PR 187 Denial Code - Consumer Spending Account Guide
CARC 187 indicates that the payment for the claim was made using a consumer spending account. This could be a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA). The payment amount will be deducted from the patient's spending account balance rather than through traditional insurance coverage.
Who Pays: Group Code Liability
For CARC 187, the group code is typically PR, meaning the patient is responsible for the amount deducted from their consumer spending account. The provider can bill the patient if the account does not cover the entire charge.
Why Claims Get Code 187
- The patient opted to use their FSA, HSA, or HRA to pay for the service.
- The payer processed the claim under the patient's spending account instead of through the insurance policy.
- The patient's spending account had sufficient funds to cover the claim at the time of processing.
- The patient's insurance plan setup includes automatic spending account utilization.
- The patient requested the spending account be used for eligible services.
How to Fix & Resubmit
- Verify the amount paid from the consumer spending account on the remittance advice.
- Check the patient’s account balance to ensure there are sufficient funds for full payment.
- Contact the patient to confirm their preference for using the spending account if the payment does not cover the full charge.
- If the spending account does not cover the full charge, bill the patient for the remaining balance.
- If there was an error in processing, contact the payer for clarification or reprocessing.
Corrected Claim or Appeal?
Since CARC 187 involves patient-directed spending accounts, a corrected claim is not typically applicable. Contact the patient if there is a discrepancy or if more funds are needed. Only appeal if there is a processing error that requires payer intervention.
Preventing Future 187 Denials
- Verify the patient’s spending account details and balance during registration or check-in.
- Ensure the patient understands their responsibility when opting to use a spending account.
- Communicate clearly with patients about the possible need to cover any remaining balance not covered by the account.
- Set up alerts in your billing system for claims involving consumer spending accounts to ensure proper follow-up.