Claim form

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Claim Form

A Claim Form (pronounced: klām fôrm) is a document used by insured individuals to request reimbursement for health care services from their insurance provider.

Etymology

The term "Claim Form" is derived from the English words "claim" and "form". "Claim" (from Old French clamer meaning 'to call, name, describe') refers to a request or demand, while "form" (from Old English forma meaning 'shape, form, beauty') refers to a document with spaces in which to write or select, for a series of documents with similar contents.

Definition

A Claim Form is a standardized document that includes spaces where the insured individual or health care provider can fill in the details about the health care services provided. This form is then submitted to the insurance company for review and potential reimbursement. The information required on a claim form may include the patient's personal identification number, the health care provider's details, the diagnosis code, and the procedure code.

Related Terms

  • Health Insurance: A type of insurance coverage that pays for medical and surgical expenses incurred by the insured.
  • Reimbursement: The act of compensating someone for an out-of-pocket expense by giving them an amount of money equal to what was spent.
  • Health Care Provider: A person or institution that provides medical services.
  • Diagnosis Code: A code that represents the patient's diagnosis at the time of the visit.
  • Procedure Code: A code that represents the medical procedure performed.

See Also

External links

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