Certified Revenue Cycle Representative (CRCR) Practice Exam 2026 - Free CRCR Practice Questions and Study Guide

The sequential order of a Silent PPO scheme is crucial for understanding how claims are processed when the patient’s insurance benefits include access to a PPO network that the provider is not directly contracted with. The correct choice illustrates an essential step in the process.

In a Silent PPO scenario, after the patient's insurance company verifies coverage and access to the PPO database, the claim can be re-priced based on the discounts that the insurance has access to. This is a key aspect, as it involves the application of contractual adjustments determined by the PPO discounts even though the provider did not explicitly agree to those terms. This step is foundational because it allows the healthcare provider to receive payment that is less than what they may have expected since the discounts do not reflect a negotiated rate they are aware of or agreed to.

The correctness of this answer lies in recognizing that the process of re-pricing based on the PPO discounts accessed comes before any further actions, such as sending the claim to the primary insurance company or the provider accepting the payment terms indicated on the EOB. It establishes the financial terms under which the claim will be settled and sets the stage for the subsequent steps in the claims management process. Understanding this order is critical for navigating the complexities of Silent PPO arrangements and the financial implications for healthcare