Manual reminder method used to track pending or resubmitted insurance claims and to telephone or send inquiries about nonpayment. Also called a suspense, follow-up file , or tracing file . Also see tracing file .

In Medicare Part D plans, a drug formulary is divided into tiers, with each representing a different level of cost-sharing by the insured. Some plans may have more tiers and some may have less (e.g., tiers 1, 2, 3 and/or a specialty tier).

Under the Medicare Part D prescription drug plan, this is a specific list of drugs. A plan may have several tiers, and the patient’s copayment amount depends on which tier the drug is listed in. The plans are variable because patients can choose their own tiers. Each plan benefit booklet contains the list of drugs pertinent to a specific plan.

1. In a managed care or insurance contract, the amount of time from the date of service to the date the insurance claim or a proof of loss can be filed with the insurance carrier. 2. Under the Medicare program, payments for Part B insurance claims must be submitted within 15 months from the date of the procedure or service. 3. Under the TRICARE program, claims must be filed within 1 year from the date a service is provided or (for inpatient care) within 1 year from the patient’s date of discharge from the inpatient facility. 4. Time period (2 to 3 years) in which an insurance company cannot deny a claim or cancel an insurance policy because of a preexisting condition or statement in an application.
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The period of time within which notice of claim or proof of loss must be filed.

Statutory authority that provides services to individuals age 60 and older such as congregate and home-delivered meals, supportive services (transportation, information and referral, legal assistance), in-home services (homemaker services, personal care, chore services), and health promotion and disease prevention services (health screenings and exercise programs).

Statutory authority for state and federal funded programs of medical assistance to low-income individuals of all ages called the Medicaid program . See Medicaid (MCD) .

Statutory authority for federal health insurance for persons age 65 and older and certain disabled persons younger than age 65 called the Medicare program . Also see Social Security Act, Medicare Part A, Medicare Part B, Medicare Part C , and Medicare Part D .

Statutory authority that allows states to create health insurance programs for children of low-income, working families known as the Children’s Health Insurance Program (CHIP) . See Children’s Special Health Care Services (CSHCS) .