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: EOB
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 […]