Commentary

Idealized Database

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.

Incurred 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).

Reported Date

Such may be (a) To Managed Care (for repricing only and not for pre-service advisories) or to (b) TPA (whether electronically or otherwise).

Outlier Date

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.

Paid Date

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.