Patient responsibility is what remains after insurance has paid its share. It appears on the remittance with group code PR (for example PR-1 for deductible, PR-2 for coinsurance, PR-3 for copay).
Estimating it at check-in and billing it promptly and clearly are the keys to collecting it.
Related terms
- CARC (claim adjustment reason code)
- The standard code that explains why a claim line was paid differently than billed.
- EOB (explanation of benefits)
- A statement from the insurer explaining how a claim was processed.
- Eligibility verification
- Confirming a patient's insurance is active and what it covers before the visit.