Adjudicate definition

Adjudicate means an insurer's decision to deny or pay a claim,

Adjudicate means an insurer pays, contests, or denies a clean claim;

Adjudicate means to determine whether all program requirements have been met and whether the claim is payable.

Adjudicate means to deny or pay a clean claim.

Adjudicate means to pay or reject a claim. A "clean claim" is a claim that can be processed without obtaining additional information from the provider of the service or from a third party. It includes a claim with errors originating in the Contractor’s claims processing computer system, and those originating from human errors. It does not include a claim under review for medical necessity, or a claim that is from a provider who is under investigation by a governmental agency or the Contractor for fraud or abuse. However, if under investigation by the Contractor, the Department must have prior notification of the investigation.

Adjudicate means the point at which a claim has reached its final disposition of paid or denied.

Adjudicate means an insurer's decision to deny or pay a claim, in whole or in part, including the decision as to how much to pay.

Adjudicate means the same as that term is defined by the District of Columbia Administrative Procedure Act, as codified at D.C. Official Code § 5-502.

Adjudicate means to make a finding of whether a child committed a delinquent act.

Adjudicate means to deny or pay a claim for services or drugs prescribed to a member by a health care provider.