Claim: A request for payment that you or your health care provider submits to your health insurer when you receive items or services you think are covered.

Claim Types:

• Medical Claims: Requests for payment for services such as doctor's visits, hospital stays, and surgeries.
• Dental Claims: Requests for payment for dental services.
• Vision Claims: Requests for payment for vision services.
• Pharmacy Claims: Requests for payment for prescription medications.

Health Care Provider: Any individual or organization that provides medical services, such as doctors, hospitals, clinics, and pharmacies.

Claimant Details: Information about the individual who is making the claim, which may include name, contact information, insurance policy number, date of birth

Refund Details: Information regarding the reimbursement of out-of-pocket expenses paid by the claimant. 

Settled Claim: A claim that has been processed and for which the insurer has made a payment or has determined that no payment is due. The settlement includes details of the amounts paid and any patient responsibility.

Unsettled Claim: A claim that has been submitted but has not yet been processed or paid. Unsettled claims may be pending due to various reasons, such as waiting for additional information or verification.