PR-3: Copay Amount
PR (Patient Responsibility)What is PR-3?
PR-3 is a Patient Responsibility code indicating the patient owes a fixed copay amount for the service. Copays are a set dollar amount defined by the patient's plan (e.g., $25 for an office visit, $50 for a specialist) and are collected at time of service.
Why Does PR-3 Occur?
- Standard copay required by the patient's plan. Most HMO and PPO plans require copays for office visits, urgent care, ER, and specialist visits.
- Copay not collected at time of service. The front desk did not collect the copay at check-in.
- Incorrect copay amount collected. The copay amount on file is outdated or does not match the service type.
How to Fix PR-3 Denials
- Verify the copay amount from the patient's insurance card or the payer's 271 eligibility response before the appointment.
- Collect the copay at check-in. If it was not collected, bill the patient with the payer's EOB as documentation.
- If the payer applied a different copay than expected, verify the correct amount for the service type (PCP vs. specialist vs. ER) against the plan's Summary of Benefits.
PR-3 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | N/A | 60 days from remittance | UHC copays vary by plan tier. Verify via 271 response. |
| Anthem | N/A | 365 days from denial notice | Anthem may have different copays for in-person vs. telehealth visits. |
| Aetna | N/A | 180 days from denial | Aetna copays are listed on the member's ID card for most plans. |
| Cigna | N/A | 180 days from denial | Cigna tiered networks may have different copays per provider tier. |
| Medicare | N/A | 120 days (redetermination at MAC) | Traditional Medicare does not use copays. Medicare Advantage plans set their own copay schedules. |
Related CARC Codes
If you are seeing PR-3, check these related codes: PR-1 (deductible), PR-2 (coinsurance), CO-44 (subscriber not eligible).
Common Questions About PR-3
Should copays be collected at the front desk?
Yes. Collecting copays at check-in reduces patient AR and improves cash flow. Most practice management systems can display the expected copay from the eligibility check.
What if the copay amount is wrong on the EOB?
Compare the EOB to the patient's plan Summary of Benefits. If the payer applied the wrong copay tier (e.g., specialist rate for a PCP visit), file a dispute with the payer.
Altair catches PR-3 denials before submission with copay estimation at check-in. See how pre-submit claim scoring works.