CARC 139 Active

PR-139: Contracted Funding Agreement — Subscriber Employed by Provider

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-139 Mean?

With PR (Patient Responsibility), the CARC 139 adjustment for contracted funding agreement — subscriber employed by provider 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 139 appears on a remittance when the payer applies an adjustment for contracted funding agreement — subscriber employed by provider. 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 is also the employer (or part of the same organization) that funds the patient's health plan, and a contracted funding adjustment applies to align the payment with the self-funded plan terms; The employer/provider organization offers a discounted rate or special benefit terms for employees, and CARC 139 reflects the adjustment per those terms; The self-funded plan's stop-loss or reinsurance provisions apply to this claim, resulting in an adjustment to the payment. The group code paired with CARC 139 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.

How to Resolve

  1. Review the adjustment Examine the PR-139 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 contracted funding agreement adjustment for a subscriber employed by the provider. If the amount is incorrect, address it through the plan administration process, not the claims appeal process.

How to Prevent PR-139

Also Filed As

The same CARC 139 may appear with different Group Codes:

CO-139 OA-139

Related Denial Codes

PR-45 — Charge Exceeds Fee Schedule/Maximum Allowable PR-222 — Exceeds Contracted Maximum Hours/Days/Units PR-260 — Processed Under Medicaid ACA Enhanced Fee Schedule PR-308 — Contracted Funding Agreement Adjustment PR-P12 — Workers' Compensation Jurisdictional Fee Schedule Adjustment

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/139
  4. Codes maintained by X12. Visit x12.org for official definitions.