PR-238Patient ResponsibilityEligibility
PR-238 Denial Code: Reduction for ineligible coverage period
The claim spans eligible and ineligible coverage periods — this is the reduction for the ineligible slice, shifted to the patient.
Why PR-238 happens
- ●Stay/service series straddling a coverage termination or lapse
How to fix a PR-238 denial
- 1
Verify the coverage boundary dates; bill the patient for the ineligible portion
How to prevent it
Re-verify eligibility during long episodes, not just at the start.
Drowning in PR-238 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.