Claims Basics
This is the first step in processing a claim, where all the details are gathered from the claimant
What is claim intake
This U.S. ac sets standards for handling personal health information in claims
What is HIPPA
The standard set of industry codes used to classify medical procedures for billing
What are CPT codes
This term describes when a claim is reviewed to ensure proper handling and payment
What is claims audit
In many states, this program provides partial wage replacement when caring for a new child or seriously ill family member
What is Paid Family Leave
The period of time in which a claim must be filed after an incident
This process allows an injured worker to receive benefits without proving fault
What is workers compensation
The maximum number of weeks an employee can receive Paid Family leave benefits in New York as of 2025
What is 12 weeks
This was created to improve quality service delivered via phone contacts with claimants.
What is Care Call
in States like New Jersey, Washington and California, this benefit can run concurrently with FMLA under certain circumstances
What is state family leave
This policy clause prevents a claimant from collecting more than the actual loss
What is indemnity clause
This is the process of transferring legal rights to recover damages from the insured to the insurer
What is subrogation
This California state law provides up to 12 weeks of unpaid, job-protected leave for certain medical and family reasons.
What is the California Family Rights Act (CFRA)