PR-3
PR · Patient Responsibility
PR-3 Denial Code: Patient's fixed copay for the service
The patient's fixed copay for the service. 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*3*125.00On a paper EOB it shows as PR-3.What PR-3 means
PR-3 is the flat copayment the plan assigns to the visit or service type. It is an adjustment, not a denial. Ideally the copay is collected at the time of service; otherwise post to patient responsibility and bill.
Common causes
- The plan applies a fixed copay to this visit or service type.
- The copay was not collected at the front desk.
- A specialist or facility copay tier applied.
How to fix it
- Collect or bill the copay as patient responsibility.
- Reconcile against any copay collected at check-in to avoid double-billing.
- Confirm the copay tier matches the plan if it looks wrong.
How to prevent it
- Collect copays at check-in based on verified benefits.
- Display the correct copay tier (PCP vs. specialist vs. facility) to front-desk staff.
- Reconcile collected copays against remittances during posting.
No - verify it was applied correctlyPR-3 is a plan cost-share, not a payer error, so there is no denial to appeal - but confirm the copay tier is correct and was not already collected at check-in; if misapplied, request reprocessing. Then bill any secondary payer or the patient.