What does denial code PR mean?
Patient Responsibility
What does the denial code PR mean? PR Meaning: Patient Responsibility (patient is financially liable). A provider is prohibited from billing a Medicare beneficiary for any adjustment amount identified with a CO group code, but may bill a beneficiary for an adjustment amount identified with a PR group code.
What does PR mean in medical billing?
PR (Patient Responsibility) is used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials.
What is reason code PR?
238 Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period (use Group Code PR). This change effective 7/1/2013: Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period.
What does PR 1 mean on an EOB?
amount applied to patient deductible
OA-23 indicates the impact of prior payer(s) adjudication, including payments and/or adjustments. PR-1 indicates amount applied to patient deductible. PR-2 indicates amount applied to patient co-insurance.
Can you bill a patient for a co denial?
You cannot bill the patient for the portion of the claim denied for this reason. However, benefit plans often have limits on chiropractic care.
What is reason code B4?
B4 Late filing penalty. B5 Payment adjusted because coverage/program guidelines were not met or. were exceeded. B6 This payment is adjusted when performed/billed by this type of provider, by. this type of provider in this type of facility, or by a provider of this specialty.
What is PR 2 medical billing?
PR 2 Coinsurance Amount Member’s plan coinsurance rate applied to allowable benefit for the rendered service(s). PR 3 Co-payment Amount Copayment Member’s plan copayment applied to the allowable benefit for the rendered service(s).
What is PR 3 on EOB?
Description: Copayment A specified dollar amount or percentage of the charge identified that is paid by a beneficiary at the time of service to a health care plan, physician, hospital, or other provider of care for covered service provided to the beneficiary.
What does code 161 mean on a claim?
Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Reason Code 162: Referral absent or exceeded. Reason Code 163: These services were submitted after this payer’s responsibility for processing claims under this plan ended. Reason Code 164: This (these) diagnosis (es) is (are) not covered.
What is the PR code for claim denied?
PR 31 Claim denied as patient cannot be identified as our insured. PR 32 Our records indicate that this dependent is not an eligible dependent as defined. PR 33 Claim denied. Insured has no dependent coverage.
What is the PR code for patient interest adjustment?
This change effective 1/1/2008: Patient Interest Adjustment (Use Only Group code PR) . PR 149 Lifetime benefit maximum has been reached for this service/benefit category. PR 166 These services were submitted after this payers responsibility for processing claims under this plan ended.
What is the difference between reason code 155 and 156?
Reason Code 155: Service/procedure was provided outside of the United States. Reason Code 156: Service/procedure was provided as a result of terrorism. Reason Code 157: Injury/illness was the result of an activity that is a benefit exclusion.