CARC P2 Active

PR-P2: Not Work-Related — Workers' Compensation Not Liable

TL;DR

The workers' compensation carrier determined the injury is not work-related. If it is work-related, appeal through the WC dispute process with incident reports and physician causation opinions. If not work-related, redirect the claim to the patient's health insurance.

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-P2 Mean?

CARC P2 indicates the workers' compensation carrier investigated the claim and determined the injury or illness is not work-related, therefore WC is not liable for payment. This denial requires the provider to redirect the claim to the patient's health insurance or, if the work-relatedness is disputed, to pursue the matter through the WC dispute process.

The carrier may have determined the injury occurred outside of work, the condition is pre-existing and not aggravated by work activities, the claim was submitted to WC in error (e.g., an auto accident injury), or the employer disputed the WC claim.

If the injury is genuinely work-related, the provider should appeal through the state workers' compensation dispute resolution process with documentation establishing the connection between the workplace and the injury. If it is not work-related, redirecting the claim to the patient's health insurance is the appropriate next step.

How to Resolve

Determine if the injury is work-related. If so, appeal through WC dispute process. If not, redirect to health insurance.

  1. Review the denial details Understand why the WC carrier determined the injury is not work-related.
  2. Assess work-relatedness Review the patient's records, injury circumstances, and the treating physician's opinion on whether the injury is work-related.
  3. Appeal if work-related File an appeal through the WC dispute process with the accident/incident report, employer's First Report of Injury, witness statements, and physician causation opinion.
  4. Redirect if not work-related If the injury is not work-related, redirect the claim to the patient's health insurance plan.
  5. File with state WC board if needed If the carrier denies the appeal, escalate to the state WC board for independent review.
Do Not Appeal This Code

Not Work-Related — Workers' Compensation Not Liable 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 P2 may appear with different Group Codes:

CO-P2 OA-P2

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.cms.gov/medicare/coordination-benefits
  3. Codes maintained by X12. Visit x12.org for official definitions.