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.
Review of a claim before reimbursement is made to the provider or subscriber.
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.
The methods by which health care service claims are professionally examined before any reimbursement is made to validate the medical appropriateness of the services provided and to be sure the cost of the service is not excessive.
The method by which a patient's health care service claims are reviewed before reimbursement is made. This is done to validate the appropriateness of services given and that the cost is not excessive.
The method by which an enrollee's health care service claims are reviewed prior to reimbursement. The purpose is to validate the medical necessity of the provided services and to be sure the cost of the service is not excessive.
The process used by insurers to determine whether the services you've received are covered under your policy.