PR 27 Denial Code: Coverage Terminated Before Service (What to Do)

PR 27 reads "expenses incurred after coverage terminated." The plan you billed says the patient's policy ended before the date of service. Because the group code is PR (patient responsibility), the balance is billable to the patient, but before you send that statement, it's worth two checks: terminations are sometimes wrong, and very often another plan is active.

PR 27 at a Glance

Question	Answer
Is it a true denial?	Yes; this payer won't pay this claim.
Can you bill the patient?	Yes, once you've confirmed no other coverage was active.
Is it appealable?	Only when the termination date is wrong, which happens with retro-terminations and employer file lags.
Prevention	Almost entirely: real-time eligibility at every visit.

Why It Happens

• Job changes. Employer coverage ends, the patient's new plan hasn't been presented, and the front desk billed the card on file.
• Missed premium payments on marketplace plans, including retroactive terminations after the grace period.
• Medicaid redeterminations. Patients churn on and off Medicaid and between MCOs; last month's active plan may be gone.
• Plan-year switches. Same insurer, new plan ID in January; the old ID rejects with PR 27 or PR 26.
• Payer data errors. Employer eligibility files lag, and a "terminated" patient is sometimes still covered.

The Workflow

1. Re-verify the termination. Run eligibility for the date of service. If the payer's portal shows active coverage that contradicts the denial, appeal with the eligibility response attached; these overturn.
2. Ask about replacement coverage. Most patients who lost one plan gained another (new employer, spouse's plan, Medicaid, marketplace). Bill the active plan; mind its timely filing clock, which has been running since the date of service.
3. Check retro-termination rules. If coverage was terminated retroactively after you verified it as active at the visit, document that verification; some states and plans restrict retro-termination clawbacks when the provider verified in good faith.
4. Then bill the patient, with a clear statement explaining the coverage termination, and offer a payment plan for larger balances.

Prevention Is a Check-In Habit

PR 27 is one of the most preventable denials in the book: verify eligibility on every visit, every time, not just for new patients. Coverage found inactive at check-in becomes a conversation and a card on file; found at denial, it becomes 60 days of chasing. That per-visit discipline is exactly what our eligibility verification service runs, and it's why practices using it see PR 27 and its cousin CO 16 nearly disappear.

More from the library: the complete denial codes list, PR 119 (benefit maximum), and CO 45 (fee schedule adjustments).