835 Denial Combination
PR-3
Patient Responsibility · Claim-Level Adjustment
What This Combination Means
Copayment applied — the patient's plan has a fixed copay for this type of service, which is the patient's responsibility. The copay is separate from deductible and coinsurance. PR means the patient owes this amount.
N/A
Appeal Success
1-2 days
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this PR-3 combination — not generic advice.
- 1
Confirm the copay amount is correct per the patient's plan benefits.
- 2
If collected at time of service, verify the amount collected matches what was applied by the payer.
- 3
If not collected, bill the patient for the copay amount.
- 4
If the copay applied differs from what the plan documents show, dispute with the payer.
Specialty Context
How PR-3 typically presents across different practice types.
Dental
Most HMO dental plans use copays per service rather than percentage coinsurance. Confirm the copay schedule from the patient's plan.
Medical
Primary care, specialist, urgent care, and ER copays are standard. Copays are often collected at the time of service.
Behavioral Health
Behavioral health copays must be no higher than the copay for primary care or specialist visits under the same plan (MHPAEA requirement for in-network services).
Individual Code References
View the standalone definition for each code in this combination.
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