Analysis of national data by Centers for Medicare and Medicaid Services (CMS) of Medicare insurance claims to locate the greatest risk of inappropriate program payment. This gathering of data is done to reduce the number of noncovered claims or unnecessary services. CMS provides its findings to the fiscal intermediaries who develop their review policies to identify abuse and overutilization of services.

State-required studies that examine a specific aspect of health care (such as prenatal care) for a defined point in time. These projects are usually based on information extracted from medical records or managed care organizations’ data (enrollment files, encounter or claims data). State staff, External Quality Review Organization (EQRO) staff, managed care organization (MCO) staff, or more than one of these entities may perform such studies at the discretion of the state.

Reminder method used to track pending or resubmitted insurance claims and to telephone or send inquiries about nonpayment. Also called a suspense, tickler file , or tracing file . Also see tracing file or tickler file .

In a workers’ compensation case, an evaluation done within 1 year following a comprehensive medical-legal examination performed by a qualified medical evaluator, agreed medical evaluator, or primary treating physician of the same injury or injuries.

Federal agency that protects public health by investigating and testing for the safety, effectiveness, and security of human and veterinary drugs, biological products, medical devices, national food supply, cosmetics, and radiation-emitting objects that are sold in the United States.

Required all household members to disclose Social Security numbers to verify that they were eligible to participate in the food stamp program.

Insurance company domiciled in another state or, in some states, an insurance company domiciled in a foreign country.
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A carrier domiciled in another country.

Insurance company organized or incorporated doing business under the laws of some other state of the United States, such as a company organized under the laws of New York doing business in Missouri. This corporation is a foreign company in Missouri. Technically, an insurance company chartered in a foreign country is called an alien company , whereas a company chartered in another state than that in which it is doing business is referred to as a foreign company .
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Term used in the U.S.A. to describe an Insurance Company established in one U.S. State when it is operating in another.

Insurance company incorporated under the laws of another state other than the one where it does business. A bank chartered in Pennsylvania but owning a loan production office in California is a foreign corporation in California. Also called out-of-state corporation . See also foreign company .