PR-147: Provider Accepted Reduced Payment from Regulatory Authority

What Does PR-147 Mean?

With PR (Patient Responsibility), the CARC 147 adjustment for provider accepted reduced payment from regulatory authority 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 147 appears on a remittance when the payer applies an adjustment for provider accepted reduced payment from regulatory authority. Review the group code and any accompanying RARC codes to understand the full context of this adjustment.

Common scenarios that trigger this adjustment include: the provider has accepted payment from a state or federal regulatory authority for the same service, and the payer is denying or reducing the claim to avoid duplicate payment; The provider received payment from workers' compensation, state fund, or another government regulatory program for this service, making the commercial claim ineligible for additional payment; The provider agreed to a reduced rate through a regulatory authority's settlement or negotiation process, and the payer applies this reduced amount. The group code paired with CARC 147 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-147 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.

How to Prevent PR-147

• Verify patient benefits and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively

Also Filed As

The same CARC 147 may appear with different Group Codes:

Related Denial Codes