Which form must be completed and submitted for reimbursement?

• A. The UB-04 Claim Form.
• B. ICD-10-CM Coding Sheet.
• C. The CMS-1500 Health Insurance Claim Form.
• D. The HIPAA 5010 Transaction Summary.

Answer: (C)

The main concept is that the CMS-1500 Health Insurance Claim Form is the standard form used to bill for professional services and seek reimbursement from payers. It is designed for individual clinicians, physicians, and other non-institutional providers to submit claims for outpatient or office-based services. In contrast, the UB-04 is used for institutional claims (hospitals and similar facilities), ICD-10-CM is the diagnosis coding system used on claims, and HIPAA 5010 refers to the electronic transmission standard for submitting claims, not a specific fillable claim form. So for reimbursement of professional services, the CMS-1500 is the form to complete and submit.