Specific Paid Claims

Effective

Policy effective date.

Policyholder

Policy holder name.

Policy holder state.

Claimant

Who made the claim.

C/B

Policy contract basis.

Whether or not the claim includes a notice.

TPA Paid Claims

Claim amount paid by the third party administrator.

Allowed

Claim amount allowable under the policy.

Deductible

Policy deductible amount.

Split Funding

Any split funding amount pertaining to the claim.

Unallowed

Amount disallowed on the claim.

Pending

Amount pending on the claim.

Reimb Limit / Reduction

Any limits or reductions in the reimbursement amount.

Reimburse

Reimbursable amount.

Pending Reimburse

Reimbursed amount pending payment.

Outstanding

Outstanding balance on reimbursable amount.

Reserves

Reserve for the claimant.