Pricer

1. Individual who reviews services, procedures, diagnoses, fee schedules, and other data and establishes the amount for a medical service or supply. Also called repricer. 2. Software package in an insurance claims processing system, specific to certain benefits, which analyzes specific data and determines the amount for a medical service or supply. Subsequently, other criteria are applied to establish the actual allowance or payment amount. It is most often used under prospective payment systems.

Prima Facie

Latin, “on first appearance.” A term frequently encountered in foreign trade. When a steamship company issued a clean bill of lading, it acknowledges that the goods were received “in apparent good order and condition” and this is said by the courts to constitute prima facie evidence of the conditions of the containers; that is, if nothing to the contrary appears, it must be inferred that the cargo was in good condition when received by the carrier.

Primacy

Status of being primary, or first in order, When two or more Insurance policies each cover the same loss, one Policy may provide that it is excess cover’ the other. The Policy not containing such a provision has primacy. In some cases, a Policy will state that it provides primary coverage, giving it primacy.

Primary

In reinsurance, this term is applied to the nouns: insurer, insured, policy and insurance and means respectively: 1) the insurance company that initially originates the business, i.e., the ceding company; 2) the policyholder insured by the primary insurer; 3) the initial policy issued by the primary insurer to the primary insured; 4) the insurance covered under the primary policy issued by the primary insurer to the primary insured (sometimes called “underlying insurance”).
***
Basic, fundamental; an insurance policy that pays first with respect to other outstanding policies.