PR-1, PR-2, PR-3 — Deductible, Coinsurance, Copay (patient responsibility)

Patient-Responsibility CARCs: PR-1, PR-2, PR-3#

These three codes carry the PR (Patient Responsibility) group code, meaning the amount can and should be billed to the patient. They are not denials — they are normal cost-sharing allocations from the patient's benefit plan.

PR-1 — Deductible Amount. The portion applied to the patient's annual deductible. Until the deductible is met, the patient pays the allowed amount for covered services. Example: PR-1 for $150 means $150 of the allowed amount went toward the deductible and is the patient's bill.

PR-2 — Coinsurance Amount. The patient's percentage share of the allowed amount after the deductible is met (e.g., 20% coinsurance). Example: PR-2 for $24 on a $120 allowed amount is the 20% coinsurance the patient owes.

PR-3 — Co-payment Amount. A fixed dollar amount the plan requires the patient to pay per service or visit (e.g., $30 specialist copay). Example: PR-3 for $30.

How they fit together on a remittance:

For a $200 billed lab test with a $120 contracted allowed amount, an ERA might show:

• CO-45 $80 — contractual write-off (provider, not billable to patient).
• PR-2 $24 — 20% coinsurance (patient owes).
• Payer pays $96.

Action: PR codes are not appealed. They drive patient statements and patient collections. The revenue cycle action is to bill the patient accurately for the PR amount, offer payment options, and — increasingly — provide an up-front patient cost estimate so the PR balance is not a surprise. Misclassifying a PR amount as a write-off (or vice versa) directly distorts net revenue.