CARC 140 Active

PR-140: Patient ID Number and Name Do Not Match

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-140 Mean?

With PR (Patient Responsibility), the CARC 140 adjustment for patient id number and name do not match 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 140 is used when the payer determines that patient id number and name do not match. The claim could not be processed as submitted because required information was absent, incomplete, or did not meet the payer's submission standards.

Common scenarios that trigger this adjustment include: the patient's name on the claim does not match the payer's enrollment file due to a spelling error, name variation, or typo; The member identification number entered on the claim is incorrect, possibly transposed, outdated, or belonging to a different family member; The patient had a legal name change (e.g., marriage, divorce) that is reflected on the claim but not yet updated in the payer's enrollment records. The group code paired with CARC 140 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-140 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 patient identification error. Correct the patient name and/or member ID number to match payer enrollment records and resubmit the claim.

How to Prevent PR-140

Also Filed As

The same CARC 140 may appear with different Group Codes:

CO-140 OA-140

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/140
  4. Codes maintained by X12. Visit x12.org for official definitions.