Paid claims means actual payments, net of recoveries, made for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders whether made to a provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier. Paid claims do not include any of the following:
Paid claims means actual payments, net of recoveries, made to a health and medical services provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier. Paid claims include payments, net of recoveries, made under a service contract for administrative services only, cost-plus or noninsured benefit plan arrangements under section 211 of the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1211, or section 5208 of the insurance code of 1956, 1956 PA 218, MCL 500.5208, for health and medical services provided under group health plans, any claims for service in this state by a pharmacy benefits manager, and individual, nongroup, and group insurance coverage to residents of this state in this state that affect the rights of an insured in this state and bear a reasonable relation to this state, regardless of whether the coverage is delivered, renewed, or issued for delivery in this state. If a carrier or a third party administrator is contractually entitled to withhold a certain amount from payments due to providers of health and medical services in order to help ensure that the providers can fulfill any financial obligations they may have under a managed care risk arrangement, the full amounts due the providers before that amount is withheld shall be included in paid claims. Paid claims include claims or payments made under any federally approved waiver or initiative to integrate medicare and medicaid funding for dual eligibles under the patient protection and affordable care act, Public Law 111-148, and the health care and education reconciliation act of 2010, Public Law 111-152. Paid claims do not include any of the following:
Paid claims means all payments made by health insurance carriers, 3rd-party administrators and employee benefit excess insurance carriers for health and medical services provided under policies that insure residents of this State or, in the case of 3rd-party administrators, for health care for residents of this State, except that "paid claims" does not include:
Examples of Paid claims in a sentence
Paid claims can be adjusted by the “Void” option or “Replacement” option.
Paid claims are reviewed and researched postpayment to determine likely cases based on information obtained through communications withmembers and providers.
Paid claims against insurance policies intended to cover losses related to various types of healthcare business interruption as of the reporting period end date.
Indicate appropriate designation for policy form, etc.4 The product street name is the product name as advertised to consumers (i.e., as consumers are likely to refer to this product/policy form when communicating with DFS.5 Paid claims in Columns 14.6 ‐ 14.7 and 15.6 ‐ 15.7 are all claims paid during experience period that are attributed to the calendar year in question.
Paid claims are analogous to the Incurred Claims defined in Section I.
More Definitions of Paid claims
Paid claims means as all transactions made on eligible participants that result in a payment to pharmacies or participants from the Plan or the Plan participant copayments. (Does not include reversals, rejected claims and adjustments.) Each unique prescription that results in payment shall be calculated separately as a paid claim.
Paid claims means the total of all benefits payable under the benefit provisions indicated in Items Four-A.1 and Four-B.1 of the most current Exhibit Number One to this Agreement which were paid under the terms of this Agreement during the Coverage Period involved. Paid Claims may also include payments made under Valid Claims, as the term is defined in the Administrative Services Agreement between Member and HEBP.
a. Claims incurred prior to the incurral period reflected in Exhibit Number One; or
b. Claims paid prior to the Effective Date of this Agreement; or
c. Claims incurred after the termination date of this Agreement; or
d. Extra contractual damages of any nature, compensatory damages, or any similar damages however assessed, or any payments made as an exception to the Plan or as settlement of a lawsuit; or
e. Any payments made at the specific written request of the Member when not provided for as benefits under the Plan or which are limited or excluded under such document; or
f. Any payments of benefits which are interpreted by the Member as coming within the terms of the Plan if HEBP notifies the Member that it does not agree with that interpretation.
Paid claims means claims for benefits under the Plan which have been processed for payment by the TPA, have been funded in U.S. Dollars by the Plan or the Plan Sponsor, and for which payment or electronic payment has been issued and transmitted to the Claimant or assignee.
Paid claims means the claims payment amounts for claims by Covered Person for Benefits for which the Plan Administrator is liable under the provisions of this Agreement and excludes the amount of such claims for which the Covered Persons are liable. Under this system:
Paid claims means amounts paid through March 31, 2021 that were for services incurred or provided during that Reporting Period. Include: Claims paid on a fee-for-service basis.
Paid claims means actual payments, net of recoveries,
Paid claims means claims for benefits under the Plan that have been processed for payment by the TPA, have been funded in U.S. Dollars by the Plan or the Plan Sponsor, and for which payment or electronic payment has been issued and transmitted to the Claimant or assignee.