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What is a claim?

A claim is a bill of medical codes that healthcare providers charge to patients’ payors. A claim offers insight into the medical services provided during patient visits, including information on pharmaceuticals, medical devices and medical supplies. Healthcare organizations can also use claims to track referral patterns

Payors include private insurers, Medicare and Medicaid, and common medical code sets are the International Classification of Disease (ICD-10), Healthcare Common Procedure Coding System (HCPCS) and the Current Procedural Terminology (CPT).  

Why are claims important to healthcare?

Claims are important to healthcare because they track critical medical information related to care locations, procedures, costs and diagnoses. Claims data can also help healthcare organizations enhance their go-to-market strategies by targeting total addressable markets (TAMs), territories and providers more effectively.