CARC 146 Active

PR-146: Diagnosis Invalid for Date of 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-146 Mean?

With PR (Patient Responsibility), the CARC 146 adjustment for diagnosis invalid for date of 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 146 appears on a remittance when the payer identifies an issue related to diagnosis invalid for date of service. This is a technical billing or coding problem that must be corrected before the claim can be processed for payment. The denial indicates the claim data did not meet the payer's adjudication requirements.

Common scenarios that trigger this adjustment include: the diagnosis code used on the claim was valid at one point but has been retired or replaced with a newer code effective before the date of service; The diagnosis code used on the claim has a future effective date and was not valid on the date the service was rendered; The ICD-10 code lacks required specificity digits — the code was submitted without the necessary 4th, 5th, 6th, or 7th character required for the date of service. The group code paired with CARC 146 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-146 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 denial indicates the diagnosis code was invalid for the date of service. Correct the diagnosis code to one that was active on the service date and resubmit the claim rather than appealing.

How to Prevent PR-146

Also Filed As

The same CARC 146 may appear with different Group Codes:

CO-146 OA-146

Related Denial Codes

PR-16 — Missing Information or Billing Error PR-148 — Information from Another Provider Not Provided or Incomplete PR-175 — Prescription Is Incomplete PR-181 — Procedure Code Invalid on Date of Service PR-206 — National Provider Identifier - Missing

Sources

  1. https://www.mdclarity.com/denial-code/146
  2. https://myfcbilling.com/denial-code-146-diagnosis-invalid-for-the-date-of-service/
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.