Pesquisa
Descritor em português: Revisão da Utilização de Seguros
Descritor em inglês: Insurance Claim Review
Descritor em espanhol: Revisión de Utilización de Seguros
Descritor revisión de las reclamaciones al seguro
Termo(s) alternativo(s) análisis de las reclamaciones al seguro
auditoría del seguro
procesado de las reclamaciones a los seguros
revisión de reclamaciones
Nota de escopo: 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.
Descritor em francês: Examen des demandes de remboursement d'assurance
Termo(s) alternativo(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
Código(s) hierárquico(s): N03.219.521.576.215
Identificador Único RDF: https://id.nlm.nih.gov/mesh/D007345
Nota de escopo: 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.
Qualificadores permitidos: CL classification
EC economics
ES ethics
HI history
LJ legislation & jurisprudence
OG organization & administration
SN statistics & numerical data
ST standards
TD trends
Indexação Anterior: Insurance, Health/utilization (1966-1985)
Insurance, Hospitalization/utilization (1966-1985)
Utilization Review (1968-1985)
Nota MeSH pública: 91; was see under INSURANCE, HEALTH 1986-90
Nota histórica: 91(86); was see under INSURANCE, HEALTH 1986-90
Versão alternativa: INSURANCE CLAIM REV
Identificador DeCS: 17646
ID do descritor: D007345
Documentos indexados na Biblioteca Virtual em Saúde (BVS): Clique aqui para acessar os documentos da BVS
Data de estabelecimento: 01/01/1991
Data de entrada: 24/04/1985
Data de revisão: 13/12/2017
Insurance Claim Review - Conceito preferido
Identificador do conceito M0011450
Nota de escopo 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.
Termo preferido Insurance Claim Review
Termo(s) alternativo(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 - Mais amplo
Identificador do conceito M0011451
Termo preferido Insurance Audit
Termo(s) alternativo(s) Audit, Insurance
Audits, Insurance
Insurance Audits
Insurance Claims Processing - Mais amplo
Identificador do conceito M0011452
Termo preferido Insurance Claims Processing
Termo(s) alternativo(s) Claims Processing, Insurance
Processing, Insurance Claims



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