Review a patient’s medical case for appropriateness and necessity of admissions.
Tag: RAW
Admission wire
Blue Cross and Blue Shield phrase; a formal notice sent by a host plan to the home plan that one of their members has been admitted into a plan hospital in the host plan’s area and a request for membership information. See also approval wire.
Admission/1000
The number of hospital admissions for each 1000 members of the health plan.
Admissions per 1000 (APT)
Method used to compare the number of hospital admissions for defined populations for a specific period of time, usually 1 year. APT is commonly used by managed care plans to evaluate utilization management performance. Admissions per 1000 formula: number of hospital admissions for a population divided (÷) by the number of persons in that population, and the result multiplied (×) by 1000.
Admits
The number of admissions to a hospital (including outpatient and inpatient facilities).
Admitted (Authorized) Reinsurance
Reinsurance for which credit is given in the ceding company’s Annual Statement because the reinsurer is licensed or otherwise authorized to transact business in the jurisdiction of domicile of the ceding company. (See also Non-Admitted Reinsurance)
Admitted Assets
Those assets of an insurer that under IRDA guidelines can be taken into account in representing the financial position of the company.
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Cash and investments that meet criteria for liquidity and safety set by the National Association of Insurance Commissioners (NAIC) and by individual state commissioners. Only admitted assets are used in measuring the capacity and soundness of an insurer. Nonadmitted assets, such as overdue receivables, are excluded from statutory assets and surplus.
Admitted Company
A company licensed to provide insurance in a particular state.
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US: A company licensed or authorized to sell insurance to the general public. In the United States, admitted companies are licensed on a state-by-state basis and differentiated from surplus lines insurers, which are authorized to sell insurance in a state on a nonadmitted basis.
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An insurance company that is licensed (admitted) to conduct business within a given state.
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Admitted insurance
Insurance written by an insurer licensed to do business in the state or country in which the insured exposure is located.
Admitted Insurance or Reinsurance
Insurance from an insurer who is licensed to do business in India or a given country. Reinsurance from a reinsurer who is licensed or approved to business in India or a given country.