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 or a claim under ORS 656.386(1)(b)(B), (C) or (D) to which the insurer or self-insured employer does not timely respond.
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.
You can reverse only a Paid claim or reverse and adjust a Paid or Denied claim.
LEXIS 5343 (E.D. Pa.) Denied claim permitted by operator of defective crane that dropped a wood timber and killed a bystander; Straub v.
Denied claim or line item: A claim or line item that has been accepted by the claims processing or payment system, adjudicated for payment and not approved for payment in whole or in part.
No. 1231 Denied claim and referred to District’s insurance carrier.
More Definitions of 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 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. An adjudicated claim that does not result in a payment obligation to a provider.
Denied claim. A claim for which no payment is made to a provider by the Contractor for any of several reasons, including but not limited to, the claim is for non-MCO covered services, an ineligible provider or enrollee, is a duplicate of another transaction, or has failed to pass a significant requirement in the claims processing system.
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 limited one or more of the major life activities of an individual. DSM-IV means the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which is the American Psychiatry Association's official classification of behavioral health disorders.
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.