PR-2
PR · Patient Responsibility
PR-2 Denial Code: Patient's coinsurance share of the allowed amount
The patient's coinsurance share of the allowed amount. Patient responsibility and 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*2*125.00On a paper EOB it shows as PR-2.What PR-2 means
PR-2 is the coinsurance portion - the percentage of the allowed amount the patient owes after any deductible. It is an adjustment, not a denial. Post it to patient responsibility and bill the patient or secondary payer.
Common causes
- The plan requires the patient to pay a percentage (for example 20%) of the allowed amount.
- The service fell under a benefit tier with coinsurance rather than a flat copay.
- Out-of-network benefits applied a higher coinsurance rate.
How to fix it
- Post the PR-2 amount to patient responsibility and bill accordingly.
- Bill any secondary payer, which may cover part or all of the coinsurance.
- Verify the coinsurance percentage matches the plan if the amount seems incorrect.
How to prevent it
- Confirm coinsurance rates during eligibility verification.
- Estimate and communicate patient responsibility before or at the visit.
- Submit to secondary coverage quickly to reduce patient balances.
No - verify it was applied correctlyPR-2 is a plan cost-share, not a payer error, so there is no denial to appeal - but confirm the coinsurance percentage and amount are correct for the plan; if misapplied, request reprocessing. Then bill any secondary payer and the patient for the balance.