PR 27: Coverage Terminated
Coverage had ended on the date of service.
Re-verify eligibility. If another plan was active, rebill that payer.
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What PR 27 means
PR: Patient responsibility. This one goes on the patient statement.
So the balance is billable to the patient, provided your advance notice was in order. Check that before the statement goes out. Billing a patient for something you contractually agreed to absorb is the expensive mistake on this code.
The same code, a different prefix. 27 also arrives as CO 27. The reason for the denial is the same. The prefix decides who pays for it, so the next step is not the same. If your remit says CO 27, read that page instead.
Is It Worth Appealing?
Usually lost. Recoverable only with unusual evidence. Triage by dollar value.
Why It Fires
In the order we see it.
Coverage had terminated before the date of service.
How to Appeal PR 27, Step by Step
Re-verify eligibility. If another plan was active, rebill that payer.
- 1Step 1: Read the remark code. Find the remark code printed next to PR 27 on the 835 or EOB. It says what the payer wants back. The usual ones are N30.
- 2Step 2: Find the cause. Match the denial to one of the cause in Why It Fires above, and fix that one.
- 3Step 3: Take the first action. Re-verify eligibility. If another plan was active, rebill that payer.
- 4Step 4: Attach the documentation. Evidence another plan was active, and a rebill to that payer.
- 5Step 5: Send the appeal before the deadline. Send it to the payer with the claim, the denial and the documentation, inside the payer's appeal window. See what an appeal letter must contain and the filing limits by payer.
The common mistake. Re-verify eligibility before writing this off. A termination date in the payer's system is sometimes wrong, and the patient often has other coverage.
Free: the Denial Code Appeal Playbook. 53 codes on one sheet: appeal, fix and resubmit, or let it go, and what to attach. Get the playbook
PR 27 description
Coverage had ended on the date of service.
Coverage had ended on the date of service. So the balance is billable to the patient, provided your advance notice was in order. Check that before the statement goes out. Billing a patient for something you contractually agreed to absorb is the expensive mistake on this code.
This is our plain-English wording, not the official X12 text. X12 asserts copyright over the published descriptions, so we write our own and say what it means for the money rather than restating the code.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
The Remark Code Beside It
The adjustment code says the claim was reduced. The remark code printed next to it says why, and it is the one that tells you what to send back.
| Remark | What it means |
|---|---|
| N30 | The patient was not eligible for this particular service on that date. That is narrower than not being covered at all, and the difference matters. |
Related Codes
CO 185
The rendering provider is not eligible to perform the service billed.
Read the CO 185 pagePR 242
The provider was out of network, or not the patient's assigned primary care provider.
Read the PR 242 pagePR 26
Service fell before coverage started.
Read the PR 26 pageCO B7
The provider was not certified or eligible for this service on that date.
Read the CO B7 page
Your Questions Answered
What does PR 27 mean?
Coverage had ended on the date of service. Patient responsibility. This one goes on the patient statement.
Can you appeal PR 27?
Usually lost. Re-verify eligibility. If another plan was active, rebill that payer.
Why does PR 27 happen?
Coverage had terminated before the date of service.
What documentation wins a PR 27 appeal?
Evidence another plan was active, and a rebill to that payer.
How do I appeal a PR 27 denial?
Step 1: Read the remark code. Find the remark code printed next to PR 27 on the 835 or EOB. It says what the payer wants back. Step 2: Find the cause. Match the denial to one cause: Coverage had terminated before the date of service. Step 3: Take the first action. Re-verify eligibility. If another plan was active, rebill that payer. Step 4: Attach the documentation. Evidence another plan was active, and a rebill to that payer. Step 5: Send the appeal before the deadline. Send it to the payer with the claim, the denial and the documentation, inside the payer's appeal window.
Most searched: CO 97 · CO 96 · OA 23 · PR 204 · CO 109 · CO 197 · CO 45 · CO 50
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