CARC 239 Active

PR-239: Claim Spans Eligible/Ineligible Periods - Rebill Separately

TL;DR

After splitting the claim, the patient owes for the ineligible portion.

Action
Review & Decide
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-239 Mean?

With PR, the patient is responsible for the ineligible portion after the claim is split.

CARC 239 is similar to CARC 238 but requires a different resolution. Instead of automatically reducing the payment, the payer instructs the provider to split the claim into two separate submissions — one for the eligible period and one for the ineligible period. The payer cannot process the claim as a single submission when it straddles the eligibility boundary.

This is common for inpatient stays where coverage began or ended midway through the admission. The provider must rebill with the correct dates for each coverage period.

How to Resolve

  1. Split the claim Separate the eligible and ineligible portions.
  2. Collect from the patient Bill the patient for the uncovered period.
Do Not Appeal This Code

The claim spans eligible and ineligible periods of coverage. Split the claim into separate claims for each coverage period and resubmit. An appeal is not appropriate for this type of denial.

How to Prevent PR-239

Also Filed As

The same CARC 239 may appear with different Group Codes:

CO-239 OA-239

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. 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
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.