PR-142: Monthly Medicaid Patient Liability Amount

What Does PR-142 Mean?

PR-142 is the primary pairing for this code. The PR group code confirms that the adjusted amount is the patient's direct financial responsibility — this is their Medicaid spend-down liability. The provider should collect this amount from the patient just as they would a deductible or copay. Once collected, the liability is satisfied and Medicaid will cover eligible services for the remainder of the coverage period.

CARC 142 is a Medicaid-specific code that appears when the state Medicaid agency has assigned a monthly liability (also called spend-down) to the patient. Medicaid spend-down works like a deductible — the patient must incur medical expenses up to a specified amount each month before Medicaid begins paying. The monthly liability amount is determined by the state based on the patient's income and household size, and it resets each eligibility period.

When CARC 142 appears on the remittance, the payer is telling you that the patient's Medicaid coverage is conditional on meeting their spend-down obligation, and the patient has not yet satisfied that requirement for the service period. The adjusted amount represents the patient's liability — the portion the patient must pay out of pocket. Once the spend-down is met (through payments to your practice or other providers), Medicaid will cover the remaining eligible services.

This code most commonly appears with Group Code PR, reflecting that the adjusted amount is the patient's direct financial responsibility. The key workflow consideration is timing — the patient may be meeting their spend-down with multiple providers simultaneously, so coordinating with the Medicaid agency to track the liability balance is important. Collecting the liability amount at the time of service, when possible, simplifies the process and reduces the chance of resubmission delays.

Common Causes

How to Resolve

Verify the patient's Medicaid spend-down status, collect the liability amount from the patient, and resubmit to Medicaid once the spend-down is satisfied.

1. Check spend-down balance Verify the patient's remaining spend-down liability with the Medicaid agency to determine how much the patient still owes.
2. Collect patient liability Bill and collect the patient's spend-down amount. Provide a receipt that the patient can use for their Medicaid records.
3. Report to Medicaid Submit documentation to the Medicaid agency confirming the patient has paid their liability, then resubmit the claim for Medicaid payment.

Common RARC Pairings

The RARC code tells you exactly what triggered the PR-142:

How to Prevent PR-142

• Check Medicaid eligibility and spend-down status before every visit to know whether the patient's liability has been met
• Collect the patient's liability amount at the time of service when possible to avoid post-service collection challenges
• Track patients with Medicaid spend-down requirements in the billing system and verify their status before claim submission
• Communicate clearly with patients about their monthly Medicaid liability and how it affects their coverage

General Prevention

• Check the patient's Medicaid eligibility and current spend-down status before every visit to determine whether the liability has been met
• Collect the patient's liability amount at the time of service whenever possible to ensure the spend-down is satisfied before submitting the claim
• Maintain communication with the state Medicaid agency to track patients' spend-down balances, especially for patients with recurring monthly liabilities
• Train front-desk and billing staff on Medicaid spend-down rules and the impact on claim processing
• Document all patient liability collections and spend-down satisfaction in the billing system so claims are submitted with accurate information
• Submit claims promptly after the liability is met to avoid timing issues with Medicaid eligibility periods

Also Filed As

The same CARC 142 may appear with different Group Codes:

Related Denial Codes