Claim
In the healthcare industry, a Claim is a formal request for payment submitted to an insurance company by a healthcare provider or patient. It details the medical services, treatments, or procedures provided to a patient and requests reimbursement based on the terms of the patient’s insurance policy. Claims include information such as patient details, diagnosis codes, procedure codes, dates of service, and the costs associated with the services rendered.
Once a claim is submitted, the insurance company reviews it to determine the amount of payment it will approve based on the patient’s coverage plan. The claim may be fully paid, partially paid, or denied, and they are essential for ensuring that healthcare providers receive compensation for their services and that patients’ insurance benefits are appropriately utilized.