835 Denial Combination
PR-1
Patient Responsibility · Claim-Level Adjustment
What This Combination Means
Deductible applied — the patient has not met their annual deductible, so all or part of the allowed amount is applied to the deductible. PR (Patient Responsibility) means this amount is billable to the patient. This is correct and expected processing for plans with deductibles.
N/A
Appeal Success
1-3 days
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this PR-1 combination — not generic advice.
- 1
Confirm the deductible amount applied is correct by running an eligibility check showing the patient's year-to-date deductible and remaining balance.
- 2
Verify the patient's deductible applies to this type of service (some plans exempt certain preventive services).
- 3
Bill the patient for the deductible amount per your billing policy.
- 4
If the deductible amount differs from your eligibility verification, contact the payer to reconcile.
Specialty Context
How PR-1 typically presents across different practice types.
Dental
Dental plans typically apply annual deductibles to restorative and major services. Preventive services are often deductible-exempt.
Medical
Medical plan deductibles are applied to allowed amounts, not billed amounts. Patients are responsible for the deductible per their plan's cost-sharing structure.
Behavioral Health
Under MHPAEA, behavioral health deductibles cannot be higher than medical/surgical deductibles under the same plan.
Individual Code References
View the standalone definition for each code in this combination.
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