A written description of the service provided that is prepared when the term “by report” is included in a procedure code nomenclature; may be requested by a third-party payer to provide additional information for claims processing.
A federal act, passed in 1974, which established new standards and reporting/disclosure requirements for employer-funded pension and welfare benefit programs. To date, self-funded health benefit plans operating under ERISA have been held to be exempt from most state insurance laws, although the courts have held that the states can regulate the medical care provided under such plans, as by requiring mandatory review of adverse HMO determinations.