A request for payment by the healthcare provider to the insurance company.

A request for payment by the healthcare provider to the insurance company.

• A. Premium
• B. Claim
• C. Co-payment
• D. Deductible

Answer: (B)

In healthcare billing, a claim is the formal request for payment that the provider submits to the insurance company for services rendered to a patient. The provider sends the claim with details of the visit, the procedures and diagnoses coded, and the patient’s insurance information so the insurer can review and determine payment. This is distinct from a premium, which is the regular payment the insured makes to maintain coverage; a co-payment, which is the patient’s out-of-pocket amount due at the time of service; and a deductible, which is the amount the patient must pay before the insurer begins to pay.

In healthcare billing, a claim is the formal request for payment that the provider submits to the insurance company for services rendered to a patient. The provider sends the claim with details of the visit, the procedures and diagnoses coded, and the patient’s insurance information so the insurer can review and determine payment. This is distinct from a premium, which is the regular payment the insured makes to maintain coverage; a co-payment, which is the patient’s out-of-pocket amount due at the time of service; and a deductible, which is the amount the patient must pay before the insurer begins to pay.