PR-275Patient ResponsibilityCoordination of Benefits
PR-275 Denial Code: Prior payer's patient responsibility not covered
The secondary payer doesn't cover the primary's patient-responsibility amounts (deductible/coinsurance/copay) — they remain with the patient.
Why PR-275 happens
- ●Secondary plan without deductible/coinsurance coverage benefits
- ●Non-supplement plans billed like Medigap
How to fix a PR-275 denial
- 1
Bill the patient for the primary's cost-sharing per plan terms
- 2
Exception: QMB and similar protected categories — never bill those patients (see CO-303)
How to prevent it
Understand which secondaries actually cover cost-sharing before writing off or billing.
Drowning in PR-275 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.