Question Any idea what "PR-106 - Patient payment option/election not in effect" means?

puddinman

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I'm trying to get an answer from BCBS but they really don't know either. I did put this as patient responsibility and billed them for it, but I'm sure the patient is going to ask me what this means and I was hoping someone here had some experience with this denial code.
 

danachock

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Hi puddinman,
Patient Inquiries can be sometimes time consuming especially with limited time with BCBS. I know that PR-106 is patient responsibility. Did BCBS (which state) provide a second or possibly a third adjustment code? From my experience the first adjustment codes provides endless opportunites when actually the second or even third adjustment code is what is actually needed to figure this denial out and NRP the patient. What procedure(s) were billed? That may be the key along with the state we are billing to provide an answer.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Analyst (May 2018-present), Anesthesia, Pathology, Laboratory Coder (Fall 2012-May 2018), Denial Specialist (December 2012-December 2016)
 

casseciella

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I'm trying to get an answer from BCBS but they really don't know either. I did put this as patient responsibility and billed them for it, but I'm sure the patient is going to ask me what this means and I was hoping someone here had some experience with this denial code.
I would suggest the patient hasn't paid their premium, i worked at BCBS for 6 years, and if that is the case, they typically won't come out and say it. DO you know if is an individual purchase plan? If so, based off the wording in the denial, it just sounds like the patient hasn't made their payment. however, if they patient does call you questioning it, I would advise they contact their insurance, BCBS should provide them more information on the denial.
 
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