Definitions
Health Insurance Terms
Claim

Claim

Definition:

A request for payment by a medical provider for a given medical service or item.

Application:

This is the means by which medical providers are paid for the services they perform on their patients. The claim includes CPT codes describing the service, ICD-9 codes identifying the diagnosis, demographic data on the patient and subscriber, information on who performed the service, and finally, the amount of the charge. An insurance company usually has 30 to 45 days to make a payment decision on the claim.

Definition Categories

Want to learn more? Schedule a Consultation

Get started and schedule a no cost consultation with the Business Benefits Team to learn how your business can better manage your employee benefits.

Get Started