Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 6 > Part II > Subpart B - Medical Claims

• Accepted claim: means either of the following:

  (a)  A nonelectronic claim on a HCFA 1500 form or Uniform Billing Form 92 (UB92), properly completed according to Medicare guidelines. See Louisiana Revised Statutes 22:1831

• Activities: means marketing, promotions, sales efforts, events, and any other services that are reasonably related to the enhancement of tourism. See Louisiana Revised Statutes 33:4600.3
• 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.
• Assessed business: means a business operated by a business owner who is required to pay an assessment pursuant to this Chapter. See Louisiana Revised Statutes 33:4600.3
• Assessment: means the levy imposed pursuant to this Chapter. See Louisiana Revised Statutes 33:4600.3
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Business: means any type of tourism business, including but not limited to any tourist home, hotel, motel, or trailer court accommodations, recreational vehicle park, privately owned or managed campgrounds, other lodging intended for short-term occupancy, restaurant, tourism attraction, activity provider, and other tourism businesses that benefit from the visitor economy. See Louisiana Revised Statutes 33:4600.3
• Business owner: means any person recognized by the tourist commissioners as the owner of the business subject to assessment. See Louisiana Revised Statutes 33:4600.3
• Claim: means a request by a health care provider for payment from a health insurance issuer. See Louisiana Revised Statutes 22:1831
• Clean claim: means an accepted claim that has no defect or impropriety including any lack of required substantiating documentation or other particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this Subpart. See Louisiana Revised Statutes 22:1831
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1831
• Contract: A legal written agreement that becomes binding when signed.
• Correct claims address: means the address appearing on an enrollee's or insured's current identification card issued by the health insurance issuer as the current address at which claims are received, or, if no address appears on the identification card, the current address for receipt of claims provided by the health insurance issuer to the department. See Louisiana Revised Statutes 22:1831
• coverage: means benefits consisting of health care services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care services under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization agreement, or health maintenance organization contract offered by a health insurance issuer. See Louisiana Revised Statutes 22:1831
• Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1831
• Department: means the state Department of Education. See Louisiana Revised Statutes 17:396
• Dependent: A person dependent for support upon another.
• Electronic claim: means a claim submitted by a health care provider or its agent to a health insurance issuer in compliance with the provisions of the Health Insurance Portability and Accountability Act (42 USC 1302d et seq. See Louisiana Revised Statutes 22:1831
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Exception report: means an electronic communication related to an electronic claim submission of each electronic claim transaction in that submission that is not deemed an accepted claim. See Louisiana Revised Statutes 22:1831
• 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.
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care clearinghouse: means a public or private entity that does  either of the following:

  (a)  Processes or facilitates the processing of information from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction. See Louisiana Revised Statutes 22:1831

• Health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1831
• Health insurance issuer liability: means the contractual liability of a health insurance issuer for covered health care services pursuant to the plan or policy provisions between the enrollee or insured and the health insurance issuer. See Louisiana Revised Statutes 22:1831
• Improvement: means the acquisition, construction, installation, or maintenance of any corporeal property with an estimated useful life of five years or more that is reasonably related to the enhancement of tourism. See Louisiana Revised Statutes 33:4600.3
• insured: means an individual who is enrolled or insured by a health insurance issuer for health insurance coverage. See Louisiana Revised Statutes 22:1831
• issuer: means any entity that offers health insurance coverage through a policy, contract,  or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1831
• 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 resolution: A legislative measure which requires the approval of both chambers.
• 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}
• Management plan: means a plan adopted or amended pursuant to this Chapter for the development, redevelopment, maintenance, operation, and promotion of a tourism recovery and improvement district. See Louisiana Revised Statutes 33:4600.3
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• network: means an entity, including but not limited to a preferred provider organization as defined in La. See Louisiana Revised Statutes 22:1831
• Nonelectronic claim: means a claim submitted by a health care provider or its agent to a health insurance issuer or its agent using a HCFA 1500 form or a Uniform Billing Form 92 (UB92), as appropriate, or a successor to either of these forms adopted by the National Uniform Billing Committee or its successor. See Louisiana Revised Statutes 22:1831
• 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.
• Paid: means the transfer by the health insurance issuer or its agent of the amount of the health insurance issuer liability on either of the following dates:

  (a)  The date of mailing of a check via the United States Postal Service or a commercial carrier to the correct address. See Louisiana Revised Statutes 22:1831

• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• Person: means an individual, public entity, firm, corporation, partnership, limited liability company, trust, association, or any other business entity or juridical person, whether operating on a for-profit or nonprofit basis. See Louisiana Revised Statutes 33:4600.3
• provider: means :

  (a)  A physician or other health care practitioner licensed, certified, registered, or otherwise authorized to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:1831

• Pupil progression plan: means the comprehensive plan developed and adopted by each city and parish school board which shall be based on student performance in the state testing program with goals and objectives which are compatible with the Louisiana competency-based education program contained within La. See Louisiana Revised Statutes 17:396
• Quorum: The number of legislators that must be present to do business.
• receipt: means :

  (a)  For a nonelectronic claim:

  (i)  For a claim mailed via the United States Postal Service for which no return receipt is requested, the physical receipt of the claim by the health insurance issuer or its agent designated for the receipt of claims at the correct claims address, as documented in accordance with claims filing procedures filed by the health insurance issuer with the department. See Louisiana Revised Statutes 22:1831

• Remedial program: means a program to assist students to overcome educational deficits identified as a result of the state's testing program. See Louisiana Revised Statutes 17:396
• Remittance advice: means a written or electronic communication explaining the issuer's action on each claim adjudicated by the issuer. See Louisiana Revised Statutes 22:1831
• Rural hospital: shall mean either:

  (a)  A hospital with sixty or fewer beds located in either:

  (i)  A parish with a population of less than fifty thousand according to the most recent federal decennial census. See Louisiana Revised Statutes 22:1831

• State board: means the State Board of Elementary and Secondary Education. See Louisiana Revised Statutes 17:396
• Surcharge: means any charge to the consumer that is required to be paid for goods and services that is passed through to the consumer as a charge on the customer's receipt or guest folio. See Louisiana Revised Statutes 33:4600.3
• Tourist commission: means a political subdivision created pursuant to La. See Louisiana Revised Statutes 33:4600.3
• Tourist commissioners: means the members of the governing body of a tourist commission. See Louisiana Revised Statutes 33:4600.3