PR-2 denial code: coinsurance amount

Claim adjustment reason code 2 is the coinsurance amount: the patient's percentage share of the allowed amount, after any deductible has been met.

With group code PR, it is the patient's responsibility. Nothing went wrong with the claim; this is the plan's cost-sharing working as designed.

Coinsurance is a percentage of the allowed amount, not of your billed charge. For most outpatient services under Medicare Part B, the patient pays 20% of the Medicare-approved amount once the Part B deductible is met. Commercial plans set their own percentages, often different in and out of network.

If the allowed amount is wrong, the coinsurance is wrong too, so an underpayment also changes what the patient owes.

• Is there a secondary plan? Medicare supplement plans and Medicaid often pay Medicare coinsurance. Bill them first.
• Is the patient a Qualified Medicare Beneficiary? Federal law bars billing patients in the QMB program for Medicare coinsurance.
• Does the percentage match the plan? Check it against the patient's benefits for that type of service.

1. Bill any secondary payer first, with the primary payer's payment information.
2. Send the patient a statement that shows the allowed amount and their percentage.
3. Make paying easy, with a payment link and a clear due date.
4. Estimate it next time, before the visit.

• Estimate the patient's share at booking, including coinsurance after the deductible.
• Check for supplemental coverage at every visit.
• Collect at check-in where your financial policy allows.

PR-2 is estimated before the visit and collected after the payer answers.

Claira Health's AI agents follow every denial and every payment until it's resolved, and flag money that comes up short. Your team sees only what needs a decision, and approves every step. On a 20-minute call, we’ll walk through it using one of your own denials.

Book a 20-minute call and bring a remittance with coinsurance on it.