After review of the information provided, are there any errors on the claim form? If so, which elements are incorrect?
I. Primary insurance
II. Secondary insurance
III. Primary insurance policy number
IV. Date of birth
V. Date of injury
VI. Relationship to the insured
VII. Dates patient is unable to work
VIII. CPT codes
IX. Modifier use
X. Diagnosis code
A. I, VI, and X
B. VII, VIII, IX, and X
C. II, III, III, IV, V, and VI
D. None of the above.