What is a claim?

A claim is the bill you send to an insurance company for care a patient received.

Think of it as an envelope. The money itself does not live in the envelope. The money lives on the patient’s account as charges. A claim picks up some of those charges and carries them to the payer.

Every claim names three things before anything else:

• The patient who was treated.
• The practice doing the billing, which decides the prices.
• The doctor who actually provided the care at that visit.

On top of that it carries the payer, the place of service, the diagnosis, and one line per service performed. Those service lines are the charges the envelope is carrying.

A claim starts life as a draft. Nothing leaves your office until a person presses send. See What is a draft claim, and when does it actually go out?.

One more thing worth knowing early: a claim can be sent more than once. If the first attempt comes back rejected or denied, you fix it and send it again, and the whole history is kept.