In the Medicare program, a course of action used by a patient (beneficiary) if he or she disagrees with any decision about the health care services received. Now referred to as redetermination process.

1. Request process to reconsider a decision by an insurance plan after a first appeal. 2. In the Medicare program, the first step for an appeal is called redetermination (telephone, letter, or CMS-20027 Form) and the second step after a first appeal is called reconsideration.

Right of an individual or provider to ask for a review of the case for a possible change in the decision.

In workers’ compensation cases, this phrase refers to the Workers’ Compensation Appeals Board (WCAB) of the Division of Workers’ Compensation in each state.

Individual who appeals a claim decision.

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The person making an appeal to the higher court.

1. Person applying for insurance coverage. 2. Practitioner, provider, or supplier that is applying for a Medicare national provider number.

1. Request form to be completed with pertinent data when applying for employment. This may be done in person, by telephone, or on the Internet. 2. Statement of information form that is completed and signed by an individual to obtain insurance coverage. The prospective insured is required to undergo a medical examination. The information supplied on this form and the results of the medical examination assist the insurance company in making a decision whether to accept or reject the risk. The application is usually made part of the policy.

In workers’ compensation cases, the process of determining if some portion of an injured worker’s permanent disability is due to a cause other than the current injury. This is an estimate of the degree of either occupational or nonoccupational factors that may have contributed to the impairment. Apportionment applies only to permanent disability.

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The method of dividing a loss among insurers in the same proportions as their participation when two or more companies cover the same loss.

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The method of dividing a loss among multiple insurers that cover the same loss.

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A method of dividing a claim among more than one insurance company.