Examlex
What was the original reason for granting Congress the power to regulate interstate commerce after the Revolution?
Precertification
Refers to obtaining plan approval for services prior to the patient receiving them; refers to seeking approval for a treatment (surgery, hospitalization, diagnostic test) under the patient’s insurance contract.
Specified Outpatient
Specified Outpatient refers to particular outpatient medical treatments or procedures that are predefined under a health plan or policy for coverage or reimbursement.
Coordination of Benefits (COB)
A process in health insurance to determine the order of responsibility when a person is covered by more than one insurance plan, to avoid overlapping payments.
Duplication of Payment
An error or fraud resulting in the repeated payment for a single invoice or service.
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