PR-1: Deductible Amount

What Does PR-1 Mean?

With PR (Patient Responsibility), the deductible amount is owed directly by the patient. This is the standard application — the insurer processed the claim, applied the patient's plan deductible, and the remaining balance is the patient's obligation.

CARC 1 appears on a remittance when the payer reduces payment because the patient has not yet satisfied their annual deductible. The deductible is the dollar amount a patient must pay out-of-pocket each plan year before the insurance plan begins covering services. Until that threshold is met, the full allowed amount (or a portion of it) is shifted to the patient.

This adjustment is especially common early in the calendar year when deductibles reset, and for patients enrolled in high-deductible health plans (HDHPs) where the deductible can exceed several thousand dollars. The code itself is not a denial — it confirms that the payer processed the claim correctly and applied the patient's plan benefits as designed.

Common Causes

How to Resolve

1. Verify deductible status with the payer Check the patient's current deductible accumulation through the payer's eligibility system to confirm the applied amount is accurate.
2. Confirm allowed amount and deductible match Ensure the deductible amount on the remittance matches the patient's plan benefits. Cross-reference with the Explanation of Benefits.
3. Generate and send patient statement Prepare a statement that itemizes the service, allowed amount, deductible applied, and the patient's balance owed.
4. Collect the deductible amount Follow your practice's patient collection workflow. For large HDHP deductibles, proactively offer structured payment plans.
5. Monitor outstanding balances Track patient payments and send follow-up statements at regular intervals per your collection policy.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-1:

How to Prevent PR-1

• Run eligibility verification before the appointment and check the patient's remaining deductible
• Inform patients of their deductible balance at check-in so they understand potential out-of-pocket costs
• Collect estimated deductible amounts at time of service, especially early in the plan year
• Use real-time benefit verification tools to pull exact deductible status
• Track deductible accumulation throughout the year for patients with high-deductible plans

General Prevention

• Verify insurance eligibility and deductible status before providing services
• Inform patients of their remaining deductible amount at check-in
• Collect estimated deductible amounts at time of service
• Use real-time eligibility verification tools to check benefit status
• Track deductible accumulation throughout the plan year

Also Filed As

The same CARC 1 may appear with different Group Codes:

Related Denial Codes