CARC 144 Active

PR-144: Incentive Adjustment for Preferred Product/Service

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-144 Mean?

With PR (Patient Responsibility), the CARC 144 adjustment for incentive adjustment for preferred product/service 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 144 means the payer adjusted the payment based on incentive adjustment for preferred product/service. The reimbursement was calculated using the payer's fee schedule, contracted rate, or regulatory payment methodology rather than the billed charge.

Common scenarios that trigger this adjustment include: the provider used a product, device, or medication that is not on the payer's preferred list, and the payer applies an incentive adjustment to encourage use of the preferred alternative; The provider is enrolled in an incentive program such as preferred drug formulary or value-based purchasing but the specific claim does not meet the program's criteria for the incentive payment; The claim was submitted with codes that do not align with the payer's incentive program requirements, preventing the incentive payment from being applied. The group code paired with CARC 144 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-144 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

Incentive Adjustment for Preferred Product/Service grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

How to Prevent PR-144

Also Filed As

The same CARC 144 may appear with different Group Codes:

CO-144 OA-144

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.mdclarity.com/denial-code/144
  2. https://www.codingahead.com/denial-code-144/
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/FAQS-on-QRURs-and-VM.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.