AAPC Certified Professional Biller (CPB) — Question 2

Which document communicates to the payer that the provider is requesting reimbursement?

Answer options

• A. Centers of Medicare and Medicaid Services150 (CMS1500)
• B. Explanation of Benefits
• C. Hold Harmless Clause
• D. Health Insurance Claim

Correct answer: D

Explanation

The Health Insurance Claim is the correct answer because it is the formal request sent to the payer for reimbursement. The CMS1500 is a specific form used to submit claims, but it does not independently communicate the request. The Explanation of Benefits details the payer's processing of claims, while the Hold Harmless Clause pertains to liability issues, not reimbursement requests.