Claims
Claims (medicine)
Claims (pronounced: /kleɪmz/) in the context of medicine, refer to the formal request or demand that an insurer, typically a health insurance company, pays for the healthcare services obtained by an insured individual. The term is derived from the Middle English word 'claimen', which means 'to demand by right'.
Types of Claims
There are several types of claims in the medical field, including:
- Preauthorization Claim: This is a claim made before a medical service is rendered. It is a request to a health insurance company to review a planned medical service and approve it in advance.
- Direct Claim: This is a claim made by a healthcare provider directly to the health insurance company for payment for services rendered to an insured individual.
- Reimbursement Claim: This is a claim made by an insured individual to their health insurance company to reimburse them for medical expenses they have paid out-of-pocket.
Process of Making a Claim
The process of making a claim typically involves the following steps:
- The insured individual receives healthcare services from a healthcare provider.
- The healthcare provider sends a Claim Form to the health insurance company. This form contains details of the services provided and the charges for these services.
- The health insurance company reviews the claim form and decides whether to approve or deny the claim based on the terms of the insured individual's health insurance policy.
- If the claim is approved, the health insurance company pays the healthcare provider directly (in the case of a direct claim) or reimburses the insured individual (in the case of a reimbursement claim).
Related Terms
- Claim Form: A document that a healthcare provider sends to a health insurance company to request payment for healthcare services provided to an insured individual.
- Claim Adjustment: A change made to a claim by a health insurance company, usually to correct an error or reflect additional information.
- Claim Denial: A decision by a health insurance company not to pay a claim, usually because the services provided are not covered by the insured individual's health insurance policy.
- Claim Review: The process by which a health insurance company examines a claim to determine whether to approve or deny it.
External links
- Medical encyclopedia article on Claims
- Wikipedia's article - Claims
This WikiMD dictionary article is a stub. You can help make it a full article.
Languages: - East Asian
中文,
日本,
한국어,
South Asian
हिन्दी,
Urdu,
বাংলা,
తెలుగు,
தமிழ்,
ಕನ್ನಡ,
Southeast Asian
Indonesian,
Vietnamese,
Thai,
မြန်မာဘာသာ,
European
español,
Deutsch,
français,
русский,
português do Brasil,
Italian,
polski