Service after coverage ended
The patient's coverage with this payer had ended before the date of service.
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
- Patient changed jobs or plans and did not tell the practice.
- Coverage terminated for non-payment of premium.
- Wrong date of service on the claim.
The fix
Ask the patient for current insurance and bill it. If no coverage was active, bill the patient. Run an eligibility check before every visit so this is caught at check-in.
Appeal or corrected claim?
Nothing to appeal. Redirect to the new plan or bill the patient.
Deadline to watch
The new plan's timely filing limit runs from the date of service, so move quickly.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
PR-27 in short
What does PR-27 mean?
The patient's coverage with this payer had ended before the date of service. The official X12 text reads: "Expenses incurred after coverage terminated."
What usually causes a PR-27 denial?
Patient changed jobs or plans and did not tell the practice. Coverage terminated for non-payment of premium. Wrong date of service on the claim.
How do I fix PR-27?
Ask the patient for current insurance and bill it. If no coverage was active, bill the patient. Run an eligibility check before every visit so this is caught at check-in.
Should I appeal PR-27 or send a corrected claim?
Patient responsibility. Nothing to appeal. Redirect to the new plan or bill the patient.
What deadline applies to PR-27?
The new plan's timely filing limit runs from the date of service, so move quickly.