CARC 179 Active

PR-179: Patient Has Not Met Required Waiting Period

TL;DR

The patient owes this amount because the plan's waiting period had not elapsed. Collect from the patient.

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-179 Mean?

With PR (Patient Responsibility), the patient is financially responsible for the service because their waiting period had not been completed. The patient must pay for the service out of pocket since their plan benefit was not yet active.

CARC 179 indicates that the patient's insurance plan includes a waiting period for certain benefits, and that period had not elapsed when the service was provided. Waiting periods are common in new enrollment situations where the plan requires a specified number of days or months before a particular benefit activates.

This code is frequently seen with dental and vision plans that impose waiting periods for major services, employer-sponsored plans with enrollment waiting periods, and certain non-ACA-compliant plans with pre-existing condition waiting periods. The service itself may be a covered benefit — it simply was not yet available to the patient on the date it was rendered.

How to Resolve

  1. Confirm the waiting period status Verify with the payer that the waiting period was genuinely not met on the date of service.
  2. Communicate with the patient Explain the waiting period requirement and when their coverage will become active for this service.
  3. Collect from the patient Send a statement and follow your collection workflow for the patient balance.
Do Not Appeal This Code

Patient Has Not Met Required Waiting Period 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-179

Also Filed As

The same CARC 179 may appear with different Group Codes:

CO-179 OA-179

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-carcs
  2. https://x12.org/codes/claim-adjustment-reason-codes
  3. 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
  4. https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.