Paid claims means actual payments, net of recoveries, made for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders whether made to a provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier. Paid claims do not include any of the following:
Paid claims means actual payments, net of recoveries, made to a health and medical services provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier. Paid claims include payments, net of recoveries, made under a service contract for administrative services only, cost-plus or noninsured benefit plan arrangements under section 211 of the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1211, or section 5208 of the insurance code of 1956, 1956 PA 218, MCL 500.5208, for health and medical services provided under group health plans, any claims for service in this state by a pharmacy benefits manager, and individual, nongroup, and group insurance coverage to residents of this state in this state that affect the rights of an insured in this state and bear a reasonable relation to this state, regardless of whether the coverage is delivered, renewed, or issued for delivery in this state. If a carrier or a third party administrator is contractually entitled to withhold a certain amount from payments due to providers of health and medical services in order to help ensure that the providers can fulfill any financial obligations they may have under a managed care risk arrangement, the full amounts due the providers before that amount is withheld shall be included in paid claims. Paid claims include claims or payments made under any federally approved waiver or initiative to integrate medicare and medicaid funding for dual eligibles under the patient protection and affordable care act, Public Law 111-148, and the health care and education reconciliation act of 2010, Public Law 111-152. Paid claims do not include any of the following:
Paid claims means all payments made by health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers for health and medical services provided under policies that insure residents of this State or, in the case of 3rd-party administrators, for health care for residents of this State, except that "paid claims" does not include:
Examples of Paid claims in a sentence
Paid claims can be adjusted by the “Void” option or “Replacement” option.
Paid claims, for which a third party resource is later identified, may be voided by Medicaid if the date of service is within one year of the resource identification.
Basis of Presentation (Continued) Government-wide Financial StatementsThe Statement of Net Position and the Statement of Activities display information about the City as a whole.
Paid claims trend at a higher rate than allowed due to leveraging.
Paid claims are reviewed and researched postpayment to determine likely cases based on information obtained through communications withmembers and providers.
More Definitions of Paid claims
Paid claims means the total of all benefits payable under the benefit provisions indicated in Items Four-A.1 and Four-B.1 of the most current Exhibit Number One to this Agreement which were paid under the terms of this Agreement during the Coverage Period involved. Paid Claims may also include payments made under Valid Claims, as the term is defined in the Administrative Services Agreement between Member and HEBP. Paid Claims shall not include:
Paid claims means as all transactions made on eligible participants that result in a payment to pharmacies or participants from the Plan or the Plan participant copayments. (Does not include reversals, rejected claims and adjustments.) Each unique prescription that results in payment shall be calculated separately as a paid claim.
Paid claims means the claims payment amounts for claims by Covered Person for Benefits for which the Plan Administrator is liable under the provisions of this Agreement and excludes the amount of such claims for which the Covered Persons are liable. Under this system:
Paid claims means amounts paid through March 31, 2021 that were for services incurred or provided during that Reporting Period. Include: Claims paid on a fee-for-service basis.
Paid claims means:
Paid claims means actual payments, net of recoveries,
Paid claims means claims for benefits under the Plan that have been processed for payment by the TPA, have been funded in U.S. Dollars by the Plan or the Plan Sponsor, and for which payment or electronic payment has been issued and transmitted to the Claimant or assignee.