22 CFR 304.2 - Administrative claim; when presented; appropriate Peace Corps Office.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Administrative claim; when presented; appropriate Peace Corps Office. 304.2 Section 304.2 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.2 Administrative claim; when presented; appropriate Peace...

22 CFR 304.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Administrative claim; evidence and information to be submitted. 304.4 Section 304.4 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.4 Administrative claim; evidence and information to be submitted...

22 CFR 304.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Administrative claim; evidence and information to be submitted. 304.4 Section 304.4 Foreign Relations PEACE CORPS CLAIMS AGAINST GOVERNMENT UNDER FEDERAL TORT CLAIMS ACT Procedures § 304.4 Administrative claim; evidence and information to be submitted...

40 CFR 1620.3 - Administrative claim; who may file.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) A claim based on death may be presented by the executor or administrator of the decedent's estate... that the basis for the representation is documented in writing. (d) A claim for loss totally...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

44 CFR 11.14 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Administrative claim; evidence and information to be submitted. 11.14 Section 11.14 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL CLAIMS Administrative Claims Under...

39 CFR 912.6 - Administrative claim; who may file.

Code of Federal Regulations, 2010 CFR

2010-07-01

... claim based on death may be presented by the executor or administrator of the decedent's estate, or by... accompanied by evidence of his authority to present a claim on behalf of the claimant as agent, executor...

29 CFR 15.4 - Administrative claim; where to file.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Administrative claim; where to file. 15.4 Section 15.4 Labor... to file. (a) For the purposes of this subpart, a claim shall be deemed to have been presented when... accompanied by a claim for money damages in a sum certain for injury to or loss of property or personal injury...

11 CFR 111.52 - Administrative collection of claims.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 11 Federal Elections 1 2012-01-01 2012-01-01 false Administrative collection of claims. 111.52 Section 111.52 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111...

11 CFR 111.52 - Administrative collection of claims.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Administrative collection of claims. 111.52 Section 111.52 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111...

11 CFR 111.52 - Administrative collection of claims.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Administrative collection of claims. 111.52 Section 111.52 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111...

11 CFR 111.52 - Administrative collection of claims.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 11 Federal Elections 1 2013-01-01 2012-01-01 true Administrative collection of claims. 111.52 Section 111.52 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111...

20 CFR 217.7 - Claim filed with the Social Security Administration.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Claim filed with the Social Security... RETIREMENT ACT APPLICATION FOR ANNUITY OR LUMP SUM Applications § 217.7 Claim filed with the Social Security Administration. (a) Claim is for life benefits. An application for life benefits under title II of the Social...

20 CFR 217.7 - Claim filed with the Social Security Administration.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Claim filed with the Social Security... RETIREMENT ACT APPLICATION FOR ANNUITY OR LUMP SUM Applications § 217.7 Claim filed with the Social Security Administration. (a) Claim is for life benefits. An application for life benefits under title II of the Social...

20 CFR 217.7 - Claim filed with the Social Security Administration.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true Claim filed with the Social Security... RETIREMENT ACT APPLICATION FOR ANNUITY OR LUMP SUM Applications § 217.7 Claim filed with the Social Security Administration. (a) Claim is for life benefits. An application for life benefits under title II of the Social...

20 CFR 217.7 - Claim filed with the Social Security Administration.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 1 2014-04-01 2012-04-01 true Claim filed with the Social Security... RETIREMENT ACT APPLICATION FOR ANNUITY OR LUMP SUM Applications § 217.7 Claim filed with the Social Security Administration. (a) Claim is for life benefits. An application for life benefits under title II of the Social...

20 CFR 217.7 - Claim filed with the Social Security Administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Claim filed with the Social Security... RETIREMENT ACT APPLICATION FOR ANNUITY OR LUMP SUM Applications § 217.7 Claim filed with the Social Security Administration. (a) Claim is for life benefits. An application for life benefits under title II of the Social...

20 CFR 405.340 - Deciding a claim without a hearing before an administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... administrative law judge. 405.340 Section 405.340 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.340 Deciding a claim without a hearing before an administrative law judge. (a) Decision wholly...

Using administrative claims to identify children with chronic conditions in a statewide immunization registry.

PubMed

Dombkowski, Kevin J; Costello, Lauren; Dong, Shiming; Clark, Sarah J

2014-05-01

To demonstrate the feasibility and utility of using administrative claims data from commercial health plans to establish a high-risk indicator in a statewide immunization registry for enrollees with chronic conditions. Retrospective cohort analysis. Administrative data were used to identify children with 1 or more chronic conditions enrolled in 2 commercial health plans during the 2008-2009 and 2009-2010 influenza seasons and matched with a statewide immunization registry. The proportion of cases that successfully matched and historical health services utilization, including influenza vaccinations and missed opportunities, were assessed. A total of 93% of children with chronic conditions identified through administrative claims were successfully matched with the statewide registry. Less than one-third of children received the seasonal influenza vaccine in either the 2008-2009 (29%) or 2009-2010 (32%) seasons; 30% of children received the H1N1 vaccination in 2009-2010. Most children in the 2008-2009 (63%) and 2009-2010 (63%) seasons had at least 1 missed opportunity for seasonal influenza vaccination. Younger children had the highest percentage of missed opportunities while adolescents had the lowest rate of missed opportunities for vaccination. Conclusions It is feasible to identify children with chronic conditions using administrative data and to link them with a statewide immunization registry. Low influenza vaccination rates and high occurrences of missed opportunities among children with chronic conditions suggest the utility of integrating administrative claims data with statewide registries to support various outreach mechanisms, including physician-focused and parent-targeted reminder/recall, based on target age to improve vaccination rates.

32 CFR 750.26 - The administrative claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... be filed on a Standard Form 95 or other written notification of the incident. If a letter or other... Standard Form 95. Failure to do so may result in a determination that the administrative claim is incomplete. A suit may be dismissed on the ground of lack of subject matter jurisdiction based on claimant's...

32 CFR 750.26 - The administrative claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... be filed on a Standard Form 95 or other written notification of the incident. If a letter or other... Standard Form 95. Failure to do so may result in a determination that the administrative claim is incomplete. A suit may be dismissed on the ground of lack of subject matter jurisdiction based on claimant's...

32 CFR 750.26 - The administrative claim.

Code of Federal Regulations, 2012 CFR

2012-07-01

... be filed on a Standard Form 95 or other written notification of the incident. If a letter or other... Standard Form 95. Failure to do so may result in a determination that the administrative claim is incomplete. A suit may be dismissed on the ground of lack of subject matter jurisdiction based on claimant's...

32 CFR 750.26 - The administrative claim.

Code of Federal Regulations, 2014 CFR

2014-07-01

... be filed on a Standard Form 95 or other written notification of the incident. If a letter or other... Standard Form 95. Failure to do so may result in a determination that the administrative claim is incomplete. A suit may be dismissed on the ground of lack of subject matter jurisdiction based on claimant's...

32 CFR 750.26 - The administrative claim.

Code of Federal Regulations, 2013 CFR

2013-07-01

... be filed on a Standard Form 95 or other written notification of the incident. If a letter or other... Standard Form 95. Failure to do so may result in a determination that the administrative claim is incomplete. A suit may be dismissed on the ground of lack of subject matter jurisdiction based on claimant's...

Relationship between tort claims and patient incident reports in the Veterans Health Administration

PubMed Central

Schmidek, J; Weeks, W

2005-01-01

Objective: The Veterans Health Administration's patient incident reporting system was established to obtain comprehensive data on adverse events that affect patients and to act as a harbinger for risk management. It maintains a dataset of tort claims that are made against Veterans Administration's employees acting within the scope of employment. In an effort to understand the thoroughness of reporting, we examined the relationship between tort claims and patient incident reports (PIRs). Methods: Using social security and record numbers, we matched 8260 tort claims and 32 207 PIRs from fiscal years 1993–2000. Tort claims and PIRs were considered to be related if the recorded dates of incident were within 1 month of each other. Descriptive statistics, odds ratios, and two sample t tests with unequal variances were used to determine the relationship between PIRs and tort claims. Results: 4.15% of claims had a related PIR. Claim payment (either settlement or judgment for plaintiff) was more likely when associated with a PIR (OR 3.62; 95% CI 2.87 to 4.60). Payment was most likely for medication errors (OR 8.37; 95% CI 2.05 to 73.25) and least likely for suicides (OR 0.25; 95% CI 0.11 to 0.55). Conclusions: Although few tort claims had a related PIR, if a PIR was present the tort claim was more likely to result in a payment; moreover, the payment was likely to be higher. Underreporting of patient incidents that developed into tort claims was evident. Our findings suggest that, in the Veterans Health Administration, there is a higher propensity to both report and settle PIRs with bad outcomes. PMID:15805457

Linking individual medicare health claims data with work-life claims and other administrative data.

PubMed

Mokyr Horner, Elizabeth; Cullen, Mark R

2015-09-30

Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals' health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives. The current paper is a proof-of-concept, of merging employers' administrative data and private, employment-based health claims with Medicare data. Characteristics of the linked data, including sensitivity and specificity, are evaluated with an eye toward potential uses of such linked data. This paper uses a sample of former manufacturing workers from an industrial cohort as a test case. The dataset created by this integration could be useful to research in areas such as social epidemiology and occupational health. Medicare and employment administrative data were linked for a large cohort of manufacturing workers (employed at some point during 1996-2008) who transitioned onto Medicare between 2001-2009. Data on work-life health, including biometric indicators, were used to predict health at age 65 and to investigate the concordance of employment-based insurance claims with subsequent Medicare insurance claims. Chronic diseases were found to have relatively high levels of concordance between employment-based private insurance and subsequent Medicare insurance. Information about patient health prior to receipt of Medicare, including biometric indicators, were found to predict health at age 65. Combining these data allows for evaluation of continuous health trajectories, as well as modeling later-life health as a function of work-life behaviors and exposures. It also provides a potential endpoint for occupational health research. This is the first harmonization of its kind, providing a proof-of-concept. The dataset created by this integration could be useful for research in areas such as social epidemiology and occupational health.

Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

PubMed Central

Preussler, Jaime M.; Mau, Lih-Wen; Majhail, Navneet S; Meyer, Christa L.; Denzen, Ellen; Edsall, Kristen C.; Farnia, Stephanie H.; Silver, Alicia; Saber, Wael; Burns, Linda J.; Vanness, David J.

2017-01-01

There is an increasing need for the development of approaches to measure quality, costs and resource utilization patterns among allogeneic hematopoietic cell transplant (HCT) patients. Administrative claims data provide an opportunity to examine service utilization and costs, particularly from the payer’s perspective. However, because administrative claims data are primarily designed for reimbursement purposes, challenges arise when using it for research. We use a case study with data derived from the 2007–2011 Truven Health MarketScan Research database to discuss opportunities and challenges for the use of administrative claims data to examine the costs and service utilization of allogeneic HCT and chemotherapy alone for patients with acute myeloid leukemia (AML). Starting with a cohort of 29,915 potentially eligible patients with a diagnosis of AML, we were able to identify 211 patients treated with HCT and 774 treated with chemotherapy only where we were sufficiently confident of the diagnosis and treatment path to allow analysis. Administrative claims data provide an avenue to meet the need for health care costs, resource utilization, and outcome information. However, when using these data, a balance between clinical knowledge and applied methods is critical to identifying a valid study cohort and accurate measures of costs and resource utilization. PMID:27184624

34 CFR 35.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Administrative claim; evidence and information to be submitted. 35.4 Section 35.4 Education Office of the Secretary, Department of Education TORT CLAIMS AGAINST... bills for medical, dental, and hospital expenses incurred, or itemized receipts of payment for such...

34 CFR 35.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Administrative claim; evidence and information to be submitted. 35.4 Section 35.4 Education Office of the Secretary, Department of Education TORT CLAIMS AGAINST... bills for medical, dental, and hospital expenses incurred, or itemized receipts of payment for such...

Administrative review process for adjudicating initial disability claims. Final rule.

PubMed

2006-03-31

The Social Security Administration is committed to providing the high quality of service the American people expect and deserve. In light of the significant growth in the number of disability claims and the increased complexity of those claims, the need to make substantial changes in our disability determination process has become urgent. We are publishing a final rule that amends our administrative review process for applications for benefits that are based on whether you are disabled under title II of the Social Security Act (the Act), or applications for supplemental security income (SSI) payments that are based on whether you are disabled or blind under title XVI of the Act. We expect that this final rule will improve the accuracy, consistency, and timeliness of decision-making throughout the disability determination process.

78 FR 41339 - Federal Housing Administration (FHA) Multifamily Mortgage Insurance; Capturing Excess Claim Proceeds

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

...-AJ16 Federal Housing Administration (FHA) Multifamily Mortgage Insurance; Capturing Excess Claim... reimbursement to FHA of excess claim proceeds. When a mortgagee finances mortgages through the issuance and sale of bonds or through bond anticipation notes, the mortgagee uses the FHA insurance claim funds to pay...

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications.

PubMed

Venkatesh, Arjun K; Mei, Hao; Kocher, Keith E; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S; Rothenberg, Craig; Krumholz, Harlan M; Lin, Zhenqui

2017-04-01

Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims-based definition, 2) facility claims-based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other

29 CFR 15.102 - May an insurance company file an FTCA administrative claim on behalf of a claimant?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 1 2014-07-01 2013-07-01 true May an insurance company file an FTCA administrative claim... the Federal Tort Claims Act § 15.102 May an insurance company file an FTCA administrative claim on behalf of a claimant? (a) A claim for loss wholly compensated by an insurance company may be presented by...

29 CFR 15.102 - May an insurance company file an FTCA administrative claim on behalf of a claimant?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false May an insurance company file an FTCA administrative claim... the Federal Tort Claims Act § 15.102 May an insurance company file an FTCA administrative claim on behalf of a claimant? (a) A claim for loss wholly compensated by an insurance company may be presented by...

12 CFR 793.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administration receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or... Administration or prior to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a.... (c) Forms may be obtained and claims may be filed with the regional office of the National Credit...

12 CFR 793.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Administration receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or... Administration or prior to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a.... (c) Forms may be obtained and claims may be filed with the regional office of the National Credit...

12 CFR 793.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Administration receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or... Administration or prior to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a.... (c) Forms may be obtained and claims may be filed with the regional office of the National Credit...

12 CFR 793.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Administration receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or... Administration or prior to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a.... (c) Forms may be obtained and claims may be filed with the regional office of the National Credit...

12 CFR 793.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Administration receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or... Administration or prior to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a.... (c) Forms may be obtained and claims may be filed with the regional office of the National Credit...

20 CFR 725.421 - Referral of a claim to the Office of Administrative Law Judges.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Referral of a claim to the Office of Administrative Law Judges. 725.421 Section 725.421 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE FEDERAL MINE...

28 CFR 0.103a - Delegations respecting claims against the Drug Enforcement Administration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... claims against the Drug Enforcement Administration. (a) The Administrator of DEA is authorized to... lawful activities of DEA personnel in an amount not to exceed $50,000.00 in any one case. (b) Notwithstanding the provisions of 28 CFR 0.104, the Administrator of DEA is authorized to redelegate the power and...

28 CFR 0.103a - Delegations respecting claims against the Drug Enforcement Administration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... claims against the Drug Enforcement Administration. (a) The Administrator of DEA is authorized to... lawful activities of DEA personnel in an amount not to exceed $50,000.00 in any one case. (b) Notwithstanding the provisions of 28 CFR 0.104, the Administrator of DEA is authorized to redelegate the power and...

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

PubMed Central

Venkatesh, Arjun K.; Mei, Hao; Kocher, Keith E.; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S.; Rothenberg, Craig; Krumholz, Harlan M.; Lin, Zhenqui

2018-01-01

Objectives Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. Methods We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Results Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0

Using administrative medical claims data to supplement state disease registry systems for reporting zoonotic infections.

PubMed

Jones, Stephen G; Coulter, Steven; Conner, William

2013-01-01

To determine what, if any, opportunity exists in using administrative medical claims data for supplemental reporting to the state infectious disease registry system. Cases of five tick-borne (Lyme disease (LD), babesiosis, ehrlichiosis, Rocky Mountain spotted fever (RMSF), tularemia) and two mosquito-borne diseases (West Nile virus, La Crosse viral encephalitis) reported to the Tennessee Department of Health during 2000-2009 were selected for study. Similarly, medically diagnosed cases from a Tennessee-based managed care organization (MCO) claims data warehouse were extracted for the same time period. MCO and Tennessee Department of Health incidence rates were compared using a complete randomized block design within a general linear mixed model to measure potential supplemental reporting opportunity. MCO LD incidence was 7.7 times higher (p<0.001) than that reported to the state, possibly indicating significant under-reporting (∼196 unreported cases per year). MCO data also suggest about 33 cases of RMSF go unreported each year in Tennessee (p<0.001). Three cases of babesiosis were discovered using claims data, a significant finding as this disease was only recently confirmed in Tennessee. Data sharing between MCOs and health departments for vaccine information already exists (eg, the Vaccine Safety Datalink Rapid Cycle Analysis project). There may be a significant opportunity in Tennessee to supplement the current passive infectious disease reporting system with administrative claims data, particularly for LD and RMSF. There are limitations with administrative claims data, but health plans may help bridge data gaps and support the federal administration's vision of combining public and private data into one source.

28 CFR 8.3 - Designation of the investigative bureau having administrative forfeiture authority; claims for...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Designation of the investigative bureau having administrative forfeiture authority; claims for awards, offers in compromise and matters relating to bonds. 8.3 Section 8.3 Judicial Administration DEPARTMENT OF JUSTICE FBI FORFEITURE AUTHORITY FOR...

28 CFR 8.3 - Designation of the investigative bureau having administrative forfeiture authority; claims for...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Designation of the investigative bureau having administrative forfeiture authority; claims for awards, offers in compromise and matters relating to bonds. 8.3 Section 8.3 Judicial Administration DEPARTMENT OF JUSTICE FBI FORFEITURE AUTHORITY FOR...

28 CFR 8.3 - Designation of the investigative bureau having administrative forfeiture authority; claims for...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Designation of the investigative bureau having administrative forfeiture authority; claims for awards, offers in compromise and matters relating to bonds. 8.3 Section 8.3 Judicial Administration DEPARTMENT OF JUSTICE FBI FORFEITURE AUTHORITY FOR...

Determination of colonoscopy indication from administrative claims data.

PubMed

Ko, Cynthia W; Dominitz, Jason A; Neradilek, Moni; Polissar, Nayak; Green, Pam; Kreuter, William; Baldwin, Laura-Mae

2014-04-01

Colonoscopy outcomes, such as polyp detection or complication rates, may differ by procedure indication. To develop methods to classify colonoscopy indications from administrative data, facilitating study of colonoscopy quality and outcomes. We linked 14,844 colonoscopy reports from the Clinical Outcomes Research Initiative, a national repository of endoscopic reports, to the corresponding Medicare Carrier and Outpatient File claims. Colonoscopy indication was determined from the procedure reports. We developed algorithms using classification and regression trees and linear discriminant analysis (LDA) to classify colonoscopy indication. Predictor variables included ICD-9CM and CPT/HCPCS codes present on the colonoscopy claim or in the 12 months prior, patient demographics, and site of colonoscopy service. Algorithms were developed on a training set of 7515 procedures, then validated using a test set of 7329 procedures. Sensitivity was lowest for identifying average-risk screening colonoscopies, varying between 55% and 86% for the different algorithms, but specificity for this indication was consistently over 95%. Sensitivity for diagnostic colonoscopy varied between 77% and 89%, with specificity between 55% and 87%. Algorithms with classification and regression trees with 7 variables or LDA with 10 variables had similar overall accuracy, and generally lower accuracy than the algorithm using LDA with 30 variables. Algorithms using Medicare claims data have moderate sensitivity and specificity for colonoscopy indication, and will be useful for studying colonoscopy quality in this population. Further validation may be needed before use in alternative populations.

5 CFR 177.105 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2014 CFR

2014-01-01

... information to be submitted. 177.105 Section 177.105 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... such expenses. (7) If damages for pain and suffering before death are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain...

5 CFR 177.105 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2012 CFR

2012-01-01

... information to be submitted. 177.105 Section 177.105 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... such expenses. (7) If damages for pain and suffering before death are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain...

5 CFR 177.105 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2011 CFR

2011-01-01

... information to be submitted. 177.105 Section 177.105 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... such expenses. (7) If damages for pain and suffering before death are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain...

5 CFR 177.105 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2013 CFR

2013-01-01

... information to be submitted. 177.105 Section 177.105 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... such expenses. (7) If damages for pain and suffering before death are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain...

41 CFR 102-118.550 - How does a TSP file an administrative claim using EDI or other electronic means?

Code of Federal Regulations, 2010 CFR

2010-07-01

... administrative claim using EDI or other electronic means? 102-118.550 Section 102-118.550 Public Contracts and... EDI or other electronic means? The medium and precise format of data for an administrative claim filed electronically must be approved in advance by the GSA Audit Division. GSA will use an authenticating EDI...

Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems, Washington State.

PubMed

Marcum, Jennifer L; Foley, Michael; Adams, Darrin; Bonauto, Dave

2018-06-01

Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n=1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014. Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014. We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk. Published by Elsevier Ltd.

Estimation of Missed Statin Prescription Use in an Administrative Claims Dataset.

PubMed

Wade, Rolin L; Patel, Jeetvan G; Hill, Jerrold W; De, Ajita P; Harrison, David J

2017-09-01

Nonadherence to statin medications is associated with increased risk of cardiovascular disease and poses a challenge to lipid management in patients who are at risk for atherosclerotic cardiovascular disease. Numerous studies have examined statin adherence based on administrative claims data; however, these data may underestimate statin use in patients who participate in generic drug discount programs or who have alternative coverage. To estimate the proportion of patients with missing statin claims in a claims database and determine how missing claims affect commonly used utilization metrics. This retrospective cohort study used pharmacy data from the PharMetrics Plus (P+) claims dataset linked to the IMS longitudinal pharmacy point-of-sale prescription database (LRx) from January 1, 2012, through December 31, 2014. Eligible patients were represented in the P+ and LRx datasets, had ≥1 claim for a statin (index claim) in either database, and had ≥ 24 months of continuous enrollment in P+. Patients were linked between P+ and LRx using a deterministic method. Duplicate claims between LRx and P+ were removed to produce a new dataset comprised of P+ claims augmented with LRx claims. Statin use was then compared between P+ and the augmented P+ dataset. Utilization metrics that were evaluated included percentage of patients with ≥ 1 missing statin claim over 12 months in P+; the number of patients misclassified as new users in P+; the number of patients misclassified as nonstatin users in P+; the change in 12-month medication possession ratio (MPR) and proportion of days covered (PDC) in P+; the comparison between P+ and LRx of classifications of statin treatment patterns (statin intensity and patients with treatment modifications); and the payment status for missing statin claims. Data from 965,785 patients with statin claims in P+ were analyzed (mean age 56.6 years; 57% male). In P+, 20.1% had ≥ 1 missing statin claim post-index; 13.7% were misclassified as

Tradeoffs of Using Administrative Claims and Medical Records to Identify the Use of Personalized Medicine for Patients with Breast Cancer

PubMed Central

Liang, Su-Ying; Phillips, Kathryn A.; Wang, Grace; Keohane, Carol; Armstrong, Joanne; Morris, William M.; Haas, Jennifer S.

2012-01-01

Background Administrative claims and medical records are important data sources to examine healthcare utilization and outcomes. Little is known about identifying personalized medicine technologies in these sources. Objectives To describe agreement, sensitivity, and specificity of administrative claims compared to medical records for two pairs of targeted tests and treatments for breast cancer. Research Design Retrospective analysis of medical records linked to administrative claims from a large health plan. We examined whether agreement varied by factors that facilitate tracking in claims (coding and cost) and that enhance medical record completeness (records from multiple providers). Subjects Women (35 – 65 years) with incident breast cancer diagnosed in 2006–2007 (n=775). Measures Use of human epidermal growth factor receptor 2 (HER2) and gene expression profiling (GEP) testing, trastuzumab and adjuvant chemotherapy in claims and medical records. Results Agreement between claims and records was substantial for GEP, trastuzumab, and chemotherapy, and lowest for HER2 tests. GEP, an expensive test with unique billing codes, had higher agreement (91.6% vs. 75.2%), sensitivity (94.9% vs. 76.7%), and specificity (90.1% vs. 29.2%) than HER2, a test without unique billing codes. Trastuzumab, a treatment with unique billing codes, had slightly higher agreement (95.1% vs. 90%) and sensitivity (98.1% vs. 87.9%) than adjuvant chemotherapy. Conclusions Higher agreement and specificity were associated with services that had unique billing codes and high cost. Administrative claims may be sufficient for examining services with unique billing codes. Medical records provide better data for identifying tests lacking specific codes and for research requiring detailed clinical information. PMID:21422962

Validity of administrative data claim-based methods for identifying individuals with diabetes at a population level.

PubMed

Southern, Danielle A; Roberts, Barbara; Edwards, Alun; Dean, Stafford; Norton, Peter; Svenson, Lawrence W; Larsen, Erik; Sargious, Peter; Lau, David C W; Ghali, William A

2010-01-01

This study assessed the validity of a widely-accepted administrative data surveillance methodology for identifying individuals with diabetes relative to three laboratory data reference standard definitions for diabetes. We used a combination of linked regional data (hospital discharge abstracts and physician data) and laboratory data to test the validity of administrative data surveillance definitions for diabetes relative to a laboratory data reference standard. The administrative discharge data methodology includes two definitions for diabetes: a strict administrative data definition of one hospitalization code or two physician claims indicating diabetes; and a more liberal definition of one hospitalization code or a single physician claim. The laboratory data, meanwhile, produced three reference standard definitions based on glucose levels +/- HbA1c levels. Sensitivities ranged from 68.4% to 86.9% for the administrative data definitions tested relative to the three laboratory data reference standards. Sensitivities were higher for the more liberal administrative data definition. Positive predictive values (PPV), meanwhile, ranged from 53.0% to 88.3%, with the liberal administrative data definition producing lower PPVs. These findings demonstrate the trade-offs of sensitivity and PPV for selecting diabetes surveillance definitions. Centralized laboratory data may be of value to future surveillance initiatives that use combined data sources to optimize case detection.

21 CFR 101.71 - Health claims: claims not authorized.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Health claims: claims not authorized. 101.71 Section 101.71 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.71 Health...

21 CFR 101.71 - Health claims: claims not authorized.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Health claims: claims not authorized. 101.71 Section 101.71 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.71 Health...

21 CFR 101.71 - Health claims: claims not authorized.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Health claims: claims not authorized. 101.71 Section 101.71 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.71 Health...

A systematic review of validated methods to capture acute bronchospasm using administrative or claims data.

PubMed

Sharifi, Mona; Krishanswami, Shanthi; McPheeters, Melissa L

2013-12-30

To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations. Copyright © 2013 Elsevier Ltd. All rights reserved.

45 CFR 205.35 - Mechanized claims processing and information retrieval systems; definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... claims processing and information retrieval systems; definitions. Section 205.35 through 205.38 contain...: (a) A mechanized claims processing and information retrieval system, hereafter referred to as an automated application processing and information retrieval system (APIRS), or the system, means a system of...

45 CFR 205.35 - Mechanized claims processing and information retrieval systems; definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... claims processing and information retrieval systems; definitions. Section 205.35 through 205.38 contain...: (a) A mechanized claims processing and information retrieval system, hereafter referred to as an automated application processing and information retrieval system (APIRS), or the system, means a system of...

45 CFR 205.35 - Mechanized claims processing and information retrieval systems; definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... claims processing and information retrieval systems; definitions. Section 205.35 through 205.38 contain...: (a) A mechanized claims processing and information retrieval system, hereafter referred to as an automated application processing and information retrieval system (APIRS), or the system, means a system of...

An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients.

PubMed

Bratzler, Dale W; Normand, Sharon-Lise T; Wang, Yun; O'Donnell, Walter J; Metersky, Mark; Han, Lein F; Rapp, Michael T; Krumholz, Harlan M

2011-04-12

Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.

Agreement between Internet-based self- and proxy-reported health care resource utilization and administrative health care claims.

PubMed

Palmer, Liisa; Johnston, Stephen S; Rousculp, Matthew D; Chu, Bong-Chul; Nichol, Kristin L; Mahadevia, Parthiv J

2012-05-01

Although Internet-based surveys are becoming more common, little is known about agreement between administrative claims data and Internet-based survey self- and proxy-reported health care resource utilization (HCRU) data. This analysis evaluated the level of agreement between self- and proxy-reported HCRU data, as recorded through an Internet-based survey, and administrative claims-based HCRU data. The Child and Household Influenza-Illness and Employee Function study collected self- and proxy-reported HCRU data monthly between November 2007 and May 2008. Data included the occurrence and number of visits to hospitals, emergency departments, urgent care centers, and outpatient offices for a respondent's and his or her household members' care. Administrative claims data from the MarketScan® Databases were assessed during the same time and evaluated relative to survey-based metrics. Only data for individuals with employer-sponsored health care coverage linkable to claims were included. The Kappa (κ) statistic was used to evaluate visit concordance, and the intraclass correlation coefficient was used to describe frequency consistency. Agreement for presence of a health care visit and the number of visits were similar for self- and proxy-reported HCRU data. There was moderate to substantial agreement related to health care visit occurrence between survey-based and claims-based HCRU data for inpatient, emergency department, and office visits (κ: 0.47-0.77). There was less agreement on health care visit frequencies, with intraclass correlation coefficient values ranging from 0.14 to 0.71. This study's agreement values suggest that Internet-based surveys are an effective method to collect self- and proxy-reported HCRU data. These results should increase confidence in the use of the Internet for evaluating disease burden. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

PubMed Central

Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

2011-01-01

Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

20 CFR 422.130 - Claim procedure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits SOCIAL SECURITY ADMINISTRATION ORGANIZATION AND PROCEDURES General Procedures § 422.130 Claim procedure. (a) General. The Social Security Administration provides facilities for the public to... station of the Social Security Administration, from the Division of Foreign Claims, Post Office Box 1756...

42 CFR 433.127 - Termination of FFP for failure to provide access to claims processing and information retrieval...

Code of Federal Regulations, 2014 CFR

2014-10-01

... claims processing and information retrieval systems. 433.127 Section 433.127 Public Health CENTERS FOR... PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.127 Termination of FFP for failure to provide access to claims processing and information retrieval...

42 CFR 433.127 - Termination of FFP for failure to provide access to claims processing and information retrieval...

Code of Federal Regulations, 2011 CFR

2011-10-01

... claims processing and information retrieval systems. 433.127 Section 433.127 Public Health CENTERS FOR... PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.127 Termination of FFP for failure to provide access to claims processing and information retrieval...

42 CFR 433.127 - Termination of FFP for failure to provide access to claims processing and information retrieval...

Code of Federal Regulations, 2010 CFR

2010-10-01

... claims processing and information retrieval systems. 433.127 Section 433.127 Public Health CENTERS FOR... PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.127 Termination of FFP for failure to provide access to claims processing and information retrieval...

42 CFR 433.127 - Termination of FFP for failure to provide access to claims processing and information retrieval...

Code of Federal Regulations, 2013 CFR

2013-10-01

... claims processing and information retrieval systems. 433.127 Section 433.127 Public Health CENTERS FOR... PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.127 Termination of FFP for failure to provide access to claims processing and information retrieval...

42 CFR 433.127 - Termination of FFP for failure to provide access to claims processing and information retrieval...

Code of Federal Regulations, 2012 CFR

2012-10-01

... claims processing and information retrieval systems. 433.127 Section 433.127 Public Health CENTERS FOR... PROGRAMS STATE FISCAL ADMINISTRATION Mechanized Claims Processing and Information Retrieval Systems § 433.127 Termination of FFP for failure to provide access to claims processing and information retrieval...

32 CFR 842.12 - HQ USAF claims responsibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Administrative Management Program (CAMP) reviews. (2) Implements claims and tort litigation policies, issues... LITIGATION ADMINISTRATIVE CLAIMS Functions and Responsibilities § 842.12 HQ USAF claims responsibility. (a...

10 CFR 782.6 - Processing of administrative claims.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Energy DEPARTMENT OF ENERGY CLAIMS FOR PATENT AND COPYRIGHT INFRINGEMENT Requirements and Procedures... regarding claims should be addressed to: General Counsel, ATTN: Assistant General Counsel for Patents, Office of the General Counsel, U.S. Department of Energy, Washington, DC 20545. If any communication...

10 CFR 782.6 - Processing of administrative claims.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Energy DEPARTMENT OF ENERGY CLAIMS FOR PATENT AND COPYRIGHT INFRINGEMENT Requirements and Procedures... regarding claims should be addressed to: General Counsel, ATTN: Assistant General Counsel for Patents, Office of the General Counsel, U.S. Department of Energy, Washington, DC 20545. If any communication...

10 CFR 782.6 - Processing of administrative claims.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Energy DEPARTMENT OF ENERGY CLAIMS FOR PATENT AND COPYRIGHT INFRINGEMENT Requirements and Procedures... regarding claims should be addressed to: General Counsel, ATTN: Assistant General Counsel for Patents, Office of the General Counsel, U.S. Department of Energy, Washington, DC 20545. If any communication...

10 CFR 782.6 - Processing of administrative claims.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Energy DEPARTMENT OF ENERGY CLAIMS FOR PATENT AND COPYRIGHT INFRINGEMENT Requirements and Procedures... regarding claims should be addressed to: General Counsel, ATTN: Assistant General Counsel for Patents, Office of the General Counsel, U.S. Department of Energy, Washington, DC 20545. If any communication...

10 CFR 782.6 - Processing of administrative claims.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Energy DEPARTMENT OF ENERGY CLAIMS FOR PATENT AND COPYRIGHT INFRINGEMENT Requirements and Procedures... regarding claims should be addressed to: General Counsel, ATTN: Assistant General Counsel for Patents, Office of the General Counsel, U.S. Department of Energy, Washington, DC 20545. If any communication...

Algorithms to Identify Statin Intolerance in Medicare Administrative Claim Data.

PubMed

Colantonio, Lisandro D; Kent, Shia T; Huang, Lei; Chen, Ligong; Monda, Keri L; Serban, Maria-Corina; Manthripragada, Angelika; Kilgore, Meredith L; Rosenson, Robert S; Muntner, Paul

2016-10-01

To compare characteristics of patients with possible statin intolerance identified using different claims-based algorithms versus patients with high adherence to statins. We analyzed 134,863 Medicare beneficiaries initiating statins between 2007 and 2011. Statin intolerance and discontinuation, and high adherence to statins, defined by proportion of days covered ≥80 %, were assessed during the 365 days following statin initiation. Definition 1 of statin intolerance included statin down-titration or discontinuation with ezetimibe initiation, having a claim for a rhabdomyolysis or antihyperlipidemic event followed by statin down-titration or discontinuation, or switching between ≥3 types of statins. Definition 2 included beneficiaries who met Definition 1 and those who down-titrated statin intensity. We also analyzed beneficiaries who met Definition 2 of statin intolerance or discontinued statins. The prevalence of statin intolerance was 1.0 % (n = 1320) and 5.2 % (n = 6985) using Definitions 1 and 2, respectively. Overall, 45,266 (33.6 %) beneficiaries had statin intolerance by Definition 2 or discontinued statins and 55,990 (41.5 %) beneficiaries had high adherence to statins. Compared with beneficiaries with high adherence to statins, those with statin intolerance and who had statin intolerance or discontinued statins were more likely to be female versus male, and black, Hispanic or Asian versus white. The multivariable adjusted odds ratio for statin intolerance by Definitions 1 and 2 comparing patients initiating high versus low/moderate intensity statins were 2.82 (95%CI: 2.42-3.29), and 8.58 (8.07-9.12), respectively, and for statin intolerance or statin discontinuation was 2.35 (2.25-2.45). Definitions of statin intolerance presented herein can be applied to analyses using administrative claims data.

28 CFR 32.32 - Time for filing claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Time for filing claim. 32.32 Section 32.32 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Educational Assistance Benefit Claims § 32.32 Time for filing claim. (a...

28 CFR 32.32 - Time for filing claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Time for filing claim. 32.32 Section 32.32 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Educational Assistance Benefit Claims § 32.32 Time for filing claim. (a...

A systematic review of validated methods for identifying acute respiratory failure using administrative and claims data.

PubMed

Jones, Natalie; Schneider, Gary; Kachroo, Sumesh; Rotella, Philip; Avetisyan, Ruzan; Reynolds, Matthew W

2012-01-01

The Food and Drug Administration's (FDA) Mini-Sentinel pilot program initially aims to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest (HOIs) from administrative and claims data. This paper summarizes the process and findings of the algorithm review of acute respiratory failure (ARF). PubMed and Iowa Drug Information Service searches were conducted to identify citations applicable to the anaphylaxis HOI. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles using administrative and claims data to identify ARF, including validation estimates of the coding algorithms. Our search revealed a deficiency of literature focusing on ARF algorithms and validation estimates. Only two studies provided codes for ARF, each using related yet different ICD-9 codes (i.e., ICD-9 codes 518.8, "other diseases of lung," and 518.81, "acute respiratory failure"). Neither study provided validation estimates. Research needs to be conducted on designing validation studies to test ARF algorithms and estimating their predictive power, sensitivity, and specificity. Copyright © 2012 John Wiley & Sons, Ltd.

28 CFR 32.12 - Time for filing claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Time for filing claim. 32.12 Section 32.12 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Death Benefit Claims § 32.12 Time for filing claim. (a) Unless, for good...

28 CFR 32.22 - Time for filing claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Time for filing claim. 32.22 Section 32.22 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Disability Benefit Claims § 32.22 Time for filing claim. (a) Unless, for...

28 CFR 32.12 - Time for filing claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Time for filing claim. 32.12 Section 32.12 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Death Benefit Claims § 32.12 Time for filing claim. (a) Unless, for good...

28 CFR 32.22 - Time for filing claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Time for filing claim. 32.22 Section 32.22 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS Disability Benefit Claims § 32.22 Time for filing claim. (a) Unless, for...

A systematic review of validated methods for identifying anaphylaxis, including anaphylactic shock and angioneurotic edema, using administrative and claims data.

PubMed

Schneider, Gary; Kachroo, Sumesh; Jones, Natalie; Crean, Sheila; Rotella, Philip; Avetisyan, Ruzan; Reynolds, Matthew W

2012-01-01

The Food and Drug Administration's Mini-Sentinel pilot program initially aims to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest from administrative and claims data. This article summarizes the process and findings of the algorithm review of anaphylaxis. PubMed and Iowa Drug Information Service searches were conducted to identify citations applicable to the anaphylaxis health outcome of interest. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles using administrative and claims data to identify anaphylaxis and including validation estimates of the coding algorithms. Our search revealed limited literature focusing on anaphylaxis that provided administrative and claims data-based algorithms and validation estimates. Only four studies identified via literature searches provided validated algorithms; however, two additional studies were identified by Mini-Sentinel collaborators and were incorporated. The International Classification of Diseases, Ninth Revision, codes varied, as did the positive predictive value, depending on the cohort characteristics and the specific codes used to identify anaphylaxis. Research needs to be conducted on designing validation studies to test anaphylaxis algorithms and estimating their predictive power, sensitivity, and specificity. Copyright © 2012 John Wiley & Sons, Ltd.

Expanding the use of administrative claims databases in conducting clinical real-world evidence studies in multiple sclerosis.

PubMed

Capkun, Gorana; Lahoz, Raquel; Verdun, Elisabetta; Song, Xue; Chen, Weston; Korn, Jonathan R; Dahlke, Frank; Freitas, Rita; Fraeman, Kathy; Simeone, Jason; Johnson, Barbara H; Nordstrom, Beth

2015-05-01

Administrative claims databases provide a wealth of data for assessing the effect of treatments in clinical practice. Our aim was to propose methodology for real-world studies in multiple sclerosis (MS) using these databases. In three large US administrative claims databases: MarketScan, PharMetrics Plus and Department of Defense (DoD), patients with MS were selected using an algorithm identified in the published literature and refined for accuracy. Algorithms for detecting newly diagnosed ('incident') MS cases were also refined and tested. Methodology based on resource and treatment use was developed to differentiate between relapses with and without hospitalization. When various patient selection criteria were applied to the MarketScan database, an algorithm requiring two MS diagnoses at least 30 days apart was identified as the preferred method of selecting patient cohorts. Attempts to detect incident MS cases were confounded by the limited continuous enrollment of patients in these databases. Relapse detection algorithms identified similar proportions of patients in the MarketScan and PharMetrics Plus databases experiencing relapses with (2% in both databases) and without (15-20%) hospitalization in the 1 year follow-up period, providing findings in the range of those in the published literature. Additional validation of the algorithms proposed here would increase their credibility. The methods suggested in this study offer a good foundation for performing real-world research in MS using administrative claims databases, potentially allowing evidence from different studies to be compared and combined more systematically than in current research practice.

Pluvial, urban flood mechanisms and characteristics - Assessment based on insurance claims

NASA Astrophysics Data System (ADS)

Sörensen, Johanna; Mobini, Shifteh

2017-12-01

Pluvial flooding is a problem in many cities and for city planning purpose the mechanisms behind pluvial flooding are of interest. Previous studies seldom use insurance claim data to analyse city scale characteristics that lead to flooding. In the present study, two long time series (∼20 years) of flood claims from property owners have been collected and analysed in detail to investigate the mechanisms and characteristics leading to urban flooding. The flood claim data come from the municipal water utility company and property owners with insurance that covers property loss from overland flooding, groundwater intrusion through basement walls and flooding from the drainage system. These data are used as a proxy for flood severity for several events in the Swedish city of Malmö. It is discussed which rainfall characteristics give most flooding and why some rainfall events do not lead to severe flooding, how city scale topography and sewerage system type influence spatial distribution of flood claims, and which impact high sea level has on flooding in Malmö. Three severe flood events are described in detail and compared with a number of smaller flood events. It was found that the main mechanisms and characteristics of flood extent and its spatial distribution in Malmö are intensity and spatial distribution of rainfall, distance to the main sewer system as well as overland flow paths, and type of drainage system, while high sea level has little impact on the flood extent. Finally, measures that could be taken to lower the flood risk in Malmö, and other cities with similar characteristics, are discussed.

32 CFR 842.106 - Who may file a claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... file a claim for personal injury. (c) Executors or administrators of a decedent's estate or any other... 32 National Defense 6 2011-07-01 2011-07-01 false Who may file a claim. 842.106 Section 842.106... ADMINISTRATIVE CLAIMS Claims Under the National Guard Claims Act (32 U.S.C. 715) § 842.106 Who may file a claim...

32 CFR 842.106 - Who may file a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... file a claim for personal injury. (c) Executors or administrators of a decedent's estate or any other... 32 National Defense 6 2010-07-01 2010-07-01 false Who may file a claim. 842.106 Section 842.106... ADMINISTRATIVE CLAIMS Claims Under the National Guard Claims Act (32 U.S.C. 715) § 842.106 Who may file a claim...

42 CFR 433.112 - FFP for design, development, installation or enhancement of mechanized claims processing and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... enhancement of mechanized claims processing and information retrieval systems. 433.112 Section 433.112 Public... processing and information retrieval systems. (a) Subject to paragraph (c) of this section, FFP is available... enhancement of a mechanized claims processing and information retrieval system only if the APD is approved by...

42 CFR 433.112 - FFP for design, development, installation or enhancement of mechanized claims processing and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... enhancement of mechanized claims processing and information retrieval systems. 433.112 Section 433.112 Public... processing and information retrieval systems. (a) Subject to paragraph (c) of this section, FFP is available... enhancement of a mechanized claims processing and information retrieval system only if the APD is approved by...

42 CFR 433.112 - FFP for design, development, installation or enhancement of mechanized claims processing and...

Code of Federal Regulations, 2011 CFR

2011-10-01

... enhancement of mechanized claims processing and information retrieval systems. 433.112 Section 433.112 Public... processing and information retrieval systems. (a) Subject to paragraph (c) of this section, FFP is available... enhancement of a mechanized claims processing and information retrieval system only if the APD is approved by...

42 CFR 433.112 - FFP for design, development, installation or enhancement of mechanized claims processing and...

Code of Federal Regulations, 2013 CFR

2013-10-01

... enhancement of mechanized claims processing and information retrieval systems. 433.112 Section 433.112 Public... processing and information retrieval systems. (a) Subject to paragraph (c) of this section, FFP is available... enhancement of a mechanized claims processing and information retrieval system only if the APD is approved by...

25 CFR 11.707 - Claims against estate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... executor or administrator within 60 days from official notice of the appointment of the executor or... appropriate notice for the filing of claims. (b) The executor or administrator shall examine all claims within...

An Evaluation of Algorithms for Identifying Metastatic Breast, Lung, or Colorectal Cancer in Administrative Claims Data.

PubMed

Whyte, Joanna L; Engel-Nitz, Nicole M; Teitelbaum, April; Gomez Rey, Gabriel; Kallich, Joel D

2015-07-01

Administrative health care claims data are used for epidemiologic, health services, and outcomes cancer research and thus play a significant role in policy. Cancer stage, which is often a major driver of cost and clinical outcomes, is not typically included in claims data. Evaluate algorithms used in a dataset of cancer patients to identify patients with metastatic breast (BC), lung (LC), or colorectal (CRC) cancer using claims data. Clinical data on BC, LC, or CRC patients (between January 1, 2007 and March 31, 2010) were linked to a health care claims database. Inclusion required health plan enrollment ≥3 months before initial cancer diagnosis date. Algorithms were used in the claims database to identify patients' disease status, which was compared with physician-reported metastases. Generic and tumor-specific algorithms were evaluated using ICD-9 codes, varying diagnosis time frames, and including/excluding other tumors. Positive and negative predictive values, sensitivity, and specificity were assessed. The linked databases included 14,480 patients; of whom, 32%, 17%, and 14.2% had metastatic BC, LC, and CRC, respectively, at diagnosis and met inclusion criteria. Nontumor-specific algorithms had lower specificity than tumor-specific algorithms. Tumor-specific algorithms' sensitivity and specificity were 53% and 99% for BC, 55% and 85% for LC, and 59% and 98% for CRC, respectively. Algorithms to distinguish metastatic BC, LC, and CRC from locally advanced disease should use tumor-specific primary cancer codes with 2 claims for the specific primary cancer >30-42 days apart to reduce misclassification. These performed best overall in specificity, positive predictive values, and overall accuracy to identify metastatic cancer in a health care claims database.

12 CFR 793.3 - Administrative claim; who may file.

Code of Federal Regulations, 2010 CFR

2010-01-01

... authorized agent, or his legal representative. (c) A claim based on death may be presented by the executor or... accompanied by evidence of his authority to present a claim on behalf of the claimant as agent, executor...

Employee Retirement Income Security Act of 1974: rules and regulations for administration and enforcement; claims procedure. Pension and Welfare Benefits Administration, Labor. Final regulation.

PubMed

2000-11-21

This document contains a final regulation revising the minimum requirements for benefit claims procedures of employee benefit plans covered by Title I of the Employee Retirement Income Security Act of 1974 (ERISA or the Act). The regulation establishes new standards for the processing of claims under group health plans and plans providing disability benefits and further clarifies existing standards for all other employee benefit plans. The new standards are intended to ensure more timely benefit determinations, to improve access to information on which a benefit determination is made, and to assure that participants and beneficiaries will be afforded a full and fair review of denied claims. When effective, the regulation will affect participants and beneficiaries of employee benefit plans, employers who sponsor employee benefit plans, plan fiduciaries, and others who assist in the provision of plan benefits, such as third-party benefits administrators and health service providers or health maintenance organizations that provide benefits to participants and beneficiaries of employee benefit plans.

Determination of the optimal case definition for the diagnosis of end-stage renal disease from administrative claims data in Manitoba, Canada.

PubMed

Komenda, Paul; Yu, Nancy; Leung, Stella; Bernstein, Keevin; Blanchard, James; Sood, Manish; Rigatto, Claudio; Tangri, Navdeep

2015-01-01

End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period. We determined the sensitivity, specificity, predictive value and overall accuracy of 4 administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status. During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years. Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.

32 CFR 842.61 - Who may file a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Who may file a claim. 842.61 Section 842.61... ADMINISTRATIVE CLAIMS Foreign Claims (10 U.S.C. 2734) § 842.61 Who may file a claim. (a) Owners of the property... personal injury. (c) Executors or administrators of a decedent's estate, or any other person legally...

32 CFR 842.61 - Who may file a claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Who may file a claim. 842.61 Section 842.61... ADMINISTRATIVE CLAIMS Foreign Claims (10 U.S.C. 2734) § 842.61 Who may file a claim. (a) Owners of the property... personal injury. (c) Executors or administrators of a decedent's estate, or any other person legally...

48 CFR 1604.7101 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Filing health benefit... System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Disputed Health Benefit Claims 1604.7101 Filing health benefit claims/court review of...

48 CFR 1604.7101 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Filing health benefit... System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Disputed Health Benefit Claims 1604.7101 Filing health benefit claims/court review of...

48 CFR 1604.7101 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Filing health benefit... System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Disputed Health Benefit Claims 1604.7101 Filing health benefit claims/court review of...

48 CFR 1604.7101 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Filing health benefit... System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Disputed Health Benefit Claims 1604.7101 Filing health benefit claims/court review of...

48 CFR 1604.7101 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Disputed Health Benefit Claims 1604.7101 Filing health benefit claims/court review of... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Filing health benefit...

Actuarial analysis of private payer administrative claims data for women with endometriosis.

PubMed

Mirkin, David; Murphy-Barron, Carrieann; Iwasaki, Kosuke

2007-04-01

Endometriosis is a painful, chronic disease affecting 5.5 million women and girls in the United States and Canada and millions more worldwide. The usual age range of women diagnosed with endometriosis is 20 to 45 years. Endometriosis has an estimated prevalence of 10% among women of reproductive age, although estimates of prevalence vary greatly. Endometriosis is the most common gynecological cause of chronic pelvic pain, but published information on its associated medical care costs is scarce. The aim of this study was to determine (1) the prevalence of endometriosis in the United States, (2) the amount of health care services used by women coded with endometriosis in a commercial medical claims database during 1999 to 2003, and (3) the endometriosis-related costs for 2003, the most recent data available at the time the study was performed. This study was a retrospective review of administrative data for commercial payers, which included enrollment, eligibility, and claims payment data contained in the Medstat Marketscan database for approximately 4 million commercial insurance members. All claims and membership data were extracted for each woman aged 18 to 55 years who had at least 1 medical or hospital claim with a diagnosis code for endometriosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 617.00-617.99) for 1999 through 2003. Claims data from 1999 through 2003 were used to determine prevalence and health care resource utilization (i.e., annual admission rate, annual surgical rate, distribution of endometriosis-related surgeries, and prevalence of comorbid conditions). The cost analysis was based on claims from 2003 only. Cost was defined as the payer-allowed charge, which equals the net payer cost plus member cost share. The prevalence of women with medical claims (inpatient and/or outpatient) containing ICD-9-CM codes for endometriosis was 1.1% for the age band of 30 to 39 years and 0.7% over the entire

32 CFR 842.94 - Assertable claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., against a tort-feasor when: (a) Damage results from negligence and the claim is for: (1) More than $100... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842.... (The two claims should be consolidated and processed under subpart N). (d) The Tort-feasor or his...

Development and Validation of an Algorithm to Identify Patients with Multiple Myeloma Using Administrative Claims Data.

PubMed

Princic, Nicole; Gregory, Chris; Willson, Tina; Mahue, Maya; Felici, Diana; Werther, Winifred; Lenhart, Gregory; Foley, Kathleen A

2016-01-01

The objective was to expand on prior work by developing and validating a new algorithm to identify multiple myeloma (MM) patients in administrative claims. Two files were constructed to select MM cases from MarketScan Oncology Electronic Medical Records (EMR) and controls from the MarketScan Primary Care EMR during January 1, 2000-March 31, 2014. Patients were linked to MarketScan claims databases, and files were merged. Eligible cases were age ≥18, had a diagnosis and visit for MM in the Oncology EMR, and were continuously enrolled in claims for ≥90 days preceding and ≥30 days after diagnosis. Controls were age ≥18, had ≥12 months of overlap in claims enrollment (observation period) in the Primary Care EMR and ≥1 claim with an ICD-9-CM diagnosis code of MM (203.0×) during that time. Controls were excluded if they had chemotherapy; stem cell transplant; or text documentation of MM in the EMR during the observation period. A split sample was used to develop and validate algorithms. A maximum of 180 days prior to and following each MM diagnosis was used to identify events in the diagnostic process. Of 20 algorithms explored, the baseline algorithm of 2 MM diagnoses and the 3 best performing were validated. Values for sensitivity, specificity, and positive predictive value (PPV) were calculated. Three claims-based algorithms were validated with ~10% improvement in PPV (87-94%) over prior work (81%) and the baseline algorithm (76%) and can be considered for future research. Consistent with prior work, it was found that MM diagnoses before and after tests were needed.

45 CFR 162.1401 - Health care claim status transaction.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Health care claim status transaction. 162.1401 Section 162.1401 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim...

45 CFR 162.1401 - Health care claim status transaction.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Health care claim status transaction. 162.1401 Section 162.1401 Public Welfare Department of Health and Human Services ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS ADMINISTRATIVE REQUIREMENTS Health Care Claim Status § 162.1401 Health care claim...

20 CFR 725.496 - Special claims transferred to the fund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... classes of denied claims subject to the transfer provisions: (1) Claims filed with and denied by the Social Security Administration before March 1, 1978; (2) Claims filed with the Department of Labor in...) Where more than one claim was filed with the Social Security Administration and/or the Department of...

12 CFR 380.32 - Claims bar date.

Code of Federal Regulations, 2012 CFR

2012-01-01

... LIQUIDATION AUTHORITY Receivership Administrative Claims Process § 380.32 Claims bar date. Upon its appointment as receiver for a covered financial company, the Corporation as receiver shall establish a claims bar date by which date creditors of the covered financial company shall present their claims, together...

Learning mechanisms to limit medication administration errors.

PubMed

Drach-Zahavy, Anat; Pud, Dorit

2010-04-01

This paper is a report of a study conducted to identify and test the effectiveness of learning mechanisms applied by the nursing staff of hospital wards as a means of limiting medication administration errors. Since the influential report ;To Err Is Human', research has emphasized the role of team learning in reducing medication administration errors. Nevertheless, little is known about the mechanisms underlying team learning. Thirty-two hospital wards were randomly recruited. Data were collected during 2006 in Israel by a multi-method (observations, interviews and administrative data), multi-source (head nurses, bedside nurses) approach. Medication administration error was defined as any deviation from procedures, policies and/or best practices for medication administration, and was identified using semi-structured observations of nurses administering medication. Organizational learning was measured using semi-structured interviews with head nurses, and the previous year's reported medication administration errors were assessed using administrative data. The interview data revealed four learning mechanism patterns employed in an attempt to learn from medication administration errors: integrated, non-integrated, supervisory and patchy learning. Regression analysis results demonstrated that whereas the integrated pattern of learning mechanisms was associated with decreased errors, the non-integrated pattern was associated with increased errors. Supervisory and patchy learning mechanisms were not associated with errors. Superior learning mechanisms are those that represent the whole cycle of team learning, are enacted by nurses who administer medications to patients, and emphasize a system approach to data analysis instead of analysis of individual cases.

45 CFR 504.1 - Claim defined.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Regulations Relating to Public Welfare (Continued) FOREIGN CLAIMS SETTLEMENT COMMISSION OF THE UNITED STATES, DEPARTMENT OF JUSTICE RECEIPT, ADMINISTRATION, AND PAYMENT OF CLAIMS UNDER TITLE I OF THE WAR CLAIMS ACT OF... military servicemen held as prisoners of war by forces hostile to the United States. (b) A properly...

45 CFR 504.1 - Claim defined.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Regulations Relating to Public Welfare (Continued) FOREIGN CLAIMS SETTLEMENT COMMISSION OF THE UNITED STATES, DEPARTMENT OF JUSTICE RECEIPT, ADMINISTRATION, AND PAYMENT OF CLAIMS UNDER TITLE I OF THE WAR CLAIMS ACT OF... military servicemen held as prisoners of war by forces hostile to the United States. (b) A properly...

45 CFR 504.1 - Claim defined.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Regulations Relating to Public Welfare (Continued) FOREIGN CLAIMS SETTLEMENT COMMISSION OF THE UNITED STATES, DEPARTMENT OF JUSTICE RECEIPT, ADMINISTRATION, AND PAYMENT OF CLAIMS UNDER TITLE I OF THE WAR CLAIMS ACT OF... military servicemen held as prisoners of war by forces hostile to the United States. (b) A properly...

45 CFR 504.1 - Claim defined.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Regulations Relating to Public Welfare (Continued) FOREIGN CLAIMS SETTLEMENT COMMISSION OF THE UNITED STATES, DEPARTMENT OF JUSTICE RECEIPT, ADMINISTRATION, AND PAYMENT OF CLAIMS UNDER TITLE I OF THE WAR CLAIMS ACT OF... military servicemen held as prisoners of war by forces hostile to the United States. (b) A properly...

20 CFR 405.410 - Selecting claims for Decision Review Board review.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Selecting claims for Decision Review Board review. 405.410 Section 405.410 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW... will not review claims based on the identity of the administrative law judge who decided the claim. (b...

76 FR 36176 - Fully Developed Claim (Fully Developed Claims-Applications for Compensation, Pension, DIC, Death...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-21

... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0747] Fully Developed Claim (Fully Developed Claims--Applications for Compensation, Pension, DIC, Death Pension, and/or Accrued Benefits); Correction AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice; correction...

32 CFR 842.95 - Non-assertable claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ADMINISTRATIVE CLAIMS Property Damage Tort Claims in Favor of the United States (31 U.S.C. 3701, 3711-3719) § 842...) Reimbursement for military or civilian employees for their negligence claims paid by the United States. (b) Loss...

20 CFR 356.3 - False claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false False claims. 356.3 Section 356.3 Employees' Benefits RAILROAD RETIREMENT BOARD ADMINISTRATIVE REMEDIES FOR FRAUDULENT CLAIMS OR STATEMENTS CIVIL MONETARY PENALTY INFLATION ADJUSTMENT § 356.3 False claims. In the case of penalties assessed under 31 U.S...

42 CFR 401.607 - Claims collection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Claims collection. 401.607 Section 401.607 Public... PROVISIONS GENERAL ADMINISTRATIVE REQUIREMENTS Claims Collection and Compromise § 401.607 Claims collection... appropriate, by— (1) Direct collections in lump sums or in installments; or (2) Offsets against monies owed to...

26 CFR 403.36 - Interest claimed.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 18 2013-04-01 2013-04-01 false Interest claimed. 403.36 Section 403.36... ADMINISTRATION DISPOSITION OF SEIZED PERSONAL PROPERTY Remission or Mitigation of Forfeitures § 403.36 Interest claimed. Any person claiming an interest in property seized by an officer of the Internal Revenue Service...

26 CFR 403.36 - Interest claimed.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 18 2014-04-01 2014-04-01 false Interest claimed. 403.36 Section 403.36... ADMINISTRATION DISPOSITION OF SEIZED PERSONAL PROPERTY Remission or Mitigation of Forfeitures § 403.36 Interest claimed. Any person claiming an interest in property seized by an officer of the Internal Revenue Service...

26 CFR 403.36 - Interest claimed.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 18 2012-04-01 2012-04-01 false Interest claimed. 403.36 Section 403.36... ADMINISTRATION DISPOSITION OF SEIZED PERSONAL PROPERTY Remission or Mitigation of Forfeitures § 403.36 Interest claimed. Any person claiming an interest in property seized by an officer of the Internal Revenue Service...

32 CFR 842.72 - Filing a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Filing a claim. 842.72 Section 842.72 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE... receives a claim, send it to the US sending State office for delivery to the receiving State. (b) Claims...

5 CFR 1215.24 - Claims involving criminal activity or misconduct.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Claims involving criminal activity or misconduct. 1215.24 Section 1215.24 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.24 Claims involving criminal activity or misconduct. (a...

5 CFR 1215.24 - Claims involving criminal activity or misconduct.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Claims involving criminal activity or misconduct. 1215.24 Section 1215.24 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.24 Claims involving criminal activity or misconduct. (a...

5 CFR 1215.24 - Claims involving criminal activity or misconduct.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Claims involving criminal activity or misconduct. 1215.24 Section 1215.24 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.24 Claims involving criminal activity or misconduct. (a...

5 CFR 1215.24 - Claims involving criminal activity or misconduct.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Claims involving criminal activity or misconduct. 1215.24 Section 1215.24 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.24 Claims involving criminal activity or misconduct. (a...

5 CFR 1215.24 - Claims involving criminal activity or misconduct.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Claims involving criminal activity or misconduct. 1215.24 Section 1215.24 Administrative Personnel MERIT SYSTEMS PROTECTION BOARD ORGANIZATION AND PROCEDURES DEBT MANAGEMENT Claims Collection § 1215.24 Claims involving criminal activity or misconduct. (a...

32 CFR 842.43 - Filing a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... completed Standard Form 95 or other signed and written demand for money damages in a sum certain. A claim... Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE... amend a claim at any time prior to final action. To amend a claim, the claimant or his or her authorized...

10 CFR 1014.10 - Action on approved claims.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Action on approved claims. 1014.10 Section 1014.10 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) ADMINISTRATIVE CLAIMS UNDER FEDERAL TORT CLAIMS ACT § 1014.10 Action on approved claims. (a) Payment of any approved claim shall not be made unless the claimant...

10 CFR 1014.10 - Action on approved claims.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Action on approved claims. 1014.10 Section 1014.10 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) ADMINISTRATIVE CLAIMS UNDER FEDERAL TORT CLAIMS ACT § 1014.10 Action on approved claims. (a) Payment of any approved claim shall not be made unless the claimant...

28 CFR 104.31 - Procedure for claims evaluation.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Procedure for claims evaluation. 104.31 Section 104.31 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) SEPTEMBER 11TH VICTIM... any required documents. (b) Procedural tracks. Each claim will be placed on a procedural track...

28 CFR 104.31 - Procedure for claims evaluation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Procedure for claims evaluation. 104.31 Section 104.31 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) SEPTEMBER 11TH VICTIM... any required documents. (b) Procedural tracks. Each claim will be placed on a procedural track...

20 CFR 405.510 - Claims remanded by a Federal court.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Claims remanded by a Federal court. 405.510 Section 405.510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Judicial Review § 405.510 Claims remanded by a Federal court. When a...

20 CFR 405.510 - Claims remanded by a Federal court.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Claims remanded by a Federal court. 405.510 Section 405.510 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Judicial Review § 405.510 Claims remanded by a Federal court. When a...

Infant and toddler disease score was useful for risk of hospitalization based on data from administrative claims.

PubMed

Mikaeloff, Yann; Moride, Yola; Khoshnood, Babak; Weill, Alain; Bréart, Gérard

2007-07-01

To develop the infant and toddler disease score (IDS), a population-based predictive tool of morbidity status in infants and toddlers, based on data from administrative claims. A prospective cohort study was conducted, including 35,580 children less than 2 years of age in June 2003 from the French "ERASME" database (mean follow-up 13 months). The outcome variable was incident hospitalization during the follow-up year, that is, before the second birthday for infants and before the third for toddlers. Risk factors before inclusion (age, health care use, medications) were assessed in a 50% random sample (construction sample) by a logistic regression model. Beta coefficients were summed up to obtain the IDS. The IDS was then validated for the remaining 50% of the study population (validation sample). The major variables significantly associated with the outcome were long-term disability, younger age, and >or=1 hospitalization before inclusion. The risks of hospitalization estimated by the IDS were concordant in the construction and validation samples. The IDS is a useful index for the risk of hospitalization of infants and toddlers in relation to their morbidity status and may be used for adjustment in pharmacoepidemiologic studies using administrative claims databases.

32 CFR 842.11 - Air Force claims organization.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Air Force claims organization. 842.11 Section 842.11 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE CLAIMS Functions and Responsibilities § 842.11 Air Force claims organization. Air...

32 CFR 842.11 - Air Force claims organization.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Air Force claims organization. 842.11 Section 842.11 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE CLAIMS Functions and Responsibilities § 842.11 Air Force claims organization. Air...

32 CFR 842.11 - Air Force claims organization.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Air Force claims organization. 842.11 Section 842.11 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE CLAIMS Functions and Responsibilities § 842.11 Air Force claims organization. Air...

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population.

PubMed

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Selecting from a repository containing members' data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx-486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%-92.0%) versus 73.4% (95% CI: 66.8%-79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%-87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%-80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%-92.6%). Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims

45 CFR 205.35 - Mechanized claims processing and information retrieval systems; definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... State plan requirements for an automated statewide management information system, conditions for FFP and... produce utilization and management information about such aid and services as required by the single State... 45 Public Welfare 2 2010-10-01 2010-10-01 false Mechanized claims processing and information...

13 CFR 114.109 - What if my claim is denied?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What if my claim is denied? 114.109 Section 114.109 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION ADMINISTRATIVE CLAIMS... representative in writing by certified or registered mail if it denies your claim. You have a right to file suit...

46 CFR 327.4 - Claim requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; ADMINISTRATIVE ACTION AND LITIGATION § 327.4 Claim requirements. (a) Form. The claim may be in any form and shall... of the United States. Any lawsuits filed contrary to the provisions of section 5 of the Suits in...

46 CFR 327.4 - Claim requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; ADMINISTRATIVE ACTION AND LITIGATION § 327.4 Claim requirements. (a) Form. The claim may be in any form and shall... of the United States. Any lawsuits filed contrary to the provisions of section 5 of the Suits in...

45 CFR 30.7 - Subdivision of claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Subdivision of claims. 30.7 Section 30.7 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION General Provisions § 30.7 Subdivision of claims. Debts may not be subdivided to avoid the monetary ceiling...

20 CFR 410.232 - Withdrawal of a claim.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Withdrawal of a claim. 410.232 Section 410.232 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969... Claims and Evidence § 410.232 Withdrawal of a claim. (a) Before adjudication of claim. A claimant (or an...

Decision-making and evaluation of science causal claims: Effects of goals on uses of evidence and explanatory mechanism

NASA Astrophysics Data System (ADS)

Wong, Jacqueline Yin Sang

2015-10-01

Evidence and explanatory mechanism are central to scientific practices. Using such information could also inform decisions about issues in which science can play some role, from policy issues like climate change to personal issues like vaccination. While research suggests that people tend to focus on non-science considerations when making science-related decisions, there is also evidence that people can reason very productively with evidence and mechanism. This study examines how the goals participants pursue when reading a science report influences how they attend to information about causal mechanism and evidence. Two hundred and seventeen high school students were asked either to evaluate the truth of a scientific claim, to make a personal decision based on the claim, or to make a social policy decision based on the claim using an online task-based survey. All three groups of participants attended to evidence and mechanism, but participants with different goals requested different types of information and were influenced by evidence and mechanism for different reasons. The findings suggest that goals influence how participants use evidence and mechanism.

32 CFR 842.76 - Filing a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... by a demand for money damages in a sum certain. A claim incorrectly presented to the Air Force will... Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE.... A claim has been filed when a federal agency receives from a claimant or the claimant's duly...

29 CFR 2560.503-1 - Claims procedure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are... filing a pre-service claim, within the meaning of paragraph (m)(2) of this section, the claimant or... benefits includes any pre-service claims within the meaning of paragraph (m)(2) of this section and any...

29 CFR 2560.503-1 - Claims procedure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are... filing a pre-service claim, within the meaning of paragraph (m)(2) of this section, the claimant or... benefits includes any pre-service claims within the meaning of paragraph (m)(2) of this section and any...

29 CFR 2560.503-1 - Claims procedure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are... filing a pre-service claim, within the meaning of paragraph (m)(2) of this section, the claimant or... benefits includes any pre-service claims within the meaning of paragraph (m)(2) of this section and any...

29 CFR 2560.503-1 - Claims procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are... filing a pre-service claim, within the meaning of paragraph (m)(2) of this section, the claimant or... benefits includes any pre-service claims within the meaning of paragraph (m)(2) of this section and any...

29 CFR 2560.503-1 - Claims procedure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... administrative processes and safeguards designed to ensure and to verify that benefit claim determinations are... filing a pre-service claim, within the meaning of paragraph (m)(2) of this section, the claimant or... benefits includes any pre-service claims within the meaning of paragraph (m)(2) of this section and any...

A systematic review of validated methods for identifying pulmonary fibrosis and interstitial lung disease using administrative and claims data.

PubMed

Jones, Natalie; Schneider, Gary; Kachroo, Sumesh; Rotella, Philip; Avetisyan, Ruzan; Reynolds, Matthew W

2012-01-01

The Food and Drug Administration's Mini-Sentinel pilot program initially aimed to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest (HOIs) from administrative and claims data. This paper summarizes the process and findings of the algorithm review of pulmonary fibrosis and interstitial lung disease. PubMed and Iowa Drug Information Service Web searches were conducted to identify citations applicable to the pulmonary fibrosis/interstitial lung disease HOI. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles using administrative and claims data to identify pulmonary fibrosis and interstitial lung disease, including validation estimates of the coding algorithms. Our search revealed a deficiency of literature focusing on pulmonary fibrosis and interstitial lung disease algorithms and validation estimates. Only five studies provided codes; none provided validation estimates. Because interstitial lung disease includes a broad spectrum of diseases, including pulmonary fibrosis, the scope of these studies varied, as did the corresponding diagnostic codes used. Research needs to be conducted on designing validation studies to test pulmonary fibrosis and interstitial lung disease algorithms and estimating their predictive power, sensitivity, and specificity. Copyright © 2012 John Wiley & Sons, Ltd.

32 CFR 842.24 - Filing a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... properly completed AF Form 180, DD Form 1842 or other written and signed demand for a specified sum of money. (b) Amending a claim. A claimant may amend a claim at any time prior to the expiration of the... Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE...

32 CFR 1633.2 - Claim for other than Class 1-A.

Code of Federal Regulations, 2011 CFR

2011-07-01

... initial determination of claims for all administrative classifications are made by area office compensated... local board to consider the claim. (e) The initial determination of a judgmental classification is made... ADMINISTRATION OF CLASSIFICATION § 1633.2 Claim for other than Class 1-A. (a) Any registrant who has received an...

Claim audits: a relic of the indemnity age?

PubMed

Ellender, D E

1997-09-01

Traditional claim audits offering quick fixes to specific problems or to recover overpayments will not provide benefit managers with the data and action plan they need to make informed decisions about cost-effective benefit administration. Today's benefits environment calls for a comprehensive review of claim administration, incorporating traditional audit techniques into a quality improvement audit process.

29 CFR 100.401 - Claims under the Federal Tort Claims Act for loss of or damage to property or for personal injury...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Claims under the Federal Tort Claims Act for loss of or damage to property or for personal injury or death. 100.401 Section 100.401 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD ADMINISTRATIVE REGULATIONS Claims Under the Federal Tort Claims Act § 100.401 Claims under the Federal Tort...

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population

PubMed Central

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

Objective To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Methods Selecting from a repository containing members’ data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx–486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. Results A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%–92.0%) versus 73.4% (95% CI: 66.8%–79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%–87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%–80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%–92.6%). Conclusion Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers

32 CFR 536.92 - Claims payable under the Non-Scope Claims Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... negligent or wrongful acts or omissions of Department of Defense or Department of the Army (DA) military... or regulation available to the DA for the administrative settlement of claims. (b) Personal injury or...

48 CFR 1404.804-70 - Release of claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATIVE MATTERS Contract Files 1404.804-70 Release of claims. (a) The CO shall insert the clause at 1452.204-70, Release of Claims, in all construction, architect and engineering, and cost-reimbursement... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Release of claims. 1404...

48 CFR 1404.804-70 - Release of claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATIVE MATTERS Contract Files 1404.804-70 Release of claims. (a) The CO shall insert the clause at 1452.204-70, Release of Claims, in all construction, architect and engineering, and cost-reimbursement... 48 Federal Acquisition Regulations System 5 2013-10-01 2013-10-01 false Release of claims. 1404...

48 CFR 1404.804-70 - Release of claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATIVE MATTERS Contract Files 1404.804-70 Release of claims. (a) The CO shall insert the clause at 1452.204-70, Release of Claims, in all construction, architect and engineering, and cost-reimbursement... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false Release of claims. 1404...

48 CFR 1404.804-70 - Release of claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ADMINISTRATIVE MATTERS Contract Files 1404.804-70 Release of claims. (a) The CO shall insert the clause at 1452.204-70, Release of Claims, in all construction, architect and engineering, and cost-reimbursement... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false Release of claims. 1404...

48 CFR 1404.804-70 - Release of claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATIVE MATTERS Contract Files 1404.804-70 Release of claims. (a) The CO shall insert the clause at 1452.204-70, Release of Claims, in all construction, architect and engineering, and cost-reimbursement... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false Release of claims. 1404...

20 CFR 410.705 - Duplicate claims.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Duplicate claims. 410.705 Section 410.705 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Rules for the Review of Denied and Pending Claims Under the Black Lung...

32 CFR 842.49 - Claims payable.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Claims payable. 842.49 Section 842.49 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE... civilian personnel. (3) Any mail in the possession of the US Postal Service or a Military Postal Service...

Employee Retirement Income Security Act of 1974; rules and regulations for administration and enforcement; claims procedure. Final regulation; delay of applicability date.

PubMed

2001-07-09

This action delays for at least six months and not more than one year the applicability date for the regulation governing minimum requirements for benefit claims procedures of group health plans covered by Title I of the Employee Retirement Income Security Act. As published on November 21, 2000, the benefit claims procedure would be applicable to claims filed on or after January 1, 2002. The current action amends the regulation so that it will apply to group health claims filed on or after the first day of the first plan year beginning on or after July 1, 2002, but in no event later than January 1, 2003. This action provides a limited additional period within which group health plan sponsors, administrators, and service providers can bring their claims processing systems into compliance with the new requirements. A postponement of the applicability date with respect to group health claims will allow a more orderly transition to the new standards and will avoid the confusion and additional expense that would be caused if certain pending Congressional bills are enacted before or soon after the original applicability date. This action does not apply to pension plans or plans providing disability or welfare benefits (other than group health). For these plans, the regulation will continue to be applicable to claims filed on or after January 1, 2002.

Can administrative claim file review be used to gather physical therapy, occupational therapy, and psychology payment data and functional independence measure scores? Implications for rehabilitation providers in the private health sector.

PubMed

Riis, Viivi; Jaglal, Susan; Boschen, Kathryn; Walker, Jan; Verrier, Molly

2011-01-01

Rehabilitation costs for spinal-cord injury (SCI) are increasingly borne by Canada's private health system. Because of poor outcomes, payers are questioning the value of their expenditures, but there is a paucity of data informing analysis of rehabilitation costs and outcomes. This study evaluated the feasibility of using administrative claim file review to extract rehabilitation payment data and functional status for a sample of persons with work-related SCI. Researchers reviewed 28 administrative e-claim files for persons who sustained a work-related SCI between 1996 and 2000. Payment data were extracted for physical therapy (PT), occupational therapy (OT), and psychology services. Functional Independence Measure (FIM) scores were targeted as a surrogate measure for functional outcome. Feasibility was tested using an existing approach for evaluating health services data. The process of administrative e-claim file review was not practical for extraction of the targeted data. While administrative claim files contain some rehabilitation payment and outcome data, in their present form the data are not suitable to inform rehabilitation services research. A new strategy to standardize collection, recording, and sharing of data in the rehabilitation industry should be explored as a means of promoting best practices.

13 CFR 142.3 - What is a claim?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What is a claim? 142.3 Section 142.3 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Overview and Definitions § 142.3 What is a claim? (a) Claim means any request, demand, or...

11 CFR 111.54 - Bankruptcy claims.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 11 Federal Elections 1 2013-01-01 2012-01-01 true Bankruptcy claims. 111.54 Section 111.54 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111.54 Bankruptcy claims...

45 CFR 34.4 - Allowable claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the claimant to save human life or government property. (4) Property used for the benefit of the... 45 Public Welfare 1 2011-10-01 2011-10-01 false Allowable claims. 34.4 Section 34.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS FILED UNDER THE MILITARY PERSONNEL AND...

45 CFR 34.4 - Allowable claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the claimant to save human life or government property. (4) Property used for the benefit of the... 45 Public Welfare 1 2010-10-01 2010-10-01 false Allowable claims. 34.4 Section 34.4 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS FILED UNDER THE MILITARY PERSONNEL AND...

45 CFR 30.34 - Claims Collection Litigation Report.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Claims Collection Litigation Report. 30.34 Section 30.34 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION Referrals to the Department of Justice § 30.34 Claims Collection Litigation Report. (a)(1) Unless excepted by Justice, the Secretary will complete...

32 CFR 536.122 - Limitation of settlement of maritime claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Limitation of settlement of maritime claims. 536... AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.122 Limitation of settlement of maritime claims. (a) Within the United States the period of completing an administrative settlement under...

29 CFR 15.5 - Administrative claim; evidence or information to substantiate.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of a claim for personal injury, including pain and suffering, the claimant is required to submit the... or would cost the claimant to hire someone else to do the same work he or she was doing at the time... for such expenses. (7) If damages for pain and suffering prior to death are claimed, a physician's...

40 CFR 10.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2012 CFR

2012-07-01

... section, an executed Standard Form 95 or other written notification of an incident accompanied by a claim... to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be... months after the filing of an amendment. (c) Forms may be obtained and claims may be filed with the EPA...

40 CFR 10.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2013 CFR

2013-07-01

... section, an executed Standard Form 95 or other written notification of an incident accompanied by a claim... to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be... months after the filing of an amendment. (c) Forms may be obtained and claims may be filed with the EPA...

40 CFR 10.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2014 CFR

2014-07-01

... section, an executed Standard Form 95 or other written notification of an incident accompanied by a claim... to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be... months after the filing of an amendment. (c) Forms may be obtained and claims may be filed with the EPA...

40 CFR 10.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... section, an executed Standard Form 95 or other written notification of an incident accompanied by a claim... to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be... months after the filing of an amendment. (c) Forms may be obtained and claims may be filed with the EPA...

40 CFR 10.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... section, an executed Standard Form 95 or other written notification of an incident accompanied by a claim... to the exercise of the claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be... months after the filing of an amendment. (c) Forms may be obtained and claims may be filed with the EPA...

27 CFR 24.66 - Claims on wine returned to bond.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Claims on wine returned to... BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Claims § 24.66 Claims on wine returned to bond. (a) General. A claim for credit or refund, or relief from...

20 CFR 429.103 - Who may file my claim?

Code of Federal Regulations, 2010 CFR

2010-04-01

... authorized agent, or your legal representative may file the claim. (c) Claims based on death. The executor or... behalf as agent, executor, administrator, parent, guardian or other representative. ...

13 CFR 114.104 - What evidence and information may SBA require relating to my claim?

Code of Federal Regulations, 2010 CFR

2010-01-01

... BUSINESS ADMINISTRATION ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND REPRESENTATION AND... relevant to the government's alleged liability or the damages you claim. (c) For a claim based on death: (1) An authenticated death certificate or other competent evidence showing cause of death, date of death...

20 CFR 725.401 - Claims development-general.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Claims development-general. 725.401 Section 725.401 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE... development—general. After a claim has been received by the district director, the district director shall...

23 CFR 190.7 - Processing of claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

23 CFR 190.7 - Processing of claims.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

23 CFR 190.7 - Processing of claims.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

23 CFR 190.7 - Processing of claims.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Processing of claims. 190.7 Section 190.7 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES INCENTIVE PAYMENTS FOR CONTROLLING OUTDOOR ADVERTISING ON THE INTERSTATE SYSTEM § 190.7 Processing of claims. Audited and approved PR...

Food and Drug Administration Perspective on Negative Symptoms in Schizophrenia as a Target for a Drug Treatment Claim

PubMed Central

Laughren, Thomas; Levin, Robert

2006-01-01

Negative symptoms of schizophrenia are not adequately addressed by available treatments for schizophrenia. Thus, it is reasonable to consider them as a target for a drug claim. This article describes the thought process that the Food and Drug Administration (FDA) will undertake in considering negative symptoms of schizophrenia as a novel and distinct drug target. Beyond this basic question, this article identifies a number of design issues that the FDA needs to consider regarding how best to conduct studies to support claims for this target. These design issues include (1) what population to study, (2) what phase of illness to target, (3) whether to focus on the negative symptom domain overall or on some specific aspect of negative symptoms, (4) the role of functional measures in negative symptom trials, and (5) optimal designs for targeting drugs for add-on therapy or broad-spectrum agents. PMID:16079389

Claims Procedure for Plans Providing Disability Benefits. Final rule.

PubMed

2016-12-19

This document contains a final regulation revising the claims procedure regulations under the Employee Retirement Income Security Act of 1974 (ERISA) for employee benefit plans providing disability benefits. The final rule revises and strengthens the current rules primarily by adopting certain procedural protections and safeguards for disability benefit claims that are currently applicable to claims for group health benefits pursuant to the Affordable Care Act. This rule affects plan administrators and participants and beneficiaries of plans providing disability benefits, and others who assist in the provision of these benefits, such as third-party benefits administrators and other service providers.

78 FR 26112 - Limitation on Claims Against Proposed Public Transportation Projects; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Limitation on Claims Against Proposed Public Transportation Projects; Correction AGENCY: Federal Transit Administration (FTA), DOT. ACTION... Register on April 22, 2013, concerning a limitation on claims for certain specified public transportation...

Determinants of community pharmacists' quality of care: a population-based cohort study using pharmacy administrative claims data.

PubMed

Winslade, Nancy; Tamblyn, Robyn

2017-09-21

To determine if a prototype pharmacists' services evaluation programme that uses linked community pharmacy claims and health administrative data to measure pharmacists' performance can be used to identify characteristics of pharmacies providing higher quality of care. Population-based cohort study using community pharmacy claims from 1 November 2009 to 30 June 2010. All community pharmacies in Quebec, Canada. 1742 pharmacies dispensing 8 655 348 antihypertensive prescriptions to 760 700 patients. Patient adherence to antihypertensive medications. Pharmacy level: dispensing workload, volume of pharmacist-provided professional services (eg, refusals to dispense, pharmacotherapy recommendations), pharmacy location, banner/chain, pharmacist overlap and within-pharmacy continuity of care. Patient level: sex, age, income, patient prescription cost, new/chronic therapy, single/multiple antihypertensive medications, single/multiple prescribers and single/multiple dispensing pharmacies. Dispensing level: prescription duration, time of day dispensed and antihypertensive class. Multivariate alternating logistic regression estimated predictors of the primary outcome, accounting for patient and pharmacy clustering. 9.2% of dispensings of antihypertensive medications were provided to non-adherent patients. Male sex, decreasing age, new treatment, multiple prescribers and multiple dispensing pharmacies were risk factors for increased non-adherence. Pharmacies that provided more professional services were less likely to dispense to non-adherent hypertensive patients (OR: 0.60; 95% CI: 0.57 to 0.62) as were those with better scores on the Within-Pharmacy Continuity of Care Index. Neither increased pharmacists' services for improving antihypertensive adherence per se nor increased pharmacist overlap impacted the odds of non-adherence. However, pharmacist overlap was strongly correlated with dispensing workload. There was significant unexplained variability among pharmacies

32 CFR 842.133 - Claims by customers, members, participants, or authorized users.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Claims by customers, members, participants, or authorized users. 842.133 Section 842.133 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE CLAIMS AND LITIGATION ADMINISTRATIVE CLAIMS Nonappropriated Fund Claims § 842.133 Claims...

A systematic review of validated methods for identifying erythema multiforme major/minor/not otherwise specified, Stevens-Johnson Syndrome, or toxic epidermal necrolysis using administrative and claims data.

PubMed

Schneider, Gary; Kachroo, Sumesh; Jones, Natalie; Crean, Sheila; Rotella, Philip; Avetisyan, Ruzan; Reynolds, Matthew W

2012-01-01

The Food and Drug Administration's (FDA) Mini-Sentinel pilot program aims to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest (HOIs) from administrative and claims data. This paper summarizes the process and findings of the algorithm review of erythema multiforme and related conditions. PubMed and Iowa Drug Information Service searches were conducted to identify citations applicable to the erythema multiforme HOI. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles that used administrative and claims data to identify erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis and that included validation estimates of the coding algorithms. Our search revealed limited literature focusing on erythema multiforme and related conditions that provided administrative and claims data-based algorithms and validation estimates. Only four studies provided validated algorithms and all studies used the same International Classification of Diseases code, 695.1. Approximately half of cases subjected to expert review were consistent with erythema multiforme and related conditions. Updated research needs to be conducted on designing validation studies that test algorithms for erythema multiforme and related conditions and that take into account recent changes in the diagnostic coding of these diseases. Copyright © 2012 John Wiley & Sons, Ltd.

32 CFR 842.6 - Signature on the claim form.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Signature on the claim form. 842.6 Section 842.6... ADMINISTRATIVE CLAIMS General Information § 842.6 Signature on the claim form. The claimant or authorized agent... authorized agent signing for a claimant shows, after the signature, the title or capacity and attaches...

32 CFR 842.7 - Who may file a claim.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ADMINISTRATIVE CLAIMS General Information § 842.7 Who may file a claim. (a) Property damage. The owner or owners of the property or their authorized agent may file a claim for property damage. (b) Personal injury... duly appointed guardian of a minor child or any other person legally entitled to do so under applicable...

32 CFR 842.7 - Who may file a claim.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ADMINISTRATIVE CLAIMS General Information § 842.7 Who may file a claim. (a) Property damage. The owner or owners of the property or their authorized agent may file a claim for property damage. (b) Personal injury... duly appointed guardian of a minor child or any other person legally entitled to do so under applicable...

32 CFR 842.7 - Who may file a claim.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ADMINISTRATIVE CLAIMS General Information § 842.7 Who may file a claim. (a) Property damage. The owner or owners of the property or their authorized agent may file a claim for property damage. (b) Personal injury... duly appointed guardian of a minor child or any other person legally entitled to do so under applicable...

32 CFR 842.7 - Who may file a claim.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ADMINISTRATIVE CLAIMS General Information § 842.7 Who may file a claim. (a) Property damage. The owner or owners of the property or their authorized agent may file a claim for property damage. (b) Personal injury... duly appointed guardian of a minor child or any other person legally entitled to do so under applicable...

32 CFR 842.7 - Who may file a claim.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ADMINISTRATIVE CLAIMS General Information § 842.7 Who may file a claim. (a) Property damage. The owner or owners of the property or their authorized agent may file a claim for property damage. (b) Personal injury... duly appointed guardian of a minor child or any other person legally entitled to do so under applicable...

20 CFR 410.588 - Claims of creditors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Claims of creditors. 410.588 Section 410.588 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.588 Claims of creditors. A relative or other...

20 CFR 410.588 - Claims of creditors.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Claims of creditors. 410.588 Section 410.588 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.588 Claims of creditors. A relative or other...

Deliberate choices or strong motives: Exploring the mechanisms underlying the bias of organic claims on leniency judgments.

PubMed

Prada, Marília; Rodrigues, David; Garrido, Margarida V

2016-08-01

Organic claims can influence how a product is perceived in dimensions that are unrelated with the food production method (e.g., organic food is perceived as more healthful and less caloric than conventional food). Such claims can also bias how the consumers of organic food are perceived and how other people judge their behavior. Schuldt and Schwarz (2010) have shown that individuals evaluating a target with a weight-loss goal are more lenient in judging the target forgoing exercise when the target had an organic (vs. conventional) dessert. This impact of organic claims on leniency judgments has been interpreted either as a halo or a licensing effect. In the current research we aim to replicate and extend Schuldt and Schwarz's (2010) results by examining the mechanisms that are more likely to explain the observed leniency judgments. In Experiment 1, we observed that leniency towards a target that has consumed an organic meal is only observed when the target intentionally chooses such organic meal (vs. choice determined by the situation). These findings suggest that the impact of organic claims on leniency judgments is not merely based on a halo effect. Instead, a licensing account emerges as the most probable mechanism. In Experiment 2, we further found that stronger (vs. weaker) motives for forgoing exercise influenced leniency judgments to the same extent as having had an organic meal. Understanding the mechanisms that shape consumers' decisions may have important implications to prevent bias in their judgments about food and exercise. Copyright © 2016 Elsevier Ltd. All rights reserved.

5 CFR 890.105 - Filing claims for payment or service.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administration and General Provisions § 890.105 Filing claims for payment or service. (a) General. (1) Each health benefits carrier resolves claims filed under the plan. All health benefits claims must be submitted initially to the carrier of the...

Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10). Final rule.

PubMed

2015-12-04

This final rule will extend enhanced funding for Medicaid eligibility systems as part of a state's mechanized claims processing system, and will update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes will allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems.

A systematic review of validated methods to capture stillbirth and spontaneous abortion using administrative or claims data.

PubMed

Likis, Frances E; Sathe, Nila A; Carnahan, Ryan; McPheeters, Melissa L

2013-12-30

To identify and assess diagnosis, procedure and pharmacy dispensing codes used to identify stillbirths and spontaneous abortion in administrative and claims databases from the United States or Canada. We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to stillbirth or spontaneous abortion. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics and assessed each study's methodological rigor using a pre-defined approach. Ten publications addressing stillbirth and four addressing spontaneous abortion met our inclusion criteria. The International Classification of Diseases, Ninth Revision (ICD-9) codes most commonly used in algorithms for stillbirth were those for intrauterine death (656.4) and stillborn outcomes of delivery (V27.1, V27.3-V27.4, and V27.6-V27.7). Papers identifying spontaneous abortion used codes for missed abortion and spontaneous abortion: 632, 634.x, as well as V27.0-V27.7. Only two studies identifying stillbirth reported validation of algorithms. The overall positive predictive value of the algorithms was high (99%-100%), and one study reported an algorithm with 86% sensitivity. However, the predictive value of individual codes was not assessed and study populations were limited to specific geographic areas. Additional validation studies with a nationally representative sample are needed to confirm the optimal algorithm to identify stillbirths or spontaneous abortion in administrative and claims databases.' Copyright © 2013 Elsevier Ltd. All rights reserved.

20 CFR 702.602 - Notice and claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Notice and claims. 702.602 Section 702.602 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR LONGSHOREMEN'S AND HARBOR WORKERS' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which...

Evaluation of Modified Risk Claim Advertising Formats for Camel Snus

ERIC Educational Resources Information Center

Fix, Brian V.; Adkison, Sarah E.; O'Connor, Richard J.; Bansal-Travers, Maansi; Cummings, K. Michael; Rees, Vaughan W.; Hatsukami, Dorothy K.

2017-01-01

Objectives: The US Food and Drug Administration (FDA) has regulatory authority for modified risk tobacco product advertising claims. To guide future regulatory efforts, we investigated how variations in modified risk claim advertisements influence consumer perceptions of product risk claims for Camel Snus. Methods: Young people and adults (15-65),…

10 CFR 1014.4 - Administrative claims; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-01-01

... physician employed by the DOE or another Federal agency. A copy of the physician's report shall be made...-time employee, and the wages or salary actually lost. (5) If a claim is made for loss of income and the...: (1) Proof of ownership of the property interest that is the subject of the claim. (2) A detailed...

22 CFR 304.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-04-01

... mental examination by a physician employed or designated by the Peace Corps or another Federal agency. A...-or part-time employee, and wages or salary actually lost; (5) If a claim is made for loss of income... ownership. (2) A detailed statement of the amount claimed with respect to each item of property. (3) Two or...

14 CFR 15.7 - Administrative claims; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-01-01

... physical or mental examination by a physician employed by the FAA or another Federal agency. A copy of the..., and wages or salary actually lost. (6) If a claim is made for loss of income and the claimant is self... ownership of the property interest which is the subject of the claim. (2) A detailed statement of the amount...

21 CFR 101.14 - Health claims: general requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Health claims: general requirements. 101.14 Section 101.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING General Provisions § 101.14 Health claims: general...

21 CFR 101.14 - Health claims: general requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Health claims: general requirements. 101.14 Section 101.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING General Provisions § 101.14 Health claims: general...

21 CFR 101.14 - Health claims: general requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Health claims: general requirements. 101.14 Section 101.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING General Provisions § 101.14 Health claims: general...

21 CFR 101.14 - Health claims: general requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Health claims: general requirements. 101.14 Section 101.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING General Provisions § 101.14 Health claims: general...

Claims, errors, and compensation payments in medical malpractice litigation.

PubMed

Studdert, David M; Mello, Michelle M; Gawande, Atul A; Gandhi, Tejal K; Kachalia, Allen; Yoon, Catherine; Puopolo, Ann Louise; Brennan, Troyen A

2006-05-11

In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation--claims that lack evidence of injury, substandard care, or both--is common and costly. Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error. For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy--nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors (313,205 dollars vs. 521,560 dollars, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs. Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant. Copyright 2006 Massachusetts Medical Society.

24 CFR 17.64 - Referral of claims to the Assistant Secretary for Administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... claim: (1) As to which there is an indication of fraud, the presentation of a false claim, or... from an exception made by the General Accounting Office in the account of an accountable officer. Such...

13 CFR 114.103 - Who may file a claim?

Code of Federal Regulations, 2010 CFR

2010-01-01

... THE FEDERAL TORT CLAIMS ACT AND REPRESENTATION AND INDEMNIFICATION OF SBA EMPLOYEES Administrative.... Death The executor, administrator, or legal representative of the decedent's estate, or any other person...

42 CFR 431.834 - Access to records: Claims processing assessment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.834 Access to records: Claims processing assessment systems. The agency, upon written request, must provide HHS staff with access to all records pertaining to its MQC claims processing assessment system reviews...

21 CFR 101.70 - Petitions for health claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Petitions for health claims. 101.70 Section 101.70 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.70 Petitions for...

21 CFR 101.70 - Petitions for health claims.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Petitions for health claims. 101.70 Section 101.70 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.70 Petitions for...

21 CFR 101.70 - Petitions for health claims.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Petitions for health claims. 101.70 Section 101.70 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.70 Petitions for...

21 CFR 101.70 - Petitions for health claims.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Petitions for health claims. 101.70 Section 101.70 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.70 Petitions for...

21 CFR 101.70 - Petitions for health claims.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Petitions for health claims. 101.70 Section 101.70 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.70 Petitions for...

76 FR 55470 - Notice of Limitation on Claims Against Proposed Public Transportation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Notice of Limitation on Claims Against Proposed Public Transportation Project AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice... announced herein for the listed public transportation project will be barred unless the claim is filed on or...

76 FR 4150 - Notice of Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Notice of Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice... public transportation project will be barred unless the claim is filed on or before July 25, 2011. FOR...

28 CFR 94.33 - Investigation and analysis of claims.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Investigation and analysis of claims. 94.33 Section 94.33 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Program Administration § 94.33 Investigation and...

28 CFR 94.33 - Investigation and analysis of claims.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Investigation and analysis of claims. 94.33 Section 94.33 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Program Administration § 94.33 Investigation and...

28 CFR 94.33 - Investigation and analysis of claims.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Investigation and analysis of claims. 94.33 Section 94.33 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Program Administration § 94.33 Investigation and...

28 CFR 94.33 - Investigation and analysis of claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Investigation and analysis of claims. 94.33 Section 94.33 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Program Administration § 94.33 Investigation and...

28 CFR 94.33 - Investigation and analysis of claims.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Investigation and analysis of claims. 94.33 Section 94.33 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Program Administration § 94.33 Investigation and...

46 CFR 310.9 - Medical attention and injury claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Medical attention and injury claims. 310.9 Section 310.9 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRAINING MERCHANT MARINE TRAINING... Medical attention and injury claims. (a) Medical attention and hospitalization. The school shall be...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.304 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.304 Section 308.304 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.304 Reporting casualties and filing claims. All...

46 CFR 308.410 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.410 Section 308.410 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Builder's Risk Insurance § 308.410 Reporting casualties and filing claims. Casualties...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 8 2012-10-01 2012-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 8 2011-10-01 2011-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

46 CFR 308.105 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false Reporting casualties and filing claims. 308.105 Section 308.105 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Hull and Disbursements Insurance § 308.105 Reporting casualties and filing claims. All...

28 CFR 79.12 - Criteria for eligibility for claims relating to leukemia.

Code of Federal Regulations, 2011 CFR

2011-07-01

... relating to leukemia. 79.12 Section 79.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.12 Criteria for eligibility for claims relating to leukemia. To establish eligibility for...

28 CFR 79.12 - Criteria for eligibility for claims relating to leukemia.

Code of Federal Regulations, 2010 CFR

2010-07-01

... relating to leukemia. 79.12 Section 79.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.12 Criteria for eligibility for claims relating to leukemia. To establish eligibility for...

28 CFR 79.12 - Criteria for eligibility for claims relating to leukemia.

Code of Federal Regulations, 2012 CFR

2012-07-01

... relating to leukemia. 79.12 Section 79.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.12 Criteria for eligibility for claims relating to leukemia. To establish eligibility for...

28 CFR 79.12 - Criteria for eligibility for claims relating to leukemia.

Code of Federal Regulations, 2013 CFR

2013-07-01

... relating to leukemia. 79.12 Section 79.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.12 Criteria for eligibility for claims relating to leukemia. To establish eligibility for...

28 CFR 79.12 - Criteria for eligibility for claims relating to leukemia.

Code of Federal Regulations, 2014 CFR

2014-07-01

... relating to leukemia. 79.12 Section 79.12 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims Relating to Leukemia § 79.12 Criteria for eligibility for claims relating to leukemia. To establish eligibility for...

28 CFR 79.62 - Criteria for eligibility for claims by ore transporters.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ore transporters. 79.62 Section 79.62 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims by Ore Transporters § 79.62 Criteria for eligibility for claims by ore transporters. To establish eligibility for compensation...

28 CFR 79.62 - Criteria for eligibility for claims by ore transporters.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ore transporters. 79.62 Section 79.62 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims by Ore Transporters § 79.62 Criteria for eligibility for claims by ore transporters. To establish eligibility for compensation...

28 CFR 79.62 - Criteria for eligibility for claims by ore transporters.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ore transporters. 79.62 Section 79.62 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims by Ore Transporters § 79.62 Criteria for eligibility for claims by ore transporters. To establish eligibility for compensation...

28 CFR 79.62 - Criteria for eligibility for claims by ore transporters.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ore transporters. 79.62 Section 79.62 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS UNDER THE RADIATION EXPOSURE COMPENSATION ACT Eligibility Criteria for Claims by Ore Transporters § 79.62 Criteria for eligibility for claims by ore transporters. To establish eligibility for compensation...

Food labeling: nutrient content claims, expansion of the nutrient content claim "lean". Final rule.

PubMed

2007-01-12

The Food and Drug Administration (FDA) is amending its food labeling regulations for the expanded use of the nutrient content claim "lean" on the labels of foods categorized as "mixed dishes not measurable with a cup" that meet certain criteria for total fat, saturated fat, and cholesterol content. This final rule responds to a nutrient content claim petition submitted by Nestlé Prepared Foods Co. (Nestlé) under the Federal Food, Drug, and Cosmetic Act (the act). This action is also being taken to provide reliable information that would assist consumers in maintaining healthy dietary practices.

76 FR 78332 - Amended Notice of Limitation on Claims Against Proposed Public Transportation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Amended Notice of Limitation on Claims Against Proposed Public Transportation Project AGENCY: Federal Transit Administration (FTA), DOT. ACTION... actions announced herein for the listed public transportation project will be barred unless the claim is...

Beyond comorbidity: expanding the definition and measurement of complexity among older adults using administrative claims data.

PubMed

Chrischilles, Elizabeth; Schneider, Kathleen; Wilwert, June; Lessman, Gregory; O'Donnell, Brian; Gryzlak, Brian; Wright, Kara; Wallace, Robert

2014-03-01

Studies of patients with multiple chronic conditions using claims data are often missing important determinants of treatments and outcomes, such as function status and disease severity. We sought to identify and evaluate a class of function-related indicators (FRIs) from administrative claims data. The study cohort comprised US Medicare beneficiaries aged 65 years or older with Parts A and B fee-for-service and Part D coverage, with a hospitalization for acute myocardial infarction during 2007. Measures during the year before admission included the FRIs, demographics, conventional comorbidity measures, and prior hospitalization. Outcomes were receipt of cardiac catheterization during the index hospitalization and 12-month mortality. Model development used a random sample (n=72,056) with an equal sample for validation. In addition to prior cardiovascular conditions (85%), 40% had ≥1 comorbid condition, 30% were hospitalized in the prior 6 months, and 65% had ≥1 FRI [eg, delirium/dementia (22.7%), depression (16.7%), mobility limitation (16.1%), and chronic skin ulcers (12.6%)]. Including the FRIs improved mortality and cardiac catheterization prediction models (C-statistics 0.71 and 0.77, respectively). Patients with more cardiovascular conditions received less cardiac catheterization [minimally adjusted odds ratio (OR) 0.83; 95% confidence interval (CI), 0.82-0.83], as did patients with more comorbidities (minimally adjusted OR 0.70; 95% CI, 0.69-0.71), but this was attenuated by adjusting for functional status (fully adjusted OR for cardiovascular conditions 0.95; 95% CI, 0.94-0.96 and for comorbid conditions 0.94; 95% CI, 0.92-0.95). Claims data studies that include indicators of potentially diminished patient functional status better capture heterogeneity of patients with multiple chronic conditions.

34 CFR 682.403 - Federal advances for claim payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION FEDERAL FAMILY EDUCATION LOAN (FFEL) PROGRAM Administration of the Federal Family Education Loan Programs by a Guaranty Agency § 682.403 Federal advances for claim... 34 Education 3 2010-07-01 2010-07-01 false Federal advances for claim payments. 682.403 Section...

37 CFR 104.42 - Finality of settlement or denial of claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRADEMARK OFFICE, DEPARTMENT OF COMMERCE ADMINISTRATION LEGAL PROCESSES Tort Claims § 104.42 Finality of... or denial of any claim under this subpart may be considered final for the purpose of judicial review. ...

36 CFR 1201.4 - What types of claims are excluded from these regulations?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What types of claims are... ARCHIVES AND RECORDS ADMINISTRATION GENERAL RULES COLLECTION OF CLAIMS Introduction § 1201.4 What types of claims are excluded from these regulations? The following types of claims are excluded: (a) Debts or...

36 CFR 1201.4 - What types of claims are excluded from these regulations?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false What types of claims are... ARCHIVES AND RECORDS ADMINISTRATION GENERAL RULES COLLECTION OF CLAIMS Introduction § 1201.4 What types of claims are excluded from these regulations? The following types of claims are excluded: (a) Debts or...

Administrative Ecology

ERIC Educational Resources Information Center

McGarity, Augustus C., III; Maulding, Wanda

2007-01-01

This article discusses how all four facets of administrative ecology help dispel the claims about the "impossibility" of the superintendency. These are personal ecology, professional ecology, organizational ecology, and community ecology. Using today's superintendency as an administrative platform, current literature describes a preponderance of…

13 CFR 142.5 - What is a false claim or statement?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What is a false claim or statement? 142.5 Section 142.5 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES ACT REGULATIONS Overview and Definitions § 142.5 What is a false claim or statement? (a) A claim...

29 CFR 15.201 - Where should the MPCECA claim be filed?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 1 2013-07-01 2013-07-01 false Where should the MPCECA claim be filed? 15.201 Section 15.201 Labor Office of the Secretary of Labor ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND....S. Department of Labor, Suite S4325, 200 Constitution Avenue NW., Washington, DC, 20210. (b) In all...

21 CFR 101.74 - Health claims: sodium and hypertension.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Health claims: sodium and hypertension. 101.74 Section 101.74 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.74 Health...

21 CFR 101.74 - Health claims: sodium and hypertension.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 2 2014-04-01 2014-04-01 false Health claims: sodium and hypertension. 101.74 Section 101.74 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Health Claims § 101.74 Health...

7 CFR 1.51 - Claims based on negligence, wrongful act or omission.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Claims based on negligence, wrongful act or omission. 1.51 Section 1.51 Agriculture Office of the Secretary of Agriculture ADMINISTRATIVE REGULATIONS Claims § 1.51 Claims based on negligence, wrongful act or omission. (a) Authority of the Department...

Cancer Diagnoses after Living Kidney Donation: Linking United States Registry Data and Administrative Claims

PubMed Central

Lentine, Krista L.; Vijayan, Anitha; Xiao, Huiling; Schnitzler, Mark A.; Davis, Connie L.; Garg, Amit X.; Axelrod, David; Abbott, Kevin C.; Brennan, Daniel C.

2012-01-01

Background Mortality records identify cancer as the leading cause of death among living kidney donors, but information on the burden of cancer outside of death records is limited in this population. Methods We examined a database wherein OPTN identifiers for 4,650 living kidney donors in 1987–2007 were linked to administrative data of a U.S. private health insurer (2000–2007 claims) to identify post-donation cancer diagnoses. Skin and non-skin cancer diagnoses were ascertained from ICD-9-CM codes on billing claims. Donors were also matched one-to-one with general insurance beneficiaries by sex and age when benefits began. Diagnosis rates within observation windows were compared as rate ratios. Results The median time from donation to the end of plan insurance enrollment was 7.7 years, with a median observation period of 2.1 years. Skin cancer rates were similar among prior living donors in the observation period and non-donor controls (rate ratio 0.91, 95% CI 0.59–1.40). In contrast, the rate of total non-skin cancers was significantly less common among donors than controls (rate ratio 0.74, 95% CI 0.55–0.99), although reduced relative risk was limited to donors captured earlier in relation to donation. Several cases of cancer diagnosis (uterine, melanoma, other) were identified within the first year after donation. Prostate cancer was significantly more common among living donors compared with controls (rate ratio 3.80, 95% CI 1.42–10.2). Conclusions Continued study of cancer after kidney donation is warranted to ensure that evaluation, selection, and long-term follow-up support overall good health of the donor. PMID:22825543

48 CFR 6103.303 - Responses to claims [Rule 303].

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Responses to claims [Rule 303]. 6103.303 Section 6103.303 Federal Acquisition Regulations System CIVILIAN BOARD OF CONTRACT APPEALS, GENERAL SERVICES ADMINISTRATION TRANSPORTATION RATE CASES 6103.303 Responses to claims [Rule 303]. (a) Content of responses. Within 30 calenda...

40 CFR 13.5 - Claims involving criminal activities or misconduct.

Code of Federal Regulations, 2010 CFR

2010-07-01

... misconduct. 13.5 Section 13.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS General § 13.5 Claims involving criminal activities or misconduct. (a) The Administrator will refer cases of suspected criminal activity or misconduct to the EPA Office of Inspector General...

40 CFR 13.5 - Claims involving criminal activities or misconduct.

Code of Federal Regulations, 2014 CFR

2014-07-01

... misconduct. 13.5 Section 13.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS General § 13.5 Claims involving criminal activities or misconduct. (a) The Administrator will refer cases of suspected criminal activity or misconduct to the EPA Office of Inspector General...

40 CFR 13.5 - Claims involving criminal activities or misconduct.

Code of Federal Regulations, 2011 CFR

2011-07-01

... misconduct. 13.5 Section 13.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS General § 13.5 Claims involving criminal activities or misconduct. (a) The Administrator will refer cases of suspected criminal activity or misconduct to the EPA Office of Inspector General...

40 CFR 13.5 - Claims involving criminal activities or misconduct.

Code of Federal Regulations, 2013 CFR

2013-07-01

... misconduct. 13.5 Section 13.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS General § 13.5 Claims involving criminal activities or misconduct. (a) The Administrator will refer cases of suspected criminal activity or misconduct to the EPA Office of Inspector General...

40 CFR 13.5 - Claims involving criminal activities or misconduct.

Code of Federal Regulations, 2012 CFR

2012-07-01

... misconduct. 13.5 Section 13.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CLAIMS COLLECTION STANDARDS General § 13.5 Claims involving criminal activities or misconduct. (a) The Administrator will refer cases of suspected criminal activity or misconduct to the EPA Office of Inspector General...

42 CFR 433.112 - FFP for design, development, installation or enhancement of mechanized claims processing and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... enhancement of mechanized claims processing and information retrieval systems. 433.112 Section 433.112 Public... processing and information retrieval systems. (a) FFP is available at the 90 percent rate in State... information retrieval system only if the APD is approved by CMS prior to the State's expenditure of funds for...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with the Office of Subsidy and Insurance, Maritime Administration, Department of...

42 CFR 431.832 - Reporting requirements for claims processing assessment systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... assessment systems. 431.832 Section 431.832 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... GENERAL ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.832 Reporting requirements for claims processing assessment systems. (a) The agency must submit...

46 CFR 308.205 - Reporting casualties and filing claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 308.205 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Protection and Indemnity Insurance § 308.205 Reporting casualties and filing claims. All... documents filed with “Office of Marine Insurance, Maritime Administration, Department of Transportation.” ...

Handling Claims of Constructive Discharge.

ERIC Educational Resources Information Center

Bare, Eric A.

1980-01-01

Some of the factors federal investigators and arbitrators use to distinguish between a voluntary quit and a constructive discharge are examined. Several guidelines university administrators can use to preempt and defend such claims are offered. The best way to avoid constructive discharge, it is suggested,is to conduct supervisory training. (MLW)

27 CFR 24.65 - Claims for wine or spirits lost or destroyed in bond.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Claims for wine or spirits... TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS WINE Administrative and Miscellaneous Provisions Claims § 24.65 Claims for wine or spirits lost or destroyed in bond. (a) Claim for remission of...

20 CFR 410.610 - Administrative actions that are initial determinations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... determinations. 410.610 Section 410.610 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE...) Withdrawal of claim or cancellation of withdrawal request. When a request for withdrawal of a claim, or a request for cancellation of a “request for withdrawal” of a claim, is denied by the Administration, the...

28 CFR 79.71 - Filing of claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... document or publications from the Assistant Director at that address or by accessing the Program's Web site... determination of the Social Security Administration that the person filing the claim is the spouse of the...

28 CFR 79.71 - Filing of claims.

Code of Federal Regulations, 2011 CFR

2011-07-01

... document or publications from the Assistant Director at that address or by accessing the Program's Web site... determination of the Social Security Administration that the person filing the claim is the spouse of the...

Development of a comorbidity index using physician claims data.

PubMed

Klabunde, C N; Potosky, A L; Legler, J M; Warren, J L

2000-12-01

Important comorbidities recorded on outpatient claims in administrative datasets may be missed in analyses when only inpatient care is considered. Using the comorbid conditions identified by Charlson and colleagues, we developed a comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims. In the national cohorts of elderly prostate (n = 28,868) and breast cancer (n = 14,943) patients assessed in this study, less than 10% of patients had comorbid conditions identified when only Medicare hospital (Part A) claims were examined. By incorporating physician claims, the proportion of patients with comorbid conditions increased to 25%. The new physician claims comorbidity index significantly contributes to models of 2-year noncancer mortality and treatment received in both patient cohorts. We demonstrate the utility of a disease-specific index using an alternative method of construction employing study-specific weights. The physician claims index can be used in conjunction with a comorbidity index derived from inpatient hospital claims, or employed as a stand-alone measure.

26 CFR 302.1-7 - Claims for credit or refund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND ADMINISTRATION TAXES UNDER THE INTERNATIONAL CLAIMS SETTLEMENT ACT, AS AMENDED AUGUST 9, 1955... the claim and should be filed with the district director of the district in which the tax was paid... and former owner. (c) Refund payable to Attorney General. All refund of taxes paid by the Attorney...

19 CFR 10.621 - Corrected claim or certification by importers.

Code of Federal Regulations, 2010 CFR

2010-04-01

...-Central America-United States Free Trade Agreement Penalties § 10.621 Corrected claim or certification by....621 Section 10.621 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... civil or administrative penalties under 19 U.S.C. 1592 for having made an incorrect claim or having...

Advocacy Group Claims Lack of Drug Innovation

ERIC Educational Resources Information Center

Chemical and Engineering News, 1978

1978-01-01

Reports on the Health Research Group claim that less than 7 percent of all new drugs approved by the Food and Drug Administration (FDA) in recent years were considered to be important therapeutic gains. (SL)

5 CFR 179.307 - Administrative offset.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Administrative offset. 179.307 Section 179.307 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.307 Administrative offset. (a) If the debtor does not...

20 CFR 410.219 - Filing a claim under State workmen's compensation law; when filing such claim shall be considered...

Code of Federal Regulations, 2011 CFR

2011-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK... matter of law in a denial of his claim for compensation under such law. (c) To be considered to have...

20 CFR 410.219 - Filing a claim under State workmen's compensation law; when filing such claim shall be considered...

Code of Federal Regulations, 2010 CFR

2010-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK... matter of law in a denial of his claim for compensation under such law. (c) To be considered to have...

42 CFR 431.834 - Access to records: Claims processing assessment systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Access to records: Claims processing assessment systems. 431.834 Section 431.834 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.834...

42 CFR 431.834 - Access to records: Claims processing assessment systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Access to records: Claims processing assessment systems. 431.834 Section 431.834 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.834...

20 CFR 429.203 - When is a claim allowable?

Code of Federal Regulations, 2010 CFR

2010-04-01

... of you, your agent, the members of your family, or your private employee (the standard to be applied... 429.203 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE CLAIMS UNDER THE FEDERAL... travel under orders, including property in your custody or in the custody of a carrier, an agent or...

37 CFR 1.75 - Claim(s).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 37 Patents, Trademarks, and Copyrights 1 2011-07-01 2011-07-01 false Claim(s). 1.75 Section 1.75 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES National Processing Provisions Specification § 1.75 Claim(s). (a...

37 CFR 1.75 - Claim(s).

Code of Federal Regulations, 2014 CFR

2014-07-01

... 37 Patents, Trademarks, and Copyrights 1 2014-07-01 2014-07-01 false Claim(s). 1.75 Section 1.75 Patents, Trademarks, and Copyrights UNITED STATES PATENT AND TRADEMARK OFFICE, DEPARTMENT OF COMMERCE GENERAL RULES OF PRACTICE IN PATENT CASES National Processing Provisions Specification § 1.75 Claim(s). (a...

A systematic review of validated methods to capture myopericarditis using administrative or claims data.

PubMed

Idowu, Rachel T; Carnahan, Ryan; Sathe, Nila A; McPheeters, Melissa L

2013-12-30

To identify algorithms that can capture incident cases of myocarditis and pericarditis in administrative and claims databases; these algorithms can eventually be used to identify cardiac inflammatory adverse events following vaccine administration. We searched MEDLINE from 1991 to September 2012 using controlled vocabulary and key terms related to myocarditis. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics as well as study conduct. Nine publications (including one study reported in two publications) met criteria for inclusion. Two studies performed medical record review in order to confirm that these coding algorithms actually captured patients with the disease of interest. One of these studies identified five potential cases, none of which were confirmed as acute myocarditis upon review. The other study, which employed a search algorithm based on diagnostic surveillance (using ICD-9 codes 420.90, 420.99, 422.90, 422.91 and 429.0) and sentinel reporting, identified 59 clinically confirmed cases of myopericarditis among 492,671 United States military service personnel who received smallpox vaccine between 2002 and 2003. Neither study provided algorithm validation statistics (positive predictive value, sensitivity, or specificity). A validated search algorithm is currently unavailable for identifying incident cases of pericarditis or myocarditis. Several authors have published unvalidated ICD-9-based search algorithms that appear to capture myocarditis events occurring in the context of other underlying cardiac or autoimmune conditions. Copyright © 2013. Published by Elsevier Ltd.

20 CFR 725.311 - Communications with respect to claims; time computations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Communications with respect to claims; time computations. 725.311 Section 725.311 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED CLAIMS FOR BENEFITS UNDER PART C OF...

45 CFR 95.631 - Cost identification for purpose of FFP claims.

Code of Federal Regulations, 2011 CFR

2011-10-01

... for purpose of FFP claims. The conditions of this subpart apply notwithstanding the existence of an... 45 Public Welfare 1 2011-10-01 2011-10-01 false Cost identification for purpose of FFP claims. 95.631 Section 95.631 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION...

A systematic review of validated methods for identifying hypersensitivity reactions other than anaphylaxis (fever, rash, and lymphadenopathy), using administrative and claims data.

PubMed

Schneider, Gary; Kachroo, Sumesh; Jones, Natalie; Crean, Sheila; Rotella, Philip; Avetisyan, Ruzan; Reynolds, Matthew W

2012-01-01

The Food and Drug Administration's Mini-Sentinel pilot program aims to conduct active surveillance to refine safety signals that emerge for marketed medical products. A key facet of this surveillance is to develop and understand the validity of algorithms for identifying health outcomes of interest from administrative and claims data. This article summarizes the process and findings of the algorithm review of hypersensitivity reactions. PubMed and Iowa Drug Information Service searches were conducted to identify citations applicable to the hypersensitivity reactions of health outcomes of interest. Level 1 abstract reviews and Level 2 full-text reviews were conducted to find articles using administrative and claims data to identify hypersensitivity reactions and including validation estimates of the coding algorithms. We identified five studies that provided validated hypersensitivity-reaction algorithms. Algorithm positive predictive values (PPVs) for various definitions of hypersensitivity reactions ranged from 3% to 95%. PPVs were high (i.e. 90%-95%) when both exposures and diagnoses were very specific. PPV generally decreased when the definition of hypersensitivity was expanded, except in one study that used data mining methodology for algorithm development. The ability of coding algorithms to identify hypersensitivity reactions varied, with decreasing performance occurring with expanded outcome definitions. This examination of hypersensitivity-reaction coding algorithms provides an example of surveillance bias resulting from outcome definitions that include mild cases. Data mining may provide tools for algorithm development for hypersensitivity and other health outcomes. Research needs to be conducted on designing validation studies to test hypersensitivity-reaction algorithms and estimating their predictive power, sensitivity, and specificity. Copyright © 2012 John Wiley & Sons, Ltd.

5 CFR 845.408 - Special processing for fraud claims.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Special processing for fraud claims. 845.408 Section 845.408 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES RETIREMENT SYSTEM-DEBT COLLECTION Agency Requests to OPM for Recovery of a Debt From the Civil Service...

37 CFR 1.75 - Claim(s).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Claim(s). 1.75 Section 1.75... GENERAL RULES OF PRACTICE IN PATENT CASES National Processing Provisions Specification § 1.75 Claim(s). (a.... (35 U.S.C. 6; 15 U.S.C. 1113, 1126) [31 FR 12922, Oct. 4, 1966, as amended at 36 FR 12690, July 3...

5 CFR 831.1808 - Special processing for fraud claims.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Special processing for fraud claims. 831.1808 Section 831.1808 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIREMENT Agency Requests to OPM for Recovery of a Debt from the Civil Service Retirement and Disability Fund § 831.1808...

11 CFR 111.54 - Bankruptcy claims.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 11 Federal Elections 1 2012-01-01 2012-01-01 false Bankruptcy claims. 111.54 Section 111.54 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111.54 Bankruptcy...

11 CFR 111.54 - Bankruptcy claims.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Bankruptcy claims. 111.54 Section 111.54 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111.54 Bankruptcy...

11 CFR 111.54 - Bankruptcy claims.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Bankruptcy claims. 111.54 Section 111.54 Federal Elections FEDERAL ELECTION COMMISSION GENERAL COMPLIANCE PROCEDURE (2 U.S.C. 437g, 437d(a)) Collection of Debts Arising From Enforcement and Administration of Campaign Finance Laws § 111.54 Bankruptcy...

5 CFR 179.309 - Additional administrative procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Additional administrative procedures. 179.309 Section 179.309 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS CLAIMS COLLECTION STANDARDS Administrative Offset § 179.309 Additional administrative procedures. Nothing...

45 CFR 30.3 - Antitrust, fraud, exception in the account of an accountable official, and interagency claims...

Code of Federal Regulations, 2010 CFR

2010-10-01

... accountable official, and interagency claims excluded. 30.3 Section 30.3 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CLAIMS COLLECTION General Provisions § 30.3 Antitrust, fraud, exception in the account of an accountable official, and interagency claims excluded. (a) Claims involving...

21 CFR 101.67 - Use of nutrient content claims for butter.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 2 2012-04-01 2012-04-01 false Use of nutrient content claims for butter. 101.67 Section 101.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Nutrient Content Claims § 101...

21 CFR 101.67 - Use of nutrient content claims for butter.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 2 2013-04-01 2013-04-01 false Use of nutrient content claims for butter. 101.67 Section 101.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Nutrient Content Claims § 101...

20 CFR 615.8 - Provisions of State law applicable to claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Provisions of State law applicable to claims. 615.8 Section 615.8 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR EXTENDED BENEFITS IN THE FEDERAL-STATE UNEMPLOYMENT COMPENSATION PROGRAM § 615.8 Provisions of State law applicable to claims. (a) Particular...

21 CFR 101.67 - Use of nutrient content claims for butter.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Use of nutrient content claims for butter. 101.67 Section 101.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Nutrient Content Claims § 101...

21 CFR 101.67 - Use of nutrient content claims for butter.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 2 2011-04-01 2011-04-01 false Use of nutrient content claims for butter. 101.67 Section 101.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) FOOD FOR HUMAN CONSUMPTION FOOD LABELING Specific Requirements for Nutrient Content Claims § 101...

44 CFR 206.205 - Payment of claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Payment of claims. 206.205 Section 206.205 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Public Assistance Project Administration...

34 CFR 35.3 - Administrative claim; who may file.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the executor or administrator of the decedent's estate or by any other person legally entitled to... of the claimant as agent, executor, administrator, parent, guardian, or other representative. ...

5 CFR 178.103 - Claim filed by a claimant's representative.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Claim filed by a claimant's representative. 178.103 Section 178.103 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE... supported by a duly executed power of attorney or other documentary evidence of the representative's right...

5 CFR 177.103 - Administrative claim; who may file.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the executor or administrator of the decedent's estate or by any other person legally entitled to... behalf of the claimant as agent, executor, administrator, parent, guardian, or other representative. ...

76 FR 28225 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-16

... Bank, N.A., Attention: Claims Agent, 1601 Bryan Street, Dallas, Texas 75201. SUPPLEMENTARY INFORMATION... to pay claims. Under the statutory order of priority, administrative expenses and deposit liabilities...

Use of claims data for research on treatment and outcomes of depression care.

PubMed

Melfi, C A; Croghan, T W

1999-04-01

Data sources such as medical insurance claims are increasingly used in outcomes research. In this report, we present opportunities and limitations associated with the use of such data for outcomes research in the area of depression. The purpose of this report is to illustrate the use of administrative claims data in conducting research in the area of depression. Information in this report is intended to be helpful to both experienced health services researchers and to those who may be new to the field of either outcomes research or mental health research. FORMAT: This report covers measurement of outcomes, possible data sources, episode construction, and statistical methodologies that are appropriate when conducting depression research using claims data. Through examples and references, issues to be considered in each of these areas are examined and recommendations are made. Strengths and limitations of claims data will also be pointed out. The use of claims data to conduct outcomes research in depression should be carried out responsibly. Limitations with using claims data to identify patients with depression must be acknowledged and appropriate methodologies should be used. Still, these data sources provide a rich opportunity to conduct outcomes research in depression, and much can be learned using administrative claims data.

Accuracy of using Diagnosis Procedure Combination administrative claims data for estimating the amount of opioid consumption among cancer patients in Japan.

PubMed

Iwamoto, Momoko; Higashi, Takahiro; Miura, Hiroki; Kawaguchi, Takahiro; Tanaka, Shigeyuki; Yamashita, Itsuku; Yoshimoto, Tetsusuke; Yoshida, Shigeaki; Matoba, Motohiro

2015-11-01

The state of opioid consumption among cancer patients has never been comprehensively investigated in Japan. The Diagnosis Procedure Combination claims data may be used to measure and monitor opioid consumption among cancer patients, but the accuracy of using the Diagnosis Procedure Combination data for this purpose has never been tested. We aimed to ascertain the accuracy of using the Diagnosis Procedure Combination claims data for estimating total opioid analgesic consumption by cancer patients compared with electronic medical records at Aomori Prefectural Central Hospital. We calculated percent differences between estimates obtained from electronic medical records and Diagnosis Procedure Combination claims data by month and drug type (morphine, oxycodone, fentanyl, buprenorphine, codeine and tramadol) between 1 October 2012 and 30 September 2013, and further examined the causes of discrepancy by reviewing medical and administrative charts between April and July 2013. Percent differences varied by month for drug types with small prescription volumes, but less so for drugs with larger prescription volumes. Differences also tended to diminish when consumption was compared for a year instead of a month. Total percent difference between electronic medical records and Diagnosis Procedure Combination data during the study period was -0.1% (4721 mg per year per hospital), as electronic medical records as baseline. Half of the discrepancy was caused by errors in data entry. Our study showed that Diagnosis Procedure Combination claims data can be used to accurately estimate opioid consumption among a population of cancer patients, although the same conclusion cannot be made for individual estimates or when making estimates for a group of patients over a short period of time. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

32 CFR 536.120 - Claims payable as maritime claims.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Claims payable as maritime claims. 536.120... ACCOUNTS CLAIMS AGAINST THE UNITED STATES Maritime Claims § 536.120 Claims payable as maritime claims. A claim is cognizable under this subpart if it arises in or on a maritime location, involves some...

75 FR 45114 - Determination of Insufficient Assets To Satisfy Claims Against Financial Institution in Receivership

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... FDIC as Receiver of Downey Savings and Loan Association, F.A., Attention: Claims Agent, 1601 Bryan... insured depository institution to pay claims. Under the statutory order of priority, administrative...

Claims procedures for employee benefit plans--Pension and Welfare Benefits Administration, Department of Labor. Request for information.

PubMed

1997-09-08

This document requests information from the public concerning the advisability of amending the existing regulation under the Employee Retirement Income Security Act of 1974 (ERISA) that establishes minimum requirements for employee benefit plan claims procedures. The term "claims procedure" refers to the process that employee benefit plans must provide for participants and beneficiaries who seek to obtain pension or welfare plan benefits, including requests for medical treatment or services, consideration of claims, and review of denials of claims by plans. The primary purpose of this notice is to obtain information to assist the Department of Labor (the Department) in evaluating (1) the extent to which the current claims procedure regulation assures that group health plan participants and beneficiaries are provided with effective and timely means to file and resolve claims for health care benefits, and (1) whether and in what way the existing minimum requirements should be amended with respect to group health plans covered by ERISA. The furnished information also will assist the Department in determining whether the regulation should be amended with respect to pension plans covered by ERISA and in developing legislative proposals to address any identified deficiencies relating to the claims procedures that cannot be addressed by amending the current regulation.

26 CFR 48.6427-11 - Kerosene; claims by registered ultimate vendors (blending).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 16 2010-04-01 2010-04-01 true Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-11 Kerosene... certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments allowed...

26 CFR 48.6427-11 - Kerosene; claims by registered ultimate vendors (blending).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 16 2012-04-01 2012-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-11 Kerosene... certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments allowed...

26 CFR 48.6427-11 - Kerosene; claims by registered ultimate vendors (blending).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 16 2013-04-01 2013-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-11 Kerosene... certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments allowed...

26 CFR 48.6427-11 - Kerosene; claims by registered ultimate vendors (blending).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 16 2011-04-01 2011-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-11 Kerosene... certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments allowed...

45 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2011 CFR

2011-10-01

... this section, an executed Standard Form 95 or other written notification of an incident accompanied by... suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and signed by the claimant or... an amendment. (c) Forms may be obtained and claims may be filed, with the office, local, regional, or...

45 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... this section, an executed Standard Form 95 or other written notification of an incident accompanied by... suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and signed by the claimant or... an amendment. (c) Forms may be obtained and claims may be filed, with the office, local, regional, or...

45 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... this section, an executed Standard Form 95 or other written notification of an incident accompanied by... suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and signed by the claimant or... an amendment. (c) Forms may be obtained and claims may be filed, with the office, local, regional, or...

45 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... this section, an executed Standard Form 95 or other written notification of an incident accompanied by... suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and signed by the claimant or... an amendment. (c) Forms may be obtained and claims may be filed, with the office, local, regional, or...

45 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... this section, an executed Standard Form 95 or other written notification of an incident accompanied by... suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and signed by the claimant or... an amendment. (c) Forms may be obtained and claims may be filed, with the office, local, regional, or...

Can Medicaid Claims Validly Ascertain Foster Care Status?

PubMed

Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T

2017-08-01

Medicaid claims have been used to identify populations of children in foster care in the current literature; however, the ability of such an approach to validly ascertain a foster care population is unknown. This study linked children in the National Survey of Child and Adolescent Well-Being-I to their Medicaid claims from 36 states using their Social Security numbers. Using this match, we examined discordance between caregiver report of foster care placement and the foster care eligibility code contained in the child's Medicaid claims. Only 73% of youth placed in foster care for at least a year displayed a Medicaid code for foster care eligibility. Half of all youth coming into contact with child welfare displayed discordance between caregiver report and Medicaid claims. Children with emergency department utilization, and those in primary care case management health insurance arrangements, had the highest odds of accurate ascertainment. The use of Medicaid claims to identify a cohort of children in foster care results in high rates of underascertainment. Supplementing administrative data with survey data is one way to enhance validity of ascertainment.

78 FR 33890 - Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice. SUMMARY... advising the public of final agency actions subject to Section 139(l) of Title 23, United States Code (U.S...

78 FR 4191 - Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-18

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice. SUMMARY... advising the public of final agency actions subject to Section 139(l) of Title 23, United States Code (U.S...

78 FR 16764 - Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice. SUMMARY... advising the public of final agency actions subject to Section 139(l) of Title 23, United States Code (U.S...

Effects of comparative claims in prescription drug direct-to-consumer advertising on consumer perceptions and recall.

PubMed

O'Donoghue, Amie C; Williams, Pamela A; Sullivan, Helen W; Boudewyns, Vanessa; Squire, Claudia; Willoughby, Jessica Fitts

2014-11-01

Although pharmaceutical companies cannot make comparative claims in direct-to-consumer (DTC) ads for prescription drugs without substantial evidence, the U.S. Food and Drug Administration permits some comparisons based on labeled attributes of the drug, such as dosing. Researchers have examined comparative advertising for packaged goods; however, scant research has examined comparative DTC advertising. We conducted two studies to determine if comparative claims in DTC ads influence consumers' perceptions and recall of drug information. In Experiment 1, participants with osteoarthritis (n=1934) viewed a fictitious print or video DTC ad that had no comparative claim or made an efficacy comparison to a named or unnamed competitor. Participants who viewed print (but not video) ads with named competitors had greater efficacy and lower risk perceptions than participants who viewed unnamed competitor and noncomparative ads. In Experiment 2, participants with high cholesterol or high body mass index (n=5317) viewed a fictitious print or video DTC ad that had no comparative claim or made a comparison to a named or unnamed competitor. We varied the type of comparison (of indication, dosing, or mechanism of action) and whether the comparison was accompanied by a visual depiction. Participants who viewed print and video ads with named competitors had greater efficacy perceptions than participants who viewed unnamed competitor and noncomparative ads. Unlike Experiment 1, named competitors in print ads resulted in higher risk perceptions than unnamed competitors. In video ads, participants who saw an indication comparison had greater benefit recall than participants who saw dosing or mechanism of action comparisons. In addition, visual depictions of the comparison decreased risk recall for video ads. Overall, the results suggest that comparative claims in DTC ads could mislead consumers about a drug's efficacy and risk; therefore, caution should be used when presenting

5 CFR 551.708 - Finality and effect of OPM FLSA claim decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Finality and effect of OPM FLSA claim decision. 551.708 Section 551.708 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE.... (b) A decision by OPM under the Act is binding on all administrative, certifying, payroll, disbursing...

29 CFR 15.5 - Administrative claim; evidence or information to substantiate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... physician employed or designated by the Department or another federal agency. A copy of the report of the... she is a full or part-time employee, and wages or salary actually lost. (5) If a claim is made for... with respect to each item of property: (1) Proof of ownership. (2) A detailed statement of the amount...

34 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or other... claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and... the filing of an amendment. (c) Forms may be obtained and claims may be filed, with the Department of...

34 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2012 CFR

2012-07-01

... receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or other... claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and... the filing of an amendment. (c) Forms may be obtained and claims may be filed, with the Department of...

34 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2014 CFR

2014-07-01

... receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or other... claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and... the filing of an amendment. (c) Forms may be obtained and claims may be filed, with the Department of...

34 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2013 CFR

2013-07-01

... receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or other... claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and... the filing of an amendment. (c) Forms may be obtained and claims may be filed, with the Department of...

34 CFR 35.2 - Administrative claim; when presented; place of filing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... receives, at a place designated in paragraph (b) of this section, an executed Standard Form 95 or other... claimant's option to bring suit under 28 U.S.C. 2675(a). Amendments shall be submitted in writing and... the filing of an amendment. (c) Forms may be obtained and claims may be filed, with the Department of...

20 CFR 702.604 - Determining the amount of compensation for occupational disease claims which become manifest...

Code of Federal Regulations, 2011 CFR

2011-04-01

... occupational disease claims which become manifest after retirement. 702.604 Section 702.604 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the claim is for disability benefits and the...

20 CFR 702.604 - Determining the amount of compensation for occupational disease claims which become manifest...

Code of Federal Regulations, 2013 CFR

2013-04-01

... occupational disease claims which become manifest after retirement. 702.604 Section 702.604 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the claim is for disability benefits and the...

20 CFR 702.604 - Determining the amount of compensation for occupational disease claims which become manifest...

Code of Federal Regulations, 2014 CFR

2014-04-01

... occupational disease claims which become manifest after retirement. 702.604 Section 702.604 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the claim is for disability benefits and the...

20 CFR 702.604 - Determining the amount of compensation for occupational disease claims which become manifest...

Code of Federal Regulations, 2012 CFR

2012-04-01

... occupational disease claims which become manifest after retirement. 702.604 Section 702.604 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the claim is for disability benefits and the...

Analysis of US Food and Drug Administration Warning Letters: False Promotional Claims Relating to Prescription and Over-the-Counter Medications.

PubMed

Salas, Maribel; Martin, Michelle; Pisu, Maria; McCall, Erin; Zuluaga, Alvaro; Glasser, Stephen P

2008-03-01

Recent studies have suggested that there has been an increase in the number of 'warning letters' issued by the US Food and Drug Administration (FDA) despite the publication of the FDA advertising guidelines. However, limited information is available on the description of warning letters. The objective of this study was to analyse the frequency and content of FDA warning letters in relation to promotional claims and discuss the influence of regulatory and industry constraints on promotion. All warning letters published by the FDA between 5 May 1995 and 11 June 2007 were reviewed. Warning letters related to promotional issues were included and analysed. Information related to the identification number, date of the warning letter, FDA division that issued the letter, drug name, manufacturer, specific warning problem, type of promotional material and requested action was extracted. Two independent investigators reviewed and classified each PDF file, any differences were discussed until a consensus was reached. Between May 1995 and June 2007 a total of 8692 warning letters were issued, of which 25% were related to drugs. Of these, 206 warning letters focused on drug promotion and were included in this study: 23% were issued in 2005, 15% in 2004 and 14% in 1998. In total, 47% of the warning letters were issued because of false or misleading unapproved doses and uses, 27% failed to disclose risks, 15% cited misleading promotion, 8% related to misleading labelling and 3% promoted false effectiveness claims. There is an important variation in the number of warning letters issued in the last decade, probably because of the increasing number of drugs approved by the FDA, drug withdrawal scandals, and the publication of the FDA and the Pharmaceutical Research and Manufacturers of America (PhRMA) guidelines. We found that benefit-related claims, such as unapproved uses or doses of drugs, and failure to disclose risks, are the main causes of FDA issued warning letters for

42 CFR 431.836 - Corrective action under the MQC claims processing assessment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... assessment system. 431.836 Section 431.836 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.836 Corrective action under the MQC claims processing assessment system. The agency must— (a) Take action to...

45 CFR 95.631 - Cost identification for purpose of FFP claims.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Cost identification for purpose of FFP claims. 95.631 Section 95.631 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH...

45 CFR 95.631 - Cost identification for purpose of FFP claims.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Cost identification for purpose of FFP claims. 95.631 Section 95.631 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH...

45 CFR 95.631 - Cost identification for purpose of FFP claims.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Cost identification for purpose of FFP claims. 95.631 Section 95.631 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH...

Online E-cigarette Marketing Claims: A Systematic Content and Legal Analysis.

PubMed

Klein, Elizabeth G; Berman, Micah; Hemmerich, Natalie; Carlson, Cristen; Htut, SuSandi; Slater, Michael

2016-07-01

Electronic nicotine delivery systems (ENDS), or e-cigarettes, are heavily marketed online. The purpose of our study was to perform a systematic identification and evaluation of claims made within ENDS retailer and manufacturer websites, and the legal status of such claims. We employed a systematic search protocol with popular search engines using 6 terms: (1) e-cigarettes; (2) e-cigs; (3) e-juice; (4) e-liquid; (5) e-hookah; and (6) vape pen. We analyzed English-language websites where ENDS are sold for implicit and explicit health-related claims. A legal analysis determined whether such claims are permissible under the US Food and Drug Administration's regulations. The vast majority of ENDS manufacturer (N = 78) and retailer (N = 32) websites made at least one health-related claim (77% and 65%, respectively). Modified risk claims and secondhand smoke-related claims were most prevalent, with an average of 2 claims per site. Health-related claims are plentiful within ENDS manufacturer and retailer websites. Results demonstrate that these sites focus on potential benefits while minimizing or eliminating information about possible harmful effects of ENDS. These claims are subject to the current regulatory authority by the FDA, and pose a risk of misinforming consumers.

48 CFR 3442.7002 - Litigation and claims clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Litigation and claims clause. 3442.7002 Section 3442.7002 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION ACQUISITION REGULATION CONTRACT MANAGEMENT CONTRACT ADMINISTRATION Contract Monitoring 3442.7002 Litigation...

7 CFR 210.8 - Claims for reimbursement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... lunches and meal supplements by reimbursement type served to children times the respective payment rates... problems with a school's meal counting or claiming procedures, the school food authority shall: ensure that... found by its most recent administrative review conducted in accordance with § 210.18, to have no meal...

47 CFR 54.701 - Administrator of universal service support mechanisms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... mechanisms. 54.701 Section 54.701 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON... Federal Communications Commission to determine that the Administrator is administering the universal... support mechanism; (2) the Rural Health Care Committee, which shall oversee the rural health care support...

A systematic review of validated methods for identifying patients with rheumatoid arthritis using administrative or claims data.

PubMed

Chung, Cecilia P; Rohan, Patricia; Krishnaswami, Shanthi; McPheeters, Melissa L

2013-12-30

To review the evidence supporting the validity of billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify patients with rheumatoid arthritis (RA) in administrative and claim databases. We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to RA and reference lists of included studies were searched. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria and extracted the data. Data collected included participant and algorithm characteristics. Nine studies reported validation of computer algorithms based on International Classification of Diseases (ICD) codes with or without free-text, medication use, laboratory data and the need for a diagnosis by a rheumatologist. These studies yielded positive predictive values (PPV) ranging from 34 to 97% to identify patients with RA. Higher PPVs were obtained with the use of at least two ICD and/or procedure codes (ICD-9 code 714 and others), the requirement of a prescription of a medication used to treat RA, or requirement of participation of a rheumatologist in patient care. For example, the PPV increased from 66 to 97% when the use of disease-modifying antirheumatic drugs and the presence of a positive rheumatoid factor were required. There have been substantial efforts to propose and validate algorithms to identify patients with RA in automated databases. Algorithms that include more than one code and incorporate medications or laboratory data and/or required a diagnosis by a rheumatologist may increase the PPV. Copyright © 2013 Elsevier Ltd. All rights reserved.

29 CFR 541.203 - Administrative exemption examples.

Code of Federal Regulations, 2012 CFR

2012-07-01

... or safety, building or construction, health or sanitation, environmental or soils specialists and... claims adjusters generally meet the duties requirements for the administrative exemption, whether they... prepare damage estimates; evaluating and making recommendations regarding coverage of claims; determining...

29 CFR 541.203 - Administrative exemption examples.

Code of Federal Regulations, 2013 CFR

2013-07-01

... or safety, building or construction, health or sanitation, environmental or soils specialists and... claims adjusters generally meet the duties requirements for the administrative exemption, whether they... prepare damage estimates; evaluating and making recommendations regarding coverage of claims; determining...

21 CFR 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... sweeteners and dental caries. 101.80 Section 101.80 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... Requirements for Health Claims § 101.80 Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. (a) Relationship between dietary carbohydrates and dental caries. (1) Dental caries, or tooth...

21 CFR 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... sweeteners and dental caries. 101.80 Section 101.80 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... Requirements for Health Claims § 101.80 Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. (a) Relationship between dietary carbohydrates and dental caries. (1) Dental caries, or tooth...

21 CFR 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... sweeteners and dental caries. 101.80 Section 101.80 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... Requirements for Health Claims § 101.80 Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. (a) Relationship between dietary carbohydrates and dental caries. (1) Dental caries, or tooth...

21 CFR 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... sweeteners and dental caries. 101.80 Section 101.80 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... Requirements for Health Claims § 101.80 Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. (a) Relationship between dietary carbohydrates and dental caries. (1) Dental caries, or tooth...

21 CFR 101.80 - Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... sweeteners and dental caries. 101.80 Section 101.80 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT... Requirements for Health Claims § 101.80 Health claims: dietary noncariogenic carbohydrate sweeteners and dental caries. (a) Relationship between dietary carbohydrates and dental caries. (1) Dental caries, or tooth...

Repeat workers' compensation claims: risk factors, costs and work disability

PubMed Central

2011-01-01

Background The objective of our study was to describe factors associated with repeat workers' compensation claims and to compare the work disability arising in workers with single and multiple compensation claims. Methods All initial injury claims lodged by persons of working age during a five year period (1996 to 2000) and any repeat claims were extracted from workers' compensation administrative data in the state of Victoria, Australia. Groups of workers with single and multiple claims were identified. Descriptive analysis of claims by affliction, bodily location, industry segment, occupation, employer and workplace was undertaken. Survival analysis determined the impact of these variables on the time between the claims. The economic impact and duration of work incapacity associated with initial and repeat claims was compared between groups. Results 37% of persons with an initial claim lodged a second claim. This group contained a significantly greater proportion of males, were younger and more likely to be employed in manual occupations and high-risk industries than those with single claims. 78% of repeat claims were for a second injury. Duration between the claims was shortest when the working conditions had not changed. The initial claims of repeat claimants resulted in significantly (p < 0.001) lower costs and work disability than the repeat claims. Conclusions A substantial proportion of injured workers experience a second occupational injury or disease. These workers pose a greater economic burden than those with single claims, and also experience a substantially greater cumulative period of work disability. There is potential to reduce the social, health and economic burden of workplace injury by enacting prevention programs targeted at these workers. PMID:21696637

45 CFR 1177.8 - Administrative offset.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.8 Administrative offset. (a) The... administrative offset, the National Endowment for the Humanities will send the debtor written notice of the... interest. (d) The National Endowment for the Humanities may effect an administrative offset against a...

45 CFR 1177.8 - Administrative offset.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMANITIES NATIONAL ENDOWMENT FOR THE HUMANITIES CLAIMS COLLECTION § 1177.8 Administrative offset. (a) The... administrative offset, the National Endowment for the Humanities will send the debtor written notice of the... interest. (d) The National Endowment for the Humanities may effect an administrative offset against a...

14 CFR § 1261.308 - NASA officials authorized to act upon claims.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false NASA officials authorized to act upon... ADMINISTRATION PROCESSING OF MONETARY CLAIMS (GENERAL) Claims Against NASA or Its Employees for Damage to or Loss of Property or Personal Injury or Death-Accruing On or After January 18, 1967 § 1261.308 NASA...

10 CFR 1015.208 - Administrative wage garnishment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Administrative wage garnishment. 1015.208 Section 1015.208... for the Administrative Collection of Claims § 1015.208 Administrative wage garnishment. (a) DOE may use administrative wage garnishment to collect money from a debtor's disposable pay to satisfy...

26 CFR 48.6427-10 - Kerosene; claims by registered ultimate vendors (blocked pumps).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 16 2012-04-01 2012-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-10 Kerosene... which certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments...

26 CFR 48.6427-10 - Kerosene; claims by registered ultimate vendors (blocked pumps).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 16 2011-04-01 2011-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-10 Kerosene... which certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments...

26 CFR 48.6427-10 - Kerosene; claims by registered ultimate vendors (blocked pumps).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 16 2013-04-01 2013-04-01 false Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-10 Kerosene... which certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments...

26 CFR 48.6427-10 - Kerosene; claims by registered ultimate vendors (blocked pumps).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 16 2010-04-01 2010-04-01 true Kerosene; claims by registered ultimate vendors... Administrative Provisions of Special Application to Retailers and Manufacturers Taxes § 48.6427-10 Kerosene... which certain registered ultimate vendors of taxed kerosene may claim the income tax credits or payments...

13 CFR 120.651 - Claim to FTA by Registered Holder to replace Certificate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Claim to FTA by Registered Holder to replace Certificate. 120.651 Section 120.651 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Miscellaneous Provisions § 120.651 Claim to FTA by Registered...

[Judicial or administrative settlement of medical malpractice claims. Update on medical liability].

PubMed

Crégut, P

2012-03-01

Settlement of medical malpractice claims was radically changed by the Kouchner Law that set up a rapid, effective system of indemnification. Victims can choose between conventional court proceedings and a non-judicial conciliation procedure. Choice between the two processes depends on the circumstances of the case.

21 CFR 101.62 - Nutrient content claims for fat, fatty acid, and cholesterol content of foods.

Code of Federal Regulations, 2014 CFR

2014-04-01

... cholesterol content of foods. 101.62 Section 101.62 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Nutrient Content Claims § 101.62 Nutrient content claims for fat, fatty acid, and cholesterol content of foods. (a) General requirements. A claim about the level of fat, fatty acid, and cholesterol in a food...

Functional foods: health claim-food product compatibility and the impact of health claim framing on consumer evaluation.

PubMed

van Kleef, Ellen; van Trijp, Hans C M; Luning, Pieternel

2005-06-01

Two studies are reported, which aim to strengthen the scientific underpinning of strategic decisions regarding functional food development, as to (1) which health benefits to claim, (2) with which product (category), and (3) in which communication format. The first exploratory study is a secondary analysis of 10 different health claims systematically combined with 10 different food carriers to evaluate their combined suitability for functional food positioning. The results show that consumers tend to prefer functional food concepts that primarily communicate disease-related health benefits in carriers with a healthy image or health positioning history. Study 2 examines health claim format and systematically varies the way in which specific health benefits are being communicated to the consumer. Two physiologically oriented claims (heart disease and osteoporosis) and two psychologically oriented food claims (stress and lack of energy) are expressed in enhanced function format versus disease risk reduction format. Also, it includes the individual difference variable of 'regulatory focus' and the health status of the respondent to explore how these factors impact health claim evaluation. The results show that consumer evaluations primarily differ to the extent that health claims are personally relevant in addressing an experienced disease state. Framing is important, but its effect differs by health benefit. No strong effects for consumers' regulatory focus were found. Underlying mechanisms of these effects and their implications for the development of functional foods are discussed.

28 CFR 32.8 - Exhaustion of administrative remedies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exhaustion of administrative remedies. 32.8 Section 32.8 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS General Provisions § 32.8 Exhaustion of administrative...

28 CFR 32.8 - Exhaustion of administrative remedies.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Exhaustion of administrative remedies. 32.8 Section 32.8 Judicial Administration DEPARTMENT OF JUSTICE PUBLIC SAFETY OFFICERS' DEATH, DISABILITY, AND EDUCATIONAL ASSISTANCE BENEFIT CLAIMS General Provisions § 32.8 Exhaustion of administrative...

26 CFR 302.1 - Statutory provisions and Executive order; section 212 of the International Claims Settlement Act...

Code of Federal Regulations, 2010 CFR

2010-04-01

... ADMINISTRATION TAXES UNDER THE INTERNATIONAL CLAIMS SETTLEMENT ACT, AS AMENDED AUGUST 9, 1955 § 302.1 Statutory provisions and Executive order; section 212 of the International Claims Settlement Act, and Executive Order...; section 212 of the International Claims Settlement Act, and Executive Order 10644. 302.1 Section 302.1...

12 CFR 1408.12 - Charges for interest, administrative costs, and penalties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Charges for interest, administrative costs, and penalties. 1408.12 Section 1408.12 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION COLLECTION OF CLAIMS OWED THE UNITED STATES Administrative Collection of Claims § 1408.12 Charges for interest...

50 CFR 296.6 - NMFS processing of claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false NMFS processing of claims. 296.6 Section 296.6 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE CONTINENTAL SHELF FISHERMEN'S CONTINGENCY FUND § 296.6 NMFS processing of...

20 CFR 416.922 - When you have two or more unrelated impairments-initial claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

... impairments-initial claims. 416.922 Section 416.922 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... of Disability § 416.922 When you have two or more unrelated impairments—initial claims. (a) Unrelated severe impairments. We cannot combine two or more unrelated severe impairments to meet the 12-month...

Low-Cost Generic Program Use by Medicare Beneficiaries: Implications for Medication Exposure Misclassification in Administrative Claims Data.

PubMed

Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua

2016-06-01

Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims data. Presently, there is little information regarding the use of these programs among a geriatric population. To (a) quantify the prevalence of LCGP users in a nationally representative population of Medicare beneficiaries; (b) compare clinical and demographic characteristics of LCGP users and nonusers; (c) assess determinants of LCGP use and medications acquired through these programs; and (d) analyze patterns of LCGP use during the years 2007-2012. This study relied on data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2012. The first 3 objectives were completed with a cohort of individuals in the most recent MEPS panel, while the fourth objective was completed with a separate cohort composed of individuals who participated in MEPS from 2007 to 2012. Inclusion in either study cohort required that individuals were Medicare beneficiaries aged 65 years or greater, used at least 1 prescription drug during their 2-year panel period, and participated in all 5

76 FR 46357 - Notice of Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-02

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Notice of Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice... that FTA has taken final agency actions by issuing certain approvals for the public transportation...

77 FR 26818 - Notice of Limitation on Claims Against Proposed Public Transportation Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Notice of Limitation on Claims Against Proposed Public Transportation Projects AGENCY: Federal Transit Administration (FTA), DOT. ACTION: Notice... public transportation projects listed below. The actions on these projects, as well as the laws under...

28 CFR 14.4 - Administrative claims; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-07-01

... by a physician employed by the agency or another Federal agency. A copy of the report of the... has made or agrees to make available to the agency any other physician's reports previously or... wages or salary actually lost. (5) If a claim is made for loss of income and the claimant is self...

24 CFR 17.4 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-04-01

... by a physician employed or designated by the Department or another Federal agency. A copy of the..., and wages or salary actually lost; (5) If a claim is made for loss of income and the claimant is self... may be required to submit the following evidence or information: (1) Proof of ownership; (2) A...

78 FR 57925 - Agency Information Collection (Pension Claim Questionnaire for Farm Income) Activity Under OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... Claim Questionnaire for Farm Income) Activity Under OMB Review AGENCY: Veterans Benefits Administration... INFORMATION: Title: Pension Claim Questionnaire for Farm Income, VA Form 21- 4165. OMB Control Number: 2900... to gather information necessary to determine a claimant's countable annual income and available...

49 CFR 89.35 - Administrative wage garnishment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Administrative wage garnishment. 89.35 Section 89... COLLECTION ACT Collection of Claims § 89.35 Administrative wage garnishment. (a) General. The Secretary may use administrative wage garnishment for debts referred to cross-servicing at Financial Management...

5 CFR 177.105 - Administrative claim; evidence and information to be submitted.

Code of Federal Regulations, 2010 CFR

2010-01-01

... agency. On written request, OPM will make available to the claimant a copy of the report of the examining... showing actual time lost from employment, whether he or she is a full-or part-time employee, and wages or... ownership of the property. (2) A detailed statement of the amount claimed with respect to each item of...

32 CFR 1602.2 - Administrative classification.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Administrative classification. 1602.2 Section 1602.2 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.2 Administrative classification. A reclassification action relating to a registrant's claim...

32 CFR 1602.2 - Administrative classification.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 6 2014-07-01 2014-07-01 false Administrative classification. 1602.2 Section 1602.2 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.2 Administrative classification. A reclassification action relating to a registrant's claim...

32 CFR 1602.2 - Administrative classification.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Administrative classification. 1602.2 Section 1602.2 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.2 Administrative classification. A reclassification action relating to a registrant's claim...

32 CFR 1602.2 - Administrative classification.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Administrative classification. 1602.2 Section 1602.2 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.2 Administrative classification. A reclassification action relating to a registrant's claim...

32 CFR 1602.2 - Administrative classification.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Administrative classification. 1602.2 Section 1602.2 National Defense Other Regulations Relating to National Defense SELECTIVE SERVICE SYSTEM DEFINITIONS § 1602.2 Administrative classification. A reclassification action relating to a registrant's claim...

20 CFR 405.320 - Administrative law judge hearing procedures-general.

Code of Federal Regulations, 2011 CFR

2011-04-01

... PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.320... medical, psychological, or vocational expert in your claim, the Medical and Vocational Expert Unit (see...

20 CFR 405.320 - Administrative law judge hearing procedures-general.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.320... medical, psychological, or vocational expert in your claim, the Medical and Vocational Expert Unit (see...

76 FR 44504 - Claims for Patent and Copyright Infringement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

.... ACTION: Proposed rule. SUMMARY: The National Aeronautics and Space Administration (NASA) proposes regulations relating to requirements for the filing of claims against NASA where a potential claimant believes NASA is infringing privately owned rights in patented inventions or copyrighted works. The requirements...

Measuring ability to assess claims about treatment effects: the development of the 'Claim Evaluation Tools'.

PubMed

Austvoll-Dahlgren, Astrid; Semakula, Daniel; Nsangi, Allen; Oxman, Andrew David; Chalmers, Iain; Rosenbaum, Sarah; Guttersrud, Øystein

2017-05-17

To describe the development of the Claim Evaluation Tools, a set of flexible items to measure people's ability to assess claims about treatment effects. Methodologists and members of the community (including children) in Uganda, Rwanda, Kenya, Norway, the UK and Australia. In the iterative development of the items, we used purposeful sampling of people with training in research methodology, such as teachers of evidence-based medicine, as well as patients and members of the public from low-income and high-income countries. Development consisted of 4 processes: (1) determining the scope of the Claim Evaluation Tools and development of items; (2) expert item review and feedback (n=63); (3) cognitive interviews with children and adult end-users (n=109); and (4) piloting and administrative tests (n=956). The Claim Evaluation Tools database currently includes a battery of multiple-choice items. Each item begins with a scenario which is intended to be relevant across contexts, and which can be used for children (from age 10  and above), adult members of the public and health professionals. People with expertise in research methods judged the items to have face validity, and end-users judged them relevant and acceptable in their settings. In response to feedback from methodologists and end-users, we simplified some text, explained terms where needed, and redesigned formats and instructions. The Claim Evaluation Tools database is a flexible resource from which researchers, teachers and others can design measurement instruments to meet their own requirements. These evaluation tools are being managed and made freely available for non-commercial use (on request) through Testing Treatments interactive (testingtreatments.org). PACTR201606001679337 and PACTR201606001676150; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

42 CFR 1001.901 - False or improper claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false False or improper claims. 1001.901 Section 1001.901 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG... individual or entity has a documented history of criminal, civil or administrative wrongdoing (The lack of...

42 CFR 431.834 - Access to records: Claims processing assessment systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.834... to which the State has access, including information available under part 435, subpart J, of this...

42 CFR 431.834 - Access to records: Claims processing assessment systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ADMINISTRATION Quality Control Medicaid Quality Control (mqc) Claims Processing Assessment System § 431.834... to which the State has access, including information available under part 435, subpart J, of this...

6 CFR 11.5 - Administrative wage garnishment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Administrative wage garnishment. 11.5 Section 11.5 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY CLAIMS § 11.5 Administrative wage garnishment. DHS may collect debts from a debtor's wages by means of administrative wage...

32 CFR 536.85 - Claims payable under the Federal Tort Claims Act.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 3 2013-07-01 2013-07-01 false Claims payable under the Federal Tort Claims Act... AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Claims Cognizable Under the Federal Tort Claims Act § 536.85 Claims payable under the Federal Tort Claims Act. (a) Unless otherwise prescribed, claims for...

75 FR 39051 - Allstate Insurance Company, Altoona Express Market Claim Office, Including On-Site Leased Workers...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-07

... former workers of Allstate Insurance Company, Altoona Express Market Claim Office, including on- site... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,536] Allstate Insurance Company, Altoona Express Market Claim Office, Including On-Site Leased Workers From Kelly Services...

75 FR 2161 - Proposed Extension of Information Collection; Comment Request; Employee Benefit Plan Claims...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-14

... DEPARTMENT OF LABOR Employee Benefits Security Administration Proposed Extension of Information Collection; Comment Request; Employee Benefit Plan Claims Procedures Under ERISA AGENCY: Employee Benefits... Employee Benefits Security Administration (EBSA) is soliciting comments on a proposed extension of the...

41 CFR 101-39.405 - Claims against the Government.

Code of Federal Regulations, 2014 CFR

2014-07-01

... effected, to prepare completely, from an administrative standpoint, the Government's defense of the claim. The agency shall thereafter transmit the complete case through appropriate channels to the Department... furnish the appropriate GSA Regional Counsel with a copy of all papers served in the action. When...

41 CFR 101-39.405 - Claims against the Government.

Code of Federal Regulations, 2011 CFR

2011-07-01

... effected, to prepare completely, from an administrative standpoint, the Government's defense of the claim. The agency shall thereafter transmit the complete case through appropriate channels to the Department... furnish the appropriate GSA Regional Counsel with a copy of all papers served in the action. When...

41 CFR 101-39.405 - Claims against the Government.

Code of Federal Regulations, 2010 CFR

2010-07-01

... effected, to prepare completely, from an administrative standpoint, the Government's defense of the claim. The agency shall thereafter transmit the complete case through appropriate channels to the Department... furnish the appropriate GSA Regional Counsel with a copy of all papers served in the action. When...

20 CFR 638.526 - Tort and other claims.

Code of Federal Regulations, 2010 CFR

2010-04-01

....526 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR JOB CORPS PROGRAM UNDER TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.526 Tort and other claims... persons or property, which is believed to have resulted from operation of a Job Corps center and to be a...

45 CFR 507.1 - Payments under the War Claims Act of 1948, as amended by Public Law 91-289.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Payments under the War Claims Act of 1948, as..., ADMINISTRATION, AND PAYMENT OF CLAIMS UNDER TITLE I OF THE WAR CLAIMS ACT OF 1948, AS AMENDED PAYMENT § 507.1 Payments under the War Claims Act of 1948, as amended by Public Law 91-289. (a) Upon a determination by the...

20 CFR 702.603 - Determining the payrate for compensating occupational disease claims which become manifest after...

Code of Federal Regulations, 2011 CFR

2011-04-01

... occupational disease claims which become manifest after retirement. 702.603 Section 702.603 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the time of injury occurs within the first...

20 CFR 702.603 - Determining the payrate for compensating occupational disease claims which become manifest after...

Code of Federal Regulations, 2012 CFR

2012-04-01

... occupational disease claims which become manifest after retirement. 702.603 Section 702.603 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the time of injury occurs within the first...

20 CFR 702.603 - Determining the payrate for compensating occupational disease claims which become manifest after...

Code of Federal Regulations, 2014 CFR

2014-04-01

... occupational disease claims which become manifest after retirement. 702.603 Section 702.603 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the time of injury occurs within the first...

20 CFR 702.603 - Determining the payrate for compensating occupational disease claims which become manifest after...

Code of Federal Regulations, 2013 CFR

2013-04-01

... occupational disease claims which become manifest after retirement. 702.603 Section 702.603 Employees' Benefits...' COMPENSATION ACT AND RELATED STATUTES ADMINISTRATION AND PROCEDURE Occupational Disease Which Does Not... disease claims which become manifest after retirement. (a) If the time of injury occurs within the first...

75 FR 65525 - Anthem Blue Cross Blue Shield, Claim Management Services, Inc. Operations, a Division of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-25

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,327] Anthem Blue Cross Blue Shield, Claim Management Services, Inc. Operations, a Division of Wellpoint, Inc., Green Bay, WI; Notice... former workers of Anthem Blue Cross Blue Shield, Claim Management Services, Inc. Operations, a Division...

19 CFR 201.206 - Administrative offset.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Administrative offset. 201.206 Section 201.206 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.206 Administrative offset. (a) Collection. The Director may collect a claim pursuant to 31 U...

19 CFR 201.206 - Administrative offset.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 3 2012-04-01 2012-04-01 false Administrative offset. 201.206 Section 201.206 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.206 Administrative offset. (a) Collection. The Director may collect a claim pursuant to 31 U...

19 CFR 201.206 - Administrative offset.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 3 2013-04-01 2013-04-01 false Administrative offset. 201.206 Section 201.206 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.206 Administrative offset. (a) Collection. The Director may collect a claim pursuant to 31 U...

19 CFR 201.206 - Administrative offset.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 3 2014-04-01 2014-04-01 false Administrative offset. 201.206 Section 201.206 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.206 Administrative offset. (a) Collection. The Director may collect a claim pursuant to 31 U...

19 CFR 201.206 - Administrative offset.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 3 2011-04-01 2011-04-01 false Administrative offset. 201.206 Section 201.206 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.206 Administrative offset. (a) Collection. The Director may collect a claim pursuant to 31 U...

14 CFR 1261.107 - Evidence in support of claim.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Evidence in support of claim. 1261.107 Section 1261.107 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROCESSING OF... statement from the claimant's supervisor or other person or persons having personal knowledge of the facts...

14 CFR 1261.107 - Evidence in support of claim.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Evidence in support of claim. 1261.107 Section 1261.107 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROCESSING OF... statement from the claimant's supervisor or other person or persons having personal knowledge of the facts...

50 CFR 296.13 - Payment of award for claim.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Payment of award for claim. 296.13 Section 296.13 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE CONTINENTAL SHELF FISHERMEN'S CONTINGENCY FUND § 296.13 Payment of award...

Defining hip fracture with claims data: outpatient and provider claims matter.

PubMed

Berry, S D; Zullo, A R; McConeghy, K; Lee, Y; Daiello, L; Kiel, D P

2017-07-01

Medicare claims are commonly used to identify hip fractures, but there is no universally accepted definition. We found that a definition using inpatient claims identified fewer fractures than a definition including outpatient and provider claims. Few additional fractures were identified by including inconsistent diagnostic and procedural codes at contiguous sites. Medicare claims data is commonly used in research studies to identify hip fractures, but there is no universally accepted definition of fracture. Our purpose was to describe potential misclassification when hip fractures are defined using Medicare Part A (inpatient) claims without considering Part B (outpatient and provider) claims and when inconsistent diagnostic and procedural codes occur at contiguous fracture sites (e.g., femoral shaft or pelvic). Participants included all long-stay nursing home residents enrolled in Medicare Parts A and B fee-for-service between 1/1/2008 and 12/31/2009 with follow-up through 12/31/2011. We compared the number of hip fractures identified using only Part A claims to (1) Part A plus Part B claims and (2) Part A and Part B claims plus discordant codes at contiguous fracture sites. Among 1,257,279 long-stay residents, 40,932 (3.2%) met the definition of hip fracture using Part A claims, and 41,687 residents (3.3%) met the definition using Part B claims. 4566 hip fractures identified using Part B claims would not have been captured using Part A claims. An additional 227 hip fractures were identified after considering contiguous fracture sites. When ascertaining hip fractures, a definition using outpatient and provider claims identified 11% more fractures than a definition with only inpatient claims. Future studies should publish their definition of fracture and specify if diagnostic codes from contiguous fracture sites were used.

20 CFR 405.325 - Issues before an administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Issues before an administrative law judge. 405.325 Section 405.325 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.325 Issues...

Using Self-reports or Claims to Assess Disease Prevalence: It's Complicated.

PubMed

St Clair, Patricia; Gaudette, Étienne; Zhao, Henu; Tysinger, Bryan; Seyedin, Roxanna; Goldman, Dana P

2017-08-01

Two common ways of measuring disease prevalence include: (1) using self-reported disease diagnosis from survey responses; and (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates. Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence. Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc. Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack. Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences. Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

38 CFR 3.153 - Claims filed with Social Security.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Claims filed with Social... Social Security. An application on a form jointly prescribed by the Secretary and the Commissioner of Social Security filed with the Social Security Administration on or after January 1, 1957, will be...

38 CFR 3.153 - Claims filed with Social Security.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Claims filed with Social... Social Security. An application on a form jointly prescribed by the Secretary and the Commissioner of Social Security filed with the Social Security Administration on or after January 1, 1957, will be...

38 CFR 3.153 - Claims filed with Social Security.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Claims filed with Social... Social Security. An application on a form jointly prescribed by the Secretary and the Commissioner of Social Security filed with the Social Security Administration on or after January 1, 1957, will be...

38 CFR 3.153 - Claims filed with Social Security.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Claims filed with Social... Social Security. An application on a form jointly prescribed by the Secretary and the Commissioner of Social Security filed with the Social Security Administration on or after January 1, 1957, will be...

38 CFR 3.153 - Claims filed with Social Security.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Claims filed with Social... Social Security. An application on a form jointly prescribed by the Secretary and the Commissioner of Social Security filed with the Social Security Administration on or after January 1, 1957, will be...

13 CFR 115.35 - Claims for reimbursement of Losses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... suits arising from a defaulted bond, and compromise, settle and defend such suits. The Surety must... Administrative Action” (SBA Form 994H), within 1 year from the time of each disbursement. Claims submitted after... limited to the Surety's compliance with SBA's regulations and forms. (d) Status updates. The Surety must...

13 CFR 115.35 - Claims for reimbursement of Losses.

Code of Federal Regulations, 2012 CFR

2012-01-01

... suits arising from a defaulted bond, and compromise, settle and defend such suits. The Surety must... Administrative Action” (SBA Form 994H), within 1 year from the time of each disbursement. Claims submitted after... limited to the Surety's compliance with SBA's regulations and forms. (d) Status updates. The Surety must...

13 CFR 115.35 - Claims for reimbursement of Losses.

Code of Federal Regulations, 2011 CFR

2011-01-01

... suits arising from a defaulted bond, and compromise, settle and defend such suits. The Surety must... Administrative Action” (SBA Form 994H), within 1 year from the time of each disbursement. Claims submitted after... limited to the Surety's compliance with SBA's regulations and forms. (d) Status updates. The Surety must...

13 CFR 115.35 - Claims for reimbursement of Losses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... suits arising from a defaulted bond, and compromise, settle and defend such suits. The Surety must... Administrative Action” (SBA Form 994H), within 1 year from the time of each disbursement. Claims submitted after... limited to the Surety's compliance with SBA's regulations and forms. (d) Status updates. The Surety must...

13 CFR 115.35 - Claims for reimbursement of Losses.

Code of Federal Regulations, 2014 CFR

2014-01-01

... suits arising from a defaulted bond, and compromise, settle and defend such suits. The Surety must... Administrative Action” (SBA Form 994H), within 1 year from the time of each disbursement. Claims submitted after... limited to the Surety's compliance with SBA's regulations and forms. (d) Status updates. The Surety must...

5 CFR 1605.22 - Claims for correction of Board or TSP record keeper errors; time limitations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... record keeper errors; time limitations. 1605.22 Section 1605.22 Administrative Personnel FEDERAL... § 1605.22 Claims for correction of Board or TSP record keeper errors; time limitations. (a) Filing claims... after that time, the Board or TSP record keeper may use its sound discretion in deciding whether to...

29 CFR 15.6 - Administrative action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Administrative action. 15.6 Section 15.6 Labor Office of the... Against the Government Under the Federal Tort Claims Act § 15.6 Administrative action. (a) Investigation... such harm, it has the responsibility to fully investigate the incident and to take all actions...

20 CFR 405.370 - Decision by the administrative law judge.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Decision by the administrative law judge. 405.370 Section 405.370 Employees' Benefits SOCIAL SECURITY ADMINISTRATION ADMINISTRATIVE REVIEW PROCESS FOR ADJUDICATING INITIAL DISABILITY CLAIMS Administrative Law Judge Hearing § 405.370 Decision by the...

42 CFR 433.15 - Rates of FFP for administration.

Code of Federal Regulations, 2013 CFR

2013-10-01

...).) (3) Design, development, or installation of mechanized claims processing and information retrieval...) Operation of mechanized claims processing and information retrieval systems: 75 percent. (Section 1903(a) (3...

42 CFR 433.15 - Rates of FFP for administration.

Code of Federal Regulations, 2010 CFR

2010-10-01

...).) (3) Design, development, or installation of mechanized claims processing and information retrieval...) Operation of mechanized claims processing and information retrieval systems: 75 percent. (Section 1903(a) (3...

42 CFR 433.15 - Rates of FFP for administration.

Code of Federal Regulations, 2012 CFR

2012-10-01

...).) (3) Design, development, or installation of mechanized claims processing and information retrieval...) Operation of mechanized claims processing and information retrieval systems: 75 percent. (Section 1903(a) (3...

42 CFR 433.15 - Rates of FFP for administration.

Code of Federal Regulations, 2014 CFR

2014-10-01

...).) (3) Design, development, or installation of mechanized claims processing and information retrieval...) Operation of mechanized claims processing and information retrieval systems: 75 percent. (Section 1903(a) (3...

42 CFR 433.15 - Rates of FFP for administration.

Code of Federal Regulations, 2011 CFR

2011-10-01

...).) (3) Design, development, or installation of mechanized claims processing and information retrieval...) Operation of mechanized claims processing and information retrieval systems: 75 percent. (Section 1903(a) (3...

Student Grading Policies: Legal Issues and Administrative Review

ERIC Educational Resources Information Center

Gregory, Richard A.

2005-01-01

This case study focuses on the legal aspects of school district grading policies. Given parental and student challenges to assigned grades, a school district and its employees must be prepared to respond appropriately to substantive and procedural claims. Moreover, when these claims cannot be resolved at the building level, administrative reviews,…

Laboratory testing for cytomegalovirus among pregnant women in the United States: a retrospective study using administrative claims data

PubMed Central

2012-01-01

Background Routine cytomegalovirus (CMV) screening during pregnancy is not recommended in the United States and the extent to which it is performed is unknown. Using a medical claims database, we computed rates of CMV-specific testing among pregnant women. Methods We used medical claims from the 2009 Truven Health MarketScan® Commercial databases. We computed CMV-specific testing rates using CPT codes. Results We identified 77,773 pregnant women, of whom 1,668 (2%) had a claim for CMV-specific testing. CMV-specific testing was significantly associated with older age, Northeast or urban residence, and a diagnostic code for mononucleosis. We identified 44 women with a diagnostic code for mononucleosis, of whom 14% had CMV-specific testing. Conclusions Few pregnant women had CMV-specific testing, suggesting that screening for CMV infection during pregnancy is not commonly performed. In the absence of national surveillance for CMV infections during pregnancy, healthcare claims are a potential source for monitoring practices of CMV-specific testing. PMID:23198949

Understanding the types of fraud in claims to South African medical schemes.

PubMed

Legotlo, T G; Mutezo, A

2018-03-28

Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims. To identify the types of fraudulent activities committed in SA medical scheme claims. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany). The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims.

The Basis of Structure/Function Claims of Nutraceuticals.

PubMed

Borchers, Andrea T; Keen, Carl L; Gershwin, M Eric

2016-12-01

In the United States, as in most of the world, there are large numbers of nutraceuticals that are sold and which people take to boost their immune response. There are, in addition, almost an equal number of products sold to reduce allergies. However, very few consumers, and indeed physicians, are aware of what a structure/function claim is. Structure/function claims are labeling claims that can be used to describe the potential effects of a dietary ingredient or similar substance on the structure or function of the human body. This category of claims was created by legislation contained in the Dietary Supplement Health and Education Act. The intent was to supply consumers with reasonably substantiated information that would allow them to make educated choices about their diet and health. They were not intended to have the same weight and substantiation as the claims made for conventional prescription pharmaceuticals. Rather, they were proposed to fill the gap between consumer desire for over-the-counter supplements and foods, and rigorous and generally more potent and potentially "toxic" prescription medications. The legally mandated disclaimer, stating that the U.S. Food and Drug Administration has not evaluated the structure/function claim, often leads to misinterpretation. While there should be a biologic premise underlying the claim, there is not an absolute requirement for a conventional rigorous placebo-controlled dose response trial. While this may not be the clinical standard that a typical scientific oriented society might desire, it reflects the attempts of the FDA to find common grounds and to allow consumers to use products that are generally considered as safe based on historical use and biologic comparisons. The logic of, indeed need for, structure/function claims is straightforward; however, of equal importance is that nutraceuticals should be properly labeled, have accuracy in their ingredients, be free of contamination, be safe, and have a

Big Data in Organ Transplantation: Registries and Administrative Claims

PubMed Central

Massie, Allan B.; Kucirka, Lauren; Segev, Dorry L.

2015-01-01

The field of organ transplantation benefits from large, comprehensive, transplant-specific national datasets available to researchers. In addition to the widely-used OPTN-based registries (the UNOS and SRTR datasets) and USRDS datasets, there are other publicly available national datasets, not specific to transplantation, which have historically been underutilized in the field of transplantation. Of particular interest are the Nationwide Inpatient Sample (NIS) and State Inpatient Databases (SID), produced by the Agency for Healthcare Research and Quality (AHRQ). The United States Renal Data System (USRDS) database provides extensive data relevant to studies of kidney transplantation. Linkage of publicly available datasets to external data sources such as private claims or pharmacy data provides further resources for registry-based research. Although these resources can transcend some limitations of OPTN-based registry data, they come with their own limitations, which must be understood to avoid biased inference. This review discusses different registry-based data sources available in the United States, as well as the proper design and conduct of registry-based research. PMID:25040084

Health claims in the labelling and marketing of food products:

PubMed Central

Asp, Nils-Georg; Bryngelsson, Susanne

2007-01-01

Since 1990 certain health claims in the labelling and marketing of food products have been allowed in Sweden within the food sector's Code of Practice. The rules were developed in close dialogue with the authorities. The legal basis was a decision by the authorities not to apply the medicinal products’ legislation to “foods normally found on the dinner table” provided the rules defined in the Code were followed. The Code of Practice lists nine well-established diet–health relationships eligible for generic disease risk reduction claims in two steps and general rules regarding nutrient function claims. Since 2001, there has also been the possibility for using “product-specific physiological claims (PFP)”, subject to premarketing evaluation of the scientific dossier supporting the claim. The scientific documentation has been approved for 10 products with PFP, and another 15 products have been found to fulfil the Code's criteria for “low glycaemic index”. In the third edition of the Code, active since 2004, conditions in terms of nutritional composition were set, i.e. “nutrient profiles”, with a general reference to the Swedish National Food Administration's regulation on the use of a particular symbol, i.e. the keyhole symbol. Applying the Swedish Code of practice has provided experience useful in the implementation of the European Regulation on nutrition and health claims made on foods, effective from 2007.

Patient-reported outcomes to support medical product labeling claims: FDA perspective.

PubMed

Patrick, Donald L; Burke, Laurie B; Powers, John H; Scott, Jane A; Rock, Edwin P; Dawisha, Sahar; O'Neill, Robert; Kennedy, Dianne L

2007-01-01

This article concerns development and use of patient-reported outcomes (PROs) in clinical trials to evaluate medical products. A PRO is any report coming directly from patients, without interpretation by physicians or others, about how they function or feel in relation to a health condition and its therapy. PRO instruments are used to measure these patient reports. PROs provide a unique perspective on medical therapy, because some effects of a health condition and its therapy are known only to patients. Properly developed and evaluated PRO instruments also have the potential to provide more sensitive and specific measurements of the effects of medical therapies, thereby increasing the efficiency of clinical trials that attempt to measure the meaningful treatment benefits of those therapies. Poorly developed and evaluated instruments may provide misleading conclusions or data that cannot be used to support product labeling claims. We review selected major challenges from Food and Drug Administration's perspective in using PRO instruments, measures, and end points to support treatment benefit claims in product labeling. These challenges highlight the need for sponsors to formulate desired labeling claim(s) prospectively, to acquire and document information needed to support these claim(s), and to identify existing instruments or develop new and more appropriate PRO instruments for evaluating treatment benefit in the defined population in which they will seek claims.

Small Claims Court.

ERIC Educational Resources Information Center

McKitric, Eloise; Davis, Janet

The study examined individuals and companies who used small claims courts and the results of decisions reached in small claims cases. A review of studies including an empirical study of two Ohio small claims courts monitored for 12 months made it clear that small claims courts need to be examined to determine if utilization and accessibility to…