PR-118: ESRD Network Support Adjustment

What Does PR-118 Mean?

With PR (Patient Responsibility), the CARC 118 adjustment for esrd network support adjustment shifts the financial impact to the patient. Before billing the patient, verify that the denial reason is valid. if the underlying issue can be corrected, resubmit the claim first to potentially eliminate the patient's liability.

CARC 118 means the payer adjusted the payment based on esrd network support adjustment. The reimbursement was calculated using the payer's fee schedule, contracted rate, or regulatory payment methodology rather than the billed charge.

Common scenarios that trigger this adjustment include: medicare deducts a per-treatment amount from ESRD facility payments to fund the ESRD Network Organizations that oversee quality of care for dialysis patients. CARC 118 reflects this standard deduction.; The per-treatment network support deduction rate was updated by CMS, and the new rate is reflected in the payment adjustment. The group code paired with CARC 118 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

How to Resolve

1. Review the adjustment Examine the PR-118 adjustment and any RARC codes to understand the basis for the patient responsibility.
2. Verify the adjustment is correct Confirm the PR designation and amount are appropriate based on the patient's plan benefits.
3. Appeal if incorrect If the adjustment appears incorrect, file an appeal with supporting documentation.
4. Collect from the patient if valid If the adjustment is confirmed correct, generate a patient statement and follow standard collection procedures.

How to Prevent PR-118

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

Also Filed As

The same CARC 118 may appear with different Group Codes:

Related Denial Codes