An insurer's estimate of costs associated with claims that have not yet been submitted for payment, based on studies of prior lags in claim submissions. Used to set claim reserves.
The actuarial estimate of amounts required to pay ultimate net losses after netting out existing amounts on reported but unpaid claims. The IBNR estimate includes an allowance for potential changes in such existing amounts as well as additional amounts for claims that have already occurred but are yet to be reported.
(IBNR): These are medical expenses that the authorization system has not captured and for which claims have not yet his the door. Unexpected IBNRs have torpedoed more managed care plans than any other cause.
The liability for future payments on losses that have already occurred, but have not yet been reported, either to the reinsured or to the reinsurer. Under some reinsurance contracts, this definition may be extended to include expected future development of claims already reported.
The actuarial estimate of reserves required to pay ultimate net losses (UNL) after netting out existing reserves on reported but unpaid claims (case reserves). This estimate includes an allowance for potential changes in such existing reserves for claims that have already occurred but yet to be reported.
Claims: Claims associated with services already provided but not yet submitted to a payer.
A term used to refer to losses that have occurred during a specific period but not been claimed.
A term applied to claims wherein the service has been provided by the health professional (incurred) but has not yet been processed and paid. This amount is also referred to as the RESERVE.
A phrase referring to losses that have occurred, but have not yet been reported to the insurer or reinsurer.)
At the end of a period of account a reserve in respect of property, liability and pecuniary insurances to cover the expected cost of losses that have occurred but have not yet been reported to the insurer or reinsurer.
This refers to losses, which have occurred during a stated period, usually a calendar year, but have not yet been reported to the insurer as of the date under consideration.
Those losses that have arisen on policies or contracts written by the insurer or reinsurer but which have not yet been advised to them.
Refers to claims which reflect services already delivered, but, for whatever reason, have not yet been reimbursed. These are bills "in the pipeline." This is a crucial concept for proactive providers who are beginning to explore arrangements that put them in the role of adjudicating claims--as the result, perhaps, of operating in a sub-capitated system (see below). Failure to account for these potential claims could lead to some very bad decisions. Good administrative operations have fairly sophisticated mathematical models to estimate this amount at any given time.