Medical claims file means a data set composed of health care service level remittance information for all adjudicated claims for each billed service including but not limited to provider information, charge and payment information, and clinical diagnosis and procedure codes for an Oregon resident as defined in ORS 803.355 or a non-Oregon resident who is a member of a PEBB or OEBB group health insurance plan.
Medical claims file means all submitted and non-denied adjudicated claims for each billed service paid by an Insurer as defined in §18 on behalf of a Member as defined in §17 regardless of where the service was provided. This data file includes but is not limited to service level remittance information including, but not limited to, member encrypted unique identifier, provider information, charge/payment information, and clinical diagnosis/procedure codes
Medical claims file means all submitted and non-denied adjudicated claims for each billed service paid by an Insurer as defined in § 5.2(A)(16) of this Part on behalf of a Member as defined in § 5.2(A)(18) of this Part regardless of where the service was provided. This data file includes but is not limited to service level remittance information including, but not limited to, Member Encrypted Unique Identifier, provider information, charge/payment information, and clinical diagnosis/procedure codes as described further in the RIAPCD Technical Specification Manual.
More Definitions of Medical claims file
Medical claims file means a data file com- posed of service level remittance information for all non-denied adjudicated claims for each billed service including, but not limited to member demographics, provider information, charge/payment information, and clinical diagnosis and procedure codes, and shall include all claims related to behavioral or mental health.
Medical claims file means a data set composed of health care service level remittance information for all adjudicated claims for each billed service including but not limited to provider information, charge and payment information, and clinical diagnosis and procedure codes for an Oregon resident as defined in ORS 803.355 or a non- Oregon resident who is a member of a PEBB or OEBB group health insurance plan. (6162) “Medicare” means coverage under Part A, Part B, Part C, or Part D of Title XVIII of the Social Security Act, 42 U.S.C. 135 et seq., as amended.
Medical claims file means a data file composed of medical
Medical claims file means a data file composed of service level remittance information for all adjudicated claims for each billed medical service provided to members, including data for services provided under alternative payment arrangements with zero paid amounts.
Medical claims file means all submitted and non-denied adjudicated claims for each billed service paid by an Insurer as defined in §1.18 on behalf of a Member as defined in
Medical claims file means a data file composed of service level remittance information for all non-denied adjudicated claims for each billed service including, but not limited to, member demographics; provider information; charge/payment information; and clinical diagnosis/procedure codes. The term includes data related to behavioral, mental health, or substance abuse treatment.
Medical claims file means a data file composed of service level remittance information for all non-denied adjudicated claims for each billed service including, but not limited to: