Topic 1- Introduction
A “One-Size-Fits-All” Database is a concept used by this E-Text only to assist the reader in grasping the scope of a health plan claim reserve.
Topic 2 - Significant Dates
Dates may be (a) Incurred Date, (b) Reported Date, (c) Outlier Date or (d) Paid Date.
Such may be (a) Claims Made Date (accident date, e.g.), (b) Event/Onset Date (resultant medical problem began), (c) Diagnosis Date (medical appraisal made), (d) Service Date (treatment provided) or (e) legal liability Date (facts/circumstances matter).
Such may be (a) To Managed Care (for repricing only and not for pre-service advisories) or to (b) TPA (whether electronically or otherwise).
Such is the date that a claim is removed from the normal status and classed as an Outlier. Examples are (a) COB, (b) Medicare Secondary, (c) lawsuits, (d) large or significantly non-usual claims.
The customary Paid Date is when the Claims Payer releases such into the “mail Stream” (or the equivalent) whether or not such system uses a voucher. Optionally, the Paid Date could be the Presented-for-Payment Date.