IntroductionWe always say I'm healthy, but what does being healthy really mean? The term healthy is defined differently by different people. Generally, being healthy means being free from disease or any form of injury. But is this really true? Can we really be safe from all forms of illness or injury? The answer to this question is no. People are prone to illness or injury, but after getting sick, what? Next comes the visit to the service provider. The number of visits (to doctors' offices, hospital outpatient clinics, and emergency departments) amounts to 1.2 billion in the United States alone [1]. In addition, these visits are very expensive. The only factor that makes it affordable is health insurance. What is health insurance? According to the Health Insurance Association of America, health insurance is defined as “coverage that provides for the payment of benefits following an illness or injury.” Includes insurance for losses due to accident. , medical expenses, disability or accidental death and dismemberment” [2]. Health insurance processing is one of the few complex processes that takes place after the provider visit. The claim request is made after prior authorization. Pre-authorization is an integral part of usage management. What is utilization management? Utilization management (UM) is the process by which a health care system, services and facilities can be evaluated for appropriateness and whether they are established according to established guidelines. by health insurance plans. Utilization management describes proactive procedures, discharge planning, concurrent planning, precertification, and clinical case calls. UM also covers concurrent clinical review and appeals initiated by the provider, payer, or patient. Middle of paper usage......the Statement of Benefits (EOB) is created with the benefits check that is mailed to the patient and physician respectively. , Institution for Health Care Research and Policy, Georgetown University, on behalf of the Henry J. Kaiser Family Foundation.[3] http://chiroeco.com/chiro-blog/medical-clearinghouse/2009/04/07/paper-claims-vs-electronic-claims/[4] http://www.ihealthbeat.org/picture-of-health /2013/what-percentage-of-health-insurance-claims-were-filed-by-paper-or-electronic-processes[5] http://www.wisegeek.org/what-is-claims-adjudication.htm [6] http://www.staysmartstayhealthy.com/health_insurance_deductibles