PR-293: Payment Made to Employer

What Does PR-293 Mean?

When paired with Group Code PR, CARC 293 shifts the financial responsibility to the patient. The adjustment for payment made to employer is deemed the patient's responsibility. The provider should verify the PR designation is correct before billing the patient.

CARC 293 appears when the payer has processed a claim and directed payment to the patient's employer instead of the billing provider. This is an unusual code that typically arises in specific payment arrangement scenarios, most commonly with self-funded employer health plans or when coordination of benefits determinations route payment through the employer.

Self-funded employer plans operate differently from fully insured plans. In a self-funded arrangement, the employer assumes the financial risk for employee health claims and often uses a third-party administrator (TPA) to process claims. In some configurations, claim payments are routed through the employer as the plan fiduciary before reaching the provider. CARC 293 tells the provider that the payer processed the claim but directed the funds to the employer entity rather than to the provider's payment address.

This code can also surface when there are errors in payment routing information, incorrect employer group numbers, or when the payer's system is configured to send payments to the employer based on the plan's administrative setup. Regardless of the cause, the provider needs to trace the payment and either have it redirected or collect directly from the employer who received the funds.

How to Resolve

1. Verify patient responsibility Confirm that the PR group code assignment is correct for the CARC 293 adjustment. Review the remittance advice and any RARC codes for context.
2. Review for potential errors Check whether the underlying denial reason can be corrected, which may eliminate the patient's responsibility. Verify coding accuracy and documentation completeness.
3. Appeal if designation is incorrect If the PR assignment appears incorrect or the denial is in error, file an appeal with supporting documentation before billing the patient.
4. Generate patient statement If the determination is correct, generate a patient statement for the amount and follow standard patient collection procedures.
5. Communicate with the patient Explain the charge to the patient, provide information about their financial responsibility, and discuss payment options.

How to Prevent PR-293

• Verify patient coverage and financial responsibility before rendering services
• Communicate potential out-of-pocket costs to patients proactively
• Review PR-293 adjustments before billing to confirm the designation is appropriate

Also Filed As

The same CARC 293 may appear with different Group Codes:

Related Denial Codes