PR-204Patient ResponsibilityPatient Responsibility
PR-204 Denial Code: Not covered under benefit plan (patient liability)
Service not covered under the patient's current benefit plan; responsibility assigned to the patient.
Why PR-204 happens
- ●Plan exclusion where the patient accepted financial responsibility
- ●Non-covered elective service
How to fix a PR-204 denial
- 1
Confirm exclusion and any signed financial waiver
- 2
Bill the patient with clear explanation
How to prevent it
Use financial waivers/ABN-equivalents for likely non-covered services.
Drowning in PR-204 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.