Certified Revenue Cycle Representative (CRCR) Practice Exam

If both of a patient's insurance plans are processed as primary, what should the provider do?

1. Accept the payment and move on

2. Determine the correct payer and notify the incorrect payer of the processing error

3. Contact the patient for clarification

4. Void the claims and resubmit

The correct answer is: Determine the correct payer and notify the incorrect payer of the processing error

When both of a patient's insurance plans are processed as primary, the most appropriate action for the provider is to determine the correct payer and notify the incorrect payer of the processing error. This approach is essential in ensuring that the claims are settled accurately and in accordance with payer guidelines. Each insurance policy has specific rules about coordination of benefits, which dictates how claims should be submitted and processed between multiple plans, usually identifying one as primary and the other as secondary. By notifying the incorrect payer, the provider can rectify any billing discrepancies and ensure that the patient is not double-billed for the same services. This resolution process also helps maintain compliance with regulatory requirements and upholds the integrity of the revenue cycle, which is crucial for the financial health of healthcare providers. It supports proper payment for services delivered while also protecting the provider from potential future billing disputes or audits related to claims processing. The other options do not effectively resolve the issue. Simply accepting the payment and moving on does not address the potential overpayment or incorrect billing situation. Contacting the patient for clarification may lead to unnecessary delays and might not provide the information needed to identify the correct insurance policy. Voiding the claims and resubmitting them is not an effective initial response, as it does not address identifying the correct