Deductible amount — patient responsibility

What PR-1 means

The amount reflects the patient's unmet deductible and is properly the patient's responsibility. This is usually correct, but can be wrong if deductible accumulation data is stale or if a secondary payer should cover it.

Common causes

• Patient has not met their annual deductible
• Deductible accumulation data on file is out of date
• A secondary payer has not been billed

How to appeal PR-1

Verify the deductible balance with the payer. If the amount is correct, bill the patient. If a secondary policy exists, submit to the secondary with the primary EOB. If deductible data is stale (e.g., claims from another provider already satisfied it), request a deductible reconciliation.