Claim adjustment reason code
Denial code PR-1 meaning
CARC 1, usually seen as PR-1: The allowed amount went toward the patient's deductible, so the plan paid less or nothing and the patient owes this amount.
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- Reason code
- CARC 1
- Short name
- Deductible
- Plain meaning
- The allowed amount went toward the patient's deductible, so the plan paid less or nothing and the patient owes this amount.
- Group codes
- PR-1: Patient responsibility. The patient, or a secondary payer, may owe the amount.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- The patient has not met the plan year deductible yet.
- The service falls under a separate deductible, such as a Part A or out-of-network deductible.
What to check before resubmitting
- Confirm the deductible balance with the payer's eligibility response.
- Bill the patient or the secondary payer for the amount shown.
Remark codes that often come with it
Related reason codes
Related pages
Questions
What does denial code PR-1 mean?
The allowed amount went toward the patient's deductible, so the plan paid less or nothing and the patient owes this amount. This is Rivvi's plain-English summary of CARC 1. X12's exact wording is on x12.org.
How do I fix PR-1?
Confirm the deductible balance with the payer's eligibility response. Bill the patient or the secondary payer for the amount shown.
Can I bill the patient for PR-1?
When it comes with group code PR, the patient or a secondary payer may owe the amount. When it comes with CO, the provider writes it off.
Which group codes come with CARC 1?
Most often PR (patient responsibility). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.