PR-193: Original Payment Decision Maintained on Review

What Does PR-193 Mean?

With PR (Patient Responsibility), the appeal denial means the patient remains financially responsible as originally determined. The patient has the right to pursue their own appeal if they wish to challenge the decision.

CARC 193 indicates that the provider submitted an appeal, reconsideration, or redetermination request, and after reviewing the case, the payer determined the original payment decision was correct. The appeal did not result in a change to the original determination.

This code does not mean the case is closed. In most situations, higher levels of appeal are available. For Medicare claims, the five-level appeal process includes redetermination (MAC), reconsideration (QIC), Administrative Law Judge (ALJ) hearing, Medicare Appeals Council review, and federal court review. Commercial payers also typically offer multiple appeal levels. The key is to identify why the appeal was denied and submit a stronger case at the next level.

How to Resolve

1. Communicate the appeal result Inform the patient that the appeal was denied and explain their options for further appeal.
2. Collect from the patient If the patient does not wish to pursue further appeals, collect the outstanding balance.
3. Assist with patient-initiated appeal If the patient wants to appeal, provide them with the necessary documentation and guidance.

How to Prevent PR-193

• Keep patients informed throughout the appeal process
• Provide strong initial appeals to avoid escalation and patient burden

Also Filed As

The same CARC 193 may appear with different Group Codes:

Related Denial Codes