PR-142: Monthly Medicaid Patient Liability Amount
The patient owes this monthly medicaid patient liability amount. Verify the balance and collect from the patient.
What Does PR-142 Mean?
With PR (Patient Responsibility), the monthly medicaid patient liability amount is the patient's financial obligation. The insurer processed the claim, applied the patient's plan benefits, and this amount is owed directly by the patient. The most common scenario is the Medicaid beneficiary has a monthly spend-down (patient liability) amount they must incur in medical expenses before Medicaid coverage begins. CARC 142 represents this patient liability portion..
CARC 142 appears on a remittance when the payer adjusts payment for the monthly medicaid patient liability amount. This is a standard plan-defined cost-sharing amount that the patient is obligated to pay per their insurance benefits. The code confirms the payer processed the claim correctly and applied the plan's benefit structure as designed.
Common scenarios that trigger this adjustment include: the Medicaid beneficiary has a monthly spend-down (patient liability) amount they must incur in medical expenses before Medicaid coverage begins. CARC 142 represents this patient liability portion.; The patient's income is above the Medicaid eligibility threshold, but they qualify under a medically needy or spend-down program. The liability amount equals the excess income that must be applied to medical costs.; For Medicaid long-term care beneficiaries, the patient's income (minus personal needs allowance) must be applied to the cost of care. CARC 142 reflects this monthly patient contribution.. The group code paired with CARC 142 determines who bears the financial responsibility — PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment, CO places it on the provider as a contractual obligation.
Common Causes
| Cause | Frequency |
|---|---|
| Medicaid spend-down obligation not yet met The Medicaid beneficiary has a monthly spend-down (patient liability) amount they must incur in medical expenses before Medicaid coverage begins. CARC 142 represents this patient liability portion. | Most Common |
| Patient income exceeds Medicaid income threshold The patient's income is above the Medicaid eligibility threshold, but they qualify under a medically needy or spend-down program. The liability amount equals the excess income that must be applied to medical costs. | Most Common |
| Long-term care patient contribution to cost of care For Medicaid long-term care beneficiaries, the patient's income (minus personal needs allowance) must be applied to the cost of care. CARC 142 reflects this monthly patient contribution. | Common |
| State-specific Medicaid cost-sharing applied The state Medicaid program has cost-sharing requirements for certain beneficiary categories, and the patient's share is reflected in the CARC 142 amount | Common |
How to Resolve
- Verify the monthly medicaid patient liability amount Cross-reference the adjusted amount against the patient's benefits summary or eligibility response to confirm the monthly medicaid patient liability amount was applied correctly per plan terms.
- Confirm plan benefit details Review the patient's specific plan structure. Confirm the correct amount was applied for this service type.
- Generate a patient statement Prepare a clear statement showing the service rendered, the allowed amount, the monthly medicaid patient liability amount, and the balance the patient owes.
- Collect from the patient Send the statement and follow your practice's collection workflow. Offer payment plan options for substantial balances.
- Track and follow up Record payments received, update the account balance, and follow up on outstanding amounts per your collection policy.
The patient's monthly Medicaid liability is determined by the state Medicaid agency based on the patient's income. Collect from the patient. If the patient disputes the liability amount, they should contact their state Medicaid office.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-142:
| RARC | Description |
|---|---|
| N381 | This amount represents the patient's monthly Medicaid liability/spend-down obligation Collect the patient liability amount and track spend-down progress → |
How to Prevent PR-142
- Verify Medicaid eligibility and patient liability/spend-down status before service delivery
- Inform patients of their monthly Medicaid liability obligation during registration
- Track patient liability accumulations to know when Medicaid coverage activates
- Implement a process to notify Medicaid when the patient's spend-down is met
- Collect patient liability amounts at the point of service when possible
Also Filed As
The same CARC 142 may appear with different Group Codes: