PR-106: Patient Payment Option Not in Effect

What Does PR-106 Mean?

With PR (Patient Responsibility), the patient payment option not in effect is the patient's financial obligation. The insurer processed the claim, applied the patient's plan benefits, and this amount is owed directly by the patient. The most common scenario is because the patient's payment option is not in effect, the patient is responsible for the applicable cost-sharing under standard benefit terms.

CARC 106 appears on a remittance when the payer applies an adjustment for patient payment option not in effect. Review the group code and any accompanying RARC codes to understand the full context of this adjustment.

Common scenarios that trigger this adjustment include: the patient selected a specific payment option (such as an installment plan or payroll deduction) that was not in effect at the time the claim was processed; The patient's chosen payment arrangement does not apply to the type of service billed, and the standard payment methodology applies instead; The patient's payment option enrollment was not properly processed or recorded in the payer's system. The group code paired with CARC 106 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

Common Causes

How to Resolve

1. Verify the patient payment option not in effect amount Cross-reference the adjusted amount against the patient's benefits summary or eligibility response to confirm the patient payment option not in effect amount was applied correctly per plan terms.
2. Confirm plan benefit details Use the payer portal or eligibility tool to verify the patient's current benefit status and confirm the adjustment aligns with plan terms.
3. Generate a patient statement Prepare a clear statement showing the service rendered, the allowed amount, the patient payment option not in effect amount, and the balance the patient owes.
4. Collect from the patient Send the statement and follow your practice's collection workflow. Offer payment plan options for substantial balances.
5. Track and follow up Record payments received, update the account balance, and follow up on outstanding amounts per your collection policy.

How to Prevent PR-106

• Verify patient benefits and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively

Also Filed As

The same CARC 106 may appear with different Group Codes:

Related Denial Codes