PR-1 denial code
The amount is applied to the patient's deductible. Not a denial at all — the payer is telling you the patient has not met their deductible yet and this amount is theirs to pay.
PR — Patient Responsibility. The amount is the patient's to pay: deductible, coinsurance, or copay. These are not denials, and they are collectible.
Why you got it
- 1The patient's annual deductible has not been satisfied.
- 2It is early in the plan year and most patients have not met it.
How do I fix a PR-1 denial?
- Bill the patient. This is patient responsibility and it is legitimately collectible.
- Check it against the patient's benefits if the amount looks wrong.
How to stop the next one
Nothing to prevent. But knowing the deductible status at check-in means you can collect it then, rather than chasing it for ninety days afterwards.
Our diagnosis scrubber will not catch this one. PR-1 is driven by procedure codes, modifiers, or eligibility rather than by the diagnosis set — and procedure-side checking needs an AMA CPT licence we do not hold yet. We would rather tell you that than sell you a tool that quietly misses your most common denial.
If denials like this are a volume problem rather than a one-off, the denial management page explains how the paid workspace catches the coding causes on every claim, and the free ICD-10-CM lookup shows the coding notes behind any diagnosis code on the remittance.