Denial Code PR-1

Why PR-1 Happens, Common Root Causes

Patient statement template

Use this statement to bill the patient for the adjusted amount. Before sending, verify the patient owes the balance per their plan (and for Medicare, that a valid ABN was signed when required).

[Your Practice Letterhead]
[Date]

[Patient Name]
[Patient Address]

Re: Account Balance, Date of Service [DOS]
Claim Number: [Claim Number]

Dear [Patient Name]:

Your insurance claim for the service provided on [DOS] has been processed by [Payer Name]. The insurer has determined that the following amount is your responsibility under your plan benefit design:

Adjustment code: PR-1
Description: Deductible Amount
Amount due: $[Amount]

This amount represents your [deductible / copay / coinsurance / non-covered portion] per your plan terms. Please remit payment by [Due Date] or contact our billing office at [Phone] to arrange a payment plan.

If you believe this amount is incorrect, please contact [Payer Name] member services using the number on the back of your insurance card to verify your benefit details.

Sincerely,
[Practice Name] Billing Department
[Phone] · [Email]

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Before sending: if this is a Medicare claim and a valid Advance Beneficiary Notice (ABN) was not signed before the service, consult Medicare guidelines. Certain non-covered services cannot be billed to the patient without proper advance notice. Practices should maintain ABN records and verify signature status before generating patient statements for PR-denied Medicare claims.

PR-1 FAQ