Health Care Claim definition

Health Care Claim means any action, suit, complaint, summons, citation, notice, warning letter, untitled letter, directive, order, writ, injunction, seizure, decree, claim, litigation, investigation, judicial or administrative proceeding, judgment, letter or other communication, from any Person or Governmental Authority relating to or arising out of or asserting, in writing, any alleged or actual violation of, non-compliance with, or liability under, any Health Care Law.
Sample 1Sample 2Sample 3
Health Care Claim means a request by a Claimant for a benefit under a Benefit Program that is a group health plan (i.e., an employee welfare benefit plan within the meaning of ERISA Section 3(1) to the extent that such plan provides “medical care” within the meaning of ERISA Section 733(a)) that is made in accordance with the rules and procedures established by the Administrator.
Sample 1Sample 2Sample 3
Health Care Claim means a Pre-Service Claim, a Post-Service Claim, a Concurrent Care Decision or an Urgent Care Claim.
Sample 1

Examples of Health Care Claim in a sentence

  • Topic #512 Electronic837 TransactionEven if the original claim was submitted on paper, providers may submit electronic adjustment requests using an 837 (837 Health Care Claim) transaction.

  • The Explanation of Medical Benefits form requirement for paper claims and adjustments is intended to help ensure consistency with electronic claims and adjustments submitted via the ForwardHealth Portal or using an 837 (837 Health Care Claim) transaction (including those submitted using PES (Provider Electronic Solutions) software or through a clearinghouse or software vendor).

  • Submitting a Claim To submit an Extended Health Care claim, you must complete an Extended Health Care Claim form, except when claiming for physician or hospital expenses incurred outside your province of residence.

  • Designating a Trading Partner to Receive 835 Health Care Claim Payment/Advice TransactionsProviders must designate a trading partner to receive their 835 transaction for ForwardHealth interChange.

  • Even if the original claim was submitted on paper, providers may submit electronic adjustment requests using an 837 (837 Health Care Claim) transaction.

  • The ASC X12N 837—Health Care Claim: Dental, Version 4010, May 2000, Washington Publishing Company, 004010X097 and Addenda to Health Care Claim: Dental, Version 4010, October 2002, Washington Publishing Company, 004010X097A1.

  • Extended Health Care -Submitting a ClaimSubmitting a Claim To submit an Extended Health Care claim, you must complete an Extended Health Care Claim form, except when claiming for physician or hospital expenses incurred outside your province of residence.

  • The Health Care Claim: Professional (837P) transaction is used for professional claims.

  • Providers submitting claims electronically using the 837I (837 Health Care Claim: Institutional) should refer to the appropriate companion guide for instructions on including a modifier.Providers using a professional claim form should indicate modifier UA with the advanced imaging procedure code.

  • Non-healthcare providers may enter their Provider ID.SECTION II — CLAIM INFORMATION (Pharmacy)Element 5 — Remittance Advice or X12 835 Health Care Claim Payment / Advice, Check Issue Date, or Payment DateEnter the date of the remittance advice or the payment date or check issue date from the 835.


More Definitions of Health Care Claim

Health Care Claim means a Pre-Service Claim, a Post-Service Claim, a Concurrent Care Decision or an Urgent Care Claim. (m)Health Care Professional means a physician or other health care service provider who is licensed, accredited, or certified to perform the specified health services consistent with state law. (n) Independent Review Organization or IRO means an entity that conducts independent External Reviews of Adverse Benefit Determinations and Final Internal Adverse Benefit Determinations pursuant to Section 6.9. (o) Other Claim means a claim other than (i) a Disability Claim or (ii) a Health Care Claim. (p) Pre-Service Claim means a claim for a benefit under a group health plan that, under the terms of the applicable plan, conditions the receipt of the benefit, in whole or in part, on pre-approval of the benefit in advance of obtaining medical care. (q) Post-Service Claim means a claim for a benefit under a group health plan for reimbursement or consideration of payment for the cost of medical care that has already been rendered. A Post-Service Claim is a claim that is neither a Pre-Service Claim nor an Urgent Care Claim. (r) Urgent Care Claim means a claim for medical care or treatment that, if not received,
Sample 1
Health Care Claim means any litigation, proceeding, order, investigation, directive, summons, complaint or citation from any governmental authority relating to Health Care Laws.
Sample 1
Health Care Claim means a civil claim alleging personal injury or death arising out
Sample 1

Related to Health Care Claim

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Health care entity means any health care provider, health plan or health care clearinghouse.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Health care provider or "provider" means:

  • Home Health Care Agency means an agency or organization which provides a program of home health care and which:

  • Health care professional means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law.

  • Health carrier or "carrier" means a disability insurer

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).

  • Health care practitioner means an individual licensed

  • Health care decision means any decision regarding the health care of the prospective donor.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Health care service means that service offered or provided

  • Health Care Law means any Applicable Law regulating the acquisition, construction, operation, maintenance or management of a healthcare practice, facility, provider or payor.

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Indian Health Care Provider means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in § 4 of the Indian Health Care Improvement Act (25 USC § 1603). Indian Health Care Provider includes a 638 Facility and provision of Indian Health Service Contract Health Services (IHS CHS).

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

  • Adult care home means any nursing facility, nursing facility for

  • Federal Health Care Program means any “federal health care program” as defined in 42 U.S.C. § 1320a-7b(f), including Medicare, state Medicaid programs, state CHIP programs, the Veterans Administration, TRICARE and similar or successor programs with or for the benefit of any Governmental Authority, and in each case any third party payor administering such programs.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Home health care services means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.

  • Health Care Authority or “HCA” means the Washington State Health Care Authority, any division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully representing HCA.

  • Health care organization ’ means any person or en-