Which form is sent to both patient and provider detailing the payment or denial for procedures performed?

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

Answer: (A)

Understanding how claims are settled is essential for clear billing communication. The form sent to both the patient and the provider that details how a claim was processed—what was paid, what was denied, and what the patient may owe—is the insurer’s benefits statement. It lays out the billed amount, the allowed amount, any payments made by the insurer, any adjustments, and the denial reasons if applicable. This document directly explains the financial outcome of procedures, making it the best fit for describing payment or denial.

This differs from an encounter, which is the clinical record of the visit; a co-payment, which is the fixed amount paid at the time of service; and a procedure number, which is a billing code used for documentation, not a summary of payment results.