CARC 163 Active

PR-163: Attachment/Documentation Referenced on Claim Not Received

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-163 Mean?

With PR (Patient Responsibility), the CARC 163 adjustment for attachment/documentation referenced on claim not received 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 163 is used when the payer determines that attachment/documentation referenced on claim not received. The claim could not be processed as submitted because required information was absent, incomplete, or did not meet the payer's submission standards.

Common scenarios that trigger this adjustment include: the claim indicated that supporting documentation was attached, but the payer did not receive the referenced attachment with the electronic or paper claim; The documentation was sent separately from the claim and was lost, misfiled, or not linked to the claim during payer processing; The attachment control number on the claim does not match the control number on the submitted documentation, preventing the payer from linking them. The group code paired with CARC 163 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-163 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 payer did not receive the referenced attachment. Resubmit the documentation with the correct claim reference number rather than filing an appeal. If you have proof the documentation was previously sent, contact the payer to request reprocessing.

How to Prevent PR-163

Also Filed As

The same CARC 163 may appear with different Group Codes:

CO-163 OA-163

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/163
  2. https://www.arlearningonline.com/2019/12/163-attachmentother-documentation.html
  3. https://x12.org/codes/claim-adjustment-reason-codes
  4. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.