A Statement of Claim and Benefit is provided to the claimant when a patient claim has been lodged in real time, processed by the agency and a benefit amount returned to the claimant.

In CE, this form is generates when the user submits a PCI (Medicare) claim via Eclipse. This can be seen by checking the History tab for a claim status of Medicare ASSESSED:

By clicking the icon on the left most side of the History row containing the "Retrieved claim form" text, the user can view the document.