Very CommonPatient Responsibility (PR)Patient Responsibility
PR-2: Coinsurance amount
The patient is responsible for the coinsurance amount on this claim. After the deductible is met, the patient owes their coinsurance percentage (commonly 10-40%) of the allowed amount.
Common Causes
- Standard coinsurance applies after deductible is met
- Out-of-network coinsurance rate applied (typically higher than in-network)
- Service falls under a benefit tier with different coinsurance
How to Resolve PR-2
- 1This is not a denial -- the claim was processed correctly. Bill the patient.
- 2Verify the coinsurance percentage matches the patient's plan
- 3Send a patient statement for the coinsurance amount
- 4If the coinsurance rate seems incorrect, verify the patient's network status and plan type
How to Prevent PR-2 Denials
- Know the patient's coinsurance rate before the visit
- Provide cost estimates to patients that include coinsurance
- Verify whether the patient has met their out-of-pocket maximum
Related Denial Codes
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