PR-1 Denial Code Explained

PR-1 is a medical billing denial code that indicates the patient is responsible for the deductible amount associated with the insurance plan. This adjustment commonly occurs before insurance coverage begins paying eligible claim expenses.

What Does PR-1 Mean?

The PR-1 denial code means part of the claim balance has been applied to the patient’s deductible responsibility according to the terms of the insurance policy.

This is not typically considered a billing error or claim rejection.

Common Reasons for PR-1

• Annual deductible not yet met

• High deductible health plans

• Patient cost-sharing requirements

• Insurance benefit plan limitations

• Deductible applied to covered services

How To Handle PR-1

Review the patient’s explanation of benefits (EOB) and confirm the deductible amount applied by the insurance payer. Providers may bill the patient directly for the deductible balance according to payer guidelines and signed financial agreements.

It is important to verify patient benefits and deductible status before treatment whenever possible.

Related Denial Codes

You may also encounter:

• PR-2 — Coinsurance amount

• PR-3 — Co-payment amount

• PR-204 — Service not covered under patient benefit plan

• CO-45 — Charge exceeds payer fee schedule

Quick Summary

PR-1 indicates the patient is responsible for the deductible portion of the claim. These adjustments are commonly related to insurance cost-sharing requirements.