Denial Code Decoder

PR-3 — Copay amount

The fixed per-visit copay is the patient's share for this service. Like PR-1, this is patient responsibility being assigned, not a denial — the only question is whether it was collected at the visit.

Billable to the patient? Yes — the copay is patient responsibility by design.

Where it strikes

Where this denial is born

Front desk
Coding
Claim build
Submission
Adjudication

This denial is usually created at the highlighted stage — that is where prevention lives.

Work the denial

Answer the questions — follow the path

The same questions an experienced biller asks, in order. Your answers draw the route to the right action.

Was the copay collected at the time of service?

Every path

The full decision tree

Was the copay collected at the time of service?

Yes →
Post and reconcile. Apply the collected copay against the assigned amount; any small variance follows your credit/balance policy.
No →
Bill the patient — and fix collection at the desk. Statement the copay now, and flag the visit type so the front desk collects it at check-in next time.

Stop the repeat

Prevention

Collect the copay at check-in, every visit — the eligibility response states it, and point-of-service collection is the cheapest dollar in the revenue cycle.

Go deeper

The code list, and when it was last checked

X12 maintains the Claim Adjustment Reason Codes list, where this code is listed as 3. The list carries the number alone: the PR in front of it is the adjustment group the payer chose for this line, which decides who owes the balance, and the same code can arrive under a different group from a different payer. It has been on the list since January 1, 1995.

Checked against the list revision dated November 1, 2025 on August 7, 2026, where it reads as an active code.

X12 — Claim Adjustment Reason Codes (opens in a new tab)

Check the reasoning