How do I resolve a PR-1 denial?

Transfer deductible amount to patient account: Post the PR-1 amount from insurance adjustment to patient responsibility balance in your practice management system Generate patient statement for deductible balance: Issue itemized statement showing the service date, billed amount, insurance adjustment, and remaining deductible owed Initiate patient collection process per practice policy: Follow standard patient billing workflows including payment plan options if the deductible amount exceeds practice thresholds

835 Denial Combination

PR-1

Patient Responsibility · Claim-Level Adjustment

Patient Responsibility

What This Combination Means

This combination indicates the patient has not yet met their annual or per-service deductible under their benefit plan. The applied amount represents the patient's financial obligation before insurance coverage begins or continues, and the provider should collect this directly from the patient.

Financial Responsibility

patient responsibility

The patient owes the full adjusted amount as their deductible obligation per their insurance plan terms. The provider must bill the patient directly for this portion.

N/A

Appeal Success

Immediate (patient billing)

Avg. Resolution

Easy

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this PR-1 combination — not generic advice.

Not Appealable:Deductible amounts are contractual obligations defined in the patient's benefit plan and cannot be appealed.

1
Transfer deductible amount to patient account
Post the PR-1 amount from insurance adjustment to patient responsibility balance in your practice management system
2
Generate patient statement for deductible balance
Issue itemized statement showing the service date, billed amount, insurance adjustment, and remaining deductible owed
3
Initiate patient collection process per practice policy
Follow standard patient billing workflows including payment plan options if the deductible amount exceeds practice thresholds

Specialty Context

How PR-1 typically presents across different practice types.

Dental

Dental plans often have separate deductibles for basic, major, and orthodontic services; verify which deductible category applies to the service rendered

Medical

Annual medical deductibles typically reset on January 1st or at plan anniversary; high-deductible health plans (HDHPs) may result in substantial patient balances early in the benefit year

Behavioral Health

Mental health and substance abuse services may have separate deductibles from medical services depending on plan structure and parity compliance requirements

Individual Code References

View the standalone definition for each code in this combination.

CARC 1

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Synthesized from official definitions — not from training data

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