Claim

A submission for reimbursement (e.g., from fee-for-service providers).A claim is defined as in, 45 CFR § 162.1101 - Health care claims or equivalent encounter information transaction. The health care claims or equivalent encounter information transaction is the transmission of either of the following: (a) A request to obtain payment, and the necessary accompanying information from a health care provider to a health plan, for health care. (b) If there is no direct claim, because the reimbursement contract is based on a mechanism other than charges or reimbursement rates for specific services, the transaction is the transmission of encounter information for the purpose of reporting health care.