PR - Patient Responsebility denial code list

MCR - 835 Denial Code List  
PR - Patient Responsebility

PR 1 Deductible Amount

PR 2 Coinsurance Amount

PR 3 Co-payment Amount

PR 25 Payment denied. Your Stop loss deductible has not been met.

PR 26 Expenses incurred prior to coverage.

PR 27 Expenses incurred after coverage terminated.

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.

PR 34 Claim denied. Insured has no coverage for newborns.

PR 35 Lifetime benefit maximum has been reached.

PR 85 Interest amount. This change effective 1/1/2008: Patient Interest Adjustment (Use Only Group code PR)

PR 126 Deductible -- Major Medical

PR 127 Coinsurance -- Major Medical

PR 140 Patient/Insured health identification number and name do not match.

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.

PR 168 Payment denied as Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan

PR 177 Payment denied because the patient has not met the required eligibility requirements

PR 200 Expenses incurred during lapse in coverage

PR 201 Workers Compensation case settled. Patient is responsible for amount of this claim/service through WC “Medicare set aside arrangement” or other agreement. (Use group code PR).

PR 204 This service/equipment/drug is not covered under the patient’s current benefit plan

PR B1 Non-covered visits.

PR B9 Services not covered because the patient is enrolled in a Hospice.