106Denial Code (CARC)Active
Denial Code PR 106 - Patient Payment Option Issues
Code 106 indicates that the patient's chosen payment option or election was not active or valid at the time of service. This commonly appears on remittances when there is an issue with the patient's payment arrangement, such as a health savings account or payment plan not being set up correctly.
Who Pays: Group Code Liability
For code 106, the liability typically falls under PR, meaning the patient can be billed for the amount since their payment option was not valid. However, verify with the payer if any exceptions apply.
Why Claims Get Code 106
- The patient failed to renew or activate their payment plan or health savings account.
- The provider did not have the correct payment option information on file.
- The payer did not process the patient's payment option update in time.
- The patient's payment election was not communicated properly to the provider.
- The payment option expired before the date of service.
How to Fix & Resubmit
- Verify with the patient if their payment option or election should be active.
- Contact the payer to confirm the status of the patient's payment arrangement.
- Update the patient's payment information in the billing system if needed.
- If the patient resolves the payment option issue, resubmit the claim with the corrected information.
- If the payment option cannot be validated, bill the patient directly for the service.
Corrected Claim or Appeal?
For code 106, resubmitting a corrected claim is appropriate once the payment option issue is resolved. If the patient cannot provide a valid payment option, billing them directly may be necessary.
Preventing Future 106 Denials
- Ensure patient payment option details are updated and verified at each visit.
- Train staff to confirm payment arrangements with patients during registration.
- Establish a process to verify payment options with payers regularly.
- Communicate actively with patients about the status of their payment options.