PR-200Patient ResponsibilityEligibility
PR-200 Denial Code: Expenses during coverage lapse
Services fell in a period when coverage had lapsed (usually non-payment of premium) — patient responsibility.
Why PR-200 happens
- ●Premium non-payment lapse spanning the DOS
- ●Coverage reinstated later but not retroactively
How to fix a PR-200 denial
- 1
Confirm lapse dates; if coverage was reinstated retroactively, rebill
- 2
Otherwise bill the patient with the payer's lapse documentation
How to prevent it
Real-time eligibility at check-in catches most lapses.
Drowning in PR-200 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.