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Healthcare Management vocabulary · Billing and Coding

Claim

Meaning in healthcare management, with examples

/kleɪm/nounCore term

In healthcare management, claim means: A formal request that a hospital or patient sends to an insurer or public payer, listing the care given and asking to be paid for it.

In Turkish: ödeme talebi, fatura, sigorta talebi

How it is used

Hospitals submit, file or send claims; payers process, pay, reject or deny them. Claims teams follow up unpaid claims and correct errors before resubmitting them. A 'clean claim' has no errors and can be paid quickly.

Example sentences

  1. We submitted the claim in March, but the insurer still hasn't paid it.

  2. Most rejected claims had a missing authorization number.

Common collocations

  • submit a claim
  • process a claim
  • reject a claim
  • clean claim
  • claims department
  • billingThe work of recording the services a patient received, turning them into charges and sending bills or claims to patients and payers.
  • claim denialA payer's refusal to pay a claim, for example because approval was missing, the codes were wrong, documents were missing or the service is not covered.
  • reimbursementThe money that an insurer or public payer pays a hospital or doctor for care already given to a patient, according to agreed rules and prices.
  • clinical codingThe process of turning the diagnoses and procedures in a patient's record into standard codes, which are used for payment, statistics and planning.
  • prior authorizationApproval that a provider must get from an insurer before certain tests, treatments or medicines; without it, the insurer may refuse to pay.

This word in other fields

The same English word can have a different meaning in another field:

More terms: Billing and Coding

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This page explains English vocabulary for learners. It is not medical advice.