PR-187: Consumer Spending Account Payment Not Approved

What Does PR-187 Mean?

With PR (Patient Responsibility), the spending account could not cover the expense and the patient must pay out of pocket. The patient is financially responsible through an alternative payment method since the spending account was not approved.

CARC 187 indicates that a payment attempted through the patient's consumer spending account — such as a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Arrangement (HRA) — was not approved. The spending account administrator determined the expense could not be reimbursed from the account.

Common reasons include the service not being an eligible expense under IRS guidelines or the plan design, insufficient funds in the account, missing substantiation documentation, or the expense already being covered by primary insurance. This code affects the payment source rather than the service coverage itself — the service may be legitimate, but the spending account cannot be used to pay for it.

How to Resolve

1. Inform the patient Communicate that the spending account payment was not approved and explain why.
2. Help the patient submit documentation If the denial was for missing substantiation, help the patient submit the required documentation to the account administrator.
3. Collect via alternative payment If the spending account cannot be used, collect payment from the patient through other means.

How to Prevent PR-187

• Help patients verify spending account eligibility before scheduling services
• Collect alternative payment information at check-in in case spending account payments are denied

Also Filed As

The same CARC 187 may appear with different Group Codes:

Related Denial Codes