Claims adjudication is the process by which insurance companies review, evaluate, and make a determination on healthcare claims submitted by healthcare providers. It involves the examination of the claim for accuracy, completeness, medical necessity, and compliance with the insurance policy’s terms and conditions. The goal of claims adjudication is to determine the appropriate payment or […]
Articles Tagged: claim
What is EOB in medical billing?
An Explanation of Benefits (EOB) is a document provided by an insurance company to the policyholder and the healthcare provider, detailing the outcome of a medical claim. It serves as a summary of how the insurance company processed the claim, the amounts billed, the amounts covered, and any remaining balances or patient responsibilities. Here’s what […]
What is Coordination of Benefits (COB) in Medical Billing?
Coordination of Benefits (COB) is a process used in medical billing to determine the primary and secondary insurance coverage for an individual who has multiple health insurance plans. When a person is covered by more than one insurance plan, COB ensures that the total benefits paid by all the plans do not exceed the actual […]
What is claim denial in medical billing?
Claim denial in medical billing refers to the rejection or refusal of a submitted healthcare claim by an insurance company or payer. When a claim is denied, it means that the insurance company has determined that the billed services or procedures are not eligible for reimbursement or do not meet the necessary requirements for payment. […]