CARC 130 Active

PR-130: Claim Submission Fee

TL;DR

Patient responsibility — review the adjustment and determine if the patient truly owes this amount.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does PR-130 Mean?

With PR (Patient Responsibility), the CARC 130 adjustment for claim submission fee 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 130 means the payer adjusted the payment based on claim submission fee. 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: the payer charges a fee for processing paper claims to incentivize electronic submission, and the fee is deducted from the payment; The payer's contract includes a per-claim transaction fee that is deducted from each payment as an administrative cost; The payer charges a fee for resubmitted or corrected claims, and the fee is deducted from the reprocessed payment. The group code paired with CARC 130 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-130 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.
Do Not Appeal This Code

This is a contractual claim submission fee, not a denial. If the fee is not in your contract, contact the payer directly to dispute it as a contract issue.

How to Prevent PR-130

Also Filed As

The same CARC 130 may appear with different Group Codes:

CO-130 OA-130

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://www.cms.gov/medicare/claims-appeals/organization-determinations
  2. https://www.aapc.com/resources/claim-adjustment-reason-code-carc
  3. https://www.mdclarity.com/denial-code/130
  4. Codes maintained by X12. Visit x12.org for official definitions.