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An insurance claim is a formal request by a policyholder to an insurance company for coverage or compensation for a covered loss or policy event. The insurance company validates the claim (or denies the claim).

Medical claims are the claims that an insurance company (Payer) receives from a Physician about his services to a patient (Subscriber of the insurance company). Hospital claims are the claims that an Insurance firm receives from Hospital for the services it rendered to a patient.

What is a medical claim? A medical claim is a bill that healthcare providers submit to a patient's insurance provider. This bill contains unique medical codes detailing the care administered during a patient visit. The medical codes describe any service that a provider used to render care, including: A diagnosis.