Insurance contract rule or section of a life insurance policy that allows the managed care payer or insurance company to reimburse someone other than the member or provider (e.g., designated beneficiary or estate of the insured). This clause allows the insurance company to pay benefits to the beneficiary in a timely manner.

Diagnostic codes that do not describe a problem or a service but state a fact. Generally these codes do not represent an outpatient primary or inpatient principal diagnosis.

Statistical record used by insurance underwriters to establish the net worth of an insurance applicant. It shows the dollar amount to multiply with the applicant’s annual income to obtain the maximum allowable amount of insurance.

Policies and procedures in a document that state the manner in which patient services are delivered by a teaching program or medical school faculty physicians, the method of obtaining payment, and the disposition of the funds obtained for the services. Also known as clinical practice plan and medical practice plan .

Federal legislation (Public Law 108-159) enacted on December 4, 2003, that established medical privacy provisions as part of consumer credit law. This bill amended the Fair Credit Reporting Act (FCRA) to include improved medical privacy protections and protections against identity theft.

Federal regulations that apply to open-end credit accounts such as credit cards and revolving charge accounts for department store accounts. It gives consumers the right to dispute charges on their credit card accounts and either withhold payment or ask for a refund because of a billing error. It also allows consumers to dispute charges if they are dissatisfied with the quality of the merchandise received. The federal law limits the consumer’s responsibility for unauthorized charges to $50.

United States federal or state law that regulates the keeping and protecting of consumer credit reports by credit reporting agencies (e.g., acting fairly, impartially, and confidentially). It allows the consumer to see and correct his or her credit report. The federal FCRA was enacted in 1970.

In the Medicare program, this stage of appeal of a claim has been renamed and is now called reconsideration . See reconsideration .

Insurance pools that sell property insurance to individuals who cannot purchase it in the volunteer marketplace because of their high exposure to risks that they may have no control over.