CARC 301 Active

PR-301: Medical Plan Claim — Submit to Behavioral Health Plan

TL;DR

The patient is temporarily responsible. Resubmit to the behavioral health plan before collecting from the patient.

Action

Verify & Resubmit

Who Pays

Patient

Appeal

Yes

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-301 Mean?

With PR, the patient is financially responsible until the claim is submitted to the correct behavioral health plan. However, the patient should not be balance-billed until the behavioral health plan has had an opportunity to process the claim.

CARC 301 appears on a remittance when the medical plan determines that the billed service falls under behavioral health coverage rather than the medical benefit. Many insurers use a carve-out arrangement that separates behavioral health from the medical plan, and when the medical plan identifies a claim as behavioral health, it denies the claim and directs the provider to submit it to the appropriate behavioral health plan.

This code is most common when providers submit mental health or substance abuse services to a medical plan that does not administer those benefits. It can also appear when diagnosis or procedure codes on the claim trigger the medical plan's behavioral health classification logic, even if the provider views the service as primarily medical.

Common Causes

Cause	Frequency
Service classified as behavioral health Medical plan determined the service falls under behavioral health and patient is responsible until claim is submitted to the correct plan	Most Common
Behavioral health carve-out with patient liability Patient's plan uses a behavioral health carve-out and the patient bears financial responsibility until the correct plan processes the claim	Common
Out-of-network behavioral health provider The behavioral health provider is out-of-network, resulting in patient responsibility for the charges	Common

How to Resolve

Inform the patient that the claim must be submitted to their behavioral health plan
Assist the patient in identifying their behavioral health plan contact information
Resubmit the claim to the behavioral health plan on behalf of the patient
If the service is medical, appeal the PR designation with clinical documentation supporting medical classification

Appeal Guide

Appeal with clinical documentation showing the service is medical, not behavioral health. Include physician notes and relevant coverage policies to support reclassification under the medical plan.

How to Prevent PR-301

Verify insurance benefits before scheduling behavioral health services
Inform patients about their behavioral health plan coverage during intake
Collect behavioral health plan information at the time of registration

Also Filed As

The same CARC 301 may appear with different Group Codes:

CO-301 OA-301

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

https://x12.org/codes/claim-adjustment-reason-codes
https://www.mdclarity.com/denial-code/301
https://www.cms.gov/medicare/payment/prospective-payment-systems
Codes maintained by X12. Visit x12.org for official definitions.