How to Work PR-2 for UnitedHealthcare

PR-2 is a Patient Responsibility (PR) CARC indicating that the coinsurance amount has been applied to the claim. Coinsurance is the percentage of the allowed amount that the patient owes after the deductible has been met. This is not a denial — the claim was processed, and the patient owes their coinsurance share.

PR-2 occurs after the patient's deductible has been met. The insurance plan pays a percentage of the allowed amount (e.g., 80%), and the patient owes the remaining percentage (e.g., 20%) as coinsurance. Coinsurance continues until the patient reaches their out-of-pocket maximum. This is a standard part of most insurance plans.

• 1UHC plan has coinsurance (e.g., 20% after deductible)
• 2Patient has not met their out-of-pocket maximum
• 3Out-of-network coinsurance higher than in-network
• 4HDHP with coinsurance after the deductible is met

• ERA/EOB showing the coinsurance amount applied (PR-2)
• Patient's insurance card and benefit information
• Patient financial responsibility agreement (signed at registration)
• Evidence of deductible status and out-of-pocket maximum

1. 1Review the ERA/EOB to confirm the PR-2 amount and the coinsurance percentage.
2. 2Verify the patient's coinsurance rate and out-of-pocket maximum through the payer portal.
3. 3Confirm the deductible has been met (if applicable) before coinsurance applies.
4. 4Check if the patient has secondary insurance that may cover the coinsurance.
5. 5Verify the allowed amount is correct per your contract.

1. 1Bill the patient for the PR-2 amount with a clear statement showing the EOB details.
2. 2If the patient has secondary insurance: submit a claim to the secondary payer for the coinsurance amount.
3. 3If the patient disputes the charge: provide the EOB and verify the coinsurance rate with the payer.
4. 4If the patient has met their out-of-pocket maximum: request a reprocessing from the payer.
5. 5Offer payment plans for patients who cannot pay the full amount upfront.

PR-2 is generally not appealable because it reflects the patient's plan design. However, if the coinsurance was applied incorrectly (e.g., wrong percentage, or applied after the out-of-pocket maximum was reached), file a formal appeal with proof of the plan design and out-of-pocket status.

• Verify patient eligibility and benefits before the visit, including coinsurance rate.
• Inform patients of their potential financial responsibility before the visit.
• Have patients sign a financial responsibility agreement at registration.
• Collect estimated patient responsibility at the time of service when possible.
• Check for secondary insurance that may cover coinsurance.
• Post ERA/EOB adjustments promptly to avoid delayed patient billing.
• Train front desk staff to explain coinsurance to patients.