PR-27 Denial Code Explained

PR-27 is a medical billing denial code that indicates expenses were incurred after the patient's insurance coverage terminated. This denial commonly occurs when services are provided after the policy's effective coverage period has ended.

What Does PR-27 Mean?

The PR-27 denial code means the insurance payer determined the patient's coverage was no longer active on the date of service.

This denial is often related to terminated policies, eligibility issues, or outdated insurance information.

Common Reasons for PR-27

• Insurance coverage terminated before the date of service

• Incorrect coverage information on file

• Patient failed to maintain insurance coverage

• Employer-sponsored coverage ended

• Policy cancellation

• Eligibility verification issues

How To Fix PR-27

Review the patient's insurance eligibility and verify coverage dates. Confirm whether active coverage existed on the date of service and update any incorrect insurance information.

If coverage was active and the denial was issued incorrectly, submit documentation supporting eligibility and request claim reconsideration.

Frequently Asked Questions

What does PR-27 mean?

PR-27 means the payer determined the patient's insurance coverage had terminated before the date of service.

Can PR-27 be appealed?

Yes. If the patient had active coverage on the service date, supporting eligibility documentation may help overturn the denial.

Can the patient be billed for PR-27?

In many cases, yes. If coverage truly terminated before services were provided, the patient may be responsible for the charges.

How can providers prevent PR-27 denials?

Verify patient eligibility and coverage status before services are rendered.

Is PR-27 related to eligibility verification?

Yes. Eligibility and coverage date errors are among the most common causes of PR-27 denials.

Related Denial Codes

You may also encounter:

• CO-26 — Expenses incurred prior to coverage

• CO-27 — Expenses incurred after coverage terminated

• CO-20 — Another payer is primary

• CO-109 — Claim not covered by this payer

Quick Summary

PR-27 indicates expenses were incurred after the patient's insurance coverage terminated. Most denials are caused by eligibility issues, terminated policies, or outdated insurance information.