|Term Sort descending||Definition|
|ASSOCIATION FOR ELECTRONIC HEALTH CARE TRANSACTIONS||
An organization that promotes the use of EDI in the health care industry.
Values relating to future trends in certain key factors that affect the balance in the trust funds. Demographic assumptions include fertility, mortality, net immigration, marriage, divorce, retirement patterns, disability incidence and termination rates, and changes in the labor force. Economic assumptions include unemployment, average earnings, inflation, interest rates, and productivity. Three sets of economic assumptions are presented in the Trustees Report:
See also Hospital assumptions.
Information, hard copy or electronic, related to a particular claim. Attachments may be structured (such as Certificates of Medical Necessity) or non-structured (such as an Operative Report). Though attachments may be submitted separately, it is common to say the attachment was "submitted with the claim."
Number of the licensed physician who would normally be expected to certify and recertify the medical necessity of the number of services rendered and/or who has primary responsibility for the patient's medical care and treatment.
Method or type of approval that requires a determination that the service is likely to have a diagnostic or therapeutic benefit for patients for whom it is intended.
Written medical or scientific conclusions demonstrating the medical effectiveness of a service produced by the following:
MCO approval necessary prior to the receipt of care. (Generally, this is different from a referral in that, an authorization can be a verbal or written approval from the MCO whereas a referral is generally a written document that must be received by a doctor before giving care to the beneficiary.)
|AUTOMATED CLAIM REVIEW||
Claim review and determination made using system logic (edits). Automated claim reviews never require the intervention of a human to make a claim determination.
|AVERAGE MARKET YIELD||
A computation that is made on all marketable interest-bearing obligations of the United States. It is computed on the basis of market quotations as of the end of the calendar month immediately preceding the date of such issue.
The period from the end of World War II through the mid-1960s marked by unusually high birth rates.