Insurance Company statement of how a claim is settled

Insurance Company statement of how a claim is settled

• A. Capitation
• B. Explanation of Benefits
• C. Clean claim
• D. Fraud

Answer: (B)

Understanding how a claim is settled is shown by the EOB, which details the insurer's payments and the patient's responsibility. It lists what was charged, what the insurer allowed, what the payer actually covered, any patient cost share, and reasons for any adjustments or denials. This document gives the final disposition of the claim and explains why certain amounts are paid or unpaid. Capitation describes a payer model that gives a provider a fixed amount per patient, not how a specific claim is settled. A clean claim refers to a properly submitted claim ready for processing, not the result of the settlement. Fraud is illegal manipulation of claims. The settlement-focused information and explanations in the EOB make it the best fit.

Understanding how a claim is settled is shown by the EOB, which details the insurer's payments and the patient's responsibility. It lists what was charged, what the insurer allowed, what the payer actually covered, any patient cost share, and reasons for any adjustments or denials. This document gives the final disposition of the claim and explains why certain amounts are paid or unpaid. Capitation describes a payer model that gives a provider a fixed amount per patient, not how a specific claim is settled. A clean claim refers to a properly submitted claim ready for processing, not the result of the settlement. Fraud is illegal manipulation of claims. The settlement-focused information and explanations in the EOB make it the best fit.