Claim Transaction definition

Claim Transaction means a medical, surgical, laboratory, radiology, therapy or other service claim or encounter, whether for a Covered Service or any other service or product, submitted to Customer by a Provider detailing services or products provided by such Provider to an Enrollee.
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Claim Transaction means only those transactions set forth in item (1) of Exhibit H. An "EDI Transaction" means a Transaction accomplished through electronic data interchange.
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Claim Transaction means (a) a "Claim Submission," comprised of the electronic submission by a Plan Provider, pharmacy or laboratory of a claim for services to a single patient on the same date of service or for an RX Order or Diagnostic Order, limited to six transaction lines, and involving for each Claim Submission (i) edit checking based on Kaiser Message Specifications, (ii) duplicate claims checking for both the service and date of service for all claims submitted through the Cymedix Software and (iii) match checking of Provider ID, physician ID, specialty and location for correlation under the appropriate Kaiser contract, with the resubmission of a Claim Submission by a Plan Provider or other Healthcare Participant resulting from any error not caused by the Cymedix Software to be treated as a separate Claim Submission, and (b) a "Claim Acknowledgment," comprised of an electronic acknowledge of receipt by Kaiser or its designated Plan TPA of the Claim Submission, together with an explanation of any rejection for failure to satisfy required components, expressed in mutually acceptable codes included in the Kaiser Message Specifications.
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Examples of Claim Transaction in a sentence

  • The SDMC II database is queried for service lines from approved claims that are claimed with the following Electronic Data Interchange Health Care Claim Transaction Set (837) data elements: • A Demonstration Project Identifier (DPI) set to “KTA”, or • Healthcare Common Procedure Coding System (HCPCS) codes for Intensive Care Coordination (ICC) or Intensive Home Based Services (IHBS).

  • Encounter reporting follows a HIPAA format similar to the 837 Health Care Claim Transaction.

  • Linking an 837 to the 277CAAs per the HIPAA Technical Report for the 277CA transaction, the 277CA file reports the 837’s BHT03 Originator Application Transaction Identifier value in the Claim Transaction Batch Number (2200B – TRN02) of the 277CA.

  • Given these considerations, the Department’s plan, subject to further input from stakeholders, is to require PHPs to provide encounter data directly to the designated CINs or third- party partners of Tier 3 and Tier 4 AMHs, as appropriate, using the same specifications that PHPs will use to share encounter data with the Department; i.e., X12 Electronic Data Interchange (EDI) format, 837 Healthcare Claim Transaction Set and National Council for Prescription Drug Programs (NCPDP) format for pharmacy data.

  • Claim Transaction Code CHAR 1 185 185 The code derived by CWF to indicate the type of claim submitted by an institutional provider.

  • This chapter of the BCBSNC Companion Guide identifies processing or adjudication particular to BCBSNC in its implementation of the 837 Professional Health Care Claim Transaction for version 5010.

  • Watch for updates as additional transactions become available on EDI, eServices and IVR.Table 6-4: Claim Transaction Overview TransactionMember Eligibility Verification Y Request for Reconsideration of TimelyFiling Limit*NView/Print Remittance Advice (RA) N Y NAvailable 24/7 for all claim transactions received.

  • Claim Transaction Code‌ 1 135 135 CHAR‌‌‌ The code derived by CWF to indicate the type of claim submitted by an institutional provider.‌ DB2 ALIAS : CLM_TRANS_CD‌ SAS ALIAS : TRANS_CD STANDARD ALIAS : CLM_TRANS_CD TITLE ALIAS : TRANSACTION_CODE LENGTH : 1‌‌ SOURCE : CWF LIMITATIONS :‌‌‌‌ REFER TO : CLM_TRANS_CD_LIM‌ CODE TABLE : CLM_TRANS_TB‌‌ 33.

  • FSS Sectoral Operations ManagementFax No.: (+632) 8899-8423 Department (SOMD-FSS) E-mail Address: francis.lachica@philcopy.net Certification of As per Funded Claim Transaction SheetAvailability of issued by FAD dated 10 June 2020; Funds Re-certified on 30 December 2020 Dear Sir/Madam:Please supply us with the article(s) specified, and within the period stated below: Digitally signed by Jimmy A.

  • The Founders would have recognized that as an assembly, regard- less of their unfamiliarity with yard signs or their in- ability to tell whether Officer Heffernan completely shared the goals of the leaders of the political cam- paign.


More Definitions of Claim Transaction

Claim Transaction means any transaction for which a control number has been assigned for processing through the Assuming Company's claims system and that is processed to a final disposition status including payment, non-payment, partial payment, and payments attributed toward deductibles. A Claim Transaction for Professional services shall not exceed ten (10) input lines, and a Claim Transaction for Facility services shall not exceed twenty (20) input lines. Each additional segment of ten (10) input lines or less in the case of Professional services, or twenty (20) input lines or less in the case of Facility services counts as an additional Claim Transaction. Claim Transaction shall not mean any transaction resulting from error identification and correction, from adjustments due to utilization review or other coverage information, from duplicate submissions by health care providers, or from retroactive benefit adjustments.
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Related to Claim Transaction

  • M&A Transaction means (a) a transaction in which all or substantially all of the assets to which the subject matter of this Agreement relates are acquired by or assigned to party that is not an Affiliate, or (b) a sale of all or substantially all of the share capital of BioLine (or its Affiliates), (c) the merger of BioLine (or its Affiliates) with any other entity, or any other similar corporate action, except an internal reorganization of BioLine (or its Affiliates) for tax-related reasons otherwise.

  • SPAC Transaction means a transaction or series of related transactions by merger, consolidation, share exchange or otherwise of the Company with a publicly traded “special purpose acquisition company” or its subsidiary (collectively, a “SPAC”), immediately following the consummation of which the common stock or share capital of the SPAC or its successor entity is listed on the Nasdaq Stock Market, the New York Stock Exchange or another exchange or marketplace approved by the Board of Directors, including a majority of the Preferred Directors.

  • Acquisition Transaction means any transaction or series of transactions involving:

  • Termination Transaction has the meaning set forth in Section 11.2.B hereof.

  • Excluded Transaction means any transaction in which assets are transferred to: (A) a shareholder of the Company (determined immediately before the asset transfer) in exchange for or with respect to its stock; (B) an entity, fifty percent (50%) or more of the total value or voting power of which is owned, directly or indirectly, by the Company (determined after the asset transfer); (C) a Person, or more than one Person Acting as a Group, that owns, directly or indirectly, fifty percent (50%) or more of the total value or voting power of all the outstanding stock of the Company (determined after the asset transfer); or (D) an entity at least fifty percent (50%) of the total value or voting power of which is owned, directly or indirectly, by a Person described in clause (C) (determined after the asset transfer).

  • Proposed Acquisition Transaction means, with respect to a SpinCo, a transaction or series of transactions (or any agreement, understanding or arrangement, within the meaning of Section 355(e) of the Code and Treasury Regulations Section 1.355-7, or any other Treasury Regulations promulgated thereunder, to enter into a transaction or series of transactions), whether such transaction is supported by the management or shareholders of such SpinCo, is a hostile acquisition, or otherwise, as a result of which such SpinCo would merge or consolidate with any other Person or as a result of which any Person or Persons would (directly or indirectly) acquire, or have the right to acquire, from such SpinCo and/or one or more holders of outstanding shares of Capital Stock of such SpinCo, a number of shares of Capital Stock of such SpinCo that would, when combined with any other changes in ownership of Capital Stock of such SpinCo pertinent for purposes of Section 355(e) of the Code, comprise 45% or more of (a) the value of all outstanding shares of stock of such SpinCo as of the date of such transaction, or in the case of a series of transactions, the date of the last transaction of such series, or (b) the total combined voting power of all outstanding shares of voting stock of such SpinCo as of the date of such transaction, or in the case of a series of transactions, the date of the last transaction of such series. Notwithstanding the foregoing, a Proposed Acquisition Transaction shall not include (i) the adoption by such SpinCo of a shareholder rights plan or (ii) issuances by such SpinCo that satisfy Safe Harbor VIII (relating to acquisitions in connection with a person’s performance of services) or Safe Harbor IX (relating to acquisitions by a retirement plan of an employer) of Treasury Regulations Section 1.355-7(d). For purposes of determining whether a transaction constitutes an indirect acquisition, any recapitalization resulting in a shift of voting power or any redemption of shares of stock shall be treated as an indirect acquisition of shares of stock by the non-exchanging shareholders. This definition and the application thereof is intended to monitor compliance with Section 355(e) of the Code and shall be interpreted accordingly. Any clarification of, or change in, the statute or Treasury Regulations promulgated under Section 355(e) of the Code shall be incorporated into this definition and its interpretation.

  • Pawn transaction means the same as that term is defined in Section 13-32a-102.

  • Acquisition Transaction Announcement means (i) the announcement of an Acquisition Transaction, (ii) an announcement that Counterparty or any of its subsidiaries has entered into an agreement, a letter of intent or an understanding designed to result in an Acquisition Transaction, (iii) the announcement of the intention to solicit or enter into, or to explore strategic alternatives or other similar undertaking that may include, an Acquisition Transaction, (iv) any other announcement that in the reasonable judgment of the Calculation Agent may result in an Acquisition Transaction or (v) any announcement of any change or amendment to any previous Acquisition Transaction Announcement (including any announcement of the abandonment of any such previously announced Acquisition Transaction, agreement, letter of intent, understanding or intention). For the avoidance of doubt, announcements as used in the definition of Acquisition Transaction Announcement refer to any public announcement whether made by the Issuer or a third party.

  • FICASH III Transaction means a repurchase transaction in which the Repurchase Date is the Banking Day next following the Sale Date and for which securities issued by the government of the United States of America that are direct obligations of the government of the United States of America shall constitute Eligible Securities.

  • FICASH II Transaction means a repurchase transaction in which the Repurchase Date is the Banking Day next following the Sale Date and for which one or more of the following two categories of securities, as specified by the Funds, shall constitute Eligible Securities: (x) securities issued by the government of the United States of America that are direct obligations of the government of the United States of America, or (y) securities issued by or guaranteed as to principal and interest by the government of the United States of America, or by its agencies and/or instrumentalities, including, but not limited to, the Federal Home Loan Bank, Federal Home Loan Mortgage Corp., Government National Mortgage Association, Federal National Mortgage Association, Federal Farm Credit Bank, Federal Intermediate Credit Bank, Banks for Cooperatives, and Federal Land Banks.

  • Company Acquisition Transaction means any transaction or series of transactions involving:

  • Acquisition Transactions means the transactions contemplated by the Acquisition Agreement.

  • Separation Transaction means the sale or separation of the non-television business of the Holding Company in whole or in part, whether by asset sale or otherwise.

  • Third Party Acquisition has the meaning set forth in Section 4.7(a).

  • MFN Transaction means a transaction in which the Company issues or sells any securities in a capital raising transaction or series of related transactions which grants to an investor the right to receive additional shares based upon future transactions of the Company on terms more favorable than those granted to such investor in such offering.

  • Roll-Up Transaction means a transaction involving the acquisition, merger, conversion or consolidation either directly or indirectly of the Company and the issuance of securities of a Roll-Up Entity to the holders of Common Shares. Such term does not include:

  • Closing Transactions has the meaning set forth in Section 11.8(a) of these Bylaws.

  • Merger Transaction means any merger, acquisition or similar transaction involving a recapitalization as contemplated by Rule 10b-18(a)(13)(iv) under the Exchange Act.

  • Reorganization Transaction see clause (d) of the definition of “Change of Control.”

  • Insurance transaction means any transaction involving insurance primarily for personal, family, or household needs rather than business or professional needs that entails:

  • Potential Co-Investment Transaction means any investment opportunity in which a Regulated Fund (or its Wholly-Owned Investment Sub) could not participate together with one or more Affiliated Funds and/or one or more other Regulated Funds without obtaining and relying on the Order.

  • Excluded Transactions means:

  • Void Transaction means any transaction wherein the transaction has taken place but has been cancelled /rejected /unsuccessful by the Alliance Partner.

  • Sale Transaction has the meaning set forth in Section 3(a).

  • Merger Transactions means the Merger and the other transactions relating thereto or contemplated by the Merger Agreement.

  • Closing Date Transactions means, collectively (a) the funding of the Loans on the Closing Date and the execution and delivery of Loan Documents to be entered into on the Closing Date, (b) the Debt Proceeds Transfer, and (c) the payment of Closing Date Transaction Expenses.