835 Denial Combination
PR-2
Patient Responsibility · Claim-Level Adjustment
What This Combination Means
Coinsurance applied — the patient's plan requires a coinsurance percentage for this service. The PR amount is the patient's share of the allowed amount after deductible. This is expected processing and the patient is responsible for the coinsurance.
N/A
Appeal Success
1-3 days
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this PR-2 combination — not generic advice.
- 1
Confirm the coinsurance rate is correct per the patient's plan documents.
- 2
Verify the allowed amount is correct — coinsurance is calculated on the payer's allowed amount.
- 3
Bill the patient for the coinsurance per your billing policy.
- 4
If the coinsurance rate applied differs from the plan documents, contact the payer to dispute.
Specialty Context
How PR-2 typically presents across different practice types.
Dental
Coinsurance structures vary: preventive typically 100% covered, basic 80% covered (20% patient), major 50% covered. Confirm the tier the procedure falls under.
Medical
Medical coinsurance is applied to the payer's allowed amount (not billed charges). A 20% coinsurance on a $100 allowed amount = $20 patient responsibility.
Behavioral Health
MHPAEA requires coinsurance rates for behavioral health to be no higher than medical/surgical coinsurance rates under the same plan.
Individual Code References
View the standalone definition for each code in this combination.
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