Insurance denies claim with CO1 or PR 1 denial code with a reason of Deductible Amount which means that the claim for services was denied because the patient has not yet met their annual deductible for their insurance plan.
A deductible is the amount that the patient must pay out of pocket before their insurance plan starts covering the costs of their medical care. Once the patient has met their deductible, their insurance plan will start covering a portion of the costs of the services.
Denial Code CO 1 Description – Deductible Amount
If you have received claim denial code CO 1 OR PR 1 on EOB or ERA for the healthcare services you have performed to the patient, it means that the patient receives a service or procedure before their annual deductible has been met and the provider submits a claim for the service to the insurance company.
The insurance company would deny the claim and inform the provider that the patient has not yet met their annual deductible and that the patient is responsible for the full cost of the service.
Solution of Denial Code CO 1
There are a few ways to resolve a CO 1 denial code with a reason of “Deductible Amount.” It is important to note that it’s always best to check with the insurance company to confirm the denial reason and to understand the best course of action. Some possible solutions include the following:
1. Contact the insurance company and ask them about the patient total deductible and how much is remaining. You can also use patient insurance web portal to check eligibility of patient and the amount of deductible they have.
2. Once you confirm from insurance that the applied patient deductible is accurate, contact patient and inform him about the deductible. Ask him to pay the deductible amount because it is the patient responsibility.
Note: In some cases, patients have secondary insurance, so you can also bill the deductible amount to secondary insurance company if it covers the deductible.
3. Once the patient agrees to pay the deductible amount, send him the invoice and he will pay the amount to the provider.
What if patient doesn’t pay the deductible?
Waiting until the patient meets their annual deductible: If the patient has not yet met their annual deductible, they will need to pay out of pocket for the cost of the service or procedure until they have met their deductible. Once they have met their deductible, their insurance plan will start covering a portion of the costs of the services.
What can patient do if he isn’t able to pay the deductible?
Negotiate with the provider: The patient can negotiate with the provider to see if they can lower the cost of the service or procedure and can pay the deductible partially. Patient can also check if there is any other option that can be covered by their insurance plan or if there is any other program that can help them to pay the deductible for the service or procedure.
Final Remarks about PR1 Denial Code
It’s important to note that this type of denial i.e. PR 1 is not necessarily a permanent denial and the services could be covered once the patient has met their deductible, so the provider or patient should check with the insurance company to confirm this.
Hi, I’m Deborah Baker from Houston, Texas. Back in 2009, I started my carrier in medical billing as an account receivable in a medical billing company. Now, with an experience of more than a decade, I am sharing my knowledge and experience to help you code and bill accurately.