PR-227 denial code
The payer asked the patient for information and never got it, so the claim is denied to the patient. Common after anything accident-shaped: the payer sends the member a questionnaire, the member ignores it, and your claim pays for their silence.
PR — Patient Responsibility. The amount is the patient's to pay: deductible, coinsurance, or copay. These are not denials, and they are collectible.
Why you got it
- 1A coordination-of-benefits or 'do you have other insurance' questionnaire went unanswered.
- 2An accident-details questionnaire (was this an auto accident? work-related?) sat on the patient's kitchen counter.
- 3A student-status or dependent-eligibility verification was never returned.
How do I fix a PR-227 denial?
- Contact the patient, tell them exactly what the payer sent them, and have them call the number on their card to answer it. Most patients have no idea their unanswered mail is why they got a bill.
- Once the member responds, ask the payer to reprocess — this usually reopens without a formal appeal.
- Document your outreach. If the patient never responds, the PR grouping means the balance is genuinely theirs, and your records show you tried to help them avoid it.
How to stop the next one
Warn patients at intake — especially after injuries — that their insurer may mail them a questionnaire, and that ignoring it turns a covered visit into their bill. One sentence at the desk prevents most of these.
Our diagnosis scrubber will not catch this one. PR-227 is driven by procedure codes, modifiers, or eligibility rather than by the diagnosis set — and procedure-side checking needs CPT codes, which aren’t included yet. We would rather tell you that than sell you a tool that quietly misses your most common denial.
If denials like this are a volume problem rather than a one-off, the denial management page explains how the paid workspace catches the coding causes on every claim, and the free ICD-10-CM lookup shows the coding notes behind any diagnosis code on the remittance.