Process or system in which a dissatisfied patient or participating provider of a managed care plan can express complaints to get a situation resolved. Such procedures include a due process provision and subject these procedures to a specific and standard adjudication method.
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A procedure which allows an insurer or a provider of benefits to express complaints and seek remedies.
Tag: RAW
Grievance procedure (Health Insurance)
A process instituted by a health plan or benefit provider for policyholders to file complaints.
Grievances and complaints
Information from a discontented patient or dissatisfied provider transmitted to a managed care plan’s grievance committee to seek remedies for resolution of the problem(s).
Grievous Hurt
According to Sec, 320 of the Indian Penal code the following kinds of hurt are designated as ‘grievous’: Emasculation. Permanent privation of the sight of the eye. Permanent privation of the hearing of either ear. Privation of any member or joint. Destruction or permanent impairing of the powers of any member or joint. Permanent disfiguration of the head or face. Fracture or dislocation of bone or tooth. Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuits.G.S.A. : General Sales Agent acting on behalf of an airline. Usually Broker or Forwarder.
Gross charges per 1000
Statistic used to evaluate utilization management performance for inpatient, outpatient, partial hospitalization, and so on. Providers in a managed care environment need this information. The formula is to take the gross charges incurred by a specific group for a specific time period and divide it by the average number of members in that group during the same period and then multiply the result by 1000.
Gross claims
Claims under contracts of insurance underwritten by the members of a syndicate plus internal and external claims settlement expenses less salvage or other recoveries, but before the deduction of reinsurance recoveries.
Gross Claims Incurred
Claims incurred without deduction for payment of reinsurers.
Gross conversion factor
Dollar amount that is obtained when converting a provider’s fee schedule that is not based on the resource-based relative value scale (RBRVS) to one that is using only the current fee schedule. Because income is related to the fee for each service and to the frequency performed, this gives only a rough conversion factor. For a more accurate conversion factor formula, see frequency-adjusted conversion factor (FACF) .
Gross cost
Total price of an insurance program for a certain time period such as 1 year before dividends and rate credits are considered.
Gross costs per 1000
Statistic used to evaluate utilization management performance for inpatient, outpatient, partial hospitalization, and so on. The formula is to take the gross costs incurred for services received by a specific group for a certain time period and divide it by the average number of covered members in that group during the same period, and multiply the result by 1000. Providers in a managed care environment need this information because it is imperative to keep gross costs per 1000 below collections per 1000.