PR-275PR group · Patient responsibility

PR-275 denial code: prior payer's patient responsibility not covered

PR-275 is the code that tells a patient their second insurance does not do what they assumed it did.

PR-275 means the secondary payer is not covering the patient-responsibility amount the primary assigned. The balance stays with the patient.

What PR-275 means

Secondary coverage is often assumed to absorb whatever the primary left, and many plans do not work that way. Where the secondary's own benefit calculation produces a lower allowed amount than the primary already paid, it owes nothing, and the primary's patient responsibility remains the patient's. That is coordination operating as designed rather than a refusal, and it is usually explained by comparing the two remittances.

Why PR-275 fires

  • The secondary's allowed amount is lower than what the primary already paid.
  • The secondary's plan design excludes the cost-sharing category.
  • The service is not covered under the secondary's benefits.
  • Coordination rules leave the balance with the patient.

Is PR-275 worth appealing?

Rarely an appeal — usually a fix

Usually correct. Compare the two remittances before disputing — where the secondary's allowed amount is at or below what the primary paid, there is nothing left for it to cover.

PR-275 — frequently asked

Why did the secondary pay nothing?
Because its own allowed amount was at or below what the primary already paid. Secondary coverage supplements a benefit calculation rather than absorbing whatever the primary left.
Can the patient be told this in advance?
Broadly, yes. Patients with two plans frequently expect zero liability, and setting that expectation early avoids a difficult conversation later.

Related guides

CO-23 · Coordination of benefitsOA-23 · Coordination of benefitsPR-2 · Patient responsibility

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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