Claims history definition

Claims history means a summary of the claims made against the applicant for a charitable provider contract with a contracting agency, including the number of claims, a brief description of each claim, the type of health care services being provided that precipitated each claim, and the money that was paid, or is being paid, for each claim, if any.
View Source
Claims history means a detailed list of all claims made against any of the following:
View Source

Examples of Claims history in a sentence

  • The premium may be calculated on such basis as the Insurer determines and the Firm accepts including, without limitation, a basis which recognises Claims history, categories of work performed by the Firm, numbers of Principals and Employees, revenue derived from the Firm’s Practice and other risk factors determined by the Insurer.

  • The Department will use Claims history to determine the most recent, regularly visited primary care physicians (PCP).

  • Maintain non-claim-specific financial transactions as a logical component of Claims history.

  • The PH-MCO’s MIS must be able to maintain its Claims history with sufficient detail to meet all Department reporting and Encounter requirements.

  • The CHC-MCO’s MIS must be able to maintain Claims history with sufficient detail to meet all Department reporting and Encounter requirements.

  • The Contractor shall use predictive modeling data, to identify Enrollees’ changing needs on an ongoing basis, where Claims history is available.

  • The Contractor shall utilize predictive modeling software to stratify Enrollees for whom Claims history exists into low-, moderate-, and high-risk categories.

  • The underwriting exposures that will be evaluated are: Ø Revenue Ø Mix of services provided and average transaction size Ø Industry verticals served Ø Experience of management Ø Review of client contracts for indemnity, harmless and damage limitations Ø Regulatory considerations Ø Claims history The principal coverage in this sector is E&O but may include private company D&O and occasionally EPLI or PTL.

  • Claims history must be maintained with sufficient detail to meet all Department reporting and encounter requirements.

  • Exposures to be considered and underwritten include: Ø The business model: Ø Real estate classes Ø Geography Ø Financials and the portfolio makeup Ø Experience of management Ø Leverage Ø Valuation Ø Customer base Ø Outside service providers Ø Regulatory considerations Ø Macroeconomic consideration Ø If publicly traded, metrics like market cap analysis and review of regulatory filings Ø Claims history Private RE Funds have had a favorable loss history over a long period and are considered a preferred class.