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PR-3 - Denial Journal
CARC PR — Patient Responsibility

PR-3

Co-payment amount

What This Code Means

The amount applied is the patient’s fixed co-payment for this type of visit or service.

Common Causes

  • Standard fixed cost-share defined by the plan
  • Copay amount differs for specialist vs. primary care visits

How to Resolve or Appeal

  1. Collect the copay at time of service going forward to reduce A/R
  2. Confirm the copay amount matches the patient's ID card/plan
  3. Bill retroactively if not collected at check-in

More Denial Codes to Check

CARC CO-276 RARC MA55 CARC CO-60 Outpatient services not covered within a period before/after inpatient services CARC CO-147 Provider contracted/negotiated rate expired or not on file CARC CO-35 Lifetime benefit maximum has been reached CARC PR-204 Service/equipment/drug not covered under the patient's current benefit plan CARC CO-45 Charge exceeds fee schedule/maximum allowable or contracted amount

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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