PR-1
PR · Patient Responsibility
PR-1 Denial Code: Amount applied to the patient's deductible
The amount applied to the patient's plan deductible. This is patient responsibility, not a denial, and is billable to the patient.
- Group code
- PR - Patient Responsibility
- Code type
- CARC
- Billable to patient?
- Yes - patient responsibility
- Appealable?
- No - verify it was applied correctly
- Category
- Patient Responsibility
On a remittance
CAS*PR*1*125.00On a paper EOB it shows as PR-1.What PR-1 means
PR-1 is an adjustment, not a denial. It shows the portion of the allowed amount applied to the patient's deductible before the plan begins paying. With the PR group code, this is billable to the patient. Post it to patient responsibility and bill per your financial policy.
Common causes
- The patient had not yet met their plan deductible for the benefit period.
- A high-deductible health plan applies most early-year costs to the patient.
- The service applies to a separate (for example, out-of-network) deductible.
How to fix it
- Post the PR-1 amount to patient responsibility and bill the patient.
- Confirm the deductible was applied correctly against remaining deductible if the amount looks off.
- Coordinate with any secondary payer, which may pick up part of the deductible.
How to prevent it
- Verify remaining deductible at eligibility check and set patient expectations up front.
- Collect estimated patient responsibility at time of service where appropriate.
- Bill secondary coverage promptly when present.
No - verify it was applied correctlyPR-1 is a plan cost-share, not a payer error, so there is no denial to appeal - but you are not stuck. Verify the deductible was applied correctly (payers do misapply it, for example charging a deductible that was already met); if it is wrong, request reprocessing. Otherwise bill any secondary payer, then bill the patient for the remainder.