CPB Certified Professional Biller Certification Practice Exam

What does the claim's validation table refer to in medical billing?

1. ASC X12 837

2. MCR 4500

3. CMS 1500

4. UB-04

The correct answer is: ASC X12 837

The claim's validation table refers to a standardized format that outlines the required data elements for electronic claims submissions, specifically within the ASC X12 837 format. This format is a critical component of medical billing as it dictates how claims data is structured when transmitted electronically between healthcare providers and payers. Using the ASC X12 837 format allows for efficient processing and minimizes errors, which is essential in ensuring that claims are paid accurately and promptly. Following this standardized format is vital as it ensures compliance with industry regulations and enhances the interoperability of billing systems across different providers and payers. In contrast, the other options refer to different forms and documents used in the billing process. The MCR 4500 is not a standard for electronic claims submission but is rather linked to Medicare claims. The CMS 1500 is a paper claim form used primarily for billing outpatient services, and the UB-04 is used for institutional claims, primarily from hospitals. While these forms are important in the billing process, they do not specifically refer to the claim's validation table in the context of electronic claim submissions.