Universal insurance claim form developed and approved by the American Medical Association Council on Medical Service and the Centers for Medicare and Medicaid Services, formerly the Health Care Financing Administration. It is used by physicians and other professionals to bill outpatient services and supplies to TRICARE, Medicare, and some Medicaid programs, as well as most private insurance carriers and managed care plans.

Division of the Department of Health and Human Services (DHHS), formerly Health Care Financing Administration (HCFA). Develops and administers policies for the Medicare program and works with the states to manage the Medicaid program. Responsibilities include managing contractor claims payment, fiscal audit and/or overpayment prevention and recovery, and developing and monitoring payment safeguards necessary to detect and respond to payment errors or abusive patterns of service delivery. CMS sets standards for Medicare Part D insurance plans. CMS maintains the UB-92 institutional EMC format specifications, the professional EMC NSF specifications, and specifications for certifications and authorizations used by the Medicare and Medicaid programs. CMS maintains the HCPCS medical code set and the Medicare Remittance Advice Remark Codes administrative code set.

Form that is required for access to the CMS data center.

Insurance company payment that will be made under any circumstances and is not contingent on any predesignated condition.

Insured individual of a group insurance policy that has been issued a certificate of insurance, which certifies that an insurance contract has been written.This certification of insurance contains a summary of the coverage of the policy in general terms applicable to that member.
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The entity that is provided a certificate of insurance as evidence of the insurance maintained by another entity. In standard certificate forms, the certificate holder is usually listed in the space provided for that purpose.

Largest total payment limit that an insurance plan will generate for certain kinds of care that a member may receive while the certificate is valid.

Numeric or alphanumeric characters issued to an insured or member of an insurance plan and used for identification. It appears on an insured’s health insurance identification card and is placed on insurance claim forms when submitting claims or when communicating with insurance companies. Also called identification number (ID #).

In assumption reinsurance, each policyholder is sent an official document (certificate) when the policy has been ceded about a notice of the assumption and information about the new insurer.

1. State license to operate as a health maintenance organization (HMO). 2. Insurance company’s document that grants authority to a particular agent or group of agents to act on behalf of the insurer. 3. Certificate issued by a state’s insurance department that authorizes an insurance company to issue certain types of insurance in the state.

Federal document that legally protects researchers from having to disclose information about research participants as a result of a subpoena or court order. It is for projects involving information of a sensitive nature that, if released, could harm participants. See sensitive information.