PR100 denial code description and corrective action

Payment made to patient, insured or responsible party.

This denial mostly occurs when the patient has not signed the Assignment of Benefits (AOB).
An Assignment of Benefits (AOB) is an agreement between the member and the insurance company that allows the insurance to pay the provider directly for the patient’s healthcare services.

Actions

First, we need to verify the status of the claim. This can be done by checking the status through the insurance web portal or by calling the payer.
If the claim is paid to the patient, then the bill should be sent directly to the patient.
Do not bill the secondary or any consecutive payer, as it is the patient’s responsibility to forward this amount to the provider.
Representatives and web portals do not provide payment details, such as the check number, when the AOB is not signed by the patient.

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