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PR-1
Recoverability: Patient responsibility
Deductible amount
The amount applied to the member's deductible, assigned to patient responsibility. It is not a denial and is not recoverable from the payer; the work is accurate posting and clean patient collection.
Why this happens on dental claims
- Annual dental deductibles, commonly 25 to 100 dollars, applied to the first basic or major services of the plan year
- Family deductible logic applying the amount to a different family member's claim than expected
- Deductibles taken by both primary and secondary plans on dual-coverage patients
How to appeal PR-1
- Verify the deductible was not already met this plan year using the payer's accumulator
- Confirm the service category is subject to the deductible, since many plans waive it for preventive care
- On dual coverage, check whether the secondary plan picks up the primary's deductible under its coordination method
- Post patient-responsibility amounts to the ledger the day the remittance arrives and collect at the next contact
How to prevent it
- Check deductible status at eligibility verification and collect expected deductibles at the visit
Related codes
How much PR-1 money is sitting in your remittances?
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