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PR-27 Denial Code: Coverage Terminated Before Service

PR-27 means the payer denied the claim because the patient's coverage had already terminated on the date of service. Under PR the patient is responsible unless they had other coverage that day or the termination is later reversed.

Quick facts

Code
PR-27 (CARC 27)
Status
Active In use since January 1, 1995.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The usual group. The patient is responsible because this plan's coverage had ended, unless other coverage applies.
  • CO (Contractual Obligation): Some payers report it as CO, which means the provider can't bill the patient on this denial. Find the correct payer or dispute the termination date.
Official description
Expenses incurred after coverage terminated.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-27 means

CARC 27 says expenses incurred after coverage terminated. According to the payer, the patient’s plan ended before the date of service in box 24A, so the payer has no obligation for the claim. With the PR group code, the payer considers the patient responsible.

A common twist is retroactive termination. Eligibility can look active when you check it, and then be ended back to an earlier date because the employer reported a job loss late or premiums weren’t paid. The claim arrives after the change and comes back PR-27, even though your front desk did everything right.

Common causes

  • Job change or loss, with the patient still presenting the old card.
  • Retroactive termination by the employer or plan after the visit.
  • Non-payment of premium, including marketplace plans after a grace period ends.
  • Aging out of dependent coverage or other life events.
  • Medicaid redetermination that ended coverage.
  • Wrong date of service keyed on the claim.

How to fix it

  1. Verify the date of service in the record.
  2. Run eligibility for that date to confirm the termination date the payer has on file.
  3. Ask the patient about new coverage, including COBRA, a new employer plan, Medicaid, Medicare, or a marketplace plan, and bill that payer.
  4. Check whether reinstatement is pending. If the patient elects COBRA or pays premiums in time, coverage may be restored; request reprocessing once it is.
  5. If the date was wrong, send a corrected claim with resubmission code 7 in box 22.
  6. Bill the patient if no coverage applies, following your financial policy.

How to prevent it

  • Verify eligibility before every visit, and again for recurring services.
  • Ask patients at check-in whether their job or insurance has changed.
  • Watch for termination dates in eligibility responses that fall near upcoming appointments.
  • Use an ERA review to spot PR-27 clusters by payer, which can reveal retroactive termination patterns. See eligibility and COB denials.

Specialty notes

Practices with frequent recurring visits, such as behavioral health, PT/OT, and dialysis, can accumulate several PR-27 denials before learning a patient’s coverage ended. Monthly eligibility rechecks for active patients catch terminations sooner.

Remark codes that may appear with PR-27

  • N30 (Patient ineligible for this service.): The patient was ineligible for this service on the date of service.
  • N52 (Patient not enrolled in the billing provider's managed care plan on the date of service.): Patient not enrolled in the billing provider's managed care plan on that date.
  • PR-26 (Expenses incurred prior to coverage.): The service was before coverage started rather than after it ended.
  • CO-200 (Expenses incurred during lapse in coverage): Service during a lapse in coverage.
  • CO-166 (These services were submitted after this payers responsibility for processing claims under this plan ended.): Submitted after this payer's responsibility for claims under the plan ended, a filing issue rather than an eligibility issue.
  • OA-257 (The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements.): Disposition undetermined during a premium payment grace period.
  • CO-239 (Claim spans eligible and ineligible periods of coverage.): The claim spans eligible and ineligible periods.

PR-27 FAQ

How do I fix a PR-27 denial?

Run eligibility for the date of service to confirm the termination, then ask the patient for any new coverage, such as a new employer plan, COBRA, Medicaid, or marketplace coverage, and bill that payer. If none exists, bill the patient.

Can terminated coverage be reinstated?

Sometimes. COBRA elections and premium payments can reinstate coverage retroactively within their allowed windows, and some terminations are reversed after enrollment errors are corrected. If that happens, ask the payer to reprocess.

Why did the claim deny when eligibility was verified?

Coverage may have been terminated retroactively after your check, commonly for non-payment of premium or late employer notice of job loss.