PR-27 denial code: expenses incurred after coverage terminated

Claim adjustment reason code 27 says: expenses incurred after coverage terminated. On the date of service, the patient was no longer covered by the plan you billed.

With group code PR, the payer has assigned the amount to the patient. That is the payer's view; whether you should send the patient a bill depends on whether they now have other coverage that should pay first.

• The patient changed jobs or lost employer coverage, and the visit happened after the plan ended.
• The patient moved to a different plan at the start of a year or during a special enrollment period, and the card on file is the old one.
• The patient moved from Original Medicare to a Medicare Advantage plan, or from one plan to another.
• Premiums weren't paid and the plan ended coverage at the end of a grace period.
• A dependent aged out of a parent's plan.

1. Contact the patient for current coverage. Most PR-27s are a new plan nobody told the front desk about.
2. Verify the new coverage for the date of service before resubmitting.
3. Bill the new payer as a new claim, within its timely filing limit.
4. If the patient had no coverage on that date, bill the patient under your financial policy, and update their account.

• Check eligibility for every visit, not just the first one. Coverage that was active at the first visit can end mid-course of treatment.
• Check before the day, so the front desk can ask for new insurance when the patient arrives.
• Ask every patient at check-in whether their insurance has changed, and scan the card again.

PR-27 is decided by the patient's coverage on the day, so it is prevented at booking.

Claira Health's AI agents confirm coverage and the right payer before the visit, so this denial is stopped at the front desk instead of coming back weeks later. Your team sees only what needs a decision, and approves every step. On a 20-minute call, we’ll walk through it using one of your own denials.

Book a 20-minute call to see how many of your patients' plans changed between visits.