 67.