Evaluation of health care services to determine medical necessity and appropriateness of medical care during the time the services are being provided. It is done to encourage discharge of the patient from the hospital as soon as his or her medical condition no longer needs continued inpatient care. This may occur for inpatient, residential, partial hospitalization treatment, and outpatient care. The review is usually done at the time services are provided by a health care provider other than the one giving the care.
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A case management technique which allows insurers to monitor an insured’s hospital stay and to know in advance if there are any changes in the expected period of confinement and the planned release date.
Tag: RAW
Concussion damage
Damage caused by a violent shock as in the case of an explosion. The standard fire policy covers explosion damage caused by domestic boilers or the explosion of gas used for domestic purposes or used for lighting or heating the building (provided it is not a part of a gas works).
COND
the FSA’s Threshold Conditions manual, the minimum standards for becoming and remaining authorised.
Condensation for Damages in Transit
There are essentially two types of condensation. Ship sweat is caused largely by parts of cargo getting heated and giving off vapor which condenses on ship’s structure. Cargo sweat is caused by condensation on cold cargo, of moisture carried by air in ship’s hold. Sweat damage can ruin many types of cargo. Textile goods may be discolored, metal and machinery parts may be rested, food products may lose their taste, fibers and wooden material may be stained and chemical substance may change their composition and properties.
Condition
(i) Those provisions in insurance contracts that quality the insurer’s promise of indemnity or those obligations on the insured.(ii) A part of a contract which must be complied with by one party or the other. A condition governs the validity of the contract. (iii) Provision in as Insurance Policy which, along with the insuring agreements, defines the respective rights and duties of the Insurer and the insured in carrying out the terms of the Policy.
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MEDICAL,USA: 1. Any illness, disease, injury, pregnancy, bodily defect or abnormality, mental illness, alcoholism, or drug or chemical dependence. 2. Part of an insurance policy that states the insured’s obligation and those of the insurance company in order for the policy to be in effect.
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An action that must be completed to have the insurance policy remain valid and for claims to be paid. For example, the policy’s premiums must be paid up to date.
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One of the obligations of either the insured or the insurer imposed in the insurance contract.
condition category (CC)
Wide-ranging sets of similar diseases clinically and cost comparable under the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCC) Model for capitated payments to managed care organizations.
condition code (CC)
Two-digit numeric code inserted in Fields 18 through 28 on the Uniform Bill (UB-04) insurance claim form to show that a condition applies and affects payment of the claim. Condition codes denote if coverage exists under another insurance, the illness or injury is employment related, the bill is an outlier, or medical necessity affects room assignment.
Condition Precedent of the Policy
A condition of an insurance a breach of which by the insured entitles the insurers to avoid the policy.
Condition subsequent
A stipulation in the policy that will cause the contract to be invalid, should a certain event take place.
Condition Subsequent to the Policy
A condition of an insurance a breach of which by the insured entitles the insurers to sue for damage though not to escape liability for a claim.