PR-1 (Deductible)
Patient Responsibility 1 — the amount applied to the patient's deductible.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Denials & Appeals
- Primary sources
- 1
- Workspace handoff
- denial workbench →
Where this comes up
This is denial-workbench territory. A remit posts with a CARC/RARC, the biller decides whether to rebill, appeal, or write off, and the appeal packet has to cite the chart, the order, and the payer's own policy language. Recurring patterns trace back to an upstream workflow gap.
Full definition
What it is in practice
PR-1 amounts are the patient's responsibility until the annual deductible is met. Run eligibility (270/271) before each encounter to estimate.
How it shows up in your practice
Collect at time of service when possible. Track deductible status throughout the year to estimate future PR-1.
Sources
- CMS — CARChttps://x12.org/codes/claim-adjustment-reason-codes
Auto-route PR-1 in the Denial Workbench
Open denial workbench →Related terms
- Denials & AppealsPR (Patient Responsibility)An X12 adjustment group code indicating the patient owes the amount (deductible, coinsurance, copay, or non-covered service).
- Payer270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- PayerGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryPR (Patient Responsibility)An X12 adjustment group code indicating the patient owes the amount (deductible, coinsurance, copay, or non-covered service).
- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryGood Faith Estimate (GFE)Under the No Surprises Act, the written estimate of expected charges providers must give to uninsured and self-pay patients prior to scheduled services.
- GlossaryAppeal LetterThe written request to a payer to reconsider a denied or partially-paid claim.
- GlossaryCARC (Claim Adjustment Reason Code)X12-maintained codes communicating why a claim or service line was paid differently than billed.
- GlossaryCO-109 (Claim Not Covered by Payer)Contractual Obligation 109 — the claim is not covered by this payer/contractor.
- GlossaryCO-16 (Claim Lacks Information)Contractual Obligation 16 — the claim or service line lacks information or has submission/billing errors.
- BillingHow to Appeal an Insurance Denial: Step-by-Step GuideClaim denied? Step-by-step appeal process with payer deadlines, denial code fixes, appeal letter template, and escalation options.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.