Insurance Claim Review
Research News and Information

Saturday, November 21, 2009

Enhancing the medical homes model for children with asthma.

30 Oct 2009 BACKGROUND: Medical Home is an evolving concept of patient-centered care yet little information is available on its effect on health care expenditures for children. OBJECTIVES: To quantify differences in patterns of care and costs to the North ... Read more...

Medicare managed care enrollment by disability-eligible and age-eligible veterans.

30 Oct 2009 OBJECTIVE: To assess factors associated with enrollment in a Medicare advantage (MA) plan versus Medicare fee-for-service plan in 2000-2004 by Medicare-eligible veterans. We also assessed whether these factors differed between disability-eligible ... Read more...

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...

Latest indexed articles for 'Insurance Claim Review'

These are the very latest articles for this heading:

• Enhancing the medical homes model for children with asthma. 30 Oct 2009
• Medicare managed care enrollment by disability-eligible and age-eligible veterans. 30 Oct 2009
• Revised medical criteria for evaluating malignant neoplastic diseases. Final rule. 4 Oct 2009
• A critique of the changes in Hawai'i's Medicaid system. 29 Sep 2009
• Nothing to fear but fear itself. 30 Aug 2009
• [New knowledge about whiplash injuries] 30 Aug 2009
• Universal health insurance and equity in primary care and specialist office visits: a population-based study. 30 Aug 2009
• [Renewed review during continuous investigation--in reality a reconsideration] 30 Aug 2009
• Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. 30 Aug 2009
• [To the Occupational Minister] 29 Aug 2009
• [Emperor's new clothes?] 25 Aug 2009
• Mental health treatment received by youths in the year before and after a new diagnosis of bipolar disorder. 30 Jul 2009
• [The challenge of auditing by medical health insurance inspectors: development of individual case inspections according to 275ff SGB V] 30 Jul 2009
• [Limit the Swedish Social Insurance Agency's review of occupational injury cases] 30 Jul 2009
• Applying the teaching physician guidelines. 30 Jul 2009
• The RAC coordinator's role. RAC audits require a coordinator to ensure compliance. 30 Jul 2009
• Managing medical necessity and notification denials. 30 Jul 2009
• Patterns of single and multiple claims of epididymitis among young privately-insured males in the United States, 2001 to 2004. 30 Jul 2009
• Recovery audit contractors: Mississippi physicians and Medicare audits. 30 Jul 2009
• The risk and safety of anesthesia at remote locations: the US closed claims analysis. 30 Jul 2009

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