Very CommonPatient Responsibility (PR)Patient Responsibility
PR-1: Deductible amount
The patient is responsible for the deductible amount on this claim. The service is covered, but the patient has not yet met their annual deductible, so the allowed amount (or portion of it) is being applied to the patient's deductible.
Common Causes
- Patient has not met their annual deductible
- Deductible resets at the beginning of the plan year
- High-deductible health plan (HDHP) with large deductible amounts
- Service applies to the medical deductible rather than a separate deductible category
How to Resolve PR-1
- 1This is not a denial -- the claim was processed correctly. The patient owes this amount.
- 2Send a patient statement for the deductible amount
- 3Offer payment plans for large deductible amounts
- 4Verify the deductible amount matches the patient's plan benefits
- 5If the deductible should have been met, appeal with documentation of prior payments
How to Prevent PR-1 Denials
- Check deductible status during pre-visit verification so you know what to collect
- Inform patients of their deductible responsibility before the visit
- Collect estimated patient responsibility at time of service when possible
- Verify deductible accumulation for patients with January/February dates of service
Related Denial Codes
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