Insurance Claim Review - Legislation & jurisprudence
Research News and Information

Saturday, November 21, 2009

Revised medical criteria for evaluating malignant neoplastic diseases. Final rule.

4 Oct 2009 We are revising some of the criteria in the Listing of Impairments (the listings) that we use to evaluate claims involving malignant neoplastic diseases (cancer) under titles II and XVI of the Social Security Act (Act). The revisions reflect our ... Read more...

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA): preauthorization of durable medical equipment. Final rule.

29 Jun 2009 This document amends the Department of Veterans Affairs (VA) medical regulations for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) preauthorization section by increasing the dollar ceiling for purchase or ... Read more...

Analysis of malpractice claims in mammography: a complex issue.

12 May 2009 PURPOSE: The aim of this study was to analyse malpractice claims in mammography, estimate the specific risk of future claims and assess their impact on radiologists and society. MATERIALS AND METHODS: The study considered insurance claims filed by ... Read more...

Latest indexed articles for 'Insurance Claim Review - Legislation & jurisprudence'

These are the very latest articles for this heading:

• Revised medical criteria for evaluating malignant neoplastic diseases. Final rule. 4 Oct 2009
• [New knowledge about whiplash injuries] 30 Aug 2009
• [Renewed review during continuous investigation--in reality a reconsideration] 30 Aug 2009
• [To the Occupational Minister] 29 Aug 2009
• [Limit the Swedish Social Insurance Agency's review of occupational injury cases] 30 Jul 2009
• Applying the teaching physician guidelines. 30 Jul 2009
• Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA): preauthorization of durable medical equipment. Final rule. 29 Jun 2009
• Analysis of malpractice claims in mammography: a complex issue. 12 May 2009
• FootForum: experimental surgery. 29 Apr 2009
• Liability related to peripheral venous and arterial catheterization: a closed claims analysis. 15 Apr 2009
• "RAC" up for providers. 30 Mar 2009
• Medicare program; changes to the Medicare claims appeal procedures; continuation of effectiveness and extension of timeline for publication of final rule. Interim final rule with comment period; continuation of effectiveness and extension of timeline for publication of final rule. 25 Feb 2009
• It's no longer just members who are suing health plans. 30 Jan 2009
• Injuries as a result of treatment of tibial fractures in children: Claims for compensation submitted to the Patient Insurance Center in Finland. 30 Jan 2009
• Health care fraud: physicians as white collar criminals? 30 Dec 2008
• The disabled and disability insurance: an introduction to legal and claim assessment issues. 30 Dec 2008
• A compendium of Maryland insurance law. 30 Dec 2008
• Effect of delegation on standard of review. Geddes v. United Staffing, 469 F.3d 919 (10th Cir. 2006). 30 Dec 2008
• Standard of review-effect of conflict on standard of review. Metropolitan Life Insurance Co. v. Glenn, _S. Ct._, 2008 WL 2444796 (6/19/08). 30 Dec 2008
• Liability associated with obstetric anesthesia: a closed claims analysis. 30 Dec 2008

See a longer list of these articles.

Technical information about 'Insurance Claim Review'

Definition: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.

Descriptor UI: D007345

Alternative terms: Insurance Claim Review; Review, Insurance Claim; Claims Review; Claims Analysis; Review, Claims; Claims Reviews; Reviews, Claims; Claim Review, Insurance; Claim Reviews, Insurance; Insurance Claim Reviews; Reviews, Insurance Claim; Analysis, Claims; Analyses, Claims; Claims Analyses; Insurance Audit; Audit, Insurance; Audits, Insurance; Insurance Audits; Insurance Claims Processing; Claims Processing, Insurance; Processing, Insurance Claims;

Allowable Qualifiers: classification; economics; history; legislation & jurisprudence; organization & administration; standards; trends; utilization; statistics & numerical data; ethics;

Tree Number: N03.219.521.576.215;

History Note: 91(86); was see under INSURANCE, HEALTH 1986-90