PR-2: Coinsurance amount

What it means

PR-2 means the payer assigned the patient their coinsurance, the percentage of the allowed amount the plan requires the member to pay after any deductible. It is normal cost sharing, not a denial.

Mechanically the payer prices the service to the allowed amount and splits it into plan payment and member coinsurance according to the benefit. As a PR code the coinsurance is the patient's responsibility and is properly billed to the patient or the secondary payer.

Why it happens in behavioral health

Coinsurance adds up fast in behavioral health because programs bill many days. A twenty percent coinsurance on a multi-week residential or PHP episode becomes a substantial patient balance, which affects both revenue and the client's ability to stay in treatment.

Because SUD and mental health episodes are intensive and repeated, coinsurance on daily services is a recurring collections challenge. Estimate total episode coinsurance at intake and coordinate secondary coverage where it exists, so patients are not surprised mid-treatment.

How to fix it

• Confirm the coinsurance percentage and calculation match the patient's benefit.
• Post the PR-2 amount to patient responsibility and bill the patient or secondary payer.
• If a secondary plan exists, submit the coinsurance to it with the primary EOB.
• Dispute the amount with the payer if the coinsurance was calculated on the wrong allowed amount.

How to prevent it

• Estimate total episode coinsurance at intake so patients understand their share.
• Identify and bill secondary coverage that offsets coinsurance.
• Offer payment arrangements before long episodes to reduce mid-treatment balances.

Related denial codes