Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 18 - Internal Claims and Appeals Process and External Review Act

• Adverse determination: means any of the following:

              (a) A determination by a health insurance issuer or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health insurance issuer's health benefit plan upon application of any utilization review technique does not meet the health insurance issuer's requirements for medical necessity, appropriateness, health care setting, level of care, or effectiveness or is determined to be experimental or investigational and the requested benefit is therefore denied, reduced, or terminated or payment is not provided or made, in whole or in part, for the benefit. See Louisiana Revised Statutes 22:2392

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Aggregating period: means :

              (a) For a political committee, except a political committee which supports only one candidate, the period from January first of the calendar year through December thirty-first of the same calendar year. See Louisiana Revised Statutes 18:1483

• Ambulatory review: means utilization review of health care services performed or provided in an outpatient setting. See Louisiana Revised Statutes 22:2392
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Amortization: Paying off a loan by regular installments.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Authorized representative: means any of the following:

              (a) A person to whom a covered person has given express written consent to represent the covered person for purposes of this Chapter. See Louisiana Revised Statutes 22:2392

• Autonomous technology: means technology installed on a motor vehicle that has the capability to drive the vehicle on which the technology is installed in high-or full-automation mode, without any supervision by a human operator, with specific driving mode performance by the automated driving system of all aspects of the dynamic driving task that can be managed by a human driver, including the ability to automatically bring the motor vehicle into a minimal-risk condition in the event of a critical vehicle or system failure, or other emergency event. See Louisiana Revised Statutes 32:1
• Axle: means the common axis of rotation of one or more wheels whether power-driven or freely rotating, and whether in one or more segments, and regardless of the number of wheels carried thereon. See Louisiana Revised Statutes 32:1
• Axle group: means an assemblage of two or more consecutive axles considered together in determining their combined load effect on a highway. See Louisiana Revised Statutes 32:1
• Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
• barber college: shall include a school of barbering, college of barbering, barber school, barber college, and any other place or institution for the instruction or training of persons to engage in the practice of barbering. See Louisiana Revised Statutes 37:355
• benefits: means those health care services to which a covered person is entitled under the terms of a health benefit plan. See Louisiana Revised Statutes 22:2392
• Best evidence: means evidence based on any of the following:

              (a) Randomized clinical trials. See Louisiana Revised Statutes 22:2392

• Business day: means a day of normal business operation other than federally recognized holidays. See Louisiana Revised Statutes 22:2392
• Candidate: means a person who seeks nomination or election to public office, except the office of president or vice president of the United States, presidential elector, delegate to a political party convention, United States senator, United States congressman, or political party office. See Louisiana Revised Statutes 18:1483
• Cargo: means the items or freight to be moved, including items placed on or in a vehicle, towed by a vehicle, or a vehicle itself. See Louisiana Revised Statutes 32:1
• Case management: means a coordinated set of activities conducted for individual patient management of serious, complicated, protracted, or other health conditions. See Louisiana Revised Statutes 22:2392
• Case-series: means an evaluation of a series of patients with a particular outcome, without the use of a control group. See Louisiana Revised Statutes 22:2392
• Caucus: From the Algonquian Indian language, a caucus meant "to meet together." An informal organization of members of the legislature that exists to discuss issues of mutual concern and possibly to perform legislative research and policy planning for its members. There are regional, political or ideological, ethnic, and economic-based caucuses.
• Chairman: means the principal executive officer of a political committee regardless of his title. See Louisiana Revised Statutes 18:1483
• Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
• Clinical peer: means a physician or other health care professional who holds a nonrestricted license in a state of the United States and in the same or similar specialty as typically manages the medical condition, procedure, or treatment under review. See Louisiana Revised Statutes 22:2392
• Clinical review criteria: means the written screening procedures, decision abstracts, clinical protocols, and practice guidelines used by the health insurance issuer to determine the medical necessity and appropriateness of health care services including those used in the determination of an item or health care service as experimental. See Louisiana Revised Statutes 22:2392
• Closing date: means the date through which the report is complete. See Louisiana Revised Statutes 18:1483
• Combination of vehicles: means every group of two or more vehicles howsoever joined together which are drawn or propelled by a single motor vehicle. See Louisiana Revised Statutes 32:1
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:2392
• Commissioner: means the secretary of the Department of Public Safety and Corrections. See Louisiana Revised Statutes 32:1
• committee: means two or more persons, other than a husband and wife, and any legal entity organized for the primary purpose of supporting or opposing one or more candidates, propositions, recalls of a public officer, or political parties, which accepts contributions in the name of the committee, or makes expenditures from committee funds or in the name of the committee, or makes a transfer of funds to or receives a transfer of funds from another committee, or receives or makes loans in an aggregate amount in excess of five hundred dollars within any calendar year. See Louisiana Revised Statutes 18:1483
• Concurrent review: means utilization review conducted during a patient's stay or course of treatment in a facility, the office of a health care professional, or other inpatient or outpatient health care setting. See Louisiana Revised Statutes 22:2392
• Construction or development project: means a program of construction or development, either new or continuing, that will be planned and implemented with the primary goal of improving ports and harbors in the state. See Louisiana Revised Statutes 34:3451
• Contract: A legal written agreement that becomes binding when signed.
• Contribution: except as otherwise provided in this Chapter, means a gift, conveyance, payment, or deposit of money or anything of value, or the forgiveness of a loan or of a debt, made for the purpose of supporting, opposing, or otherwise influencing the nomination or election of a person to public office, for the purpose of supporting or opposing a proposition or question submitted to the voters, or for the purpose of supporting or opposing the recall of a public officer, whether made before or after the election. See Louisiana Revised Statutes 18:1483
• Conviction: A judgement of guilt against a criminal defendant.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Corporation: means the Louisiana Citizens Property Insurance Corporation, and includes the residual market insurance programs known as the "Coastal Plan" and the "FAIR Plan". See Louisiana Revised Statutes 22:2292
• Covered person: means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. See Louisiana Revised Statutes 22:2392
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Department: means the Department of Transportation and Development. See Louisiana Revised Statutes 34:3451
• Department: means the Department of Transportation and Development. See Louisiana Revised Statutes 32:1
• Discharge planning: means the formal process for determining, prior to discharge from a facility, the coordination and management of the care that a patient receives following discharge from a facility. See Louisiana Revised Statutes 22:2392
• Disclose: means to release, transfer, or otherwise divulge protected health information to any person other than the individual who is the subject of the protected health information. See Louisiana Revised Statutes 22:2392
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• District office: means the following offices but shall not include any major office:

              (a) The office of a member of the Louisiana Legislature. See Louisiana Revised Statutes 18:1483

• Divided highway: means any highway divided into roadways by a median, physical barrier, or clearly indicated dividing section so constructed as to impede vehicular traffic. See Louisiana Revised Statutes 32:1
• Donor: The person who makes a gift.
• Driver: means every person who drives or is in actual physical control of a vehicle. See Louisiana Revised Statutes 32:1
• Election: means any primary, general, or special election held, pursuant to the laws of this state or a parish or municipal charter or ordinance or a court order, to choose a public officer or nominee. See Louisiana Revised Statutes 18:1483
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Emergency medical condition: means a medical condition manifesting itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy. See Louisiana Revised Statutes 22:2392
• Emergency services: means health care items and services furnished or required to evaluate and treat an emergency medical condition. See Louisiana Revised Statutes 22:2392
• entity: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing. See Louisiana Revised Statutes 22:2392
• Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. ^{Source: OCC}
• Evidence-based standard: means the conscientious, explicit, and judicious use of the current best evidence based on the overall systematic review of the research in making decisions about the care of individual patients. See Louisiana Revised Statutes 22:2392
• Ex officio: Literally, by virtue of one's office.
• Expenditure: means a purchase, payment, advance, deposit, or gift, of money or anything of value made for the purpose of supporting, opposing, or otherwise influencing the nomination or election of a person to public office, for the purpose of supporting or opposing a proposition or question submitted to the voters, or for the purpose of supporting or opposing the recall of a public officer, whether made before or after the election. See Louisiana Revised Statutes 18:1483
• Expert opinion: means a belief or an interpretation by specialists with experience in a specific area about the scientific evidence pertaining to a particular service, intervention, or therapy. See Louisiana Revised Statutes 22:2392
• Explosives: means any chemical compound or mechanical mixture that is commonly used or intended for the purpose of producing an explosion and which contains any oxidizing and combustive units or other ingredients in such proportions, quantities, or packing that an ignition by fire, by friction, by concussion, by percussion, or by detonator of any part of the compound or mixture may cause such a sudden generation of highly heated gases that the resultant gaseous pressures are capable of producing destructive effects on contiguous objects or of destroying life or limb. See Louisiana Revised Statutes 32:1
• Facility: means an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, rehabilitation and other therapeutic health settings, and inpatient hospice facilities. See Louisiana Revised Statutes 22:2392
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• FAIR Plan: means the successor to that program established by Act 424 of the 1992 Regular Session, and designated as the "Fair Access to Insurance Requirements Plan" to provide a residual market for adequate insurance on property in the state, now available as a program of the Louisiana Citizens Property Insurance Corporation. See Louisiana Revised Statutes 22:2292
• Farm tractor: means every motor vehicle designed and used primarily as a farm implement, for drawing plows, mowing machines, and other implements of husbandry. See Louisiana Revised Statutes 32:1
• Federal Deposit Insurance Corporation: A government corporation that insures the deposits of all national and state banks that are members of the Federal Reserve System. ^{Source: OCC}
• Fiduciary: A trustee, executor, or administrator.
• Final adverse determination: means an adverse determination, including medical judgment, involving a covered benefit that has been upheld by a health insurance issuer, or its designee utilization review organization, at the completion of the health insurance issuer's internal claims and appeals process procedures provided pursuant to Louisiana Revised Statutes 22:2392
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Flammable liquid: means any liquid which has a flash point of seventy degrees F. See Louisiana Revised Statutes 32:1
• Fraud: Intentional deception resulting in injury to another.
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Governing board: means that board of directors which is established under Louisiana Revised Statutes 22:2292
• Grand jury: agreement providing that a lender will delay exercising its rights (in the case of a mortgage,
• Grievance: means , in a health insurance issuer's internal claims and appeals process, a written complaint or oral complaint, if the complaint involves an urgent care request submitted by or on behalf of a covered person regarding any of the following:

              (a) Availability, delivery, or quality of health care services, including a complaint regarding an adverse determination made pursuant to utilization review. See Louisiana Revised Statutes 22:2392

• Gross weight: means the weight of a vehicle and/or combination of vehicles without load on all axles including the steering axle plus the weight of any load thereon. See Louisiana Revised Statutes 32:1
• Guarantor: A party who agrees to be responsible for the payment of another party's debts should that party default. ^{Source: OCC}
• Health benefit plan: means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Louisiana Revised Statutes 22:2392
• Health care professional: means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:2392
• Health care services: means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:2392
• Health information: means information or data, whether oral or recorded in any form or medium, and personal facts or information about events or relationships that relate to any of the following:

              (a) The past, present, or future physical, mental, or behavioral health or condition of an individual or a member of the individual's family. See Louisiana Revised Statutes 22:2392

• Health insurance issuer: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including through a health benefit plan as defined in this Section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits. See Louisiana Revised Statutes 22:2392
• Height: means the total vertical dimension of any vehicle above the ground surface including any load and load-holding devices thereon. See Louisiana Revised Statutes 32:1
• Highway: means the entire width between the boundary lines of every way or place of whatever nature publicly maintained and open to the use of the public for the purpose of vehicular travel, including bridges, causeways, tunnels and ferries; synonymous with the word "street". See Louisiana Revised Statutes 32:1
• Immediately: means as expeditiously as the medical situation of the covered person requires but in no event longer than one day for expedited reviews or one business day for standard reviews. See Louisiana Revised Statutes 22:2392
• Independent review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations. See Louisiana Revised Statutes 22:2392
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• Intersection: means : The area embraced within the prolongation or connection of the lateral curb lines, or, if none, then the lateral boundary lines of the roadways of two highways which join one another at, or approximately at, right angles, or the area within which vehicles traveling upon different highways joining at any other angle may come in conflict. See Louisiana Revised Statutes 32:1
• Interstate highway: means a fully controlled access highway which is a part of the National System of Interstate and Defense Highways. See Louisiana Revised Statutes 32:1
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• Joint committee: means the House Committee on Transportation, Highways and Public Works and the Senate Committee on Transportation, Highways and Public Works, functioning as a joint legislative committee. See Louisiana Revised Statutes 34:3451
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legislative session: That part of a chamber's daily session in which it considers legislative business (bills, resolutions, and actions related thereto).
• Length: means the total longitudinal dimension of a single vehicle, a trailer, or a semi-trailer. See Louisiana Revised Statutes 32:1
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Load: means a weight or quantity of anything resting upon something else regarded as its support. See Louisiana Revised Statutes 32:1
• Loan: means a transfer of money, property, or anything of value in exchange for an obligation to repay in whole or in part, made for the purpose of supporting, opposing, or otherwise influencing the nomination for election, or election, of any person to public office, for the purpose of supporting or opposing a proposition or question submitted to the voters, or for the purpose of supporting or opposing the recall of a public officer, whether made before or after the election. See Louisiana Revised Statutes 18:1483
• Major office: means the following offices: governor, lieutenant governor, secretary of state, attorney general, state treasurer, commissioner of agriculture, commissioner of insurance, the superintendent of education, public service commissioner, justice of the supreme court, court of appeal judge, district court judge in a judicial district comprised of a single parish with a population in excess of four hundred fifty thousand persons as determined by the most recently published decennial federal census where the election district is parishwide, as long as these offices are elective offices, and any candidate for office with an election district containing a population in excess of two hundred fifty thousand persons as determined by the most recently published decennial federal census. See Louisiana Revised Statutes 18:1483
• Medical or scientific evidence: means evidence found in the following sources:

              (a) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff. See Louisiana Revised Statutes 22:2392

• Mobile home: means : (a) a trailer or semitrailer which is designed, constructed and equipped as a dwelling place, living abode, or sleeping place, either permanently or temporarily, and is equipped for use as a conveyance on highways; or, (b) a trailer or semitrailer whose chassis and exterior shell is designed and constructed for use as a mobile home, as defined in (a), but which is used instead permanently or temporarily for the advertising, sales, display, or promotion of merchandise or services, or for any other commercial purpose except the transportation of property for hire or the transportation of property for distribution by a private carrier. See Louisiana Revised Statutes 32:1
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Motor carrier: means any person owning, controlling, managing, operating, or causing to be used or operated any commercial motor vehicle used in the transportation of persons or property over the public highways of this state, whether as a transportation agency or howsoever utilizing said public facilities. See Louisiana Revised Statutes 32:1
• Motor vehicle: means every vehicle which is self-propelled, and every vehicle which is propelled by electric power obtained from overhead trolley wires, but not operated upon rails, but excluding a motorized bicycle and an electric-assisted bicycle. See Louisiana Revised Statutes 32:1
• Municipality: means an incorporated village, town, or city created under the authority of the constitution or laws of this state. See Louisiana Revised Statutes 32:1
• National Credit Union Administration: The federal regulatory agency that charters and supervises federal credit unions. (NCUA also administers the National Credit Union Share Insurance Fund, which insures the deposits of federal credit unions.) ^{Source: OCC}
• Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
• Oath: A promise to tell the truth.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Operational: means steering, braking, accelerating, or monitoring the vehicle and roadway. See Louisiana Revised Statutes 32:1
• Operator: means every person, other than a chauffeur, who drives or is in actual physical control of a motor vehicle upon a highway or who is exercising control over or steering a vehicle being towed by a motor vehicle. See Louisiana Revised Statutes 32:1
• Oversight: Committee review of the activities of a Federal agency or program.
• Owner: means a person who holds a legal title to a vehicle or in the event a vehicle is the subject of an agreement for the conditional sale, lease, or transfer of possession thereof with the right of purchase upon the performance of the conditions stated in the agreement, with the right of immediate possession in the vendee, lessee, possessor, or in the event such similar transaction is had by means of mortgage and the mortgagor of a vehicle is entitled to possession, then the conditional vendee, lessee, possessor, or mortgagor shall be deemed the owner for the purposes of this Chapter. See Louisiana Revised Statutes 32:1
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Pavement structure: means the combination of subbase, base course, and surface course placed on an earth subgrade to support the traffic load and distribute it to the roadbed. See Louisiana Revised Statutes 32:1
• Person: means any individual, partnership, limited liability company or corporation, association, labor union, political committee, corporation, or other legal entity, including their subsidiaries. See Louisiana Revised Statutes 18:1483
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Personal property: All property that is not real property.
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Plan of operation: means the document setting the rules of operation of the corporation, as promulgated by the governing board and approved by the Louisiana Senate Committee on Insurance and the Louisiana House Committee on Insurance pursuant to the provisions of this Chapter. See Louisiana Revised Statutes 22:2292
• Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Police officer: means every officer authorized to direct or regulate traffic or to make arrests for violations of traffic regulations. See Louisiana Revised Statutes 32:1
• Port authority: means the governing authority of any port area or port, harbor, and terminal district. See Louisiana Revised Statutes 34:3451
• Principal campaign committee: means a political committee designated by a candidate pursuant to Louisiana Revised Statutes 18:1483
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Prospective review: means utilization review conducted prior to an admission or the provision of a health care service or a course of treatment in accordance with a health insurance issuer's requirement that the health care service or course of treatment, in whole or in part, be approved prior to its provision. See Louisiana Revised Statutes 22:2392
• Protected health information: means either of the following:

              (a) Health information that identifies an individual who is the subject of the information. See Louisiana Revised Statutes 22:2392

• provider: means a health care professional or a facility. See Louisiana Revised Statutes 22:2392
• Public office: means any state, parish, municipal, ward, district, or other office or position that is filled by election of the voters, except those specifically excepted in Paragraph (3) of this Section. See Louisiana Revised Statutes 18:1483
• Quadrum axle: means any four consecutive axles whose centers are more than forty inches but not more than ninety-six inches apart, and are designed to equalize the load between axles. See Louisiana Revised Statutes 32:1
• Quorum: The number of legislators that must be present to do business.
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Reporting period: shall mean those periods established by Louisiana Revised Statutes 18:1483
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• Rescission: means cancellation or discontinuance of coverage under a health benefit plan that has a retroactive effect. See Louisiana Revised Statutes 22:2392
• Retrospective review: means a utilization review conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment. See Louisiana Revised Statutes 22:2392
• Roadway: means that portion of a highway improved, designed, or ordinarily used for vehicular traffic, exclusive of the berm or shoulder. See Louisiana Revised Statutes 32:1
• School bus: means every motor vehicle that is used to transport students to and from school or in connection with school activities, but not including a charter bus or transit bus. See Louisiana Revised Statutes 32:1
• Second opinion: means an opportunity or requirement to obtain a clinical evaluation by a provider other than the one originally making a recommendation for a proposed health care service to assess the clinical or medical necessity and appropriateness of the initial proposed health care service. See Louisiana Revised Statutes 22:2392
• Secretary: means the secretary of the Department of Transportation and Development or his delegated or authorized representative. See Louisiana Revised Statutes 32:1
• Semitrailer: means every single vehicle without motive power designed for carrying property and passengers and so designed in conjunction and used with a motor vehicle that some part of its own weight and that of its own load rests or is carried by another vehicle and having one or more load-carrying axles. See Louisiana Revised Statutes 32:1
• Service of process: The service of writs or summonses to the appropriate party.
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Shoulder: means the portion of the highway contiguous with the roadway for accommodation of stopped vehicles, for emergency use, pedestrian use, mobility aid use, bicycle use, and for lateral support of base and surface. See Louisiana Revised Statutes 32:1
• Single axle: means an assembly of two or more wheels, whose centers are in one transverse vertical plane or may be included between two parallel transverse vertical planes forty inches apart extending across the full width of the vehicle. See Louisiana Revised Statutes 32:1
• Special permit: means a written authorization to move or operate on a highway a vehicle or combination of vehicles with indivisible load of size and/or weight exceeding the limits prescribed for vehicles in regular operation. See Louisiana Revised Statutes 32:1
• Special permit applicant: means an individual, firm, partnership, corporation, or association making application for a special permit to transport a vehicle, combination of vehicles, and/or load which is oversize or overweight and under whose authority and responsibility such vehicle or load is transported. See Louisiana Revised Statutes 32:1
• State maintained highway: means any highway in this state which is contained in the state highway system as defined by law or which is maintained by the department. See Louisiana Revised Statutes 32:1
• Statute: A law passed by a legislature.
• Steering axle: means the axle of a motor vehicle or combination of vehicles by which the same is guided or steered. See Louisiana Revised Statutes 32:1
• Stop: means , when required, the complete cessation from movement. See Louisiana Revised Statutes 32:1
• stopping: means , when prohibited, any halting, even momentarily of a vehicle, whether occupied or not, except when necessary to avoid conflict with other traffic or in compliance with the directions of a police officer, weights and standards police officer, or traffic control sign or signal. See Louisiana Revised Statutes 32:1
• Subpoena: A command to a witness to appear and give testimony.
• Subsidiary committee: means a political committee other than a principal campaign committee, designated by a candidate or by a principal campaign committee pursuant to Louisiana Revised Statutes 18:1483
• Supervisory committee: means the Board of Ethics established in Louisiana Revised Statutes 18:1483
• Tandem axle: means any two consecutive axles whose centers are more than forty inches but not more than ninety-six inches apart, and are designed to equalize the load between axles. See Louisiana Revised Statutes 32:1
• Tandem axle weight: means the total weight transmitted to the road by a tandem axle. See Louisiana Revised Statutes 32:1
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• Traffic: means pedestrians, ridden or herded animals, vehicles, and other conveyances either singly or together while using any highway for purposes of travel. See Louisiana Revised Statutes 32:1
• Trailer: means every single vehicle without motive power designed for carrying property or passengers wholly on its own structure, drawn by a motor vehicle which carries no part of the weight and load of the trailer on its own wheels and having two or more load carrying axles. See Louisiana Revised Statutes 32:1
• Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
• Transfer of funds: means any money, regardless of amount, received by a committee from another committee or money given by a committee to another committee. See Louisiana Revised Statutes 18:1483
• Tridum axle: means any three consecutive axles whose centers are more than forty inches but not more than ninety-six inches apart, and are designed to equalize the load between axles. See Louisiana Revised Statutes 32:1
• Truck: means every motor propelled single vehicle for the conveyance of property or things for hauling purposes and having one front steering axle and one rear or load carrying axle. See Louisiana Revised Statutes 32:1
• Truck-tractor: means every motor vehicle designed and used primarily for drawing other vehicles and not so constructed as to carry a load other than a part of the weight of the vehicle and load drawn. See Louisiana Revised Statutes 32:1
• Trustee: A person or institution holding and administering property in trust.
• Uphold: The decision of an appellate court not to reverse a lower court decision.
• Urgent care request: means :

              (a) A request for a health care service or course of treatment with respect to which the time periods for making a non-urgent care request determination either:

              (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function. See Louisiana Revised Statutes 22:2392

• Utilization review: means a set of formal techniques designed to monitor the use of or evaluate the clinical or medical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. See Louisiana Revised Statutes 22:2392
• Utilization review organization: means a licensed entity that conducts utilization review in the internal claims and appeals process provided pursuant to Louisiana Revised Statutes 22:2392
• Vehicle: means every device by which persons or things may be transported upon a public highway or bridge, except devices moved by human power or used exclusively upon stationary rails or tracks. See Louisiana Revised Statutes 32:1
• Venue: The geographical location in which a case is tried.
• Verdict: The decision of a petit jury or a judge.
• Width: means the total outside transverse dimension of a vehicle including any load or load holding devices thereon but excluding approved safety devices and tire bulge due to load. See Louisiana Revised Statutes 32:1