How do I resolve a PR-2 denial?

Post the coinsurance amount to the patient account ledger: This is the patient's contracted cost-sharing obligation and should be transferred from insurance balance to patient balance Generate and send a patient statement showing the coinsurance amount due: Ensure the statement clearly identifies this as coinsurance per their insurance plan, not a denial Apply payment or establish payment arrangement when patient remits: Process according to your standard patient collections workflow for coinsurance obligations

835 Denial Combination

PR-2

Patient Responsibility · Claim-Level Adjustment

Patient Responsibility

What This Combination Means

This combination indicates the patient is responsible for the coinsurance portion of the claim per their benefit plan. The payer has processed the claim and applied the patient's coinsurance obligation based on their contracted plan design. This is a standard cost-sharing adjustment, not a denial.

Financial Responsibility

patient responsibility

The patient owes the coinsurance amount as specified in their insurance policy. This is a contractual obligation between the patient and their insurer.

N/A

Appeal Success

Immediate (patient billing)

Avg. Resolution

Easy

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this PR-2 combination — not generic advice.

Not Appealable:Patient responsibility adjustments for coinsurance are contractual obligations under the benefit plan and are not subject to appeal.

1
Post the coinsurance amount to the patient account ledger
This is the patient's contracted cost-sharing obligation and should be transferred from insurance balance to patient balance
2
Generate and send a patient statement showing the coinsurance amount due
Ensure the statement clearly identifies this as coinsurance per their insurance plan, not a denial
3
Apply payment or establish payment arrangement when patient remits
Process according to your standard patient collections workflow for coinsurance obligations

Specialty Context

How PR-2 typically presents across different practice types.

Dental

Coinsurance is common in dental plans, often 20-50% for major procedures after deductible is met, frequently applied to crowns, bridges, and periodontal treatments.

Medical

Typical coinsurance is 10-30% for medical services after deductible, commonly seen for office visits, outpatient procedures, and durable medical equipment.

Behavioral Health

Coinsurance applies to therapy sessions and psychiatric services after deductible, typically 20% for in-network providers under parity requirements.

Individual Code References

View the standalone definition for each code in this combination.

CARC 2

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Synthesized from official definitions — not from training data

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