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Definitions for "Claims Review"
Keywords:  reimbursement, enrollee, necessity, sure, validate
Related Terms: Prior authorization, Retrospective review, Hcfa-1500, Covered services, Hcfa 1500, Preferred provider, Fee for service, Preauthorization, Fee-for-service plan, Msn, Preferred provider network, Medicare summary notice, Non-participating provider, Exclusive provider organization, Pre-authorization, Ppo, Medicare hmo, Precertification, Preferred provider organization, Out-of-network, Pre-certification, Nonparticipating provider, Participating provider, Epo, Dhmo, Dental health maintenance organization, Provider network, Health maintenance organizations, Prepaid health plan, Point-of-service plan, Point of service plan, Preferred provider organizations, Medicare part b, Php , Medicare+choice, Original medicare, Dual eligible, Carve-out, Fee-for-service, Individual practice association, Part b, Health maintenance organization, Managed care plan, Network provider, Advance beneficiary notice, Hmo, Abn, Eomb, Out-of-network services, In-network
The method by which an enrollee's health care services are reviewed prior to reimbursement. The purpose of the claims review process is to validate the medical necessity of the provided services and to establish that the cost of the service is not excessive.
amsa.org
Review of a claim before reimbursement is made to the provider or subscriber.
compdent.com
The method by which an enrollee's health care service claims are reviewed before reimbursement is made. The purpose of this monitoring system is to validate the medical appropriateness of the provided services and to be sure the cost of service is not excessive.
billpro.net
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