What is a claim in the context of healthcare?

In the context of healthcare, a claim is fundamentally understood as a request for payment for services provided to patients. When healthcare providers offer medical services or treatments, they submit claims to insurance companies or payers to receive reimbursement for those services. This process typically involves detailing the specific services rendered, associated costs, and relevant patient information, allowing the payer to assess the claim and determine the coverage eligibility according to the patient’s insurance plan.

The other options describe related concepts but do not accurately define what a claim is. A summary of services rendered, for instance, might be included in part of a claim but does not encompass the claim itself. An internal audit of financial practices pertains to evaluating an organization’s financial integrity and performance, while a notification of changes in patient eligibility refers to updates on whether a patient’s insurance coverage is valid, which is separate from the claims process.