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 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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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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Examples of Claim Transaction in a sentence

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

  • The same procedures applicable to a Proposed Stock Transaction Notice (described in Section 2) will apply with respect to a Proposed Covered Claim Transaction Notice.

  • 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).

  • As there are many different business applications for the Health Care claim, there can be slight derivations to cover off claims involving unique claims such as for Institutions, Professionals, Chiropractors, and Dentists etc.EDI Retail Pharmacy Claim Transaction (NCPDP Telecommunications Standard version 5.1) is used to submit retail pharmacy claims to payers by health care professionals who dispense medications, either directly or via intermediary billers and claims clearinghouses.

  • 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.

  • For example, the Department will provide a detailed attribution file layout and a technical reference guide with details for encounter data that will align with the following standards: X12 EDI format, 837 Healthcare Claim Transaction Set, and National Council for Prescription Drug Programs (NCPDP) format for pharmacy encounter data.

  • The same procedures applicable to a Proposed Stock Transaction Notice will apply with respect to a Proposed Covered Claim Transaction Notice.

  • Claim Transaction Code CHAR 1 129 129 The code derived by CWF to indicate the type of claim institutional provider.

  • This is accomplished through the 837 Health Care Claim Transaction, which allows for the electronic submission of adjustments to previously processed claims.


More Definitions of Claim Transaction

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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Related to Claim Transaction

  • M&A Transaction means any acquisition, directly or indirectly, by a Project Holdco, whether by purchase, merger or otherwise, of all or substantially all of the assets of, all or a portion of the Equity Interests of, or a business line or unit or a division of, any Person.

  • 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 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 regulations promulgated thereunder, to enter into a transaction or series of transactions), whether such transaction is supported by SpinCo management or shareholders, is a hostile acquisition, or otherwise, as a result of which SpinCo (or any successor thereto) would merge or consolidate with any other Person or as a result of which one or more Persons would (directly or indirectly) acquire, or have the right to acquire, from SpinCo (or any successor thereto) and/or one or more holders of SpinCo Capital Stock, respectively, any amount of stock of SpinCo, that would, when combined with any other direct or indirect changes in ownership of the stock of SpinCo pertinent for purposes of Section 355(e) of the Code and the Treasury Regulations promulgated thereunder, comprise forty percent (40%) or more of (i) the value of all outstanding shares of 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 (ii) the total combined voting power of all outstanding shares of voting stock of 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 SpinCo of a customary shareholder rights plan or (ii) issuances by 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 are intended to monitor compliance with Section 355(e) of the Code and the Treasury Regulations promulgated thereunder and shall be interpreted and applied accordingly. Any clarification of, or change in, the statute or regulations promulgated under Section 355(e) of the Code shall be incorporated in this definition and its interpretation.

  • 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.

  • 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)(i) 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.”

  • Excluded Transactions means:

  • 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.

  • Distribution Transaction means any distribution of equity securities of a Subsidiary of the Company to holders of Common Stock, whether by means of a spin-off, split-off, redemption, reclassification, exchange, stock dividend, share distribution, rights offering or similar transaction.

  • Separation Transactions means the Contribution, the Distribution and the other transactions contemplated by this Agreement and the Separation Step Plan.

  • Transaction Proposal has the meaning specified in Section 8.02(c).