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 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.
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?
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.
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.
Related reading
Drowning in PR-3 denials?
Our denial team works them for you — root cause to recovery.
Ready to improve your revenue cycle?
Explore our services and knowledge base to see how we can help.