Copayment
The fixed per-visit copay the patient owes under the plan.
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 plan cost sharing.
- The front desk did not collect the copay at check-in.
The fix
Collect at the visit whenever possible. If it was not collected, send a statement. Verify copay amounts during eligibility checks so staff quote the right number.
Appeal or corrected claim?
Nothing to appeal or correct.
Deadline to watch
None from the payer.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
PR-3 in short
What does PR-3 mean?
The fixed per-visit copay the patient owes under the plan. The official X12 text reads: "Co-payment Amount"
What usually causes a PR-3 denial?
Normal plan cost sharing. The front desk did not collect the copay at check-in.
How do I fix PR-3?
Collect at the visit whenever possible. If it was not collected, send a statement. Verify copay amounts during eligibility checks so staff quote the right number.
Should I appeal PR-3 or send a corrected claim?
Patient responsibility. Nothing to appeal or correct.
What deadline applies to PR-3?
None from the payer.