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At least 109 records · Page 6Linked to original sources
PubMed2003

Agreement between insurance claim and self-reported hospital and emergency room utilization data among persons with diabetes.

As part of a retrospective evaluation of a diabetes management program, the agreement between self-reported and insurance claim data on hospitalization and emergency room utilization was examined. Data agreement on hospitalization or emergency room visits between the two collection modes was evaluated through the use of simple agreement proportions and the kappa agreement statistic. A total of 1,230 participant responses were studied. The proportions of patients with hospitalization or emergency room visits were indistinguishable between the self-reported and medical claims data, and kappa statistics also indicated good-to-excellent agreement between data sets. The percentages of participants whose self-reported hospitalization and emergency room utilization exactly matched data derived from insurance claims were high (89.1% and 87.2%, respectively). Furthermore, the kappa statistics of agreement for the number of hospitalizations (0.6366) and emergency room visits (0.5390) indicate good agreement between self-reported and insurance claim data. The results of this study suggest either self-reported or insurance claims data can be used to evaluate the impact of health care interventions on hospital or emergency room utilization.

Aged↗
PubMed1995

An investigation of the effects of lifestyle on care-seeking behavior using data from health insurance claims.

To clarify the effects of lifestyle on care-seeking behavior, we conducted a questionnaire survey using Morimoto's 8 lifestyle factors and tabulated the medical evaluations at annual medical checkup of 1212 male white-collar employees of a company (aged 21-60 years in 1991), and then extracted the health insurance data for these subjects for the first half of 1992 from the health insurance-carrier computer system. The percentage of employees who visited medical facilities, the number of days of medical care, and the medical fees reported on the health insurance claims were chosen as indices of care-seeking behavior, and the relationship of each index to lifestyle and medical checkup data was examined. The health practice index (HPI), which was obtained by summing the scores for the 8 lifestyle factors was associated with the medical evaluation as expected, but was inversely correlated with the indices of care-seeking behavior. The percentage of employees who visited medical facilities, the number of the days of medical care, and the total medical fees were all higher for the subjects with high HPI scores than for those with low HPIs. Our findings are consistent with those of other researchers who have found an inverse relationship between tobacco smoking and health insurance claims, which has been attributed to the degree of consciousness of health. Compared to smokers, non-smokers have high consciousness of health and tend to consult a doctor more frequently, with resulting increased frequency of medical facility consultation and days of medical care, as well as medical fees. Lifestyle is an important aspect of physical and mental health status.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

MedClaims: electronic submission of direct billing claims.

In 1994 the Australian Health Insurance Commission introduced MedClaims, an electronic system for submission of "direct billing" medical claims. This report contains a description of MedClaims, how it has progressed since its implementation in 1994, its current status, and future directions. To provide a complete picture of MedClaims and the environment in which it operates, this report also contains an overview of Medicare, the federally funded health insurance system in Australia.

Australia↗
PubMed2006

Assistance provided abroad to insured travellers from Australia following the 2004 Asian tsunami.

BACKGROUND: On 26 December 2004, the Asian tsunami hit countries around the Indian Ocean rim, particularly around its earthquake-associated epicentre off Indonesia. A number of popular tourist destinations for Australian travellers are located in this region. This study was designed to investigate travel insurance claims reported by travellers from Australia following the Asian tsunami and to examine the role of travel insurance and emergency assistance companies. METHODS: In December 2005, all claims reported, following the Asian tsunami on 26 December 2004, to a major Australian travel insurance company were examined for those claims associated with the Asian tsunami. RESULTS: Twenty-two tsunami-related claims were submitted of which nine travellers (40.9%) used the travel insurance company's emergency assistance service. Four travellers (18.2%) cancelled their trip to Asia, mainly to Thailand. Five travellers (27.3%), who were already abroad, also curtailed their trip as a result of the tsunami. Half of travellers (50.0%) were claiming loss of personal belongings. Of those using the emergency assistance service, five travellers (22.7%) sought policy and claiming advice, two (9.1%) sought assistance with flight rearrangements, and one (4.5%) sought situation advice. There was also assistance provided following the death of one insured traveller as a direct consequence of the tsunami, which included a lump sum payment to the deceased estate. The mean refund, where a travel insurance claim was paid, was Australian dollars (AUD)2234 (SD=AUD5755). CONCLUSIONS: This study highlights the importance of travellers taking out appropriate travel insurance, which provides for emergency assistance. Travel insurance agencies do play some role after emergencies, such as the Asian tsunami. This assistance predominantly involves dealing with cancellation of travellers' intended visits to the affected area, but does also involve some assistance to travellers affected by the crisis. Travellers should be advised to seek travel health advice well before departure overseas and to ensure that they are aware of travel advisories for their destination.

Adult↗
PubMed1997

Spine update. Administrative databases in spine research.

The use of administrative health care databases for the storage and retrieval of information is increasing. The data collection, entry, and collation follows a predictable process for hospital admissions. Many conclusions have been drawn from research performed using administrative databases. These conclusions can have significant and important implications for patients, providers, and society at large, to the extent that such data inform participants in the current health care policy debate. In an effort to better understand the significance of conclusions drawn from studies that rely on electronic administrative databases as their source of information, the present report addresses the process, strengths, weaknesses, and future plans for the use of administrative databases in spine research.

Databases, Factual↗
PubMed1987

The dentist's role in the insurance-legal claims process.

The involvement of the clinician in the insurance-legal process is inevitable. A clear documentation and reporting format will facilitate the dentist's participation. Information is presented to prepare the practitioner for his or her role as an expert witness.

Dental Records↗
PubMed2005

A re-examination of the whiplash associated disorders (WAD) as a systemic illness.

OBJECTIVE: To describe the systemic nature of the illness reported after motor vehicle collisions using data from a large, population based cohort of individuals making an injury insurance claim. METHODS: All subjects who submitted a claim or were treated for whiplash injury following a motor vehicle collision in Saskatchewan, Canada during an 18 month period were examined. Demographics of claimants, collision related data, pre-collision health data, symptom prevalence, and scores on the short form 36 item general health survey (SF-36) were obtained on average within one month post-collision. RESULTS: Of 9006 potentially eligible claimants, 7462 (83%) met criteria for whiplash injury and provided information regarding demographics and injury related symptoms; 45% of these consented to complete the SF-36 at baseline. For most subjects, neck pain was only one of many diffuse and intense symptoms, including, often, low back pain. The range of symptoms, including fatigue, dizziness, paraesthesiae, headache, spinal pain, nausea, and jaw pain, could be interpreted as a systemic disorder. SF-36 scores showed low physical and mental functioning one month post-collision. CONCLUSIONS: What is commonly referred to as whiplash associated disorders (WAD) is best appreciated as a syndrome extending well beyond what can be labelled as a neck injury. More research is needed for a better understanding of the underlying mechanisms involved so that treatment can be directed at the broad spectrum of the illness rather than focusing on finding a focal neck injury.

Accidents, Traffic↗
PubMed2002

Continuing education: insurance cross coding: submitting medical insurance.

This continuing education course is designed for general dentists, dental hygienists, dental assistants, and office managers. This continuing education course will provide general information pertaining to the reporting of dental services to medical third parties. An office protocol outlining the steps necessary to file medical insurance claims for dental treatment will serve as a guide in the management of third party payment.

Current Procedural Terminology↗
PubMed1980

Coordination of benefits in dental prepayment programs: Council on Dental Care Programs.

The 1979 House of Delegates adopted Resolution 49H which directed the Council on Dental Care Programs to initiate discussion with the Health Insurance Association of America, Delta Dental Plans Association, Blue Cross and Blue Shield Associations, and the Health Care Financing Administration, Department of Health and Human Services, to develop suitable inexpensive, uniform procedures for the Coordination of Benefits of Prepaid Dental Programs. Additionally, the Council was directed to disseminate these procedures to the membership through Association publications. The following is a report detailing the results of the Council's activities.

Humans↗