Match the following:

Question

A) release of information form
B) superbill
C) CMS-1500
D) clearinghouse
E) billing service
F) guarantor
G) policyholder
H) assignment of benefits
I) UB-04
J) patient information form

1) Form containing demographic, employment, and insurance information about a patient
2) Claim form used by hospitals to report services to insurance carriers
3) The person ultimately responsible for paying for medical services
4) The person who purchased an insurance policy
5) Form that allows payment to be made directly from an insurance carrier to the physician
6) Form that allows protected health information to be sent to an insurance carrier as part of the claims process
7) Form used by the provider to document ICD-10 and CPT codes from the patient visit
8) The company that provides data- and claims-processing services to physicians' offices for a fee
9) Claim form used to report services provided by physicians
10) A company hired by physician offices to file claims on their behalf

Answer 1

1) G) policyholder
2) J) patient information form
3) F) guarantor
4) H) assignment of benefits
5) I) UB-04
6) A) release of information form
7) B) superbill
8) E) billing service
9) C) CMS-1500
10) D) clearinghouse