Which term describes a request for payment submitted to an insurer by a healthcare provider?

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Multiple Choice

Which term describes a request for payment submitted to an insurer by a healthcare provider?

The term that describes the request for payment submitted to an insurer by a healthcare provider is a claim. When a service is provided, the provider sends a claim with patient and provider details, codes for the procedures and diagnoses, dates of service, and charges. This is the formal request that starts the insurer’s payment decision. The other concepts describe parts of the billing outcome rather than the submission itself: the provider charge is the amount the provider billed; the allowed amount is the insurer’s maximum recognized payment for that service under the contract; the reimbursement amount is the actual payment the provider receives after the claim is adjudicated, once patient responsibility and any discounts or deductions are applied.

The term that describes the request for payment submitted to an insurer by a healthcare provider is a claim. When a service is provided, the provider sends a claim with patient and provider details, codes for the procedures and diagnoses, dates of service, and charges. This is the formal request that starts the insurer’s payment decision.

The other concepts describe parts of the billing outcome rather than the submission itself: the provider charge is the amount the provider billed; the allowed amount is the insurer’s maximum recognized payment for that service under the contract; the reimbursement amount is the actual payment the provider receives after the claim is adjudicated, once patient responsibility and any discounts or deductions are applied.

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