MCMCB Pro

PR-3 denial code

Copay. A fixed amount the patient owes for the visit. Not a denial.

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

  1. 1The plan has a fixed copay for this service type.

How do I fix a PR-3 denial?

  • Collect from the patient. Ideally you already did, at check-in.

How to stop the next one

Nothing to prevent — but a copay collected at the desk costs nothing to collect.

Our diagnosis scrubber will not catch this one. PR-3 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.

Related denials

The explanation above is ours, written to be useful. The official wording of PR-3 is published and copyrighted by X12, and we do not reproduce it — read it at X12. Reference information for professional coders and billers; not billing or legal advice.