CARC 131 Active

PR-131: Claim-Specific Negotiated Discount

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-131 Mean?

With PR (Patient Responsibility), the CARC 131 adjustment for claim-specific negotiated discount 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 131 means the payer adjusted the payment based on claim-specific negotiated discount. 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: a single-case agreement was negotiated between the provider and payer for a specific claim, and CARC 131 reflects the negotiated discount from the billed charges; The payer and provider agreed to a reduced rate for a specific claim or service, different from the standard contracted rate; An out-of-network provider negotiated a specific discount for a particular claim as part of the payment arrangement. The group code paired with CARC 131 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-131 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 voluntarily negotiated discount, not a denial. If the discount amount does not match the agreed terms, contact the payer to resolve it as a contract dispute.

How to Prevent PR-131

Also Filed As

The same CARC 131 may appear with different Group Codes:

CO-131 OA-131

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/131
  4. Codes maintained by X12. Visit x12.org for official definitions.