# Denial code PR-B7



## knperry (Oct 5, 2012)

Has anyone had any experience with the medicare denial code PR-B7?  What does it mean and how do I handle it?

Thanks


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## dclark7 (Oct 5, 2012)

You can find denial codes at Wasington Publishing company. I found this on their site unde claim adjustment reason codes: B7 - This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

The link is http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/

By the way, PR stands for patient responsibility. CO is contractual obligation. So according to the eob you can bill the patient.


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## npricercm (Sep 3, 2013)

knperry said:


> Has anyone had any experience with the medicare denial code PR-B7?  What does it mean and how do I handle it?
> 
> Thanks



If this is a lab charge, it may need the QW, clia waived modifier.


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