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.
Usually lost. Recoverable only with unusual evidence. Triage by dollar value.
In the order we see it.
Coverage had terminated before the date of service.
Re-verify eligibility. If another plan was active, rebill that payer.
The documentation, not the argument.
Evidence another plan was active, and a rebill to that 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.
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.
Send your denial summary for the last ninety days. Four columns: payer, CARC code, count, billed amount. I will tell you which were winnable and what they were worth.
Send your denial summary No patient data. No BAA. No charge.
AppealHound