Official CARC description: “Expenses incurred after coverage terminated.” Here’s what it actually means, why it fires, and how to get the claim paid.
Same fact pattern as CO 27 but the payer routed liability to the patient. Verify termination is real before statements go out — wrongly PR'd termination denials create patient complaints and refunds.
Liability group: PR = Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Also written: PR-27, PR27, “denial code 27”, “27 denial code” or “reason code 27” — same CARC, different ERA formatting.
Reason code 27 also appears under another group on the ERA. The number is the reason; the prefix decides who absorbs the money. This page covers PR 27 (Patient Responsibility). If your ERA shows a different prefix, use the matching page:
Re-verify eligibility and hunt for the successor plan
Bill the new plan with original-submission proof for timely filing
Marketplace plans: check the premium grace-period rules — claims in month 1 of grace must be paid
Confirmed termination: patient statements with clear DOS/coverage explanation
Appeal marketplace grace-period denials (month-one claims are payer liability by regulation) and any termination contradicted by a verified 271. Attach the verification records.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
The official CARC description for PR 27 is: “Expenses incurred after coverage terminated.” In practice: Same fact pattern as CO 27 but the payer routed liability to the patient. Verify termination is real before statements go out — wrongly PR'd termination denials create patient complaints and refunds.
Denial code 27 under the PR group (Patient Responsibility) means: Expenses incurred after coverage terminated. The number is the reason; the PR prefix decides who is liable — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Yes. PR 27, PR-27, PR27 and “denial code 27” are the same CARC — clearinghouses, payer portals and PM systems just print it differently. Only the group prefix (CO, PR, OA or PI) changes the meaning, because it changes who has to absorb the amount.
PR stands for Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Appeal marketplace grace-period denials (month-one claims are payer liability by regulation) and any termination contradicted by a verified 271. Attach the verification records.
The number 27 is the same reason code in both — what changes is the liability group. CO 27 is Contractual Obligation. PR 27 is Patient Responsibility, so the amount can be billed to the patient (deductible, coinsurance, non-covered care). Check the prefix on the ERA before you write anything off or bill the patient — a mis-grouped 27 is one of the more winnable appeals.