Which form would you review to verify if a claimed procedure was approved or denied and to see the patient's remaining balance?

Which form would you review to verify if a claimed procedure was approved or denied and to see the patient's remaining balance?

• A. Encounter
• B. Co-payment
• C. Procedure number
• D. Explanation of benefits

Answer: (D)

The form you review to verify if a claimed procedure was approved or denied and to see the patient’s remaining balance is the insurer’s benefits statement (often called an Explanation of Benefits, or EOB). This document comes after a claim is processed and shows each procedure code, whether the claim was approved or denied, the amount the insurer allowed, any patient responsibility (coinsurance, deductible, or copay), and the remaining balance the patient owes. In daily practice, the benefits statement is the clearest source to confirm adjudication status and calculate what the patient still needs to pay. The other items in the workflow don’t provide both pieces of information. The encounter record documents what happened during the visit but not the insurer’s decision or the patient’s remaining balance. The copayment is simply the amount due at the time of service. The procedure code identifies the service but doesn’t reveal approval status or the patient’s remaining financial responsibility.

The form you review to verify if a claimed procedure was approved or denied and to see the patient’s remaining balance is the insurer’s benefits statement (often called an Explanation of Benefits, or EOB). This document comes after a claim is processed and shows each procedure code, whether the claim was approved or denied, the amount the insurer allowed, any patient responsibility (coinsurance, deductible, or copay), and the remaining balance the patient owes. In daily practice, the benefits statement is the clearest source to confirm adjudication status and calculate what the patient still needs to pay.

The other items in the workflow don’t provide both pieces of information. The encounter record documents what happened during the visit but not the insurer’s decision or the patient’s remaining balance. The copayment is simply the amount due at the time of service. The procedure code identifies the service but doesn’t reveal approval status or the patient’s remaining financial responsibility.