CARC 200 Active

PR-200: Expenses Incurred During Lapse in Coverage

TL;DR

The patient had no active coverage and owes for the services. Collect from the patient.

Action
Collect from Patient
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-200 Mean?

With PR (Patient Responsibility), the patient is financially responsible for all expenses incurred during the coverage lapse. The patient did not have active insurance and must pay out of pocket for the services. Collect the balance from the patient.

CARC 200 indicates that the patient did not have active insurance coverage during the period when the service was rendered. The coverage may have lapsed due to non-payment of premiums, terminated due to job loss or aging out, or the service may have fallen in a gap between two coverage periods.

This code differs from general eligibility denials because it specifically identifies a lapse period — a time when coverage should have been or previously was active but was not on the specific date of service. It can also appear when incorrect or outdated insurance information was submitted, making it appear the patient had no coverage when they actually did.

Common Causes

Cause Frequency
Patient allowed coverage to lapse The patient did not maintain active insurance coverage during the period services were rendered, making the patient financially responsible Most Common
Patient was between coverage periods The patient was in a gap between insurance plans and is responsible for services during that uninsured period Common

How to Resolve

  1. Confirm the coverage lapse Verify the coverage dates with the payer.
  2. Notify the patient Communicate the financial responsibility and provide an itemized statement.
  3. Collect from the patient Follow your collection workflow and offer payment plan options.
Do Not Appeal This Code

The patient's coverage was not active on the date of service. The patient is financially responsible for all expenses incurred during the coverage lapse. Collect the balance from the patient.

How to Prevent PR-200

Also Filed As

The same CARC 200 may appear with different Group Codes:

CO-200 OA-200

Related Denial Codes

PR-26 — Expenses Incurred Prior to Coverage PR-27 — Expenses Incurred After Coverage Terminated PR-32 — Patient Not Eligible Dependent PR-33 — Insured Has No Dependent Coverage PR-34 — No Coverage for Newborns

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/200
  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. Codes maintained by X12. Visit x12.org for official definitions.