Billing tool used for choosing the action to take after receiving an explanation of benefits document from a third-party payer.
Tag: RAW
Reimbursement manager
Individual who designs systems to assure generation of accurate clinical documentation to substantiate billing and develops and puts into action systems to assure the secure transmission of data to billing centers, clearinghouses, or third-party payers.
Reimbursement specialist
See: insurance billing specialist .
Reinstate
To place an insurance policy in force again without any probationary period that has lapsed or terminated.
Reinstated benefits
Insurance policy that restores the lifetime maximum according to a specified schedule during periods when the insured is not drawing benefits.
Reinstatement
(i) Restoration, automatically or on application of the full amount of a Policy contract following a loss; in some cases additional premium is required. (ii) The restoration of damaged property to its original condition or, in some cases, replacement by a new property.
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UK: 1. A reinstatement condition attached to a commercial property policy to provide that a claim may be based on full repair or replacement cost without deduction for depreciation subject to certain conditions. Many household policies contain a reinstatement clause allowing ‘new for old’ settlements subject to conditions and excluded forms of property. Where a ‘new’ item is superior to an ‘old’ item the insurer, commercial or household, may replace it provided the insured contributes to the ‘betterment’. 2. Most property policies give the insurer the option to settle a claim by money, repair, reinstatement or replacement. Once the insurer opts for reinstatement it becomes an obligation to restore the property substantially to its pre-loss conditions even if its means exceeding the sum insured. 3. Following a claim, the sum insured or limit of indemnity is reduced by the amount concerned. A ‘reinstatement of sum insured (or limit of indemnity) clause’ automatically restores the sum insured after a loss. See REINSTATEMENT AVERAGE.
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UK: re-establishment of the sum insured to its original figure after it has been reduced by the amount of a loss payment, usually in return for the payment of an additional premium.
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The restoring of a lapsed policy to full force and effect. The reinstatement may be effective after the cancellation date, creating a lapse of coverage. Some companies require evidence of insurability and payment of past due premiums plus interest.
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The resumption of a policy which has lapsed.
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US: The resumption of coverage under a policy which has lapsed.
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MEDICAL,USA: To restore an insured to an active status that has been canceled for insurance coverage. This may be with or without continuation of medical benefits. Also see automatic reinstatement clause .
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UK,reinsurance: A reinsurance clause restoring cover to the level existing prior to the occurrence of a loss. The number of reinstatements to be allowed is usually negotiated when the treaty is placed. Reinstatements may be free or charged at a percentage of the treaty premium. Reinstatement applies mainly to risk excess of loss treaties covering property, marine and aviation business, and all forms of catastrophe excess of loss treaties.
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reinsurance: Re-effecting a catastrophe reinsurance policy that has already paid out for one loss caused by a catastrophe. This is usually done because of payment of a premium, known as a reinstatement premium.
Reinstatement average
Means average as applied to a policy subject to the reinstatement clause. Average will not apply if the sum insured is equal to 85 cent or more of the value at risk at per the time of reinstatement. The sum insured should therefore allow for the period of insurance plus the time estimated for rebuilding. Losses settled on an indemnity basis remain subject to normal pro rata average.
Reinstatement by the insured
An insured may be obliged to reinstate by statute or by contract under certain provisions in the Trustee Act 1925, s.20(4), or the Law of Property Act 1925 s. 108 (3).
Reinstatement Clause
A provision in a reinsurance contract stating that, when the amount of reinsurance coverage provided under a contract is reduced by the payment of loss as the result of one occurrence, the reinsurance coverage amount is automatically reinstated for the next occurrence, sometimes subject to the payment of a specified reinstatement premium. Reinsurance contracts may provide for an unlimited number of reinstatements or for a specific number of reinstatements. See Reinstatement Premium.
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When the amount of reinsurance coverage provided under a treaty is reduced by the payment of a reinsurance loss as the result of one catastrophe, the reinsurance cover is automatically reinstated usually by the payment of a reinstatement premium.
Reinstatement clause/memorandum
See: REINSTATEMENT 1.