Coinsurance
The patient's share of the allowed amount after the deductible, usually a percentage such as 20 percent. The patient owes it.
PR = Patient Responsibility. The patient owes this amount (deductible, coinsurance, copay or a non-covered service the patient agreed to pay for). The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- Normal cost sharing under the patient's plan.
- Medicare Part B leaves 20 percent coinsurance on most services.
The fix
Bill the patient or the secondary payer (Medigap, Medicaid). For Medicaid or QMB patients, do not bill the patient; see N781 and N782.
Appeal or corrected claim?
Nothing to appeal or correct unless the allowed amount itself is wrong (then compare it to your contract and dispute the allowed amount, see CO-45).
Deadline to watch
Secondary payer timely filing limit, often 90 to 365 days from the primary remittance date.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
Often seen together
Coinsurance applied for a Qualified Medicare Beneficiary. Do not bill the patient; bill Medicaid as the secondary payer.
PR-2 in short
What does PR-2 mean?
The patient's share of the allowed amount after the deductible, usually a percentage such as 20 percent. The patient owes it. The official X12 text reads: "Coinsurance Amount"
What usually causes a PR-2 denial?
Normal cost sharing under the patient's plan. Medicare Part B leaves 20 percent coinsurance on most services.
How do I fix PR-2?
Bill the patient or the secondary payer (Medigap, Medicaid). For Medicaid or QMB patients, do not bill the patient; see N781 and N782.
Should I appeal PR-2 or send a corrected claim?
Patient responsibility. Nothing to appeal or correct unless the allowed amount itself is wrong (then compare it to your contract and dispute the allowed amount, see CO-45).
What deadline applies to PR-2?
Secondary payer timely filing limit, often 90 to 365 days from the primary remittance date.