Insurance individual (agent or broker) recognized by the insurer as the one to whom the commission is to be paid.

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The Agent of Record is that agent who is authorized to represent an insured with a designated insurance company. Normally, only the agent of record is able to obtain information about the insured from an insurance company. If an insured wishes to remain with the same insurance company but also wishes to change agents, the insured furnishes the company with an “agent of record letter” notifying the company of the new agent relationship.For example, suppose John has his business insurance with Company A and is very satisfied. However, John does not think his agent is providing the service he deserves. John finds another agent he believes will provide better service and sends an agent of record letter to Company A. Company A may then give information about John’s account to his new agent.

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US: The individual or company authorized to represent an insured in the purchase, servicing, and maintenance of insurance coverage with a designated insurer. Most insurance companies will not disclose any information or discuss an insured’s account with any agent other than the agent of record. An insured wishing to change insurance agents must submit a revised agent of record letter to the insurer authorizing them to release the insured’s information and to discuss the insured’s coverage with the new agent.

Section of the insurance application form where the insurance agent reports data that he or she knows or suspects about the potential insured that is not stated by the applicant.

In workers’ compensation, change in a preexisting condition that causes a temporary or permanent increase in disability or creates a need for additional or different medical treatment. An aggravation may be caused by either a new injury or by work activity involving a physical, chemical, or biological factor.

In a managed care contract, the maximum amount (limit) for which a member is insured for any single event.

A maximum dollar amount which may be collected for any disability, period of disability, or under the policy.******Maximum amount for which an insured may collect for any disability, period of disability, or covered medical service under an insurance policy.******The maximum amount that may be claimed during a certain period or under the policy.
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The maximum amount that may be collected for any disability or period of disability under the policy.

Agreement in a managed care plan to relieve the amount of liability for insurance claims that are in excess of the amount anticipated for the contract year. Also see stop loss.

Insurance coverage that becomes effective when an employer who has self-insurance has its total group medical insurance claims reach a specific threshold chosen by the employer. This threshold is a percentage of its yearly predicted group health claim costs.

Under a system developed by Johns Hopkins University called adjusted clinical groups (ACGs) , ACGs are a comprehensive family of measurement tools designed to help explain and predict how health care resources are delivered and consumed. ACGs are based on building blocks called aggregated diagnosis groups (ADGs). ADGs are a grouping of diagnosis codes that are similar in terms of severity and likelihood of persistence of the health condition over time. There are two categories of ADGs, ambulatory diagnostic groups–major diagnostic category (ADG-MDC) and ambulatory diagnostic groups–hospital dominant (ADG-HosDom).

Document used to determine outstanding balances from each patient’s account showing status of 30, 60, 90, or 120 days from the date of insurance claim submission. It can be generated by using the date an insurance claim was filed to assess the age of the claim in days. Sometimes referred to as an aging report.

1. Document that reports the status of insurance claims to the provider of the medical services and identifies individual transactions that need to be followed up (e.g., appeal or resubmit a corrected a claim). 2. See aging accounts receivable (A/R) report.