PR-302: Precertification/Authorization Time Limit Expired
The patient is responsible for the expired authorization. Assist them with obtaining retroactive authorization if the payer allows it.
What Does PR-302 Mean?
The patient bears financial responsibility because the authorization expired. This typically occurs when the patient was responsible for obtaining the authorization or when the patient delayed scheduling an authorized service past the authorization window.
CARC 302 indicates that the precertification, notification, authorization, or pre-treatment approval associated with the claim has passed its valid time window. Payers require that authorized services be rendered within a specific period, and if the authorization expires before the service date or before claim submission, the payer denies the claim.
This situation typically arises when scheduling delays push a procedure past the authorization window, when a provider fails to request an extension or renewal, or when claim submission is delayed after the authorization period closes. In some cases, data entry errors cause the dates of service to fall outside the authorized range even when the service was rendered on time.
Common Causes
| Cause | Frequency |
|---|---|
| Patient failed to obtain required authorization The patient was responsible for obtaining pre-authorization from their plan but did not do so within the required timeframe | Most Common |
| Patient delayed scheduling authorized service The patient delayed scheduling the authorized service and the authorization expired before the service was rendered | Common |
| Self-referral without timely authorization Patient self-referred to a specialist without obtaining the required authorization within the plan's timeframe | Common |
How to Resolve
- Inform the patient of the expired authorization and their financial responsibility
- Assist the patient in obtaining a new authorization if the payer allows retroactive requests
- If the patient had valid authorization, help them file an appeal with the payer
- Establish a payment plan with the patient if the denial stands
Appeal with evidence that the authorization was valid or that circumstances warranted retroactive authorization. Include any communication records with the payer regarding the authorization.
Common RARC Pairings
The RARC code tells you exactly what triggered the PR-302:
| RARC | Description |
|---|---|
| N517 | Alert: Precertification/authorization/notification has been expired. Patient should contact their plan to request retroactive authorization → |
How to Prevent PR-302
- Educate patients about their responsibility to obtain and maintain valid authorizations
- Provide patients with authorization expiration dates and remind them to schedule services promptly
- Offer assistance with the authorization process when possible
Also Filed As
The same CARC 302 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/302
- https://www.cms.gov/medicare/regulations-guidance/manuals
- Codes maintained by X12. Visit x12.org for official definitions.