PR-187: Consumer Spending Account Payment Not Approved
The patient's spending account rejected the payment. The patient still owes the amount and must pay through a different method.
What Does PR-187 Mean?
PR-187 is the most common pairing and makes sense — the spending account payment was the patient's responsibility in the first place. The FSA, HSA, or HRA was being used to cover the patient's share (copay, deductible, coinsurance). When the spending account rejects the payment, the patient still owes the same amount through another payment method. The provider should update the patient's account and pursue standard patient collections.
CARC 187 appears on your remittance when a Consumer Spending Account payment attempt is declined by the account administrator. This code is unique because it involves a third-party payment source that is separate from the patient's traditional insurance — the FSA, HSA, or HRA is funded by the patient or their employer, and each account has its own eligibility rules for what qualifies as a covered medical expense.
The most common triggers are administrative in nature. Incorrect account numbers, wrong patient identification, or outdated account information will cause the spending account administrator to reject the payment. Missing documentation is the second most frequent cause — many FSA and HRA administrators require itemized receipts or Explanation of Benefits documents before they will approve a disbursement. The service itself may also be ineligible under the patient's specific plan, as FSA, HSA, and HRA eligible expense lists can differ.
The financial dynamics of CARC 187 are different from typical insurance denials. The spending account payment was meant to cover the patient's out-of-pocket share (copay, deductible, coinsurance), not the insurance-covered portion. When the spending account payment fails, the patient still owes the money — they just need to pay through a different method. The provider's role is to help the patient understand why the spending account payment was rejected and collect the balance through standard patient payment channels.
Common Causes
| Cause | Frequency |
|---|---|
| Incorrect patient or account information submitted Errors in patient identification, spending account numbers, or payment details caused the spending account administrator to reject the payment | Most Common |
| Missing documentation or receipts The spending account administrator requires receipts, invoices, or other documentation verifying the medical expense, and these were not provided or were incomplete | Most Common |
| Service not eligible under the spending account The billed service is not considered an eligible medical expense under the patient's FSA, HSA, or HRA plan rules, and cannot be paid from the spending account | Common |
| Account balance exceeded or insufficient funds The patient's spending account does not have sufficient funds to cover the billed amount, or the annual contribution limit has been reached | Common |
| Invalid or expired spending account The patient's spending account has been closed, terminated, is past the plan year deadline, or the account information on file is incorrect | Common |
| Coding or billing errors Incorrect CPT, HCPCS, or ICD-10 codes were used, causing the spending account administrator to reject the claim as not meeting coverage criteria | Occasional |
How to Resolve
Verify the spending account status and eligibility, correct any errors, and either resubmit to the account administrator or collect from the patient through alternative payment methods.
- Notify the patient Inform the patient that their spending account payment was not approved and explain the reason. Let them know they are still responsible for the balance.
- Offer payment alternatives Provide the patient with options to pay the balance — credit/debit card, personal check, payment plan, or resolving the spending account issue directly with their plan administrator.
- Assist with spending account resubmission If the rejection was due to missing documentation, provide the patient with the itemized receipt, EOB, or other documentation they need to resubmit to their spending account administrator.
This adjustment is correct per the patient's benefit plan. The amount is the patient's financial responsibility. Collect from the patient rather than appealing.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-187:
| RARC | Description |
|---|---|
| N130 | Alert: Review plan documents or guidelines for spending account eligibility details |
How to Prevent PR-187
- Verify the patient's spending account eligibility and balance before applying it as a payment method
- Confirm that the service is an eligible expense under the patient's specific spending account plan
- Collect accurate spending account information during patient registration and verify it before each transaction
- Keep itemized receipts and EOB documents readily available to support spending account claims
General Prevention
- Verify the patient's spending account eligibility and balance before providing services or applying the account as a payment method
- Confirm that the services being billed are eligible expenses under the patient's specific FSA, HSA, or HRA plan before submitting to the spending account
- Maintain accurate and up-to-date patient spending account information in the billing system, including account numbers and plan details
- Ensure proper CPT and ICD-10 coding to avoid rejections based on ineligible service classifications
- Submit claims to spending account administrators promptly within designated timelines to avoid plan year deadline issues
Also Filed As
The same CARC 187 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/187
- https://denialcode.com/
- Codes maintained by X12. Visit x12.org for official definitions.