PR-206: National Provider Identifier - Missing

What Does PR-206 Mean?

With PR (Patient Responsibility), the patient was assigned charges due to a missing NPI. This is unusual and likely incorrect — a missing NPI is a provider data entry issue, not a patient responsibility. Contact the payer to correct the group code.

CARC 206 indicates that one or more NPI fields on the claim were left blank. Claims require NPIs for various provider roles — billing provider, rendering provider, referring provider, and ordering provider — depending on the service type. The payer's system could not match the claim to a provider because the NPI field was empty.

This is a data entry issue, not a coverage or medical necessity denial. The fix is straightforward: add the missing NPI to the correct field and resubmit the claim. This code frequently affects claims for services that require an ordering or referring provider NPI, such as laboratory work, imaging, and DME.

How to Resolve

1. Add the NPI and resubmit Correct the claim and request the patient charges be reversed.
2. Contact the payer If PR persists after correction, contact the payer to correct the group code.

How to Prevent PR-206

• Ensure NPI completeness to prevent any charges from being assigned to patients due to provider data errors

Also Filed As

The same CARC 206 may appear with different Group Codes:

Related Denial Codes