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In insurance, an adjustment clause in a contract specifies how the amount of a claim (particularly a claim against an insurance company) will be determined for the purposes of a settlement, giving consideration to objections made by the debtor or insurance company, as well as the allegations of the claimant in support of his claim. For example ...
adjustment reasons, adjustment codes; EOB documents are protected health information. Electronic EOB documents are called edi 835 5010 files. [2] There will normally also be at least a brief explanation of any claims that were denied, along with a point to start an appeal. [3]
If you get a phone call, voicemail, email or mailed letter from your adjuster, responding promptly can help your claim move faster. Ask questions: If you are unsure of something, always ask questions.
For example, say you have $25,000 in property damage liability coverage but you total a car worth $40,000. The auto insurance company can pay up to the $25,000 allotted, but deny the remaining ...
For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, and so a $30.00 reduction (known as a "provider write off" or "contractual adjustment") would be assessed.
Adjustment of claims is not confined to claims against insurance companies. An allowance made by a creditor, particularly a storekeeper, in response to a complaint by the debtor respecting the accuracy of the account or other claim, or a reduction in the claim or account made to induce a prompt payment, is in a proper sense an adjustment.
After the claims adjudication process is complete, the insurance company often sends a letter to the person filing the claim describing the outcome. The letter, which is sometimes referred to as remittance advice, includes a statement as to whether the claim was denied or approved. If the company denied the claim, it has to provide an ...
In insurance, the insurance policy is a contract (generally a standard form contract) between the insurer and the policyholder, which determines the claims which the insurer is legally required to pay. In exchange for an initial payment, known as the premium, the insurer promises to pay for loss caused by perils covered under the policy language.
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