Decision made to either pay in full, pay in part, or deny a claim.

Communication from the Internal Revenue Service (IRS) stating whether the design of the pension plan meets the criteria to be a qualified plan.

Pathological condition (mental retardation or a related condition) that begins to develop before 18 years of age. This chronic disability results in impaired intellectual functioning and/or deficiencies in necessary physical skills used in daily living activities.

In group creditor insurance, a premium rate for a contributory plan that is higher than the prima facie rate. It is based on the group’s actual claims experience. An insurance company can charge a deviated rate only after the prima facie rate has been in effect for a specific period of time and only after being granted permission by the state insurance commissioner.
***
A rate, offered by a company that usually follows the rates recommended by a lawyer, which is lower than the recommended rate in that area.

1. Abbreviation for designated health services. See designated health services (DHS) . 2. Abbreviation for Department of Health Services. See Department of Health Services (DHS) .

Complex disorder of carbohydrate, fat, and protein metabolism that is primarily a result of a deficiency or complete lack of insulin secretion by the cells of the pancreas or resistance to insulin. There are two types as shown in Table D-1 .

Program that educates patients in taking care of themselves because they have diabetes mellitus. It includes education about treatment, diet, and exercise.

Purchased or rented ambulatory items such as glucose meters and insulin infusion pumps, prescribed by a health care provider for use in managing a patient’s diabetes, as covered by the Medicare program.

1. Identification of a disease, syndrome, or condition by scientific evaluation of history, physical signs, symptoms, tests, and procedures. Diagnosis includes the technical description of the disease or condition and its cause, as well as the proper diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code book. 2. In Medicare fraud, misrepresenting the diagnosis for the patient to justify the service provided or equipment furnished.