PR-252: Attachment Required to Adjudicate Claim

What Does PR-252 Mean?

When paired with Group Code PR, the payer is indicating the patient is financially responsible for the amount until the required documentation is provided. This is uncommon for CARC 252 and should be reviewed carefully to ensure the correct group code was applied.

CARC 252 signals that the payer received your claim but cannot complete adjudication because supporting documentation is missing. This is not a coverage determination or a judgment on medical necessity — the payer simply needs more information before it can make a payment decision.

The specific documentation needed varies by payer and service type. Common examples include clinical notes, operative reports, test results, prior authorization letters, or Explanation of Benefits from a primary payer. The accompanying RARC codes on the remittance advice are critical because they pinpoint exactly which documents the payer is requesting.

This code appears frequently on claims for services that commonly require attachments, such as complex procedures, services requiring prior authorization documentation, or secondary claims needing the primary payer's EOB. Tracking patterns of CARC 252 denials by payer can reveal systematic documentation gaps in your billing workflow.

How to Resolve

1. Verify the group code assignment Confirm that PR is the correct group code. CARC 252 is most commonly paired with CO. If PR was applied in error, contact the payer to request a correction.
2. Review the RARC codes Identify what specific documentation the payer needs by reviewing the accompanying RARC codes on the remittance advice.
3. Gather and submit missing documentation Collect the required attachments and submit them to the payer before billing the patient, as submitting the documentation may result in the claim being reprocessed.
4. Communicate with the patient Inform the patient of the situation and explain that the charge may be resolved once documentation is submitted. Hold patient billing until resubmission is processed.
5. Appeal if group code is incorrect If the PR designation is inappropriate for this documentation request, file an appeal requesting the claim be reprocessed under the correct group code.

How to Prevent PR-252

• Submit complete documentation with every claim to prevent ambiguous group code assignments
• Verify patient responsibility determinations are appropriate before billing the patient
• Establish a process to hold patient billing when documentation requests are pending

Also Filed As

The same CARC 252 may appear with different Group Codes:

Related Denial Codes