CARC P1 Active

PR-P1: State-Mandated Requirement — Property and Casualty Only

TL;DR

The claim was adjusted per a state-mandated requirement for property and casualty claims. Review the applicable state regulation and verify compliance. Appeal with documentation of regulatory compliance if the adjustment is incorrect.

Action
Review & Decide
Who Pays
Patient
Appeal
No
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-P1 Mean?

CARC P1 applies exclusively to property and casualty (P&C) claims, including auto insurance and workers' compensation. It indicates the payment was adjusted based on a state-mandated requirement — such as a state fee schedule, mandated treatment guidelines, regulatory reporting obligations, or specific billing format requirements.

P&C claims are heavily regulated at the state level, with each jurisdiction maintaining its own set of rules for fee schedules, treatment protocols, and billing requirements. CARC P1 is the catch-all code for adjustments triggered by these state-specific mandates.

The specific state mandate affecting the claim should be identifiable from the accompanying RARC codes or by contacting the P&C adjuster. Understanding the applicable state regulation is essential for determining whether to accept the adjustment or dispute it.

How to Resolve

Identify the state mandate, verify compliance, and dispute if the requirement was incorrectly applied.

  1. Identify the state mandate Review the RARC codes and contact the P&C adjuster to identify the specific state regulation driving the adjustment.
  2. Review the applicable regulation Look up the state mandate to understand the requirement and verify whether your claim complies.
  3. Verify compliance Confirm your billing, documentation, and treatment comply with the state mandate.
  4. Dispute if incorrect If the mandate was incorrectly applied, appeal with the state regulation citation, fee schedule documentation, and evidence of compliance.
  5. Accept if correct If the adjustment correctly reflects the state mandate, accept and adjust your billing practices accordingly.
Do Not Appeal This Code

State-Mandated Requirement — Property and Casualty Only grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

Also Filed As

The same CARC P1 may appear with different Group Codes:

CO-P1 OA-P1

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/p1
  3. Codes maintained by X12. Visit x12.org for official definitions.