PR-27PR group · Patient responsibility

PR-27 denial code: expenses incurred after coverage terminated

PR-27 is the most common eligibility denial a practice will see, and the termination date behind it is less stable than it looks.

PR-27 means the payer's record shows coverage terminated before the date of service, and the balance is patient responsibility. Termination dates are frequently loaded retroactively after an employment change, so the date on the remittance may post-date the eligibility check you ran at the visit.

What PR-27 means

Employers report terminations on their own cycle, and a policy that answered as active on the day of the visit can be terminated retroactively weeks later. That produces a genuine collision: the practice verified correctly and the payer's record now says otherwise. Some states limit how far back a payer may retroactively terminate for services already authorised or verified, which is worth knowing before a statement goes out.

Why PR-27 fires

  • Employment ended and the termination was reported after the visit.
  • The patient moved to a new plan and the old one closed retroactively.
  • Premiums lapsed and the grace period expired.
  • The termination date in the payer's file is wrong.

Is PR-27 worth appealing?

Sometimes worth appealing

Where you hold a verification response for the date of service, say so. A payer that answered as active and later terminated retroactively is in a different position from one that was always closed, and several states restrict retroactive termination after verification.

How to resolve or appeal PR-27

  1. 1

    Produce the eligibility response

    The dated verification you ran before the visit is the document that matters here — keep them.

  2. 2

    Ask when the termination was loaded

    A termination loaded after your verification is the fact that supports the challenge.

PR-27 — frequently asked

Can the patient be billed?
Where coverage genuinely ended before the service, yes. Where you verified as active and the payer terminated retroactively afterwards, bill only after checking your state's rules — several restrict that practice.
Does COBRA change this?
It can. An election made within the election period reinstates coverage retroactively, so a claim denied for termination may pay on resubmission once the election processes.

Related guides

CO-27 · EligibilityPR-26 · Patient responsibilityPR-31 · Eligibility

Sources

Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.

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