CLAIMS REVIEW Meaning and
Definition
-
Claims review is a systematic evaluation process aimed at determining the validity, accuracy, and appropriateness of a submitted claim for a product, service, or benefit. It involves a comprehensive examination of relevant documents, evidence, and circumstances to assess the adherence to established guidelines, policies, and regulations. The primary purpose of claims review is to ensure fair and equitable treatment for both the claimant and the organization handling the claim.
In the field of insurance, claims review is commonly employed to scrutinize insurance claims and verify their authenticity. It involves careful analysis of claim documentation, such as medical records, invoices, and declarations, to evaluate the veracity and legitimacy of the claim. This process helps identify any potential fraud or exaggeration and enables the insurance provider to make an informed decision regarding the approval or denial of the claim.
Furthermore, claims review is often conducted in the healthcare industry to assess medical claims for reimbursement. It involves examining medical records, treatment plans, diagnoses, and billing codes to ascertain the accuracy of the claim and the necessity and appropriateness of the provided medical services.
Overall, claims review serves as a vital tool for organizations to ensure the integrity of their operations, prevent fraudulent activities, and maintain compliance with applicable rules and regulations. By conducting thorough and objective reviews, organizations can minimize the risks associated with erroneous or fraudulent claims, safeguard their resources, and provide fair and reliable services to their customers.
Common Misspellings for CLAIMS REVIEW
- xlaims review
- vlaims review
- flaims review
- dlaims review
- ckaims review
- cpaims review
- coaims review
- clzims review
- clsims review
- clwims review
- clqims review
- claums review
- clajms review
- clakms review
- claoms review
- cla9ms review
- cla8ms review
- clains review
- claiks review
- claijs review
Etymology of CLAIMS REVIEW
The word "claims" originates from the Middle English word "claimen" or "cla(y)men", which meant "to assert a right". It comes from the Old French word "clamer" meaning "to call or proclaim". In turn, "clamer" comes from the Latin word "clamare", which means "to cry out" or "shout".
The term "review" comes from the Middle French word "revoir", which means "to see again". It is derived from the Latin word "revidere", where "re-" indicates repetition, and "videre" means "to see".
Therefore, "claims review" is a combination of "claims", referring to asserting a right, and "review", meaning to see or examine something again. It is the process of reevaluating or reexamining claims or assertions made by individuals or entities.
Infographic
Add the infographic to your website:
