Claims data definition

Claims data means the data required by RCW 43.371.030 to be

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Claims data means the data required by RCW 43.371.030 to be submitted to the database, including billed, allowed and paid amounts, and such additional information as defined by the director in rule.

Claims data means information included in an institutional, professional, or pharmacy claim or equivalent information transaction for a covered individual, including the amount paid to a provider of healthcare services plus any amount owed by the covered individual;

Examples of Claims data in a sentence

To facilitate this process the Contractor shall supply data, including but not limited to Claims data and Medical Records, to the EQRO.
Claims, data and other information submitted to Health Plan pursuant to this Agreement may be used, directly or indirectly, for purposes of obtaining payments from Federal or State governments under Federal Health Care Programs, and payments that Providers receive under this Agreement may be, in whole or in part, from Federal funds.
Calendar Year 1: Two semi- annual reports as follows: Due June 30 to include Claims data beginning January 1 through June 15 and due December 31 to include Claims data beginning June 16 through December 15.
Calendar Year 3: Two semi- annual reports as follows: Due June 30 to include Claims data beginning December 16 through June 15 and due January 15, 2019 to include Claims data beginning June 16 through December 31, 2018.
Risk adjustment uses information on an Enrollee’s medical conditions, as reported in Claims data, and other factors to predict health care costs and adjust payments to MCOs. Risk adjustment helps ensure payments to MCOs are more equitable and mitigates the impact of selection bias, thus protecting MCO solvency and reducing incentives for plans to avoid high-risk individuals.

Claims data means information included in an

Claims data means such information about a Claim as may be

Claims data means the data required by RCW 43.371.030 to be submitted to the database, including billed, allowed and paid amounts, and such additional information as defined by the director in rule. (("Claims data" includes: (a) Claims data related to health care coverage and services funded, in whole or in part, in the omnibus appropriations act, including coverage and services funded by appropriated and nonappropriated state and federal moneys, for medicaid programs and the public employees benefits board program; and (b) claims data voluntarily provided by other data suppliers, including carriers and self-funded employers.))

Claims data means the data required to be submitted, including billed, allowed, and paid amounts, and additional information defined in rule. "Data supplier" means a carrier that provides claims data and a carrier, third-party administrator, or other entity that provides data at the request of an employer-sponsored self-funded plan or Taft-Hartley trust.

Claims data means the data required by section 11 of this act

Claims data means the data required by section 10 of this act