Denial codes / PR-1

Denial code 1

PR-1: Deductible

Deductible amount.

What to doUsually the patient's share
Often recoverableUsually not

The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.

Why dental offices see it

  • The patient had not met the plan-year deductible.
  • The deductible was applied to a preventive service the plan normally exempts.
  • A deductible already met at another office was not yet on the insurer's record.

What to do

  1. Check the plan's deductible and whether it applies to this procedure class.
  2. If it was already met, ask the insurer to reprocess with the earlier claims that met it.
  3. If it is correct, bill the patient with the EOB.

Stop it next time

Verify remaining deductible during eligibility checks and collect it at the visit.

How many PR-1 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.

Run the free check

Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.