Health Care Claim definition

Health Care Claim means any action, suit, complaint, summons, citation, notice, warning letter, untitled letter, directive, order, writ, injunction, seizure, decree, claim, litigation, investigation, judicial or administrative proceeding, judgment, letter or other communication, from any Person or Governmental Authority relating to or arising out of or asserting, in writing, any alleged or actual violation of, non-compliance with, or liability under, any Health Care Law.

Health Care Claim means a request by a Claimant for a benefit under a Benefit Program that is a group health plan (i.e., an employee welfare benefit plan within the meaning of ERISA Section 3(1) to the extent that such plan provides “medical care” within the meaning of ERISA Section 733(a)) that is made in accordance with the rules and procedures established by the Administrator.

Health Care Claim means a Pre-Service Claim, a Post-Service Claim, a Concurrent Care Decision or an Urgent Care Claim.

Examples of Health Care Claim in a sentence

• Topic #512 Electronic837 TransactionEven if the original claim was submitted on paper, providers may submit electronic adjustment requests using an 837 (837 Health Care Claim) transaction.

• The Explanation of Medical Benefits form requirement for paper claims and adjustments is intended to help ensure consistency with electronic claims and adjustments submitted via the ForwardHealth Portal or using an 837 (837 Health Care Claim) transaction (including those submitted using PES (Provider Electronic Solutions) software or through a clearinghouse or software vendor).

• Submitting a Claim To submit an Extended Health Care claim, you must complete an Extended Health Care Claim form, except when claiming for physician or hospital expenses incurred outside your province of residence.

• Designating a Trading Partner to Receive 835 Health Care Claim Payment/Advice TransactionsProviders must designate a trading partner to receive their 835 transaction for ForwardHealth interChange.

• Even if the original claim was submitted on paper, providers may submit electronic adjustment requests using an 837 (837 Health Care Claim) transaction.

• The Health Care Claim: Professional (837P) transaction is used for professional claims.

• The ASC X12N 837—Health Care Claim: Dental, Version 4010, May 2000, Washington Publishing Company, 004010X097 and Addenda to Health Care Claim: Dental, Version 4010, October 2002, Washington Publishing Company, 004010X097A1.

• Extended Health Care -Submitting a ClaimSubmitting a Claim To submit an Extended Health Care claim, you must complete an Extended Health Care Claim form, except when claiming for physician or hospital expenses incurred outside your province of residence.

• Non-healthcare providers may enter their Provider ID.SECTION II — CLAIM INFORMATION (Pharmacy)Element 5 — Remittance Advice or X12 835 Health Care Claim Payment / Advice, Check Issue Date, or Payment DateEnter the date of the remittance advice or the payment date or check issue date from the 835.

• This allows a group billing provider to receive one reimbursement, one RA (Remittance Advice), and the 835 (835 Health Care Claim Payment/Advice) transaction for covered services rendered by individual providers within the group.

More Definitions of Health Care Claim

Health Care Claim means a claim for payment of a health care item

Health Care Claim means a civil claim alleging personal injury or death arising out

Health Care Claim means any action, suit, complaint, summons, citation, notice, warning letter, untitled letter, directive, order, writ, injunction, seizure, decree, claim, litigation, investigation, judicial or administrative proceeding, judgment, letter or other communication, from any Redline Waldencast - Credit Agreement (as amended by the Second Amendment) 2324969v9 and WALD - Credit Agreement (conformed through Third Amendment) 2412084v2 04/26/2024 1:14:08 PM Person or Governmental Authority relating to or arising out of or asserting, in writing, any alleged or actual violation of, non-compliance with, or liability under, any Health Care Law.

Health Care Claim means a Pre-Service Claim, a Post-Service Claim, a Concurrent Care Decision or an Urgent Care Claim. (m)Health Care Professional means a physician or other health care service provider who is licensed, accredited, or certified to perform the specified health services consistent with state law. (n) Independent Review Organization or IRO means an entity that conducts independent External Reviews of Adverse Benefit Determinations and Final Internal Adverse Benefit Determinations pursuant to Section 6.9. (o) Other Claim means a claim other than (i) a Disability Claim or (ii) a Health Care Claim. (p) Pre-Service Claim means a claim for a benefit under a group health plan that, under the terms of the applicable plan, conditions the receipt of the benefit, in whole or in part, on pre-approval of the benefit in advance of obtaining medical care. (q) Post-Service Claim means a claim for a benefit under a group health plan for reimbursement or consideration of payment for the cost of medical care that has already been rendered. A Post-Service Claim is a claim that is neither a Pre-Service Claim nor an Urgent Care Claim. (r) Urgent Care Claim means a claim for medical care or treatment that, if not received,

Health Care Claim means any litigation, proceeding, order, investigation, directive, summons, complaint or citation from any governmental authority relating to Health Care Laws.