Search
Descriptor English: Insurance Claim Review
Descriptor Spanish: Revisión de Utilización de Seguros
Descriptor revisión de las reclamaciones al seguro
Entry term(s) análisis de las reclamaciones al seguro
auditoría del seguro
procesado de las reclamaciones a los seguros
revisión de reclamaciones
Scope note: Revisión de las reclamaciones por parte de las compañías de seguro para determinar la responsabilidad y cantidad a pagar por los diversos servicios. La revisión puede incluir también la determinación de la elegibilidad del reclamante o beneficiario o del proveedor de la prestación, la determinación de si la prestación está cubierta o no es susceptible de pago con otra póliza y la determinación de que el servicio era necesario y de un coste y calidad razonables.
Descriptor Portuguese: Revisão da Utilização de Seguros
Descriptor French: Examen des demandes de remboursement d'assurance
Entry term(s): Analyses, Claims
Analyses, Insurance Claims
Analysis, Claims
Analysis, Insurance Claims
Audit, Insurance
Audits, Insurance
Claim Review, Insurance
Claim Reviews, Insurance
Claims Analyses
Claims Analyses, Insurance
Claims Analysis
Claims Analysis, Insurance
Claims Processing, Insurance
Claims Review
Claims Reviews
Insurance Audit
Insurance Audits
Insurance Claim Reviews
Insurance Claims Analyses
Insurance Claims Analysis
Insurance Claims Processing
Processing, Insurance Claims
Review, Claims
Review, Insurance Claim
Reviews, Claims
Reviews, Insurance Claim
Tree number(s): N03.219.521.576.215
RDF Unique Identifier: https://id.nlm.nih.gov/mesh/D007345
Scope note: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Allowable Qualifiers: CL classification
EC economics
ES ethics
HI history
LJ legislation & jurisprudence
OG organization & administration
SN statistics & numerical data
ST standards
TD trends
Previous Indexing: Insurance, Health/utilization (1966-1985)
Insurance, Hospitalization/utilization (1966-1985)
Utilization Review (1968-1985)
Public MeSH Note: 91; was see under INSURANCE, HEALTH 1986-90
History Note: 91(86); was see under INSURANCE, HEALTH 1986-90
Entry Version: INSURANCE CLAIM REV
DeCS ID: 17646
Unique ID: D007345
Documents indexed in the Virtual Health Library (VHL): Click here to access the VHL documents
Date Established: 1991/01/01
Date of Entry: 1985/04/24
Revision Date: 2017/12/13
Insurance Claim Review - Preferred
Concept UI M0011450
Scope note Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.
Preferred term Insurance Claim Review
Entry term(s) Analyses, Claims
Analyses, Insurance Claims
Analysis, Claims
Analysis, Insurance Claims
Claim Review, Insurance
Claim Reviews, Insurance
Claims Analyses
Claims Analyses, Insurance
Claims Analysis
Claims Analysis, Insurance
Claims Review
Claims Reviews
Insurance Claim Reviews
Insurance Claims Analyses
Insurance Claims Analysis
Review, Claims
Review, Insurance Claim
Reviews, Claims
Reviews, Insurance Claim
Insurance Audit - Broader
Concept UI M0011451
Preferred term Insurance Audit
Entry term(s) Audit, Insurance
Audits, Insurance
Insurance Audits
Insurance Claims Processing - Broader
Concept UI M0011452
Preferred term Insurance Claims Processing
Entry term(s) Claims Processing, Insurance
Processing, Insurance Claims



We want your feedback on the new DeCS / MeSH website

We invite you to complete a survey that will take no more than 3 minutes.

Go to survey