what is claim, claim reference number and what is EOB

• Claim:

Forms submitted for payment of physician services, other medical services and supplies provided to Insurance beneficiaries. It is an itemized statement of healthcare services and their costs provided by hospital, physician's office or other healthcare facility. A charge when filed to insurance becomes a claim.

An itemized statement of healthcare services and their costs provided by a hospital, physician's office or other provider facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

claim form

An application for payment of benefits under a health plan.

claims investigation

The process of obtaining all the information necessary to determine the appropriate amount to pay on a given claim.

• Insurance Claim number:

It is the number given by the insurance to the claim in order to identify the claim in case of reference. Some insurance companies address the claim with the help of the claim number. It can be of the combination of any numeric values along with the alphabetical values. It is insurance specific and no general format is there for this.

For Example: - 12345ABXCQ78.

• EOB:

It is defined as Explanation of Benefits. This contains the claim details, the amount paid by the insurance, Co-pay / Co-insurance amount and write-off amount. It also contains the patient name, patient address, patient account number, SSN, insurance name, insurance address, insurance contact numbers and it’s customer care numbers (if any). If insurance does not pay the claim then the reason for which the claim was not paid i.e. the denial reason is also mentioned in EOB. In simple words it can be defined as the detailed explanation of the benefits provided by the insurance for the claim. Some insurance like Medicare have their own format of EOB.

For Example:-

EOMB (Explanation of Medicare Benefits) contains a statement detailing the amount of benefits paid or denied for services under the Medicare program.