PR - Patient Responsebility denial code list

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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.
























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7 Comments

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  3. Anonymous27 May 2019 at 18:31

    Thank you for sharing this Patient Responsibility denial code list. It's very helpful and for those who avail the of dental billing services those code may help you and understand your dental biller assistant.

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