Question

instructions: select the most appropriate response.
which document communicates to the payer that the provider is requesting reimbursement?
○ a. explanation of benefits
○ b. ledger card
○ c. appeals letter
○ d. health insurance claim

Explanation:

• An explanation of benefits (a) shows what services were covered and how much the insurer paid. It is not a request for reimbursement.
• A ledger card (b) is used for record - keeping within a practice or business, not for requesting reimbursement from a payer.
• An appeals letter (c) is used to contest a decision (e.g., a denial of coverage), not to initially request reimbursement.
• A health insurance claim (d) is specifically a document sent by the provider to the payer to request reimbursement for services provided to a patient.

Answer:

d. health insurance claim