Health Insurance Glossary
Health / Health Insurance Glossary
Categorically Needy Individuals: Enrollees in Medicaid programs who meet traditional Medicaid age and income requirements.
Certificate Of Authority (COA): The license issued by a state to an HMO or insurance company which allows it to conduct business in that state.
Certificate Of Insurance: The printed description of the benefits and coverage provisions forming the contract between the carrier and the customer. Discloses what it covered, what is not, and dollar limits.
Childrens Health Insurance Program (CHIP): A program, established by the Balanced Budget Act, designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility un . . . View Full Definition
Civilian Health And Medical Program Of The Uniformed Services (CHAMPUS): A program of medical benefits available to inactive military personnel and military spouses, dependents, and beneficiaries through the Military Health Services System of the Department of De . . . View Full Definition
Claim: An itemized statement of healthcare services and their costs provided by a hospital, physician's office, or other provider facility. Claims are submitted to the insurer or managed care plan . . . View Full Definition
Claim Form: An application for payment of benefits under a health plan.
Claimant: The person or entity submitting a claim.
Claims Administration: The process of receiving, reviewing, adjudicating, and processing claims.
Claims Examiners: Employees in the claims administration department who consider all the information pertinent to a claim and make decisions about the MCO's payment of the claim. Also known as claims analysts.
Claims Investigation: The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.
Claims Supervisors: Employees in the claims administration department who oversee the work of several claims examiners.
Clayton Act: A federal act which forbids certain actions believed to lead to monopolies, including (1) charging different prices to different purchasers of the same product without justifying the price d . . . View Full Definition
Clinical Integration: A type of operational integration that enables patients to receive a variety of health services from the same organization or entity, which streamlines administrative processes and increases . . . View Full Definition
Clinical Practice Guideline: A utilization and quality management mechanism designed to aid providers in making decisions about the most appropriate course of treatment for a specific clinical case.
Clinical Status: A type of outcome measure that relates to improvement in biological health status.
Closed Access: A provision which specifies that plan members must obtain medical services only from network providers through a primary care physician to receive benefits.
Closed Formulary: The provision that only those drugs on a preferred list will be covered by a PBM or MCO.
Word of the Day:
Unfunded Debt: Property that is not subject to any claims by creditors. For example, securities bought with cash instead of on margin and homes with mortgages paid off.
Synonym of the Day:
Tender: Chewable, Edible, Eatable, Softcurrency, Money, Specie, (bank) Notes, Cash, Bills, Payment, Compensationgentle, Soft, Delicate, Light, Sensitive, Soot . . . View All Synonyms
Game of the Day:
Medical Mania
Medical Maniacs is a Doctors and Nurses themed slot game.
The slot includes a feature game that is triggered by displaying 3 or more scatter symbo Play Game