CPB Certified Professional Biller Certification Practice Exam

Which document informs the payer that the provider is requesting reimbursement?

1. Patient Registration Form

2. Health Insurance Claim

3. Benefits Application

4. Provider Agreement

The correct answer is: Health Insurance Claim

The Health Insurance Claim serves as the primary document used to inform the payer that the provider is requesting reimbursement for services rendered. This document contains detailed information about the patient, the services provided, the associated costs, and the codes that correspond to diagnoses and procedures performed. It is a formal request for payment from the insurance company and outlines all necessary details that help the payer assess the claim for reimbursement. The other options do not fulfill this role. The Patient Registration Form is primarily used to gather demographic and insurance information from the patient and does not request payment. The Benefits Application is a document used during the enrollment process for health insurance but is not a request for reimbursement. The Provider Agreement outlines the terms and conditions between the provider and the insurer but does not serve as a claim for payment. Understanding the purpose and function of the Health Insurance Claim is crucial for billing professionals, as it directly ties to how and when providers receive payment for their services.