Denied claim definition
Denied claim means a claim for compensation which an insurer or self-insured employer refuses to pay on the express ground that the injury or condition for which compensation is claimed is not compensable or otherwise does not give rise to an entitlement to any compensation.
Denied claim means the insurer refuses to pay a claim for any reason except for failure to meet the waiting period or due to an applicable preexisting condition.
Denied claim means any claim line for which the Allowed Amount equals $0. Denied Claims are not included in this Settlement.
Examples of Denied claim in a sentence
A request for reconsideration is not required and should not be considered a formal request for review of a Denied claim.
More Definitions of Denied claim
Denied claim means any claim line for which the Allowed Amount equaled $0. Without limitation of the foregoing, and by way of example only, if a provider’s request for reimbursement from the Company reflects several CPT codes or services that the Company “bundles” in connection with reimbursement – e.g., a particular CPT code or service is not reimbursed separately because it is deemed by the Company to be incidental to or included in another service that the Company reimburses – the CPT code or service that is not reimbursed separately by the Company is considered a Denied Claim.
Denied claim means a clean claim or a portion of a clean claim for which a determination is made that the claim cannot be paid. Disability means a physical or mental impairment that substantially limits one or more of the major life activities of an individual. Disability-related access means that facilities are readily accessible to and usable by individuals with disabilities, and that auxiliary aids and services are provided to ensure effective communication, in compliance with Title III of the Americans with Disabilities Act.
Denied claim. An adjudicated claim that does not result in a payment obligation to a provider.
Denied claim means a clean claim or a portion of a clean claim for which a determination is made that the claim cannot be paid.
Denied claim means a claim that has been fully and unfavorably adjudicated and the contractor determines that payment on the claim shall not be made, either in full or in part. Denials are made based on national and local policies and Medicare rules and regulations.
Denied claim or “DISALLOWED CLAIM” means (1) any Claim
Denied claim means a Claim Form submitted by a Settlement Class Member that is not approved for Cash Payment by the Settlement Administrator because it fails to satisfy one or more ofthe requirements for an Approved Claim under the terms of this Settlement Agreement.