adjusted claim

ad·just·ed claim

(ă-jŭstĕd klām)
Additional payment to a health care provider based on modification of claim reimbursement.
References in periodicals archive ?
Once signed, Bruce submitted an adjusted claim to the insurance company, doubling the original cost estimates submitted previously.
Deutsche Bank Securities analyst Bill Dreher cites the company's 7.9% gain in EBITDA per adjusted claim to $4.89 in the third quarter.
and Medco Health Solutions) on an EBITDA (earnings before interest, taxes, depreciation and amortization) per adjusted claim basis.
The value of the properly adjusted claim does not seem to be appropriately accounted for by most companies."
We can also maintain an audit trail of the considerations that were made regarding each adjusted claim."
When an adjustment resulted in a greater expense, auditors said, the state often sought reimbursement at the temporarily higher percentage for the entire adjusted claim, when that higher rate should only have applied to the increased amount over the original claim.
"For the PBM segment, we expect revenue growth of 23% to 24% and adjusted claims of approximately 895 million to 915 million," chief financial officer David Denton said in a conference call.
The total number of pharmacy claims processed edged up 0.1% to 227.8 million, but, converting 90-day scripts to 30-day equivalents, total adjusted claims slipped 0.8% to 263.9 million.
In the Pharmacy Services segment, net revenue growth is projected to increase between 24.25% and 25%, based on adjusted claims totaling between 900 million and 910 million claims.
The pharmacy services segment is projected to generate a top-line gain of 13.75% to 14.75%, based on total adjusted claims of 1.06 billion to 1.068 billion.
"We expect revenues to increase 16.75% to 18.25% for the fourth quarter and adjusted claims to be between 270 million and 275 million claims.
The total number of pharmacy claims processed advanced 10.2% to 251.1 million; converting 90-day scripts to 30-day equivalents, total adjusted claims gained 9% to 287.8 million.