PR-132: Prearranged Demonstration Project Adjustment

What Does PR-132 Mean?

With PR (Patient Responsibility), the CARC 132 adjustment for prearranged demonstration project 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 132 appears on a remittance when the payer applies an adjustment for prearranged demonstration project adjustment. 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 provider participates in a CMS Innovation Center demonstration project, and CARC 132 reflects the adjusted payment per the project's specific payment methodology; Under a bundled payment demonstration, the payment is adjusted to reflect the episode-based payment rather than fee-for-service rates; The provider participates in a value-based payment demonstration, and the payment is adjusted based on quality and cost performance metrics. The group code paired with CARC 132 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-132 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-132

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

Also Filed As

The same CARC 132 may appear with different Group Codes:

Related Denial Codes