Health care claims data definition

Health care claims data means information consisting of, or derived directly from, member enrollment, medical claims, and pharmacy claims that this rule requires a carrier to report.
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Health care claims data means the set of data files that are filed by carriers and third-party administrators under this chapter consisting of, or derived directly from, member eligibility, medical claims, pharmacy claims, and dental claims files, including a provider file. "Health care claims data" does not include analysis, reports, or studies containing information from health care claims data sets, if those analyses, reports, or studies have already been released in response to another request for information or as part of a general distribution of public information by the department.
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Health care claims data means information consisting of, or derived directly from, member eligibility files, medical claims files, and pharmacy claims files submitted by health insurance issuers.
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Examples of Health care claims data in a sentence

  • Health care claims data are made up of multiple claim line items.

  • Health care claims data is the raw data that assists DOL to study and ascertain the quality and cost of care purchased by group health plans consistent with PHSA §§ 2715A and 2717.

  • ERISA § 513 provides DOL statutory authority to engage in pilot programs to test collection of additional health care claim and related data pursuant to its power to undertake research, studies and reports.39 Health care claims data is the raw data about the cost and quality of health care that group health plans provide to enrollees and is thus clearly encompassed in the broad grant of authority to “collect, compile, analyze .

  • Health care claims data" means information consisting of, or derived directly from, member enrollment, medical claims, and pharmacy claims that this rule requires a carrier to report.

  • Medical and pharmaceutical claims data Health care claims data were provided at the individual employee level by Cigna and were used to calculate spending and utilization variables.

  • Ensure that designation of key Vendor staff includes subject matter experts in the following areas:• Health care claims data processing• Database management• Database development• Quality assurance• Project management• Web based information exchange and application development• Web publishing A single team member may be identified to fulfill the experience requirement in multiple areas.

  • For purposes of this rule, “group health plan” shall not mean any plan which is offered through a health insurance issuer; (9) "Health care claims data" means information consisting of, or derived directly from, member eligibility files, medical claims files, and pharmacy claims files submitted by health insurance issuers.

  • Health care claims data for each self-funded private employer that directs the submission of its data shall be included as part of the carrier’s or third-party administrator’s data submission as indicated on the“NHID Opt-In Form” for that employer.

  • Health care claims data for each self-funded private employer that directs the submission of its data shall be included as part of the carrier’s or third-party administrator’s data submission as indicated on the “NHID Opt-In Form” for that employer.

  • Ensure that designation of key Vendor staff includes subject matter experts in the following areas: Health care claims data processing Database management Database development Quality assurance Project management Web based information exchange and application development Web publishing A single team member may be identified to fulfill the experience requirement in multiple areas.

Related to Health care claims data

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).

  • Health data means data related to the state of physical or mental health of the data principal and includes records regarding the past, present or future state of the health of such data principal, data collected in the course of registration for, or provision of health services, data associating the data principal to the provision of specific health services.

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • Home Health Care Agency means an agency or organization which provides a program of home health care and which:

  • Health care practitioner means an individual licensed

  • Health Care Law means any Applicable Law regulating the acquisition, construction, operation, maintenance or management of a health care practice, facility, provider or payor, including without limitation, 42 U.S.C. ss.1395nn and 42 U.S.C. ss. 1320a-7b.

  • Health carrier or "carrier" means a disability insurer

  • Health care provider or "provider" means:

  • Health care professional means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Health care decision means any decision regarding the health care of the prospective donor.

  • Respiratory care practitioner means a person who is

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Indian Health Care Provider means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in § 4 of the Indian Health Care Improvement Act (25 USC § 1603). Indian Health Care Provider includes a 638 Facility and provision of Indian Health Service Contract Health Services (IHS CHS).

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care entity means any health care provider, health plan or health care clearinghouse.