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PR-3 Denial Code: What CARC 3 Means and When You Can Bill the Patient

PR-3 denial code 2026 hero banner: CARC 3 copayment amount paired with group code PR, an adjustment not a denial with no appeal path, CO-3 as a payer mapping error instead of a write-off, secondary coverage sequencing before patient billing, and the QMB, preventive care, and out-of-pocket maximum exceptions, from One O Seven RCM.

PR-3 pairs group code PR, Patient Responsibility, with Claim Adjustment Reason Code 3. X12 defines CARC 3 as Co-payment Amount. The payer processed the claim and paid its contracted share. The copay is the patient’s fixed per-visit fee under their plan. Post it to the patient ledger and bill the patient. A PR-3 denial code […]

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