A denial code tells you the reason the payer states. It does not settle what happens next on its own. The plan, the contract, the documentation behind the claim, the timing and the circumstances of that particular claim all bear on whether anything is recoverable. What a code gives you is a starting point and a short list of things worth checking. Look one up below. No patient information is needed and none is asked for.
Codes only, never patient details. This page runs the lookup in your browser. What you type is not transmitted, stored or logged, and the page loads no analytics or third-party tracking scripts.
The prefix is the payer's classification of the adjustment. What it actually permits is governed by your participation agreement and the member's plan, so treat it as the first question rather than the answer.
The payer is attributing the amount to the provider contract. Under most participation agreements a contractual adjustment is not billable to the member, but what a given contract permits is set by that contract. Whether the adjustment was applied correctly is a separate question from whether it was applied.
PR-1, PR-2 and PR-3 are deductible, coinsurance and copay, which are ordinary cost sharing rather than denials. For other PR codes, whether the balance is genuinely billable to the member depends on the plan terms, the contract and whether the claim was coded and processed correctly.
OA commonly appears in coordination between insurers. PI marks an adjustment the payer attributes to itself rather than to the contract, which is often a reason to look at the claim more closely rather than accept the posting.
Appeal windows vary by payer, by product line, by plan and by state, and they change. A published table read a year after it was written is a liability rather than a shortcut, so this page does not keep one. Here is where the answer for your claim actually lives, in the order to look.
Remittance advice and adverse determination letters generally state the appeal rights, the filing window and the address or portal for that specific determination. This is the controlling instruction for that claim, and it outranks any general reference including this one.
The contract and the manual it incorporates set the reconsideration and appeal windows that apply to your organization with that payer. Some payers require reconsideration before an appeal, and filing out of order can cost the appeal.
The same insurer administers products with different rules. A commercial group plan, a marketplace plan, a Medicare Advantage plan and a self-funded employer plan the payer only administers can each carry a different window on otherwise identical letterhead.
Medicare, Medicaid and state-regulated plans operate under published program and regulatory requirements, and the state insurance regulator sets external review rights for the plans it regulates. Self-funded employer plans generally sit outside state insurance regulation.
Verify the window for any specific claim against the denial notice and the applicable member and provider agreements before relying on it. Part of the complimentary review is identifying, for each claim reviewed, which deadline governs it and what still needs to be confirmed.
Reading a code and knowing which questions it raises is the first step on any denied claim, and there is no reason to charge for it. What this page gives you is the plain-English meaning, the factors that generally determine where a claim like it ends up, and what to check next. It does not see your contract, your documentation or your remittance, so it cannot tell you what will happen to your claim, and it does not try to.
The work is everything after that: the payer's own policy pulled and quoted, the record cited with dates, the submission made with your approval and proof of delivery, the deadlines tracked, and the outcome reconciled against the remittance. That part is the service, and on eligible commercial claims it is paid only from reimbursement that is verified as recovered.
The complimentary review works through 20 of your recent denials with your contracted amounts, your payers and the deadlines that actually govern each one, and returns an assessment of recommended action, priority and what still needs confirming. It costs nothing, and the assessment is yours whether or not you continue.