PR-B15: Qualifying Service/Procedure Not Received or Covered

What Does PR-B15 Mean?

When paired with Group Code PR, the patient is responsible because the qualifying service was not completed. This may occur when the patient failed to complete or refused the prerequisite service. Collect from the patient after verifying the denial is correct.

CARC B15 indicates the payer denied the claim because a required prerequisite service was not completed, not adjudicated, or not covered before the current service was performed. Many procedures and services require a qualifying prior step — such as a screening before a diagnostic test, an initial evaluation before a treatment series, a diagnostic test before a procedure, or a conservative treatment trial before surgery (step therapy).

The denial may occur because the qualifying service was never performed, it was performed but not yet processed by the payer, it was denied by the payer, step therapy requirements were not followed, or documentation of the qualifying service was not submitted.

Resolution typically involves locating evidence that the qualifying service was completed, ensuring it has been adjudicated by the payer, and resubmitting the dependent service claim. If the qualifying service was performed by another provider, obtaining records from that provider may be necessary.

Common Causes

How to Resolve

1. Verify qualifying service status Confirm whether the qualifying service was completed.
2. Appeal if completed If the qualifying service was done, appeal with documentation.
3. Collect if not completed If the patient did not complete the prerequisite, collect from the patient.

How to Prevent PR-B15

• Educate patients about required qualifying services during treatment planning
• Verify the patient has completed prerequisite services before scheduling dependent procedures

Also Filed As

The same CARC B15 may appear with different Group Codes:

Related Denial Codes