85Denial Code (CARC)Active
PR 85 Denial Code - Patient Interest Adjustment Guide
Code 85 signifies that an adjustment has been made to the claim due to a patient interest charge. It indicates that the patient is responsible for paying this interest, as the group code PR (Patient Responsibility) is used.
Who Pays: Group Code Liability
With code 85, the liability falls under the PR group code, meaning the interest amount is the patient's responsibility and can be billed to them.
Why Claims Get Code 85
- The payer processed the claim late, causing interest to accrue, which is then passed to the patient.
- The terms of the patient's plan include responsibility for interest charges on delayed payments.
- Patient agreement or contract specifies responsibility for interest charges on outstanding balances.
How to Fix & Resubmit
- Verify the interest charge amount and ensure it aligns with the terms outlined in the patient's insurance policy.
- Check the patient's insurance contract to confirm their responsibility for interest charges.
- Communicate with the patient to explain the interest charge and confirm their understanding.
- Bill the patient for the interest charge as it is their responsibility per code 85.
Corrected Claim or Appeal?
For code 85, neither a corrected claim nor an appeal is typically applicable, as the patient is legitimately responsible for the interest per their policy terms.
Preventing Future 85 Denials
- Review patient insurance contracts to understand terms regarding interest charges.
- Ensure timely claim submissions to avoid interest accruals.
- Educate patients upfront about potential interest charges under their insurance plan.
- Work with payers to expedite claim processing times to prevent interest charges.