PR-18: Exact Duplicate Claim/Service

What Does PR-18 Mean?

With PR (Patient Responsibility), the CARC 18 adjustment for exact duplicate claim/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 18 indicates that exact duplicate claim/service. The payer's system flagged this claim or service as a duplicate of a previously processed submission. Only one payment will be made for the same service on the same date.

Common scenarios that trigger this adjustment include: same claim submitted multiple times due to manual error or system timeout prompting resubmission; EDI system transmitted the claim twice due to timeout, connection error, or batch processing issue; Primary payer forwarded the claim as a crossover to secondary while the provider also submitted directly to the secondary. The group code paired with CARC 18 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-18 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-18

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

Also Filed As

The same CARC 18 may appear with different Group Codes:

Related Denial Codes